EP2810077A2

EP2810077A2 - Polypeptide markers for diagnosis and assessment of heart failure

Info

Publication number: EP2810077A2
Application number: EP13701490.8A
Authority: EP
Inventors: Harald Mischak
Original assignee: Mosaiques Diagnostics and Therapeutics AG
Current assignee: Mosaiques Diagnostics and Therapeutics AG
Priority date: 2012-01-30
Filing date: 2013-01-30
Publication date: 2014-12-10
Also published as: AU2013214292A1; JP2015507194A; WO2013113744A3; CA2861564A1; WO2013113744A2; US20150065391A1

Abstract

Method for diagnosis of heart failure, comprising the step of determining the presence or absence or amplitude of at least three polypeptide markers in a urine sample, the polypeptide markers being selected from the markers characterized in table 1 by values for the molecular masses and the migration time.

Description

Polypeptide marker for diagnosis and

Assessment of heart failure

Description of the invention

The present invention relates to the use of the presence or absence of one or more peptide markers in a sample of an individual for the diagnosis and evaluation of heart failure, and to a method for the diagnosis and evaluation of heart failure, wherein the presence or absence of the peptide marker (s) is indicative for heart failure.

Heart failure is a progressive disease that begins with risk factors for left ventricular dysfunction (eg, hypertension), progresses with asymptomatic changes in cardiac muscle structure (left ventricular hypertrophy) and cardiac function (eg, decreased relaxation), and then becomes clinically apparent heart failure leading to Disability and death. The five-year mortality rate for symptomatic heart failure is about 60%.

Heart failure can occur clinically with predominantly systolic (contraction) or diastolic (relaxation) dysfunction, but both can also occur together. In a random population, the incidence of asymptomatic but echocardiogram-diagnosed diastolic left ventricular dysfunction (early phase) is up to 27%. This is the proportion that is at risk of developing diastolic heart failure. Despite the associated significant burden on society, the diagnosis of heart failure and, in particular, diastolic left ventricular heart failure remains difficult. Simple-to-use screening technologies are missing.

If a diagnosis is already made in the asymptomatic stage, treatment with, for example, ACE inhibitors, angiotensin receptor could already be carried out at this time. zeptor blockers, or aldosterone antagonists, are made to delay or prevent the progression to clinical symptoms.

This shows that there is a need for a non-invasive option for the early and reliable diagnosis of heart failure.

It is therefore the object of the present invention to provide methods and means for the diagnosis of left ventricular disorders and diastolic heart failure.

The object is achieved by a method for the diagnosis of heart failure comprising the step of determining the presence or absence or amplitude of at least three polypeptide markers in a urine sample, wherein the polypeptide markers are selected from the markers given in Table 1 by values for the Molecular masses, the migration time and optionally their peptide sequence are characterized.

Table 1. Polypeptide markers

The evaluation of the measured polypeptides can be based on the presence or absence and / or amplitude of the markers taking into account the following limits:

Table 2:

ID mass; CE Time Frequency log mean Frequency log mean wilcox-p-value AUC: [Da] [min] Hl: Amp. (Median) Hl Control Amp. (Median)

control

912 826.201 33.4119 0.16 169 (153) 0.35 188 (189) 0.0014626820 0.6017219

1495 838.401; 35.0611 0.16 105 (0.92)! 0.36 2.37 (2.43) 0.0000578108: 0.6294643

HI = heart failure

AUC = Area Under the Curve Specificity is defined as the number of actual negative samples divided by the sum of the number of actual negatives and the number of False positives. A specificity of 100% means that a test identifies all healthy persons as healthy, ie no healthy person is identified as ill. This does not say anything about how well the test detects sick patients.

Sensitivity is defined as the number of actual positive samples divided by the sum of the number of actual positives and the number of false negatives. A sensitivity of 100% means that the test detects all patients. He does not say how well the test detects healthy people.

