Classifications

• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
  • G01N33/6893—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids related to diseases not provided for elsewhere
  • G01N33/6896—Neurological disorders, e.g. Alzheimer's disease
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/28—Neurological disorders
  • G01N2800/2814—Dementia; Cognitive disorders
  • G01N2800/2821—Alzheimer
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/52—Predicting or monitoring the response to treatment, e.g. for selection of therapy based on assay results in personalised medicine; Prognosis

Definitions

• the present invention relates to methods of diagnosing
• the present invention also relates to methods of screening for lead compounds that may be used for the development of therapeutic agents useful in treating or preventing Alzheimer's Disease.
• the invention also relates to methods of diagnosing Alzheimer's Disease in a subject by detecting alterations in the ratio of specific phosphorylated MAP kinase proteins in cells after stimulation with a protein kinase C activator.
• the Alzheimer's Disease-Specific Molecular Biomarkers (ADSMB) disclosed herein are useful for the diagnosis of Alzheimer's Disease, for monitoring disease progression and in screening methods for the identification of lead compounds.
• the invention also relates to methods for selecting patients who have increased responsiveness to treatment of Alzheimer's Disease.
• AD Alzheimer's Disease
• bradykinin As a potent inflammation mediator, bradykinin (BK) is produced by brain and peripheral cells under patho-physiological conditions such as trauma, stroke, pain ischemia, and asthma (Regoli et al, 1993; Bockmann & Paegelow, 2000; Ellis et al., 1989; Kamiya et al., 1993).
• BK2bR B2 bradykinin receptor
• PLC phospholipase C
• IP3 inositol 1,4,5-trisphospate
• BK also triggers production of other proinflammatory cytokines through activation of mitogen-activated protein (MAP) kinases (Hayashi et al, 2000; Schwaninger et al, 1999; Phagoo et al, 2001).
• MAP mitogen-activated protein
• Enhanced elevation of intracellular Ca 2+ levels has been found in AD brains as well as in AD peripheral cells in response to stimulation of bradykinin and inactivation of K + channels (Etcheberrigaray et al, 1993, 1998; Hirashima et al, 1996; Gibson et al, 1996(a)).
• PLC protein kinase C
• the BK-activated PLC/phospholipids- Ca 2+ /PKC cascade interacts with the Ras/Raf signaling pathway, which activates extracellular signal-regulated kinases 1/2 (Erk 1 and Erk2, which are referred to together as "Erkl/2"), a subtype of the MAP kinase family (Berridge, 1984; BAssa et al, 1999; Hayashi et al., 2000; Blaukat et al, 2000, Zhao et al.
• Erkl/2 receives signals from multiple signal transduction pathways and leads to cellular proliferation and differentiation by regulation of gene expression through a number of transcriptional factors, including AP-I, NF- ⁇ B, and cyclic AMP-responsive element binding protein (CREB).
• AP-I AP-I
• NF- ⁇ B NF- ⁇ B
• CREB cyclic AMP-responsive element binding protein
• Erk2 phosphorylates tau at multiple serine/threonine sites including Ser-262 and Ser-356 (Reynolds et al, 1993; Lu et al, 1993).
• Mitogen-activated protein kinases such as Erkl and Erk2 - regulate phosphorylation of the microtubule associated protein tau and processing of the amyloid protein ⁇ , both events critical to the pathophysiology of Azheimer's disease.
• Erkl and Erk2 Enhanced and prolonged Erkl/2 phosphorylation in response to bradykinin has been detected in fibroblasts of both familial and sporadic Alzheimer's Disease, but not age-matched controls (Zhao et al Neurobiology of Disease 1 1, 166-183, 2002).
• Sustained Erkl/2 phosphorylation induced by bradykinin has previously been found in Alzheimer's Disease fibroblasts and is the subject of WO 02/067764, which is herein incorporated by reference in its entirety.
• the present inventors have identified, for the first time, unique Alzheimer's Disease-specific molecular biomarkers useful for the diagnosis of Alzheimer's Disease in a highly sensitive and highly specific manner compared to previously known diagnostic tests.
• the unique Alzheimer's Disease-specific molecular biomarkers disclosed herein serve as the basis for diagnostic methods having a high degree of sensitivity and specificity for the detection and diagnosis of Alzheimer's Disease.
• the unique Alzheimer's Disease- specific molecular biomarkers of the present invention are also useful in screening methods to identify compounds which may be used as therapeutic agents in the treatment and prevention of Alzheimer's Disease.
• the invention is directed to methods for selecting a patient having increased responsiveness to treatment of Alzheimer's Disease comprising contacting cells from a patient with an agent that is a protein kinase C activator and measuring the value of an Alzheimer's Disease-specific molecular biomarker in said cells; wherein said increased responsiveness to treatment of Alzheimer's Disease in said patient is indicated if the value of said Alzheimer's Disease-specific molecular biomarker in said cells is a high positive value correlated to early stage Alzheimer's Disease.
• said cells are peripheral cells.
• said cells are selected from the group consisting of skin cells, fibroblast skin cells, blood cells, and buccal mucosa cells.
• said high positive value correlated to early stage Alzheimer's Disease indicates from zero to one, or zero to two, or zero to three, or zero to four, or zero to five, or zero to six years of dementia.
• said protein kinase C activator is selected from the group consisting of bradykinin, bryostatin, bombesin, cholecystokinin, thrombin, prostaglandin F2 ⁇ , and vasopressin.
• the invention is directed to a method for selecting a patient having increased responsiveness to treatment of Alzheimer's Disease comprising contacting cells from a patient with an agent that is a protein kinase C activator and measuring the value of an Alzheimer's Disease-specific molecular biomarker wherein the increased responsiveness to treatment of Alzheimer's Disease in said patient is indicated if the value of said Alzheimer's Disease-specific molecular biomarker in said cells is higher than the value of said Alzheimer's Disease-specific molecular biomarker from control cells.
• said cells are peripheral cells.
• said cells are selected from the group consisting of skin cells, fibroblast skin cells, blood cells, and buccal mucosa cells.
• said high positive value correlated to early stage Alzheimer's Disease indicates from zero to one, or zero to two, or zero to three, or zero to four, or zero to five, or zero to six years of dementia.
• said protein kinase C activator is selected from the group consisting of bradykinin, bryostatin, bombesin, cholecystokinin, thrombin, prostaglandin F2 ⁇ , and vasopressin.
• the invention is directed methods for treating a patient identified as having increased responsiveness to treatment of Alzheimer's Disease by any of the methods disclosed herein comprising administering a therapeutically effective amount of a pharmaceutical agent to said patient.
• the present invention is also directed to methods for determining or confirming the presence or absence of Alzheimer's Disease in a subject.
• the methods comprise contacting cells from a subject with an amyloid beta peptide and determining whether said contacting step induces an Alzheimer's Disease phenotype in said cells; wherein the absence of Alzheimer's Disease in said subject is established or indicated if an Alzheimer's Disease phenotype is induced in said cells by said contacting step.
• the presence of Alzheimer's Disease in said subject is established or indicated if incubation with said amyloid beta peptide results in no significant alteration or change in an Alzheimer's Disease phenotype in said cells.
• No significant alteration or change in an Alzheimer's Disease phenotype means that the value of an Alzheimer's Disease-specific molecular biomarker is unchanged compared to its value before the cells are contacted with said amyloid beta peptide, or the value of said Alzheimer's Disease-specific molecular biomarker is changed or altered compared to its value before the cells are contacted with said amyloid beta peptide by less than about 15%, or less than about 14%, or less than about 13%, or less than about 12%, or less than about 1 1%, or less than about 10%, or less than about 9%, or less than about 8%, or less than about 7%, or less than about 6%, or less than about 5%, or less than about 4%, or less than about 3% or less than about 2%, or less than about 1% or less than about 0.5%, or less than about 0.25%.
• the amyloid beta peptide is A ⁇ (1-42), although any amyloid beta peptide may be used.
• the methods comprise contacting said cells with a protein kinase C activator.
• said protein kinase C activator is selected from the group consisting of bradykinin, bryostatin, bombesin, cholecystokinin, thrombin, prostaglandin F2 ⁇ and vasopressin.
• said cells are peripheral cells.
• said cells are selected from the group consisting of fibroblasts, saliva, blood, urine, skin cells, buccal mucosa cells and cerebro spinal fluid. All of the methods described herein may be performed in vivo or in vitro. In preferred embodiments, the methods of the present invention are performed in vitro.
• Alzheimer's Disease phenotype is induced in said cells if the value of an Alzheimer's Disease-specific molecular biomarker is a positive value greater than zero.
• a preferred embodiment of the present invention is directed to a method for determining or confirming the absence of Alzheimer's Disease in a subject comprising contacting cells from a subject with A ⁇ (1-42); contacting said cells with bradykinin; measuring the value of an Alzheimer's Disease-specific molecular biomarker; wherein the absence of Alzheimer's Disease in said subject is established or indicated if the value of said Alzheimer's Disease-specific molecular biomarker is a positive value greater than zero.
