ITTO20080870A1 - Biomarcatori per la diagnosi e per rilevare la progressione di malattie neurodegenerative, in particolare della sclerosi laterale amiotrofica - Google Patents
Biomarcatori per la diagnosi e per rilevare la progressione di malattie neurodegenerative, in particolare della sclerosi laterale amiotroficaInfo
- Publication number
- ITTO20080870A1 ITTO20080870A1 IT000870A ITTO20080870A ITTO20080870A1 IT TO20080870 A1 ITTO20080870 A1 IT TO20080870A1 IT 000870 A IT000870 A IT 000870A IT TO20080870 A ITTO20080870 A IT TO20080870A IT TO20080870 A1 ITTO20080870 A1 IT TO20080870A1
- Authority
- IT
- Italy
- Prior art keywords
- leu
- glu
- lys
- ala
- asp
- Prior art date
Links
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Classifications
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- 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
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- C07K14/46—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
- C07K14/47—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
- C07K14/4701—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals not used
- C07K14/472—Complement proteins, e.g. anaphylatoxin, C3a, C5a
Description
“BIOMARCATORI PER LA DIAGNOSI E PER RILEVARE LA PROGRESSIONE DI MALATTIE NEURODEGENERATIVE, IN PARTICOLARE DELLA SCLEROSI LATERALE AMIOTROFICAâ€
La presente invenzione à ̈ relativa a biomarcatori per la diagnosi e per rilevare la progressione di malattie neurodegenerative, in particolare della Sclerosi Laterale Amiotrofica.
Stato dell’Arte
La Sclerosi Laterale Amiotrofica (SLA), conosciuta anche come malattia di Lou Gehrig, rappresenta la forma più grave di malattia del motoneurone: si tratta di una patologia devastante del sistema nervoso centrale (SNC) ad eziopatogenesi multifattoriale e decorso fatale. La SLA colpisce 5 individui su 100.000 ogni anno [Julien, 2001], ed à ̈ pertanto la terza causa di morte in età adulta per malattie neurodegenerative, dopo la malattia di Alzheimer (MA) e la malattia di Parkinson [fonte: Motor Neuron Disease Association].
Esistono forme di SLA sia familiari sia sporadiche. Le prime costituiscono solo il 5-10% di tutti i casi e sono state correlate con la presenza di diverse mutazioni genetiche: circa nel 20% dei casi familiari si sono osservate mutazioni del gene della superossidodismutasi 1 (SOD1), una proteina antiossidante ad espressione ubiquitaria. La forma sporadica e la forma familiare della malattia sono clinicamente indistinguibili, il che suggerisce una patogenesi simile innescata da eventi molecolari eterogenei [Bruijn et al., 2004].
Dal punto di vista anatomopatologico la SLA à ̈ caratterizzata dalla perdita rapida e selettiva dei motoneuroni cerebrali, troncoencefalici e/o midollari, con ripercussioni negative sulla forza, sul trofismo e sul tono muscolare. La malattia al suo esordio si presenta con una sintomatologia alquanto eterogenea che può includere debolezza degli arti e del tronco, spasticità , difficoltà ventilatorie, di parola e di masticazione e deglutizione. A questi sintomi seguono una progressiva atrofia e la paralisi più o meno completa dei muscoli scheletrici, che portano alla morte per insufficienza respiratoria generalmente tra i 3 ed i 5 anni dalla manifestazione dei primi sintomi [Belsh, 1996; Rowland, 1998].
Attualmente non sono disponibili terapie efficaci per la SLA. L’unico farmaco approvato, il riluzolo (un composto ad attività anti-glutammatergica), prolunga solo di poco l’aspettativa di vita ed allevia parzialmente alcuni sintomi, ma non à ̈ efficace nell’arrestare la progressione della neurodegenerazione, né nell’indurre la regressione dei sintomi ed il recupero parziale delle funzioni motorie [Lacomblez et al., 1996; Miller et al., 2002].