By the markers of the invention it is possible to detect heart failure with a specificity of at least 60, preferably at least 70, more preferably 80, even more preferably at least 90 and most preferably at least 95%.

By the markers according to the invention it is possible to detect heart failure with a sensitivity of at least 60, preferably at least 70, more preferably 80, even more preferably at least 90 and most preferably at least 95%.

The migration time (CE time) is determined by capillary electrophoresis (CE) - such. B. in point 2 - determined. In this example, a 90 cm long glass capillary with an inner diameter (ID) of 50 μm and an outer diameter (OD) of 360 μm is operated at an applied voltage of 30 kV. The eluent used is, for example, 30% methanol, 0.5% formic acid in water.

It is known that the CE migration time can vary. However, the order in which the polypeptide labels elute is typically the same for any CE system used under the conditions indicated. To even out any differences in migration time, the system can be normalized using standards for which migration times are known. These standards may, for. These may be, for example, the polypeptides indicated in the examples (see Example 3), or certain, known peptides from urine, as described, for example, in Jantos-Siwy et al. (Quantitative Urinary Proteome Analysis for Biomarker Evaluation in Chronic Kidney Disease. J. Proteome. Res. 8, 268-281 (2009)).

The characterization of the polypeptides shown in Table 1 was determined by capillary electrophoresis mass spectrometry (CE-MS), a method which was described e.g. B. in detail of z. Neuhoff et al. (Rapid Communications in mass spectrometry, 2004, Vol. 20, pages 149-156), Mischak, H. et al. (Cap- philary electrophoresis mass spectrometry as a powerful tool in biomarker dis- covery and clinical di- agnosis: An update of recent developments: Mass Spectrom Rev. 28, 703-724 (2009)), Mischak, H. et al , (Comprehensive human urine standards for comparability and standardization in clinical proteome analysis, Proteomics Clin Appl., 4, 464-478 (2010)), Good, D.M. et al. (Natu- rally occurring human urinary peptides for use in the diagnosis of chronic kidney disease, Mol. Cell Proteomics 9, 2424-2437 (2010)). The variation of molecular masses between individual measurements or between different mass spectrometers is relatively small with exact calibration, typically in the range of ± 0.05%, more preferably ± 0.03%, even more preferably ± 0.01% or 0.005%.

The polypeptide markers according to the invention are proteins or peptides or degradation products of proteins or peptides. They can be chemically modified, for. By post-translational modifications such as glycolization, phosphorylation, alkylation or disulfide bridging, or by other reactions, e.g. B. in the context of degradation, be changed. Based on the parameters that determine the polypeptide markers (molecular mass and migration time), it is possible to identify the sequence of the corresponding polypeptides by methods known in the art.

The polypeptides of the invention are used to diagnose heart failure. Diagnosis is the process of gaining knowledge by assigning symptoms or phenomena to a disease or injury. The presence or absence of a polypeptide marker can be measured by any method known in the art. Methods that can be used are exemplified below. A polypeptide marker is present when its reading is at least as high as the threshold. If its reading is below that, the polypeptide marker is absent. The threshold value can either be determined by the sensitivity of the measurement method (detection limit) or defined based on experience.

In the context of the present invention, the threshold is preferably exceeded when the sample reading for a given molecular mass is at least twice that of a blank (e.g., only buffer or solvent). The polypeptide marker (s) is / are used to measure its presence or absence, the presence or absence being indicative of heart failure. Thus, there are polypeptide markers that are typically present in individuals with heart failure, but are less common or non-existent in individuals without heart failure. Furthermore, there are polypeptide markers that are present in patients with heart failure, but are not or only rarely present in patients without heart failure. The frequency with which a marker occurs in the group with heart failure or in the control group is given in Table 2 as frequency.