• the presence of Alzheimer's Disease in said subject is established or indicated if incubation with said amyloid beta peptide results in no significant alteration or change in an Alzheimer's Disease phenotype in said cells.
• No significant alteration or change in an Alzheimer's Disease phenotype means that the value of an Alzheimer's Disease-specific molecular biomarker is unchanged compared to its value before the cells are contacted with said amyloid beta peptide, or the value of said Alzheimer's Disease- specific molecular biomarker is changed or altered compared to its value before the cells are contacted with said amyloid beta peptide by less than about 15%, or less than about 14%, or less than about 13%, or less than about 12%, or less than about 1 1%, or less than about 10%, or less than about 9%, or less than about 8%, or less than about 7%, or less than about 6%, or less than about 5%, or less than about 4%, or less than about 3% or less than about 2%, or less than about 1% or less than about 0.5%, or less than about 0.25%.
• said cells are peripheral cells.
• said cells are selected from the group consisting of fibroblasts, saliva, blood,
• the present invention is also directed to methods for identifying a lead compound useful for the treatment of Alzheimer's Disease comprising the steps of contacting non-Alzheimer's cells with an amyloid beta peptide, contacting the same cells with an agent that is a protein kinase C activator, further contacting the cells with a test compound, and determining the value of an Alzheimer's Disease-specific molecular biomarker.
• amyloid beta is N-(me0020] in one embodiment of the present invention.
• peptide is A ⁇ (1-42) although any amyloid beta peptide may be used.
• the non-Alzheimer's cells are selected from a group consisting of fibroblasts, saliva, blood, urine, skin cells, buccal mucosa cells, and cerebro spinal fluid.
• the protein kinase C activator is selected from the group consisting of bradykinin, bryostatin, bombesin, cholecystokinin, thrombin, prostaglandin F2 ⁇ and vasopressin.
• Alzheimer's Disease-specific molecular biomarker is indicative a compound that is useful for the treatment of Alzheimer's Disease if the value of the Alzheimer's Disease-specific molecular biomarker is less than the value of a similar molecular biomarker measured from control cells that have not been contacted with the test compound.
• the control cells have been contacted with an amyloid beta peptide.
• the amyloid beta peptide is A ⁇ (1-42) although any amyloid beta peptide may be used.
• the control cells have been contacted with an agent that is a protein kinase C activator.
• the method for identifying a lead compound useful for the treatment of Alzheimer's Disease further comprises the step of modifying the compound identified as being useful for the treatment of Alzheimer's Disease to optimize or improve its safety and efficacy compared to the safety and efficacy of an unmodified compound.
• the modified compound identified is useful for the treatment of Azheimer's disease.
• the invention also discloses a method of treating Alzheimer's
• the present invention also is directed to a method of identifying a compound useful for the treatment of Alzheimer's Disease comprising contacting non-Alzheimer's control cells with A ⁇ (1-42) although any amyloid beta peptide may be used, contacting the same control cells with bradykinin, further contacting the control cells with a test compound, and determining the value of an Alzheimer's Disease-specific molecular biomarker to identify a compound useful for the treatment of Alzheimer's Disease.
• the present invention is directed, in certain embodiments, to methods of diagnosing Alzheimer's Disease in a subject comprising the steps of contacting cells obtained from a subject with an agent that is a protein kinase C activator and measuring the ratio of specific phosphorylated MAP kinase proteins in the cells to diagnose Alzheimer's Disease in the subject.
• the ratio of specific phosphorylted MAP kinase proteins is a ratio between two phosphorylated MAP kinase proteins.
• the diagnostic methods of the invention comprise an in vitro assay.
• the specific phosphorylated MAP kinase proteins are sequence variants of each other and belong to the same family of proteins.
• the ratio of specific phosphorylated MAP kinase proteins is the ratio of phosphorylated Erkl to phosphorylated Erk2 and is calculated by dividing the normalized amount of phosphorylated Erkl by the normalized amount of phosphorylated Erk2.
• the protein kinase C activator is selected from the group consisting of bradykinin, bryostatin, bombesin, cholecystokinin, thrombin, prostaglandin F2 ⁇ and vasopressin.
• the cells that are used in the diagnostic assays are peripheral cells.
• the cells may be skin cells, skin fibroblast cells, blood cells or buccal mucosa cells.
• the cells are not isolated from cerebral spinal fluid.
• the cells do not comprise cerebral spinal fluid.
• the cells are not obtained by a spinal tap or lumbar puncture.
• a protein kinase C activator is contacted with cells in media comprising serum. In other preferred embodiments of the invention, a protein kinase C activator is contacted with said cells in serum-free media.
• phosphorylated MAP kinase proteins are detected by immunoassay.
• the immunoassay may be a radioimmunoassay, a Western blot assay, an immunofluoresence assay, an enzyme immunoassay, an immunoprecipitation assay, a chemiluminescence assay, an immunohistochemical assay, an Immunoelectrophoresis assay, a dot blot assay, or a slot blot assay.
• protein arrays or peptide arrays or protein micro arrays may be employed in the diagnostic methods.
• Alzheimer's Disease is achieved or indicated (i.e. the absence or lack of results indicating the presence of Alzheimer's Disease) using any of the diagnostic methods disclosed herein
• a further, confirmatory diagnostic method may be performed using the diagnostic methods disclosed herein directed to determining the absence of Alzheimer's Disease. Such a confirmatory diagnostic method may be performed in parallel with or subsequent to any of the diagnostic methods disclosed herein.
• a positive diagnosis of Alzheimer's Disease is indicated, (i.e. results indicating the presence of Alzheimer's Disease) using any of the diagnostic methods disclosed herein
• a further, confirmatory diagnostic method may be performed using the diagnostic methods disclosed herein directed to determining the presence of Alzheimer's Disease. Such a confirmatory diagnostic method may be performed in parallel with or subsequent to any of the diagnostic methods disclosed herein.
• Alzheimer's Disease may be diagnosed in a subject by contacting cells from the subject with an agent that is a protein kinase C activator and then measuring the ratio of a phosphorylated first MAP kinase protein to a phosphorylated second MAP kinase protein, wherein the phosphorylated first and phosphorylated second MAP kinase proteins are obtained from the cells after they have been contacted with the protein kinase C activator.
• the ratio of phosphorylated first MAP kinase protein to phosphorylated second MAP kinase protein in cells from the subject that have not been contacted with the protein kinase C activator is determined and this ratio is subtracted from the ratio of phosphorylated first and second MAP kinase proteins obtained from cells after they have been contacted with the protein kinase C activator to diagnose the presence of Alzheimer's Disease in the subject based on the difference in the ratios.
• the difference in the ratios is diagnostic of Alzheimer's Disease in the subject if the difference is a positive value.
• said difference is diagnostic of the absence of Alzheimer's Disease in the subject if the difference is a negative value or zero.
• kits for diagnosing Alzheimer's Disease in a subject may contain an agent that is a protein kinase C activator; in further embodiments of the invention, the kits may contain an antibody specific for a phosphorylated first MAP kinase protein. In still further embodiments of the invention, the kits may contain an antibody specific for a phosphorylated second MAP kinase protein. In preferred embodiments, the kits may contain any combination of the foregoing.
• kits for diagnosing are provided. [0034] In certain embodiments of the invention, the kits for diagnosing
• Alzheimer's Disease in a subject may contain one or more protein kinase C activators selected from the group consisting of bradykinin, bryostatin, bombesin, cholecystokinin, thrombin, prostaglandin F2 ⁇ and vasopressin.
• the kits may contain any combination of the foregoing.
• kits for diagnosing are provided. [0035] In certain embodiments of the invention, the kits for diagnosing
• Alzheimer's Disease in a subject may contain antibodies specific for phosphorylated Erkl or phosphorylated Erk2 or both.
• the kit may contain anti-phospho-Erkl antibody.
• the kit may contain an anti-phospho-Erk2 antibody.
• the kits may contain any combination of the foregoing.
• kits for diagnosing are provided. [0036] In certain embodiments of the invention, the kits for diagnosing
• Alzheimer's Disease may further comprise an amyloid beta peptide.
• the amyloid beta peptide may be A ⁇ (1-42).
• kits for diagnosing the presence or absence Alzheimer's Disease in a subject comprise an amyloid beta peptide; an antibody specific for a phosphorylated first MAP kinase protein; and an antibody specific for a phosphorylated second MAP kinase protein.
• the amyloid beta peptide is A ⁇ (1-42).
• the kits may contain any combination of the foregoing.