La ricerca biomedica sulla SLA ha tra le proprie priorità la scoperta di biomarcatori della malattia, in quanto attualmente mancano nella pratica clinica gli strumenti per una diagnosi molecolare di SLA. Infatti, nonostante il numero di studi, pubblicazioni e domande di brevetto sull’argomento, al momento non sono disponibili biomarcatori specifici di SLA utilizzabili clinicamente [Shaw e Williams, 2000; Bowser et al., 2006]. In particolare, nessun biomarcatore si à ̈ rivelato capace di distinguere tra pazienti di SLA e soggetti con processi infiammatori non neurologici, né sono disponibili marcatori di progressione della malattia. In mancanza di parametri biochimici che consentano di diagnosticare precocemente la SLA, la diagnostica si basa unicamente sull’osservazione clinica di sintomi (spesso già gravi ed invalidanti), che si manifestano presumibilmente molto dopo gli eventi molecolari patogenetici. Questa può essere una delle ragioni per cui i trattamenti disponibili mostrano una limitata efficacia. Va anche notato che, in mancanza di terapie efficaci, una diagnosi tempestiva permetterebbe di iniziare i trattamenti in anticipo e quindi di prolungare l’aspettativa di vita del malato [Lacomblez et al., 1996; Miller et al., 2002].
La mancanza di biomarcatori inoltre non permette un’efficiente classificazione su base molecolare dei diversi fenotipi di SLA, una malattia multifattoriale complessa che probabilmente include diversi sottotipi all’interno della sua definizione clinica [Shaw e Williams, 2000; Bowser et al., 2006].
La mancanza di biomarcatori specifici d’altro canto riflette la scarsa conoscenza dei meccanismi molecolari coinvolti nell’insorgenza e nello sviluppo della SLA, con la conseguenza che, nel testare nuovi composti per l’attività terapeutica, non à ̈ possibile ricavare un’indicazione quantitativa della loro efficacia. La scoperta di nuovi biomarcatori può in questo senso contribuire alla comprensione dei meccanismi della malattia, e quindi all’emergere di possibili nuovi bersagli terapeutici.
Alla luce di quanto appena evidenziato, risulterà chiara la necessità impellente di trovare biomarcatori specifici per la SLA. Scopo della presente invenzione à ̈ pertanto quello di fornire polipeptidi utilizzabili come biomarcatori, in particolare per la diagnosi e il rilevamento della progressione della SLA.
Secondo la presente invenzione tale scopo viene raggiunto mediante polipeptidi secondo le rivendicazioni 1 e 2. La presente invenzione difatti include l’uso dei polipeptidi delle rivendicazioni 1 e 2 per la diagnosi di patologie neurodegenerative, in particolare per la diagnosi della SLA.
Secondo la presente invenzione viene inoltre fornito l’uso dei polipeptidi delle rivendicazioni 1 e 2 per il rilevamento della progressione della SLA.
Definizioni
A meno che non sia specificato esplicitamente il contrario, i seguenti termini presentano il significato qui sotto indicato.
Nel presente testo per “percentuale di identità †e “% di identità †tra due sequenze di amminoacidi (peptidi) o di acidi nucleici (nucleotidi) si intende la percentuale di residui amminoacidici o nucleotidici identici in posizioni corrispondenti nelle due sequenze allineate in modo ottimale.
Per determinare la “percentuale di identità †delle due sequenze di amminoacidi o di acidi nucleici, le sequenze vengono tra loro allineate; per raggiungere un confronto ottimale, nelle sequenze possono venire introdotte interruzioni (vale a dire cancellazioni o inserimenti – i quali possono eventualmente essere anche disposti all’estremità delle sequenze) (gap). I residui amminoacidici e nucleotidici in posizioni corrispondenti vengono quindi confrontati. Quando una posizione nella prima sequenza à ̈ occupata dal medesimo residuo amminoacidico o nucleotide che occupa la corrispondente posizione nella seconda sequenza, le molecole sono identiche in quella posizione. La percentuale di identità tra due sequenze à ̈ funzione del numero di posizioni identiche condivise dalle sequenze [vale a dire % di identità = (numero delle posizioni identiche / numero totale delle posizioni) X 100].
Secondo una vantaggiosa forma di attuazione, le sequenze hanno la stessa lunghezza.