In addition or alternatively to the frequency (determination of presence or absence), the amplitudes can also be used for diagnosis. The amplitudes are used in a way that does not determine the presence or absence, but decides the magnitude of the signal (amplitude) in the presence of the signal in both groups. A nomination procedure makes sense in order to achieve comparability between differently concentrated samples or different measurement methods. For this purpose, collagen fragments are preferably used, as in Jantos Siwy et al. (Quantitative Urinary Proteome Analysis for Biomarker Evaluation in Chronic Kidney Disease, J. Proteome Res., 8: 268-281 (2009)). The linear correlation between the reference values for the amplitude of the given known peptides (so-called "housekeeping peptides") and the experimentally determined values is determined. The increase of the regression line corresponds exactly to the relative concentration and is used as a normalization factor for calibrating all peptide signals of this sample with a common normalization factor.

The decision to make a diagnosis depends on how high the amplitude of the respective polypeptide markers in the patient sample is compared to the mean amplitudes in the control group or the "sick" group. If the value is close to the mean amplitude of the "sick" group, it is to be assumed that the presence of a vascular disease, it corresponds more to the mean amplitudes of the control group, is not to be assumed by a vascular disease. The distance to the mean amplitude can be interpreted as a probability of belonging to a group. Alternatively, the distance between the measured value and the mean amplitude may be considered as a probability of belonging to a group.

Preferably, both the frequency and the amplitude are used for the evaluation. In each case, it is possible to derive probabilities for the assignment to the groups "heart failure" or "healthy" from measurement data of an unknown sample, from which then an overall probability results.

The Wilcox p-value is a measure of the likelihood that the association of markers with the two groups (heart failure and control) is due to a random distribution not associated with heart failure. The smaller the Wilcox p-value, the more likely is the correlation with heart failure.

The AUC value is a measure of the expressiveness of the markers; at an AUC value of 0.5, the marker would have no significance; with an AUC of 1, the marker would be able to distinguish between the two groups with 100% certainty.

The individual from whom the sample is derived, in which the presence or absence or amplitude of one or more polypeptide markers is determined, may be any individual who may suffer from heart failure. Preferably, the subject is a mammal, most preferably a human. In a preferred embodiment of the invention not only three polypeptide markers but a larger combination of markers are used. By comparing a plurality of polypeptide markers, the falsification of the overall result can be reduced or avoided by individual individual deviations from the typical probability of presence in the individual.

The sample measuring the presence or absence of the polypeptide marker (s) of the invention may be any sample recovered from the subject's body. The sample is a sample having a polypeptide composition suitable for making statements about the condition of the individual. For example, it may be blood, urine, synovial fluid, tissue fluid, body secretions, sweat, cerebrospinal fluid, lymph, intestinal, gastric, pancreatic, bile, tear fluid, tissue sample, sperm, vaginal fluid or stool sample. Preferably, it is a liquid sample. In a preferred embodiment, the sample is a urine sample.

Urine samples may be known as known in the art. Preferably, in the context of the present invention, a mid-jet urine sample is used. The urine sample may e.g. by means of a catheter or also with the aid of a urination apparatus, as described in WO 01/74275.

The presence or absence or amplitude of a polypeptide marker in the sample can be determined by any method known in the art suitable for measuring polypeptide markers. Those skilled in such methods are known. In principle, the presence or absence of a polypeptide marker can be determined by direct methods such as e.g. Mass spectrometry, or indirect methods, such. B. by ligands or specific probes such as antibodies can be determined.

If necessary or desirable, the sample of the subject, eg, the urine sample, may be pretreated by any suitable means prior to measuring the presence or absence of the polypeptide marker (s), for example be cleaned or separated. The treatment may, for. As a purification, separation, dilution or concentration include. The methods may be, for example, centrifugation, filtration, ultrafiltration, dialysis, precipitation or chromatographic methods such as affinity separation or separation by means of ion exchange chromatography, or an electrophoretic separation. Specific examples thereof include gel electrophoresis, two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), capillary electrophoresis, metal affinity chromatography, immobilized metal affinity chromatography (IMAC), lectin affinity chromatography, liquid chromatography, high performance liquid chromatography (HPLC), normal and reverse phase HPLC, cation exchange chromatography, and selective binding Surfaces. All of these methods are well known to those skilled in the art and one skilled in the art will be able to select the method depending on the sample used and the method for determining the presence or absence of the polypeptide marker (s).