• Certain embodiments of the invention are directed to methods for screening a test compound (or a lead compound) useful for the treatment or prevention of Alzheimer's Disease comprising: contacting cells isolated from a subject diagnosed with Alzheimer's Disease with an agent that is a protein kinase C activator, wherein the contacting is done in the presence of the test compound (or a lead compound); measuring the ratio of a phosphorylated first MAP kinase protein to a phosphorylated second MAP kinase protein, wherein the phosphorylated first and phosphorylated second MAP kinase proteins are obtained from the cells after the contacting; measuring the ratio of phosphorylated first MAP kinase protein to phosphorylated second MAP kinase protein in cells from the subject that have not been contacted with the test compound (or a lead compound); subtracting the ratio obtained from the contacting step done in the absence of the test compound (or a lead compound) from the ratio obtained from the contacting step done in the presence of the test
• the calculated difference in the ratios is indicative of a test compound (or a lead compound) useful for the treatment of Alzheimer's Disease if the difference is a negative value or zero.
• the invention is directed to methods for screening a test compound (or a lead compound) useful for the treatment or prevention of Alzheimer's Disease wherein the methods comprise an in vitro assay.
• the first MAP kinase protein is Erkl and the second MAP kinase protein is Erk2.
• the ratios are calculated by dividing the normalized amount of phosphorylated Erkl by the normalized amount of phosphorylated Erk2.
• the protein kinase C activator is selected from the group consisting of bradykinin, bryostatin, bombesin, cholecystokinin, thrombin, prostaglandin F2 ⁇ and vasopressin.
• the cells are peripheral cells.
• the peripheral cells are selected from the group consisting of skin cells, skin fibroblast cells, blood cells and buccal mucosa cells.
• the cells are not isolated from cerebral spinal fluid.
• the cells do not comprise cerebral spinal fluid.
• the cells are not obtained by a spinal tap or lumbar puncture.
• the protein kinase C activator is contacted with said cells in media comprising serum.
• the protein kinase C activator is contacted with said cells in serum-free media.
• the phosphorylated MAP kinase proteins are detected by immunoassay.
• the immunoassay is a radioimmunoassay, a Western blot assay, an immunofluoresence assay, an enzyme immunoassay, an immunoprecipitation assay, a chemiluminescence assay, an immunohistochemical assay, an immunoelectrophoresis assay, a dot blot assay, or a slot blot assay.
• the measuring is done using a protein array, a peptide array, or a protein micro array.
• the invention is directed to methods of monitoring Alzheimer's Disease progression in a subject comprising measuring an Alzheimer's Disease-specific molecular biomarker.
• the method comprises measuring the Alzheimer's Disease-specific molecular biomarker at more than one time point.
• the Alzheimer's Disease-specific molecular biomarker is measured at time points separated by at least six months, more preferably, at time points separated by at least 12 months.
• a decrease in the numerical value (i.e. a less positive value) of the Alzheimer's Disease-specific molecular biomarker is indicative of Alzheimer's Disease progression in said subject.
• the invention is directed to compositions useful for the treatment of Alzheimer's Disease comprising a compound identified by any of the methods for screening compounds disclosed herein.
• the compositions of the invention comprise a pharmaceutical composition for treating Alzheimer's Disease in a subject in need thereof comprising a therapeutically effective amount of a compound identified by any of the methods for screening compounds disclosed herein.
• the present invention is directed to methods of treating Alzheimer's Disease comprising administering a therapeutically effective amount of any of the pharmaceutical compositions disclosed herein to a subject in need thereof.
• Figure 1 shows the results of determinations of Alzheimer's
• AD Alzheimer's Disease cells
• Mixed AD/PD/LBD refers to cells taken from patients with mixed pathologies of Alzheimer's Disease, Parkinson's Disease and/or Loewi Body disease
• AC refers to non-dementia age- matched control cells
• Non-ADD refers to cells taken from subjects diagnosed with non-Alzheimer's Disease dementia (e.g. Huntington's disease or Parkinsons's disease or Clinical Schizophrenia).
• the Alzheimer's Disease-specific molecular biomarkers in AD cells tested was a positive value falling between greater than about 0.02 and less than about 0.4.
• the Alzheimer's Disease-specific molecular biomarkers in non- dementia age-matched control cells were negative or very low positive values, i.e. less than about 0.01.
• the Alzheimer's Disease-specific molecular biomarkers in non- ADD cells were negative values.
• Alzheimer's Disease-specific molecular biomarkers were measured by determining the ratio of phosphorylated Erkl to phosphorylated Erk2 in cells that had been stimulated with bradykinin minus the ratio of phosphorylated Erkl to phosphorylated Erk2 in cells that were stimulated with media lacking bradykinin.
• Alzheimer's Disease-specific molecular biomarker ⁇ (pErkl/pErk2)t> r adykinin ⁇ - ⁇ (pErkl/pErk2) ve h, c ie ⁇ -
• the ADSMB (noted as “Distinguishing Factor” (D.F.) in the figure) was plotted for four different categories of patients: Alzheimer's Disease (AD), mixed AD/PD/DLV (mixed diagnosis of Alzheimer's, Parkinson's and Lew body disease by autopsy confirmed) age matched control (AC) and non-AD dementia (Parkinson's disease and Huntington's disease) for Coriell cell repository and autopsy confirmed cell lines.
• Figure 2 shows a linear regression analysis of Alzheimer's
• Alzheimer's Disease-specific molecular biomarkers as a function of years of dementia.
• the linear regression shows a negative slope of approximately -0.01 indicating an inverse correlation between years of dementia and positive magnitude of the Alzheimer's Disease-specific molecular biomarker.
• the Alzheimer's Disease-specific molecular biomarker becomes a less positive numerical value. Measurement of the Alzheimer's Disease-specific molecular biomarker allows for early diagnosis of Alzheimer's Disease because a more highly positive value is indicative of early stages of the disease.
• Figure 3 shows western blot data of p-Erkl/2 (phosphorylated
• Figures 4A and 4B show Alzheimer's Disease-Specific
• ADSMB Molecular Biomarker
• FIGS 5A and 5B show soluble A ⁇ induces and bryostatin treatment reverses Alzheimer's phenotype of human fibroblast.
• A Alzheimer's Disease-Specific Molecular Biomarker (noted as “Distinguishing Factor” (D.F.) in the figure) was measured for control (non-AD) cell lines (AG07723, AGl 1363, AG09977, AG09555 and AG09878) as described herein and found small and negative.
• 1.0 ⁇ M A ⁇ -42 treatment (ADSMB) was measured again as described and found higher and positive. This shows that the bradykinin induced, activated Erkl/ Erk2 ratio becomes higher after 1.0 ⁇ M A ⁇ (l-42) treatment.
• ADSMB Sensitivity and specificity of the biomarker are plotted to show the effectiveness to detect the disease for Coriell cell repository (A) and autopsy confirmed (B) cells.
• the present invention relates, in certain aspects, to methods of diagnosing Alzheimer's Disease in human cells taken from subjects that have been identified for testing and diagnosis. The diagnosis is based upon the discovery of unique Alzheimer's Disease-specific molecular biomarkers. In certain aspects, the invention is directed to methods of monitoring Alzheimer's Disease progression and to screening methods for the identification of lead compounds for treating or preventing Alzheimer's Disease. In certain aspects, the invention is directed to methods for determining or confirming the presence or absence of Alzheimer's Disease in a subject or in samples taken from a subject.
• Alzheimer's Disease-specific molecular biomarkers provide highly practical, highly specific and highly selective tests for early diagnosis of Alzheimer's Disease.
• the Alzheimer's Disease-specific molecular biomarkers described herein provide a basis for following disease progression and for identifying therapeutic agents for drug development targeted to the treatment and prevention of Alzheimer's Disease.
• Alzheimer's Disease using peripheral (non-CNS) tissue that is useful in diagnostic assays that are highly sensitive and highly specific for the diagnosis of Alzheimer's Disease.
• a great advantage of the instant invention is that the tissue used in the assays and methods disclosed herein may be obtained from subjects using minimally invasive procedures, i.e., without the use of a spinal tap.
• one aspect of the invention is directed to an assay or test for the early detection of Alzheimer's Disease in a subject in which an internally controlled ratio of Erkl phosphorylation to Erk2 phosphorylation, which is induced by a protein kinase C activator (such as bradykinin), is measured with specific antibodies using a baseline normalization response to growth media in human cells, such as skin fibroblasts, or other peripheral cells such as blood cells.
• a protein kinase C activator such as bradykinin
• the cells that are taken from the individual or patient can be any viable cells.
• they are skin fibroblasts, but any other peripheral tissue cell (i.e. tissue cells outside of the central nervous system) may be used in the tests of this invention if such cells are more convenient to obtain or process.
• Other suitable cells include, but are not limited to, blood cells such as erythrocytes and lymphocytes, buccal mucosal cells, nerve cells such as olfactory neurons, cerebrospinal fluid, urine and any other peripheral cell type.
• the cells used for purposes of comparison do not necessarily have to be from healthy donors.
• the cells may be fresh or may be cultured (see, U.S. Patent No.