Vantaggiosamente, le sequenze confrontate non presentano interruzioni (o inserimenti).
La percentuale di identità può venire ottenuta utilizzando algoritmi matematici. Un esempio non limitativo di un algoritmo matematico utilizzato per il confronto di due sequenze à ̈ l’algoritmo di Karlin ed Altschul [Proc. Natl. Acad. Sci. USA 87 (1990) 2264-2268] modificato da Karli ed Altschul [Proc. Natl. Acad. Sci. USA 90 (1993) 5873-5877]. Tale algoritmo à ̈ incorporato nei programmi BLASTn e BLASTp di Altschul [Altschul, et al, J. Mol. Biol. 215 (1990) 403-410].
Allo scopo di ottenere allineamenti anche in presenza di una o più interruzioni (o inserimenti) à ̈ possibile utilizzare metodi che assegnano una penalità relativamente elevata a ciascuna interruzione (o inserimento) ed una penalità inferiore per ciascun residuo amminoacidico o nucleotidico aggiuntivo nell’interruzione (tale residuo amminoacidico o nucleotide aggiuntivo viene definito come estensione dell’interruzione). Alte penalità determineranno, ovviamente, allineamenti ottimizzati con un minore numero di interruzioni.
Un esempio di un programma atto a realizzare questo tipo di allineamento à ̈ il programma BLAST come descritto in Altschul, et al., Nucleic Acids Res. 25 (1997) 3389-3402. A questo scopo i programmi BLASTn e BLASTp possono essere utilizzati con i parametri di default. Utilizzando i programmi BLAST viene tipicamente impiegata la matrice BLOSUM62.
Un esempio vantaggioso e non limitativo di un programma per realizzare un allineamento ottimale à ̈ GCG Winsconsin Bestfit package (Università del Winsconsin, USA; Devereux et al., 1984, Nucleic Acids Research 12:387). Anche in questo caso vengono utilizzati i parametri di default che per una sequenza di amminoacidi prevedono una penalità di -12 per una interruzione ed una penalità di -4 per ciascuna estensione.
Nel presente testo per “percentuale di omologia†e “% di omologia†tra due sequenze di amminoacidi o di acidi nucleici si intende la percentuale di residui amminoacidici o nucleotidi omologhi in posizioni corrispondenti nelle due sequenze allineate in modo ottimale.
La percentuale di omologia fra due sequenze viene determinata in modo sostanzialmente identico a quanto sopra descritto per la determinazione della percentuale di identità eccetto per il fatto che nel calcolo vengono considerate anche le posizioni omologhe e non solo le posizioni identiche.
Per quanto riguarda una sequenza di nucleotidi, due posizioni omologhe presentano due nucleotidi differenti ma che all’interno del proprio codone portano alla codificazione del medesimo amminoacido.
Per quanto riguarda una sequenza di amminoacidi, due posizioni omologhe presentano due amminoacidi omologhi, vale a dire amminoacidi dotati di proprietà chimicofisiche simili, per esempio, amminoacidi appartenenti a medesimi gruppi come: aromatici (Phe, Trp, Tyr), acidi (Glu, Asp), polari (Gln, Asn), basici (Lys, Arg, His), alifatici (Ala, Leu, Ile, Val), con un gruppo idrossi (Ser, Thr), con catena laterale corta (Gly, Ala, Ser, Thr, Met). Ci si aspetta che sostituzioni tra tali amminoacidi omologhi non cambino il fenotipo delle proteine (sostituzioni conservative di amminoacidi). Specifici esempi di sostituzioni conservative sono note in questo campo tecnico e sono descritte in varia letteratura (ad es., Bowie et al., Science, 247:1306-1310 (1990)).
Ulteriori esempi di programmi e/o articoli relativi alla determinazione di allineamenti e delle percentuali di omologia e/o identità sono indicati in, ad esempio, US2008003202, US2007093443, WO06048777.
Nel presente testo per “posizione corrispondente†si intende una posizione in una sequenza di un polipeptide o di acidi nucleici che corrisponde (si affaccia), a seguito di un allineamento, ad una determinata posizione di una sequenza di riferimento.