Preferably, a mass spectrometric method is used to determine the presence or absence or amplitude of a polypeptide marker, which method may precede purification or separation of the sample. The mass spectrometric analysis has the advantage over current methods that the concentration of many (> 100) polypeptides of a sample can be determined by means of a single analysis. Any type of mass spectrometer can be used. With mass spectrometry it is possible to routinely measure 10 fmoles of a polypeptide marker, ie 0.1 ng of a 10 kDa protein with a measurement accuracy of approximately ± 0.01% from a complex mixture. In mass spectrometers, an ion-forming unit is coupled to a suitable analyzer. For example, electrospray ionization (ESI) interfaces are mostly used to measure ions from liquid samples, whereas the matrix assisted laser desorption / ionization (MALDI) technique is used to measure ions from sample crystallized with a matrix. For analysis of the resulting ions z. As quadrupoles, ion traps or time-of-flight (TOF) analyzers can be used. In electrospray ionization (ESI), the molecules present in solution are sprayed, inter alia, under the influence of high voltage (eg 1-8 kV), forming charged droplets, which become smaller as the solvent evaporates. Finally, so-called Coulomb explosions lead to the formation of free ions, which can then be analyzed and detected.

In the analysis of the ions by TOF, a certain acceleration voltage is applied, which gives the ions an equal kinetic energy. Then, the time required for the respective ions to travel a drift path through the flight tube is measured very accurately. Since with the same kinetic energy, the speed of the ions depends on your mass, this can thus be determined. TOF analyzers have a very high scanning speed and achieve a very high resolution.

Preferred methods for determining the presence or absence of polypeptide markers include gas phase ion spectrometry, such as laser desorption / ionization mass spectrometry, MALDI-TOF-MS, SELDI-TOF-MS (surface enhanced laser desorption ionization), LC-MS (liquid chromatography mass spectrometry), 2D-PAGE-MS and capillary electrophoresis mass spectrometry (CE-MS). All of the methods mentioned are known to the person skilled in the art.

A particularly preferred method is CE-MS, in which capillary electrophoresis is coupled with mass spectrometry. This method is in detail z. In German patent application DE 10021737, in Kaiser et al. (J. Chromatogr. A, 2003, Vol. 1013: 157-171, and Electrophoresis, 2004, 25: 2044-2055), in Wittke et al. (J. Chromatogr. A, 2003, 1013: 173-181) and Ref. The CE-MS technique allows to determine the presence of several hundreds of polypeptide markers of a sample simultaneously in a short time, a small volume and high sensitivity. After a sample has been measured, a pattern of the measured polypeptide markers is prepared (see below). This can be compared with reference patterns of ill or healthy individuals. In most cases, it is sufficient to have a limited number of polypeptide markers for the diagnosis of To use diseases. More preferred is a CE-MS method which includes CE coupled online to an ESI-TOF-MS.

For CE-MS, the use of volatile solvents is preferred, and it is best to work under essentially salt-free conditions. Examples of suitable solvents include acetonitrile, methanol, and the like. The solvents may be diluted with water and acid (e.g., 0.1% to 1% formic acid) added to protonate the analyte, preferably the polypeptides.

Capillary electrophoresis makes it possible to separate molecules according to their charge and size. Neutral particles migrate at the rate of electroosmotic flow upon application of a current, cations are accelerated to the cathode and anions are retarded. The advantage of capillaries in electrophoresis is the favorable ratio of surface area to volume, which enables a good removal of the Joule heat arising during the current flow. This in turn allows the application of high voltages (usually up to 30 kV) and thus a high separation efficiency and short analysis times.