• a punch skin biopsy can be used to obtain skin fibroblasts from a subject. These fibroblasts are analyzed directly using the techniques described herein or introduced into cell culture conditions. The resulting cultured fibroblasts are then analyzed as described in the examples and throughout the specification. Other steps may be required to prepare other types of cells which might be used for analysis such as buccal mucosal cells, nerve cells such as olfactory cells, blood cells such as erythrocytes and lymphocytes, etc. For example, blood cells can be easily obtained by drawing blood from peripheral veins. Cells can then be separated by standard procedures (e.g. using a cell sorter, centrifugation, etc.) and later analyzed.
• the present invention relates, in certain aspects, to methods for the diagnosis and treatment of Alzheimer's Disease in a subject.
• the diagnostic methods of the invention are based on measuring the ratio of two specific and distinct phosphorylated MAP kinase proteins in cells taken from a subject which have been stimulated with an agent that is a protein kinase C activator.
• the invention is also directed, in certain embodiments, to kits containing reagents useful for the detection or diagnosis of Alzheimer's Disease.
• the invention is directed to methods for screening to identify lead compounds useful for treating Alzheimer's Disease as well as to methods of using these compounds or chemical derivatives of the lead compounds in pharmaceutical formulations to treat or prevent Alzheimer's Disease in subjects in need thereof.
• sensitivity in the context of medical screening and diagnosis, means the proportion of affected individuals who give a positive test result for the disease that the test is intended to reveal, i.e., true positive results divided by total true positive and false negative results, usually expressed as a percentage.
• the term "specificity" in the context of medical screening and diagnosis means the proportion of individuals with negative test results for the disease that the test is intended to reveal, i.e., true negative results as a proportion of the total of true negative and false-positive results, usually expressed as a percentage.
• the term "highly sensitive” means a diagnostic method that is greater than or equal to about 50% sensitive, or about 55% sensitive, or about 60% sensitive, or about 65% sensitive, or about 70% sensitive, or about 75% sensitive, or about 80% sensitive, or about 85% sensitive, or about 90% sensitive, or about 95% sensitive, or about 96% sensitive, or about 97% sensitive, or about 98% sensitive, or about 99% sensitive or about 100% sensitive.
• the term "highly specific” means a diagnostic method that is greater than or equal to about 50% specific, or about 55% specific, or about 60% specific, or about 65% specific, or about 70% specific, or about 75% specific, or about 80% specific, or about 85% specific, or about 90% specific, or about 95% specific, or about 96% specific, or about 97% specific, or about 98% specific, or about 99% specific or about 100% specific.
• lead compounds are compounds identified using the methods of screening compounds disclosed herein. Lead compounds may have activity in shifting the Alzheimer's Disease-specific molecular biomarkers disclosed herein to values corresponding to those values calculated for Alzheimer's Disease-specific molecular biomarkers determined using normal healthy cells in the assays described herein. Lead compounds may be subsequently chemically modified to optimize or enhance their activity for use in pharmaceutical compositions for the treatment or prevention of Alzheimer's Disease.
• sequence variants are proteins that are related to each other both structurally and functionally.
• sequence variants are proteins that share structural similarity at the level of amino acid sequence and share functional attributes at the level of enzymatic activity.
• sequence variants are MAP kinase proteins that catalyze the phosphorylation of other proteins.
• the "absence of Alzheimer's Disease” means that a subject or cells taken from a subject do not exhibit a measurable or detectable Alzheimer's Disease phenotype.
• an "Alzheimer's Disease phenotype" in a subject or a cell sample includes but is not limited to an Alzheimer's Disease-specific molecular biomarker having a positive value greater than zero.
• an "Amyloid Beta Peptide” is any fragment of the Amyloid Beta Peptide or a full-length Amyloid Beta Peptide.
• “increased responsiveness to treatment” means the ability to respond in a positive way to treatment, thus alleviating symptoms more quickly and effectively than patients who do not exhibit said increased responsiveness to treatment.
• brain stage Alzheimer's Disease means the stage of the disease. Persons with early-stage Alzheimer's disease and related dementias have only mild impairment due to the symptoms of the disease. They may still be working, driving and need only minimal assistance with certain activities of daily living. Individuals in this stage are often self-aware of their diagnosis and abilities.
• Staging systems provide useful frames of reference for understanding how Alzheimer's disease may unfold and for making future plans. But it is important to note that not everyone will experience the same symptoms or progress at the same rate. People with Alzheimer's die an average of four to six years after diagnosis, but the duration of the disease can vary from three to 20 years.
• Alzheimer's disease and notes which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer's disease. Also noted are which stages fall within the more general divisions of early-stage, mid-stage and late- stage categories.
• Stage 2 Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease)
• the present invention is directed, in certain embodiments, to methods of diagnosing Alzheimer's Disease.
• the diagnostic methods involve the steps of obtaining a cell sample from a subject, contacting the cell sample with an agent that is a protein kinase C activator and measuring the ratio of specific phosphorylated MAP kinase proteins in said cell sample to diagnose Alzheimer's Disease in said subject.
• the diagnostic assays disclosed herein may be carried out in vitro or in vivo.
• the protein kinase C activator is bradykinin.
• the ratio of specific phosphorylated MAP kinase proteins is the ratio of phosphorylated Erkl to phosphorylated Erk2, which is calculated by dividing the relative or normalized amount of phosphorylated Erkl by the relative or normalized amount of phosphorylated Erk2.
• the diagnostic methods and methods of screening compounds useful for treating Alzheimer's Disease which are disclosed herein are based upon the discovery by the inventors of a unique molecular biomarker for Alzheimer's Disease.
• the numerical value of the Alzheimer's Disease-specific molecular biomarker will depend on certain variables, such as, for example, the cells used in the assay, the protein kinase C activator used in the assay and the specific MAP kinase proteins that are targeted for measurement of phosphorylation ratios.
• the Alzheimer's Disease-specific molecular biomarker may be measured by determining the ratio of phosphorylated Erkl to phosphorylated Erk2 in cells that have been stimulated by a protein kinase C activator and subtracting from this the ratio of phosphorylated Erkl to phosphorylated Erk2 in cells that have been stimulated with a control solution (vehicle) that lacks the protein kinase C activator.
• a control solution that lacks the protein kinase C activator.
• the difference is greater than zero, i.e. a positive value, this is diagnostic . of Alzheimer's Disease.
• the difference is less than or equal to zero, this is indicative of the absence of Alzheimer's Disease.
• the Alzheimer's Disease-specific molecular biomarkers of the present invention are measured by determining the ratio of two phosphorylated MAP kinase proteins after stimulation of cells with a protein kinase C activator.
• the molecular biomarker may be measured by determining the ratio of a first phosphorylated MAP kinase protein to a phosphorylated second MAP kinase protein in cells that have been stimulated by a protein kinase C activator and subtracting from this the ratio of phosphorylated first MAP kinase protein to phosphorylated second MAP kinase protein in cells that have been stimulated with a control solution (vehicle) that lacks the protein kinase C activator. In certain preferred embodiments, if the difference is greater than zero, i.e. a positive value, this is diagnostic of Alzheimer's Disease.
• the Alzheimer's Disease-specific molecular biomarker is a positive numerical value in cell samples taken from patients diagnosed with Alzheimer's Disease (AD cells).
• AD cells Alzheimer's Disease
• the positive numerical values for the Alzheimer's Disease-specific molecular biomarker in AD cells may range from about zero to about 0.5.
• the Alzheimer's Disease-specific molecular biomarker is a negative numerical value when measured in cells taken from subjects diagnosed with non-Alzheimer's Disease dementia (non-ADD cells), such as, for example, Parkinson's disease or Huntington's disease or Clinical Schizophrenia.
• non-ADD cells non-Alzheimer's Disease dementia
• the negative numerical values may range from about zero to about -0.2 or about -0.3.
• the Alzheimer's Disease-specific molecular biomarker may be a negative numerical value, zero or very low positive numerical value in cell samples from age-matched control cells (AC cells) taken from patients who do not have Alzheimer's Disease.
• AC cells age-matched control cells
• the Alzheimer's Disease-specific molecular biomarker in AC cells may range from less than about 0.05 to about -0.2.
• Protein kinase C activators that are specifically contemplated for use in the diagnostic methods, kits and methods of screening to identify compounds of the instant invention include, but are not limited to: Bradykinin; ⁇ -APP modulator; Bryostatin 1; Bryostatin 2; DHI; 1,2-Dioctanoyl-sn-glycerol; FTT; Gnidimacrin, Stellera chamaejasme L.; (-)-Indolactam V; Lipoxin A 4 ; Lyngbyatoxin A, Micromonospora sp.; Oleic acid; l-Oleoyl-2-acetyl-sn-glycerol; 4 ⁇ -Phorbol; Phorbol- 12, 13-dibutyrate; Phorbol- 12, 13-didecanoate; 4 ⁇ -Phorbol- 12,13- didecanoate; Phorbol-12-myristate-13-acetate; L- ⁇ -Phos
• Bryologues are described, for example, in Wender et al. Organic letters ( United States ) May 12, 2005 ,7 (10) pl995-8; Wender et al. Organic letters ( United States ) Mar 17 2005 , 7 (6) pi 177-80; Wender et al. Journal of Medicinal Chemistry ( United States ) Dec 16 2004, 47 (26) p6638-44.