Breve descrizione delle figure
Per una migliore comprensione della presente invenzione, essa viene ora descritta anche con riferimento alle figure allegate, che illustrano quanto segue:
- la Figura 1A Ã ̈ una tabella in cui sono indicati gli spot corrispondenti ai biomarcatori per la diagnosi della SLA identificati mediante elettroforesi bidimensionale (2DE), e i rispettivi identificativo di sequenza (SEQ ID NO), Accession number, numero (N.) di peptidi della identificazione Mascot, Sequenza di copertura, punto isoelettrico (pI) apparente, peso molecolare (PM) apparente, punteggio Mowse della identificazione Mascot (punteggio MS);
- la Figura 1B à ̈ una tabella in cui à ̈ indicato lo spot corrispondente al biomarcatore per il rilevamento della progressione della SLA identificato mediante 2DE, e i rispettivi SEQ ID NO, Accession number, N. di peptidi, sequenza di copertura, pI apparente, PM apparente, punteggio MS;
- la Figura 2 rappresenta un gel bidimensionale in cui sono evidenziati gli spot elencati nella tabella della Figura 1A;
- la Figura 3 à ̈ una tabella in cui sono indicati, per ciascuno degli spot identificati per 2DE, i valori medi dei volumi percentuali (Vol%) di ciascun gruppo di campioni di plasma individuali analizzati (ovvero: gruppo dei pazienti SLA, gruppo dei soggetti infartuati (INF) e gruppo dei controlli sani (CTR)), ottenuti come di seguito descritto, le deviazioni standard relative ai Vol% medi all’interno del gruppo, ed i valori di p statistico esprimente la significatività di ciascuno spot nel discriminare, sulla base dei Vol%, il gruppo SLA rispetto a ciascuno dei due gruppi di confronto ;
- la Figura 4 Ã ̈ una rappresentazione grafica della magnificazione tridimensionale dello spot 8 rilevato con colorazione di tipo Coomassie, come di seguito descritto;
- la Figura 5 Ã ̈ un grafico che riporta i livelli del biomarcatore corrispondente allo spot 8 negli individui analizzati in forma di Vol%;
- la Figura 6 Ã ̈ un istogramma dei valori della funzione diagnostica DF, calcolata come di seguito descritto, per ognuno dei soggetti inclusi nello studio;
- la Figura 7 à ̈ un grafico che mostra l’andamento decrescente del Vol% dello spot 101 in funzione del tempo trascorso dall’esordio clinico (qui indicato come “onset†) in diversi pazienti di SLA;
- la Figura 8 mostra le sequenze amminoacidiche minime dei frammenti proteici di albumina corrispondenti agli spot 65 (SEQ ID NO: 3), 110 (SEQ ID NO: 2), 8 (SEQ ID NO: 1), 66 (SEQ ID NO: 1), 34 (SEQ ID NO: 4), allineate rispetto alla sequenza amminoacidica dell’albumina intera (Accession number: 28592); e
- la Figura 9 contiene l’immagine di un gel bidimensionale in cui à ̈ evidenziato lo spot 101 elencato nella tabella della Figura 1B.
Descrizione dettagliata dell’invenzione L’identificazione di nuovi biomarcatori à ̈ avvenuta prendendo in esame le proteine del plasma. Il passaggio di molecole dal SNC al plasma permette l’individuazione direttamente nel plasma di biomarcatori provenienti dai siti affetti, che si aggiungono all’eventuale alterazione di marcatori specifici del plasma. Inoltre il campionamento di fluidi periferici consente la collezione di un maggior numero di campioni durante la fase di scoperta dei biomarcatori, permettendo di raggiungere una maggiore robustezza statistica dei risultati ottenuti.
È stato effettuato uno studio mediante 2DE del proteoma plasmatico di pazienti affetti da SLA, confrontandoli con individui sani e con pazienti non neurologici che hanno avuto un recente infarto miocardico o coronarico (d’ora in avanti semplicemente indicati come infartuati).