In capillary electrophoresis, fused silica capillaries with internal diameters of typically 50 to 75 μm are normally used. The used lengths are 30-100 cm. In addition, the capillaries usually consist of plastic-coated quartz glass. The capillaries may be both untreated, i. on the inside show their hydrophilic groups, as well as be coated on the inside. A hydrophobic coating can be used to improve the resolution. In addition to the voltage, a pressure which is typically in the range of 0-1 psi may also be applied. The pressure can also be created during the separation or changed during the process.

In a preferred method of measuring polypeptide markers, the markers of the sample are separated by capillary electrophoresis, then directly ionized and transferred online to a mass spectrometer coupled thereto for detection. In the method according to the invention, several polypeptide markers can advantageously be used for diagnostics. Preferred is the use of at least 5, 6, 8, or 10 markers. In one embodiment, 20 to 50 markers are used.

To determine the likelihood of disease using multiple markers, methods known to those skilled in the art may be used. For example, the Weissinger et al. {Kidney Int., 2004, 65: 2426-2434) using a computer program such as a computer program. B. S-Plus or the support vector machines described in the same publication. Further information can be found, for example, Dakna et al. BMC Bioinformatics 11 (2010) 594.

These methods combine multiple biomarkers into a single variable associated with both the likelihood of disease and the severity of the disease. This variable can thus also be used to determine the severity or severity of the disease (eg shown in Schiffer et al., Prediction of muscle-invasive bladder cancer using urinary proteomics.) Clin. Cancer Res. 15, 4935- 4943 (2009) for bladder carcinoma) as well as to reflect a possible response to therapy (as demonstrated, for example, in Haubitz et al., Identification and Validation of Urinary Biomarkers for Differential Diagnosis and Evaluation of Therapeutic Intervention in ANCA Associated Vasculitis Cell Proteomics 8, 2296-2307 (2009) for ANCA-associated vasculitius, or in Andersen et al., Urinary proteome analysis, assessing renoprotective treatment in type 2 diabetic patients with microalbuminuria BMC Nephrol., 11, 29 (2010) for diabetic nephropathy).

Example 1:

1. Sample preparation:

Urine was used to detect polypeptide markers for diagnosis. Urine was withdrawn from healthy donors (peer group) as well as patients suffering from vascular disease. For the subsequent CE-MS measurement, proteins such as albumin and immunoglobulins, which are also present in urine in higher concentrations, had to be separated by ultrafiltration. For this purpose, 700 μΙ urine was taken and at 700 pm Filtrationspuffer (2M urea, lM ammonia, 0.02% SDS). These 1.4 ml sample volumes were ultrafiltered (20 kDa, Sartorius, Göttingen, DE). The UF was carried out at 3000 rpm in a centrifuge until 1.1 ml ultrafiltrate was obtained.

The resulting 1.1 ml filtrate was then applied to a PD 10 column (Amersham Bioscience, Uppsala, Sweden) and eluted with 2.5 ml of 0.01% NH ₄ OH and lyophillized. For CE-MS measurement, the polypeptides were then resuspended with 20 μΙ water (HPLC grade, Merck).

2. CE-MS measurement:

The CE-MS measurements were performed with a capillary electrophoresis system from Beckman Coulter (P / ACE MDQ System, Beckman Coulter Inc, Fullerton, USA) and a Bruker ESI-TOF mass spectrometer (micro-TOF MS, Bruker Daltonik, Bremen, D). The CE capillaries were purchased from New Objective, having an ID / OD of 50/360 pm and a length of 90 cm. The mobile phase for the CE separation consisted of 20% acetonitrile and 0.25% formic acid in water. 30% isopropanol with 0.5% formic acid was used for the "sheath flow" at the MS, here with a flow rate of 20 μΙ / h. The coupling of CE and MS was realized by a CE-ESI-MS sprayer kit (Agilent Technologies, Waldbronn, DE). To inject the sample, 1 to max. 6 psi pressure applied, the duration of the injection was 99 seconds. With these parameters about 300 nl of the sample were injected into the capillary, this corresponds to about 10% of the capillary volume. To concentrate the sample in the capillary, a "stacking" technique was used. An IM NH ₃ solution is injected for 7 seconds (at 1 psi) prior to sample injection. After applying the separation voltage (25 kV), the analytes between these solutions are automatically concentrated. The following CE separation was performed by a pressure method: 0 psi for 30 minutes, 0.1 psi for 1 min, 0.2 psi for 1 min, 0.3 psi for 1 min, 0.4 psi for 1 min, and 0.5 psi for 35 min. The total duration of a separation run was thus 70 minutes.