• a protein kinase C activator may be used alone or in combination with any other protein kinase C activator in the diagnostic methods, kits and methods of screening compounds disclosed herein.
• Bradykinin is a potent vasoactive nonapeptide that is generated in the course of various inflammatory conditions. Bradykinin binds to and activates specific cell membrane bradykinin receptor(s), thereby triggering a cascade of intracellular events leading to the phosphorylation of proteins known as "mitogen activated protein kinase” (MAPK).
• MAPK mitogen activated protein kinase
• Phosphorylation of protein the addition of a phosphate group to a Ser, Thr, or Tyr residue, is mediated by a large number of enzymes known collectively as protein kinases. Phosphorylation normally modifies the function of, and usually activates, a protein.
• phosphorylation be a transient process, which is reversed by phosphatase enzymes that dephosphorylate the substrate. Any aberration in phosphorylation or dephosphorylation may disrupt biochemical pathways and cellular functions. Such disruptions may be the basis for certain brain diseases.
• the methods of diagnosing Alzheimer's Disease and methods of screening compounds to identify agents useful for the treatment or prevention of Alzheimer's Disease herein disclosed depend on measuring the Alzheimer's Disease-specific molecular biomarkers of the present invention.
• the level of phosphorylated protein present in cells is detected by Western blotting.
• Protein levels of phosphorylated Erkl or phosphorylated Erk2 can be measured in fibroblasts using anti-Erkl , anti-Erk2, anti-phospho-Erkl and anti-phospho-Erk2 antibodies (Cell Signaling Technology).
• Levels of a different protein may also be measured in the same sample as a reference protein for normalization. Examples of possible reference proteins include, but are not limited to, annexin-II or actin.
• ELISA is performed according to the following procedures: 1) Add fibroblast cell lysates after treatment in duplicates or triplicates to a 96-well microplate that is previously coated with an anti-Erk antibody. 2) Incubate samples in microplate wells at room temperature for about 2 hours. 3) Aspirate samples and wash wells with a phosphate buffered saline (PBS)-based washing buffer. 4) Add working dilution of an anti-phospho-Erkl/2, or an anti- regular Erkl/2 antibody to each well, and incubate at room temperature for about 1 hour. 5) Aspirate and wash well with washing buffer.
• PBS phosphate buffered saline
• phosphorylation of Erkl/2 is assayed on Western blots using an anti-phospho-Erkl/2 antibody.
• Levels of the immunoreactive signals for phosphorylated Erkl/2 are quantified via densitometric scan.
• the mean density of the phospho-Erkl/2 signals are normalized with the mean density of total Erkl/2 signals that are detected from the same cell lysate samples with an anti-regular Erkl/2 antibody on a separate Western blot.
• Immunoassays of the present invention for the detection of proteins may be immunofluorescent assays, radioimmunoassays, Western blot assays, enzyme immunoassay, immuno-precipitation, chemiluminescent assay, immunohistochemical assay, dot or slot blot assay and the like.
• immunofluorescent assays may be immunofluorescent assays, radioimmunoassays, Western blot assays, enzyme immunoassay, immuno-precipitation, chemiluminescent assay, immunohistochemical assay, dot or slot blot assay and the like.
• Detection may be by colorimetric or radioactive methods or any other conventional methods known to those having skill in the art. Standard techniques known in the art for ELISA are described in Methods in Immunodiagnosis, 2 nd Edition, Rose and Bigazzi, eds., John Wiley and Sons, New York 1980 and Campbell et al., Methods of Immunology,, W.A. Benjamin, Inc., 1964, both of which are incorporated herein by reference. Such assays may be direct, indirect, competitive, or noncompetitive immunoassays as described in the art (In "Principles and Practice of Immunoassay” (1991) Christopher P. Price and David J. Neoman (eds), Stockton Pres, NY, NY; Oellirich, M. 1984. J. Clin. Chem. Clin. Biochem. 22: 895-904 Ausubel, et al. (eds) 1987 in Current Protocols in Molecular Biology, John Wiley and Sons, New York, New York.
• the cells taken from the patient being diagnosed may be any cell.
• examples of cells that may be used include, but are not limited to, skin cells, skin fibroblasts, buccal mucosal cells, blood cells, such as erythrocytes, lymphocytes and Iymphoblastoid cells, and nerve cells and any other cell expressing the Erkl/2 protein.
• Necropsy samples and pathology samples may also be used. Tissues comprising these cells may also be used, including brain tissue or brain cells.
• the cells may be fresh, cultured or frozen. Protein samples isolated from the cells or tissues may be used immediately in the diagnostic assay or methods for screening compounds or frozen for later use. In a preferred embodiment fibroblast cells are used. Fibroblast cells may be obtained by a skin punch biopsy.
• Proteins may be isolated from the cells by conventional methods known to one of skill in the art.
• cells isolated from a patient are washed and pelleted in phosphate buffered saline (PBS).
• the supernatant is discarded, and "homogenization buffer” is added to the pellet followed by sonication of the pellet.
• the protein extract may be used fresh or stored at -80°C for later analysis.
• the antibodies used in the disclosed immunoassays may be monoclonal or polyclonal in origin.
• the phosphorylated and non-phosphorylated Erkl/2 protein or portions thereof used to generate the antibodies may be from natural or recombinant sources or generated by chemical synthesis.
• Natural Erkl/2 proteins can be isolated from biological samples by conventional methods.
• Examples of biological samples that may be used to isolate the Erkl/2 protein include, but are not limited to, skin cells, such as, fibroblasts, fibroblast cell lines, such as Alzheimer's Disease fibroblast cell lines and control fibroblast cell lines which are commercially available through Coriell Cell Repositories, (Camden, N.J.) and listed in the National Institute of Aging 1991 Catalog of Cell Lines, National Institute of General Medical Sciences 1992/1993 Catalog of Cell Lines [(NIH Publication 92-2011 (1992)].
• Kits for the Diagnosis of Alzheimer's Disease include, but are not limited to, skin cells, such as, fibroblasts, fibroblast cell lines, such as Alzheimer's Disease fibroblast cell lines and control fibroblast cell lines which are commercially available through Coriell Cell Repositories, (Camden, N.J.) and listed in the National Institute of Aging 1991 Catalog of Cell Lines, National Institute of General Medical Sciences 1992/1993 Catalog of Cell Lines [(NIH Publication 92-2011 (1992)
• kits which may be utilized in performing any of the diagnostic tests described above.
• the kits may contain a single diagnostic test or any combination of the tests described herein.
• the kits may comprise antibodies which recognize regular Erkl/2 (unphosphorylated Erkl or unphosphorylated Erk2) or phosphorylated Erkl/2 (phosphorylated Erkl or phosphorylated Erk2).
• the kits may contain antibodies that recognize regular MAP kinase proteins as well as phosphorylated MAP kinase proteins.
• the kits may also contain any one or more of the protein kinase C activators disclosed herein (such as, for example, bradykinin or bryostatin).
• Antibodies may be polyclonal or monoclonal.
• kits may contain instruments, buffers and storage containers necessary to perform one or more biopsies, such as punch skin biopsies.
• the kits may also contain instructions relating to the determination of the ratios used to identify the Alzheimer's Disease-specific molecular biomarkers of the instant invention as well as the use of the antibodies or other constituents in the diagnostic tests.
• the instructions may also describe the procedures for performing a biopsy, such as a punch skin biopsy.
• the kits may also contain other reagents for carrying out the diagnostic tests such as antibodies for the detection of reference proteins used for normalization. Examples of antibodies that recognize possible reference proteins include, but are not limited to, antibodies that recognize annexin-II or actin.
• the kits may also include buffers, secondary antibodies, control cells, and the like. IV. Methods of Screening Compounds Useful in the Treatment or Prevention of Alzheimer's Disease
• the present invention is also directed to methods to screen and identify substances useful for the treatment or prevention of Alzheimer's Disease.
• substances which reverse or improve the Alzheimer's Disease-specific molecular biomarkers described herein i.e. back to levels found in normal cells
• one such method of screening to identify therapeutic substances would involve the steps of contacting sample cells from an Alzheimer's Disease patient with a substance being screened in the presence of any of the protein kinase C activators disclosed herein and then measuring any of the Alzheimer's Disease-specific molecular biomarkers disclosed herein.