In order to get the best possible signal intensity on the side of the MS, no "Nebulizer gas" was used. The applied to the spray needle Voltage for generating the electrospray was 4000 - 4800 V. The remaining settings on the mass spectrometer were optimized according to the manufacturer's instructions for peptide detection. The spectra were recorded over a mass range of m / z 400 to m / z 3000 and accumulated every 3 seconds. 3. Standards for CE measurement

To control and calibrate the CE measurement, the following proteins or polypeptides were used, which are characterized under the selected conditions by the CE migration times listed below:

Protein / polypeptide migration time mass (da)

Aprotinin, (SIGMA, Taufkirchen, DE, Cat No A1153) 19.3 min 6513.09

Ribonuclease, Sigma, Taufkirchen, DE; Kat.Nr. ; R4875 19.55min 13681.32

Lysozyme, Sigma, Taufkirchen, DE; Kat.Nr. ; L7651 19.28 min 14303.88

"REV", sequence: REVQSKIGYGRQIIS 20.95 min 1732.96

"ELM", sequence: ELMTGELPYSHINNRDQIIFMVGR 23.49 min 2333.19

"KINCON", sequence: TGSLPYSHIGSRDQIIFMVGR 22.62 min 2832.41

"GIVLY" Sequence: GIVLYELMTGELPYSHIN 32.2 min 2048.03 The proteins / polypeptides are used in each case in a concentration of 10 pmol / μΙ in water. "REV", "ELM", "KINCON" and "GIVLY" represent synthetic peptides.

It is known in principle to those skilled in the art that small variations in the migration times can occur in the case of capillary electrophoretic separations. Under the conditions described, however, the migration order does not change. It is readily possible for a person skilled in the art with knowledge of the indicated masses and CE times to assign their own measurements to the polypeptide markers according to the invention. For this he can, for example, proceed as follows: first, he selects one of the polypeptides found in his measurement (peptide 1) and attempts to find one or more matching masses within a time window of the indicated CE time (for example ± 5 min). If he only finds a matching mass within this interval, the assignment is completed. If he finds several suitable masses, one must still make a decision about the assignment. For this purpose, another peptide (peptide 2) is selected from the measurement and attempts to To identify a suitable polypeptide marker, again taking into account a corresponding time window. If, in turn, several markers can be found with a corresponding mass, the most probable assignment is that in which there is a substantially linear relationship between the shift for the peptide 1 and for the peptide 2. Depending on the complexity of the assignment problem, it is obvious to a person skilled in the art to optionally use further proteins from his sample for the assignment, for example ten proteins. Typically, migration times are either lengthened or shortened by certain absolute values, or there are upsets or knocks throughout the course. Co-migrating peptides also co-migrate under such conditions.

In addition, the person skilled in the art can use the methods described by Zuerbig et al. in Electrophoresis 27 (2006), pages 2111-2125. If he uses a simple diagram to plot his measurements in terms of m / z versus migration time, the line patterns described will also be visible. By counting the lines, a simple assignment of the individual polypeptides is now possible. Other procedures for assignment are possible. In principle, one skilled in the art could also use the above peptides as an internal standard to assign its CE measurements.

4. Sequencing of polypeptides

The sequencing of the polypeptides determined by this method is known in principle to the person skilled in the art. The following method can be used.

The urine samples were analyzed according to Carty DM et al. (Urinary proteomics for predication of preeclampsia, Hypertension, 2011, 57: 561-9) with a Dionex Ultimate 3000 RSLS nanoflous system (Dionex, Camberley, UK) (LC / MS). The samples (5 μΙ) were applied to a Dionex C18 nano-trap column (0.1 × 20 mm, 5 μm) at a flow rate of 5 μΙ / min in 0.1% formic acid and 2% acetonitrile. The sample was flown at a flow rate of 0.3 μΙ / min onto an Acclaim-PepMap C18 nanocolumn (75pm x 15 cm, 2μη "100, 100 Å) The trap and the nanofluid column were maintained at 35 ° C. The samples were treated for 100 minutes with a gradient of solvent A, 0.1% formic acid, against solvent B, acetonitrile, The column was washed with 90% B before being equilibrated prior to the next sample The eluent from the column was eluted using a Proxeon nanospray ESI source (Thermo Fisher, Hemel Hempstead, UK) operating in positive-ion mode ionized into an Orbitrap-Velos FTMS The ionization voltage was 2.5 kV and the capillary temperature was 200 ° C. The mass spectrometer was measured in the MS / MS mode with a scan range of m / z 380 to 2000 amu The 10 largest multiply charged ions were selected from each scan for MS / MS analysis, and the fragmentation method was HCD with 35% collision energy Ions were determined using a data-dependent method with a repetition number of 1 and exclusion time of 15 s for MS2 selected. The ion dissolution was 60000 in MSI and 7500 for HCD-MS2. The files were used for a search against the human non-redundant IPI database using the Open Mass Spectrometry Search Algorithm (OMSSA, http://pubchem.ncbi.nlm.nih.gov/omssa) and SEQUEST (using the Thermo Proteome Discoverer) without any enzyme specificity. No fixed modification and oxidation of methionine and proline were chosen as variable modifications. The permissible mass error window for MS or MS / MS was 10 ppm or 0.05 Da. In the case of SEQUEST, the peptide data were extracted using high peptide-confidence and top-one peptide rank filters. 1% FDR was used as the threshold for identifying identified peptides. The correlation between peptide loading at the working pH of 2 and CE migration time was exploited to minimize the occurrence of false positives (Zürbig, P. et al., Bio-marker discovery by CE-MS enables sequence analysis via MS / MS with plat - Form-independent Separation Electrophoresis 27, 2111-2125 (2006)). The calculated on the basis of the number of basic amino acids CE migration time was compared with the experimental migration time. Only those peptides were accepted with both search algorithms (OMSSA and SEQUEST) were found to have a mass deviation of less than ± 10 ppm, fragment ions with a mass deviation of less than ± 0.05 Da and a deviation of the CE migration time of less than ± 2 min.

Example 2

From the FLEMENGHO study, 16 patients with symptomatic heart failure and 16 healthy controls were selected and all urine samples measured. Based on the markers, the classification accuracy was 0.84 (95% interval 0.70 to 0.98, p = 0.001, see Figure 1).

Example 3

FIG. 2 shows measured values of the biomarkers according to the invention for two unknown samples. An amplitude of 0 means that the marker was not found. From the frequency and amplitude data, a scoring was derived for belonging to the groups heart failure and healthy. A reading from the frequency / amplitude to the heart failure group received a positive score; a reading that was from the frequency / amplitude to the healthy group got a negative score. The closer the value to the values in Table 2, the greater the score. Subsequently, the individual scores were combined, whereby the Wilcox p-values and AUC values were also included in the assessment. There was a score for sample 1: 1,701, for sample 2 a score: score: -0,853.

Patients were then examined: subject 1 had clinical noncardiac cardiac insufficiency, while no evidence was found in subject 2. Example 4

FIG. 3 shows measured values for the same subjects in which only three markers were evaluated.