• An agent that reverses or improves the Alzheimer's Disease-specific molecular biomarker back to levels found in normal cells i.e. cells taken from a subject without Alzheimer's Disease
• Alzheimer's Disease-specific molecular biomarker is an agent that causes a reduction of a positive value and/or a movement towards more negative values for an Alzheimer's Disease-specific molecular biomarker.
• the present invention is also directed to methods of monitoring the progression of Alzheimer's Disease in a subject.
• Figure 2 provides a linear regression analysis of Alzheimer's Disease-specific molecular biomarkers as a function of years of duration of dementia. The linear regression shows a negative slope of approximately -0.01 indicating an inverse correlation between years of dementia and positive magnitude of the Alzheimer's Disease-specific molecular biomarker. As the years of dementia increases (i.e. as Alzheimer's Disease progresses) the Alzheimer's Disease-specific molecular biomarker becomes a less positive numerical value. Measurement of the Alzheimer's Disease-specific molecular biomarker allows for early diagnosis of Alzheimer's Disease because, in certain embodiments, a more highly positive value is indicative of early stages of the disease. In certain embodiments, as Alzheimer's Disease progresses in a subject, the Alzheimer's Disease specific molecular biomarker becomes a less positive value.
• amyloid beta peptide amyloid beta peptide
• beta amyloid protein a amyloid protein
• an amyloid beta peptide e.g., A. beta 39, A. beta 40, A. beta 41 , A. beta 42 and A. beta 43
• APP Amyloid Precursor Protein
• Multiple isoforms of APP exist, for example APP 695 , APP , and APP 770 . Examples of specific isotypes of APP which are currently known to exist in humans are the 695 amino acid polypeptide described by Kang et. al.
• A. beta Part of the hydrophobic domain of APP is found at the carboxy end of A. beta, and may account for the ability of A. beta to aggregate, particularly in the case of the long form.
• A. beta, peptide can be found in, or purified from, the body fluids of humans and other mammals, e.g. cerebrospinal fluid, including both normal individuals and individuals suffering from amyloidogenic disorders.
• amyloid beta peptide amyloid beta peptide
• beta amyloid protein a amyloid protein
• A. beta, peptides of the invention can be derived from a variety of sources, for example, tissues, cell lines, or body fluids ⁇ e.g. sera or cerebrospinal fluid).
• an A. beta can be derived from APP-expressing cells such as Chinese hamster ovary (CHO) cells as described, for example, in Walsh et al, (2002), Nature, 416, pp 535-539.
• beta, preparation can be derived from tissue sources using methods previously described ⁇ see, e.g., Johnson-Wood et al, (1997), Proc. Natl. Acad. Sci. USA 94: 1550).
• A. beta, peptides can be synthesized using methods which are well known to those in the art. See, for example, Fields et al, Synthetic Peptides: A User's Guide, ed. Grant, W.H. Freeman & Co., New York, N. Y., 1992, p 77).
• peptides can be synthesized using the automated Merrifield techniques of solid phase synthesis with the a-amino group protected by either t-Boc or F-moc chemistry using side chain protected amino acids on, for example, an Applied Biosystems Peptide Synthesizer Model 430A or 431.
• Longer peptide antigens can be synthesized using well known recombinant DNA techniques.
• a polynucleotide encoding the peptide or fusion peptide can be synthesized or molecularly cloned and inserted in a suitable expression vector for the transfection and heterologous expression by a suitable host cell.
• A. beta, peptide also refers to related A. beta sequences that results from mutations in the A. beta, region of the normal gene.
• Alzheimer's Disease-specific molecular biomarker may be used as a confirmatory test for either the presence or absence of Alzheimer's disease. Namely, a negative Amyloid Beta-Index response indicates the presence of disease, while a positive response indicates the absence of disease. That is, if an Alzheimer's Disease phenotype is induced in cells upon incubation or contact with an Amyloid Beta Peptide, this is indicative of the absence of the disease in the test cells or subject being tested. In contrast, if no or little change in an Alzheimer's Disease-specific molecular biomarker is induced in cells upon incubation or contact with an Amyloid Beta Peptide, this is indicative of the presence of Alzheimer's Disease in the test cells or subject being tested.
• amyloid beta (1-42) ⁇ i.e. A ⁇ (1-42)
• any other amyloid beta fragments such as (1-39), (1-40), (1-41), (1-43), (25-35), (16-22), (16-35), (10-35), (8-25), (28-38), (15-39), (15-40), (15-41), (15-42), (15-43) or any other amyloid beta fragment may also be used in any of the methods or kits described herein.
• the present invention is also directed to compositions useful for the treatment or prevention of Alzheimer's Disease.
• Compounds identified using the screening methods described herein may be formulated as pharmaceutical compositions for administration to subjects in need thereof.
• a pharmaceutical composition of the present invention or a compound (or a chemical derivative of a lead compound) identified using the screening methods disclosed herein can be administered safely by admixing with, for example, a pharmacologically acceptable carrier according to known methods to give a pharmaceutical composition, such as tablets (inclusive of sugar-coated tablets and film-coated tablets), powders, granules, capsules, (inclusive of soft capsules), liquids, injections, suppositories, sustained release agents and the like, for oral, subcutaneous, transdermal, transcutaneous or parenteral (e.g., topical, rectal or intravenous) administration.
• a pharmaceutical composition such as tablets (inclusive of sugar-coated tablets and film-coated tablets), powders, granules, capsules, (inclusive of soft capsules), liquids, injections, suppositories, sustained release agents and the like, for oral, subcutaneous, transdermal, transcutaneous or parenteral (e.g., topical, rectal or intravenous
• Examples of pharmacologically acceptable carriers for use in the pharmaceutical compositions of the invention include, but are not limited to various conventional organic or inorganic carriers, including excipients, lubricants, binders and disintegrators for solid preparations, and solvents, solubilizers, suspending agents, isotonic agents, buffers, soothing agents, and the like for liquid preparations.
• conventional additives such as antiseptics, antioxidants, coloring agents, sweeteners, absorbents, moistening agents and the like can be used appropriately in suitable amounts.
• excipients for use in the pharmaceutical compositions of the invention include, but are not limited to agents such as lactose, sucrose, D-mannitol, starch, corn starch, crystalline cellulose, light anhydrous silicic acid, polysaccharides, disaccharides, carbohydrates, trehalose and the like.
• binders for use in the pharmaceutical compositions of the invention include, but are not limited to crystalline cellulose, sucrose, D-mannitol, dextrin, hydroxypropylcellulose, hydroxypropylmethylcellulose, polyvinylpyrrolidone, starch, sucrose, gelatin, methylcellulose, carboxymethylcellulose sodium and the like.
• disintegrators for use in the pharmaceutical compositions of the invention include, but are not limited to starch, carboxymethylcellulose, carboxymethylcellulose calcium, sodium carboxymethyl starch, L-hydroxypropylcellulose and the like.
• solvents for use in the pharmaceutical compositions of the invention include, but are not limited to water for injection, alcohol, propylene glycol, Macrogol, sesame oil, corn oil, olive oil and the like.
• solubilizers for use in the pharmaceutical compositions of the invention include, but are not limited to polyethylene glycol, propylene glycol, D-mannitol, benzyl benzoate, ethanol, tris-aminomethane, cholesterol, triethanolamine, sodium carbonate, sodium citrate and the like.
• surfactants such as stearyl triethanolamine, sodium lauryl sulfate, lauryl aminopropionate, lecithin, benzalkonium chloride, benzethonium chloride, glyceryl monostearate and the like
• hydrophilic polymers such as polyvinyl alcohol, polyvinylpyrrolidone, carboxymethylcellulose sodium, methylcellulose, hydroxymethylcellulose, hydroxyeth
• isotonic agents for use in the pharmaceutical compositions of the invention include, but are not limited to glucose, D-sorbitol, sodium chloride, glycerine, D-mannitol and the like.
• buffers for use in the pharmaceutical compositions of the invention include, but are not limited to phosphate, acetate, carbonate, citrate etc., and the like.
• Examples of soothing agents for use in the pharmaceutical compositions of the invention include, but are not limited to benzyl alcohol and the like.
• antiseptics for use in the pharmaceutical compositions of the invention include, but are not limited to p-oxybenzoates, chlorobutanol, benzyl alcohol, phenethyl alcohol, dehydroacetic acid, sorbic acid and the like.
• antioxidants for use in the pharmaceutical compositions of the invention include, but are not limited to sulfite, ascorbic acid, ⁇ - tocopherol and the like.
• a carrier for injection to be used may include any or all of the following: a solvent, a solubilizer, a suspending agent, an isotonic agent, a buffer, a soothing agent and the like.
• a solvent include, but are not limited to water for injection, physiological saline, Ringer's solution and the like.
• the solubilizer include, but are not limited to polyethylene glycol, propylene glycol, D-mannitol, benzyl benzoate, trisaminomethane, cholesterol, triethanolamine, sodium carbonate, sodium citrate and the like.
• Examples of the isotonic agent include but are not limited to glucose, D- sorbitol, sodium chloride, glycerin, D-mannitol and the like.