Panel 1: Markers ID 5675 and 14906 were not found in the sample. Because these markers are less common in the heart failure group, absence is a positive score for heart failure. Marker 17968 occurs more frequently in the 'healthy'group; therefore, a negative score results from the presence of the marker. However, the amplitude is very close the mean amplitude of the heart failure group, this is a strong positive score; the result is a total score of 1,063.

In subject 2, the presence of marker 5675 results in a negative score. The amplitude of 2.34 is between the heart failure and the control group, but slightly closer to the heart failure group, resulting in a small positive score.

For the marker 14906 the presence results in a negative score, moreover, the amplitude is close to the mean amplitude of the control group, so that overall there is a negative score.

The presence of marker 17968 results in a negative score due to the frequencies; In addition, the amplitude of 2.67 results in a further assignment to the control group and thus a further negative score.

Overall, the three measurements for subject 2 gave a score of -1.185.

The assignment of subjects 1 and 2 could be confirmed in a clinical examination.

Claims

claims

A method of diagnosing heart failure, comprising the step of determining the presence or absence or amplitude of at least three polypeptide markers in a urine sample, wherein the polypeptide markers are selected from the markers characterized in Table 1 by molecular weight and migration time values.

A method according to claim 1, characterized in that an evaluation of the determined presence or absence or amplitude of the marker is based on the reference values listed in Table 2.

A method according to any one of claims 1 to 2, wherein at least five, at least six, at least eight, at least ten, at least 20 or at least 50 polypeptide markers are used, as defined in claim 1.

The method of any one of claims 1 to 3, wherein the sample of an individual is a midbeam urine sample.

Method according to one of claims 1 to 4, wherein capillary electrophoresis, HPLC, gas phase ion spectrometry and / or mass spectrometry is used to determine the presence or absence or amplitude of the polypeptide marker.

A method according to any one of claims 1 to 5 wherein capillary electrophoresis is performed prior to measurement of the molecular mass of the polypeptide markers.

The method of any one of claims 1 to 6, wherein mass spectrometry is used to detect the presence or absence of the polypeptide marker (s).

Use of at least three polypeptide markers selected from the markers according to Table 1, which is characterized by the values for the molecular masses and the migration time, for the diagnosis of cardiac insufficiency.

Method for the diagnosis of cardiac insufficiency comprising the steps of a) the separation of a sample into at least five, preferably 10 subsamples, b) analysis of at least five sub-samples to determine the presence or absence or amplitude of at least one polypeptide marker in the sub-sample, the polypeptide marker being selected from the markers of Table 1 characterized by the molecular masses and migration time (CE time) ,

10. The method of claim 9, wherein at least 10 subsamples are measured.

11. The method according to at least one of claims 1 to 10, characterized in that the CE time is based on a 90 cm long glass capillary having an inner diameter (ID) of 50 pm at an applied voltage of 25 kV, being used as eluent 20th % Acetonitrile, 0.25% formic acid in water is used.

12. The method according to at least one of claims 1 to 7 or 9 to 11, wherein the sensitivity is at least 60% and the specificity at least 40%.

13. The method according to any one of claims 1 to 12, wherein the heart failure is a left ventricular disorder.

14. The method according to at least one of claims 1 to 13, wherein the heart failure is a left ventricular diastolic heart failure.

15. The method according to at least one of claims 1 to 14, wherein the heart failure is asymptomatic.

16. A method for evaluating the development of heart failure comprising performing the method according to any one of claims 1 to 15 at two different times.

17. The method of claim 16 for evaluating a therapeutic intervention.

18. A method of predicting the development of heart failure, comprising the step of determining the presence or absence or amplitude of at least three polypeptide markers in a urine sample, wherein the polypeptide markers are selected from the markers found in U.S. Pat

Table 1 are characterized by values for the molecular masses and the migration time.

19. The method according to claim 18, characterized in that the Herzin ^¬ insufficiency is already clinically relevant.