• Examples of the buffer include but are not limited to buffers such as phosphate, acetate, carbonate, citrate and the like, and the like.
• Examples of the soothing agent include but are not limited to benzyl alcohol and the like.
• Examples of the pH adjusting agent include but are not limited to hydrochloric acid, phosphoric acid, citric acid, sodium hydroxide, sodium bicarbonate, sodium carbonate and the like.
• the composition for injection of the present invention may be freeze-dried in an aseptically treated freeze dryer and preserved in a powder state, or can be sealed in a container for injection (e.g., ampoule) and preserved.
• composition of the present invention may be diluted with the aforementioned carrier for injection when in use.
• the content of an active compound in the pharmaceutical composition of the present invention may vary depending on the form of the preparation, but it is generally about 0.01 -about 99 wt %, preferably about 0.1 -about 50 wt %, more preferably about 0.5-about 20 wt %, of the whole preparation.
• the content of nonionic surfactant in the pharmaceutical composition of the present invention may vary depending on the form of the preparation, but it is generally about 1 to about 99.99 wt %, preferably about 10 to about 90 wt %, more preferably about 10 to about 70 wt %, of the whole preparation.
• the content of ethanol, benzyl alcohol or dimethylacetamide in the pharmaceutical compositions of the present invention may vary depending on the form of the preparation, but it is generally about 1 to about 99.99 wt %, preferably about 10 to about 90 wt %, more preferably about 30 to about 90 wt %, of the whole preparation.
• the content of cyclodextrin derivative readily soluble in water in the pharmaceutical composition of the present invention varies depending on the form of the preparation, but it is generally about 1 to about 99.99 wt %, preferably about 10 to about 99.99 wt %, more preferably about 20 to about 97 wt %, particularly preferably about 50 to about 97 wt %, of the whole preparation.
• the content of other additives in the pharmaceutical composition of the present invention may vary depending on the form of the preparation, but it is generally about 1 to about 99.99 wt %, preferably about 10 to about 90 wt %, more preferably about 10 to about 70 wt %, of the whole preparation.
• the pharmaceutical compositions of the present invention may be a pharmaceutical composition comprising an active compound, a nonionic surfactant and a cyclodextrin derivative readily soluble in water.
• the content of each component, i.e. the active compound, the nonionic surfactant and the cyclodextrin derivative readily soluble in water is the same as in the aforementioned ranges.
• the present invention is also directed to methods of treating or preventing Alzheimer's Disease using the pharmaceutical compositions disclosed herein.
• the compounds of the present invention may be administered by oral, parenteral (for example, intramuscular, intraperitoneal, intravenous, ICV, intracisternal injection or infusion, subcutaneous injection, or implant), by inhalation spray, nasal, vaginal, rectal, sublingual, or topical routes of administration and may be formulated, alone or together, in suitable dosage unit formulations containing conventional non-toxic pharmaceutically acceptable carriers, adjuvants and vehicles appropriate for each route of administration.
• the pharmaceutical compositions and method of the present invention may further comprise other therapeutically active compounds which are usually applied in the treatment of Alzheimer's Disease.
• an appropriate dosage level will generally be about 0.001 to 100 mg per kg patient body weight per day which can be administered in single or multiple doses.
• the dosage level will be about 0.01 to about 25 tng/kg per day; more preferably about 0.05 to about 10 mg/kg per day.
• a suitable dosage level may be about 0.01 to 25 mg/kg per day, about 0.05 to 10 mg/kg per day, or about 0.1 to 5 mg/kg per day. Within this range the dosage may be about 0.005 to about 0.05, 0.05 to 0.5 or 0.5 to 5 mg/kg per day.
• compositions are preferably provided in the form of tablets containing about 1 to 1000 milligrams of the active ingredient, particularly about 1 , 5, 10, 15, 20, 25, 50, 75, 100, 150, 200, 250, 300, 400, 500, 600, 750, 800, 900, and 1000 milligrams of the active ingredient for the symptomatic adjustment of the dosage to the patient to be treated.
• the compounds may be administered on a regimen of 1 to 4 times per day, preferably once or twice per day.
• Alzheimer's Disease-Specific Molecular Biomarker ADSMB Varies with Disease Duration
• MAP Kinase phosphorylation is regulated by PKC activation that, in turn showed vulnerability to elevated levels of A ⁇ .
• the potent PKC activator, the macrolactone, Bryostatin was found to enhance PKC activation in human fibroblasts as well as to reduce A ⁇ (l-42) levels in the brains of transgenic mice with human AD genes. Based on these findings, therefore, we tested the effects of Bryostatin (O.lnM) on A ⁇ (l - 42) — treated human fibroblasts.
• Bryostatin As illustrated ( Figure 5B and Table 1 ), Bryostatin entirely reversed the change of MAP Kinase phosphorylation induced in normal fibroblasts by A ⁇ (l-42). Bryostatin changed the abnormal, positively valued of A ⁇ - treated fibroblasts into the normal, negatively valued ADSMB previously observed for non-AD fibroblasts. This "therapeutic" efficacy of Bryostatin is consistent with the greatly increased survival of AD-transgenic mice that were exposed to chronic Bryostatin treatment. Table 1
• Alzheimer's Disease-Specific Molecular Biomarker was measured for AC (control cell lines) (control), amyloid beta (A ⁇ ) induced cells and, amyloid beta (A ⁇ ) induced cells plus bryostatin treatment (A ⁇ +BY).
• ADSMB was calculated according to method use by this study. *T-test was conducted between control and AB treated cells.
• T-test was conducted between A ⁇ treated cells and A ⁇ plus bryostatin treated cells.
• MAP Kinase phosphorylation to diagnose AD suggest an important potential as a laboratory test for AD to aid in the clinical assessment of dementia.
• autopsy confirmation of clinically-diagnosed dementia is usually available only for patients with long-standing disease.
• clinical diagnosis for AD of brief duration has been found to show high inaccuracy when it is compared to clinical diagnosis later in the disease progression and then subjected to autopsy validation.
• a peripheral biomarker here a MAP kinase phosphorylation ratio for human fibroblasts, has real utility in arriving at therapeutic strategies for dementia.
• AD is also of interest to consider why the ratio of Erkl to Erk2 phosphorylation might be sensitive to abnormalities due to AD-specific differences of A ⁇ metabolism.
• One implication of this and past studies of peripheral biomarkers for AD is that the pathophysiology of AD does not only involve the brain, but also a variety of other organ systems. This systemic pathophysiologic view of AD is consistent with observations that amyloid and tau metabolic pathways are ubiquitous in the human body and manifest in blood, saliva, skin and extra-brain tissues.
• AD also focuses attention on these substrates as a "read-out" of. AD signaling.
• PKC isozymes regulate several molecular targets that converge on MAP Kinase.
• PKC activates: (1) ⁇ -secretase increase of s-APP and, thus, indirectly, reduction of ⁇ -amyloid; (2) ⁇ -amyloid activates glycogen synthase Kinase-3 ⁇ (GSK- 3 ⁇ ) that increases IVlAP kinase Phosphorylation; (3) PKC inhibits GSK-3 ⁇ ; (4) PKC itself phosphorylates GSK-3 ⁇ ; and (5) PKC activates cytokines inflammatory signals that may respond to BK and other AD-initiated events; (6) Toxic cholesterol metabolites (e.g. 17-OH cholesterol) inhibit PKC ⁇ that, on balance reduces A ⁇ , and reduces phosphorylated tau.
• Toxic cholesterol metabolites e.g. 17-OH cholesterol
• a ⁇ (l-42) solution Initially 1 mg of A ⁇ (l-42) was dissolved in hexa-fluoroisopropanol (Sigma, St. Louis, MO) at a concentration of 3 mM and separated into aliquots in sterile microcentrifuge tubes. Hexa- fluoroisopropanol was removed under vacuum and lyophilized. The A ⁇ (l-42) films were stored at -20 0 C under dry conditions until use. 5 mM A ⁇ (l-42) stock solution was prepared from the stored A ⁇ (l-42) in DMSO just before the experiment.
• hexa-fluoroisopropanol Sigma, St. Louis, MO
• DMEM medium supplied with 10% serum and penicillin/streptomycin
• a ⁇ (l-42) from a DSMO stock solution.
• DMEM medium containing 1.0 ⁇ M A ⁇ (l-42) was added to non-AD control (AC) cells at 90-100% confluence stage in 25 mL cultured flask and kept at cell culture incubator (at 37 ° C with 5% CO 2 ) for 24 hrs. Cells were 'starved' in serum free medium (DMEM) for 16 hours.
• 1OnM bradykinin (in DMSO) solution was prepared in DMEM medium with 10% serum.
• Flasks were removed from the dry ice/ethanol mixture and then 100 ⁇ L of lysis buffer (10 mM Tris, pH 7.4, 150 mM NaCl, 1 mM EDTA, 1 mM EGTA, 0.5% NP-40, 1% Triton X-100, 1% protease inhibitor cocktail, 1% ser/thr/tyrosine phosphatase inhibitor cocktails) was added into each flask. Flasks were kept on an end-to end shaker in a cold room (4°C) for 30 min and cells were collected from each flask with a cell scraper.
• lysis buffer 10 mM Tris, pH 7.4, 150 mM NaCl, 1 mM EDTA, 1 mM EGTA, 0.5% NP-40, 1% Triton X-100, 1% protease inhibitor cocktail, 1% ser/thr/tyrosine phosphatase inhibitor cocktails
• 0.1 nM bryostatin solution was prepared in regular DMEM medium (supplemented with 10% serum and penicillin/streptomycin) from DMSO stock solution. After A ⁇ treatment, cells were washed four times with regular culture medium (supplemented with 10% serum and penicillin/streptomycin). 0.1 nM bryostatin was added to cells and culture flasks were kept in the cell culture incubator (at 37 C with 5% CO 2 ) for 20 min. After five times washing with serum free medium the flasks were kept in an incubator (at 37 C with 5% CO 2 ) in serum free condition for 16 hrs. The Bradykinin induced MAPK assay was done as discussed above. Data analysis
• ADSMB [p-Erkl/p-Erk2] BK+ - [p-Erkl/p-Erk2] BK -
• ADSMB Alzheimer's Disease-Specific Molecular Biomarker
• EXAMPLE 3 In Vitro Assay of Skin Fibroblasts to Determine Ratio of Phosphorylated Erkl to Phosphorylated Erk2
• AD dementia non-ADD
• AC age- matched control cells
• DMEM serum-free medium
• BK Bradykinin
• Flasks were kept on an end-to-end shaker in a cold room (4 0 C) for 30 min and cells were collected from each flask with a cell scraper. Cells were sonicated and then centrifuged at 14000 rpm for 15 min, and the supernatant was used for Western blotting after total protein assay.
• Erk2 (p-Erkl, p-Erk2) were determined using specific antibodies: anti-regular Erkl/2 and anti-phospho ERK1/2.
• EXAMPLE 4 Skin Fibroblasts
• Banked skin fibroblasts from patients with AD and age- matched controls are purchased from the Coriell Institute for Medical Research. Autopsy confirmed skin fibroblasts are obtained separately. Patients may be clinically affected with severe dementia, progressive memory loss, and other impaired cognitive functions. Brains from these patients show abnormal EEG and different degrees of cerebral atrophy by CAT or CT scan. Cells from normal individuals with close age matches are used as controls.
• Fresh-taken skin fibroblasts The collection and culture of fibroblasts from freshly obtained skin tissue is performed as follows: Punch-biopsy skin tissues from non-FAD (nFAD) patients and age-matched controls are obtained by qualified personnel. All patients (or representatives) sign informed consent forms.
• DMEM is purchased from Gibco BRL. Fetal bovine serum is purchased from Bio Fluids. Bradykinin, diphenylboric acid 2-aminoethyl ester (2ABP), protease, and phosphatase inhibitor cocktails are purchased from Sigma; bisindolylmaleimide-1 and LY294002 are purchased from Alexis; PD98059 is purchased from Cell Signaling Technology. Anti-phospho-Erkl/2 antibodies are purchased from Cell Signaling Technology. Anti-regular Erkl/2 is purchased from Upstate Biotechnology. SDS minigels (4-20%) are purchased from Invertrogene- Novex. Nitrocellulose membranes are purchased form Schleicher & Schuell (Keene, NH). All the SDS electrophoresis reagents are purchased from Bio-Rad. The SuperSignal chemilumines-cence substrate kit is purchased from Pierce.
• Bradykinin (M.Wt. 1060.2) was purchased from
• Samples are placed in IxPBS and transported in transfer medium to the laboratory for propagation. After the transfer medium is removed, the skin tissues are rinsed with PBS and finely chopped into 1-mm-sized explants. The explants are transferred one by one onto the growth surface of vented T25 flasks with 3 ml of biopsy medium containing 45% FBS and 100 U/ml penicillin and 100 U/ml streptomycin (Pen/Strep). The tissues are cultured at 37 C for 24 h before addition of 2 ml of biopsy medium containing 10% FBS. The medium is replaced after 48 h with 5 ml of regular culture medium containing 10% FBS and 100 U/ml Pen/Strep.
• AD Alzheimer's Disease
• non AD dementia e.g. Huntingdon and Parkinson disease and Clinical Schizophrenia and age- matched control, AC
• AC Coriell Institute of Medical Research
• 1OnM bradykinin (in DMSO) solution was prepared in DMEM medium with 10% serum. 7mL of 1OnM BK solution was added to the 25mL cultured flask and incubated at 37 C for 10 min. For the controls, the same amount of DMSO was added in DMEM medium with 10% serum. 7mL of this medium with DMSO ( ⁇ 0.01%) was added to the 25mL cultured flask and incubated at 37 ° C for 10 min. After washing four times with cold (4 C) IX PBS, flasks were kept in dry ice/ethanol mixture for 15 min.
• Flasks were removed from dry ice/ethanol mixture and then lOO ⁇ L of lysis buffer (1OmM Tris, pH 7.4, 15OmM NaCl, ImM EDTA, ImM EGTA, 0.5% NP-40, 1% Triton X-I OO, 1% protease inhibitor cocktail, 1% ser/thr/tyrosine phosphatase inhibitor cocktails) was added into each flask. Flasks were kept on an end to end shaker in a cold room (4 C) for 30 min and cells were collected from each flask with a cell scraper. Cells were sonicated and then centrifuged at 14000 rpm for 15 min, and the supernatant was used for Western blotting after total protein assay.
• lysis buffer 1OmM Tris, pH 7.4, 15OmM NaCl, ImM EDTA, ImM EGTA, 0.5% NP-40, 1% Triton X-I OO, 1% protease inhibitor cocktail, 1%
• EXAMPLE 8 Treatment of Fibroblast Cells with Different Protein Kinase C Activators
• Bradykinin or different specific protein kinase C activators are used to treat fibroblasts.
• Banked AC and AD skin fibroblasts are cultured to 80-100% confluence before they are "starved” in serum-free DMEM overnight.
• Cells are treated with 10 nM protein kinase C activator at 37 C for different lengths of time to establish a time course for the protein kinase C activator-induced effects.
• the time point at which reactions are terminated immediately after application of protein kinase C activator is defined as "0 min" post-protein kinase C activator treatment.
• a control flask of cells for each cell line at each treatment time point is added with the identical volume of PBS.
• the reaction is terminated by removing the culture medium, rapidly rinsing the cells with precooled PBS, pH 7.4, and transferring the flask onto dry ice/ethanol.
• a concentration of 0.1 nM protein kinase C activator may be used for cells obtained and cultured from fresh biopsy tissues.
• the treatment time is about 10 min at 37 C.
• Protocol 1 Cell lysates are treated with an equal volume of 2X
• duplicate samples resolved on SDS-PAGE and transferred to a nitrocellulose membrane are respectively blotted with anti-phospho- and anti-regular Erk antibodies.
• the membrane After being washed with 10 mM PBS, pH 7.4, containing 0.01% Tween 20 (three times for 10 min), the membrane is blotted with an anti-regular Erkl/2 antibody, from which the total amount of Erkl/2 loaded on the SDS gel is measured.
• Protocol 2 Equal volumes of 2xSDS sample buffer were added to each cell lysate, and boiled for 10 minutes in boiling water bath. Electrophoresis was conducted on an 8-16% mini-gradient gel and transferred onto a nitrocellulose membrane. Total Erkl, Erk2 and the phosphorylated forms of Erkl and Erk2 (p-Erkl, p-Erk2) were determined using specific antibodies.
• EXAMPLE 10 Data Analysis
• Fibroblast cells are grown on the surface of 2.5-cm-diameter glass coverslips coated with 0.02 mg polylysine. Upon treatment with bradykinin or another protein kinase C activator as described above, cells are rapidly rinsed with cold PBS, pH 7.4, and fixed with 4% formaldehyde in PBS, pH 7.4, at room temperature for 15 min. After being washed with PBS, pH 7.4, three times, each lasting 5 min, cells are penetrated with 0.1% Triton x-100 in PBS, pH 7.4, at room temperature for 30 min.
• the intensity of the immunocytochemistry signals in the cell images is measured with Bio-Rad Quantity One software (BioRad) and Tnimage.
• BioRad Bio-Rad Quantity One software
• Tnimage For localization of the BK or protein kinase C activator receptors in the skin fibroblasts, a monoclonal anti-BK B2 antibody, or anti protein kinase C activator antibody is applied to the normal fibroblasts, followed by incubation with Cy 5 -conjugated anti- mouse IgG. The resulting immunoreactive signals are imaged with a fluorescence microscope.

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