L’ipotesi di lavoro della ricerca proteomica applicata à ̈ che la maggioranza delle malattie ingeneri modifiche della quantità di proteine e peptidi nei fluidi corporei e nei tessuti. Strategie di tipo proteomico possono rivelare per molte proteine sbilanciamenti tra le diverse isoforme o modifiche quali quelle derivanti da stress ossidativo, legate direttamente od indirettamente al meccanismo eziologico [Perluigi et al., 2005]: per questo motivo tanta parte dell’odierna ricerca biochimica applicata si indirizza allo studio del proteoma di fluidi biologici allo scopo di individuare biomarcatori di diverse condizioni patologiche. Per quel che riguarda miscele biologiche complesse come il sangue, analisi proteomiche diverse hanno già identificato proteine specificamente associate a malattie non genetiche e non correlate a patologie tumorali [Aivado et al., 2007; Kim et al., 2007; Li et al., 2007; Avasarala et al., 2005].
Vale la pena di sottolineare come non sempre i biomarcatori identificati consistano in proteine rare o loro frammenti, o in proteine o parti di proteine la cui espressione à ̈ peculiare e rara. Molte pubblicazioni riportano, al contrario, biomarcatori di malattia che consistono in forme modificate di proteine comuni ed ubiquitarie come l’albumina e le proteine correlate con l’albumina [Yagame et al., 1995; Kaiser et al., 2004; Funding et al., 2005; German et al., 2007]. Un vantaggio importante della proteomica basata su 2DE consiste infatti nella possibilità di identificare alterazioni nelle quantità di frammenti e forme modificate di proteine per le quali il livello della molecola intatta non cambia significativamente [Finehout et al., 2007]. Frammenti proteici peculiari, tipici della SLA e di altre malattie con forte componente apoptotica, possono derivare dall’attivazione selettiva di proteasi e vie degradative specifiche, solitamente attive a livelli bassi [Ilzecka et al., 2001]. In particolare, per quanto riguarda le malattie neurodegenerative, à ̈ stato dimostrato che frammenti C-terminali di albumina presenti nel fluido cerebrospinale (FCS) di pazienti con MA sono biomarcatori specifici di malattia, probabilmente perché la malattia comporta alterazioni nel processo di degradazione dell’albumina [Finehout et al., 2007]. E’ stato inoltre dimostrato che frammenti di albumina hanno attività tossica su colture organotipiche di neuroni colinergici e su colture primarie di astrociti [Moser e Humpel, 2007]. Pertanto, peptidi derivati dalla degradazione dell’albumina o di altre abbondanti proteine seriche potrebbero rappresentare non soltanto un epifenomeno della malattia in esame, ma anche degli attori primari della patogenesi.
Per lo studio proteomico che ha portato all’identificazione dei biomarcatori, si à ̈ considerato il proteoma plasmatico di tre gruppi di individui:
- Soggetti sani (controlli, n = 14)
- Pazienti infartuati, entro 6 ore dall’infarto miocardico o coronarico (n = 8)
- Pazienti affetti da SLA (n = 27)
Per 5 pazienti con SLA, sono stati considerati due prelievi ematici a tempi diversi. I pazienti infartuati sono stati inclusi nello studio come “filtro†per eliminare quei biomarcatori che discriminano pazienti con SLA da controlli solo a causa del processo infiammatorio in atto nei pazienti. Previo consenso informato da parte di tutti gli individui considerati, si à ̈ proceduto al prelievo di sangue venoso da cui à ̈ stato ricavato a fresco il plasma mediante metodo standard.
I campioni di plasma sono poi stati centrifugati a 400 g per 10’ a 4°C. L’albumina non à ̈ stata rimossa dai campioni, non solo perché l’albumina à ̈ una proteina di trasporto che può legare marcatori di interesse, ma anche perché (come discusso precedentemente) forme modificate di albumina differenzialmente presenti nella malattia di interesse possono avere un ruolo ai fini diagnostici. La rimozione dell’albumina può portare pertanto alla perdita di utili biomarcatori [Kawakami et al., 2005; German et al., 2007].
Una volta preparati i campioni, per ognuno di essi à ̈ stato effettuato un esperimento di 2DE ed almeno un replicato tecnico, secondo la procedura di Jacobs et al.
[2001] con alcune modifiche. In breve, per ciascun campione un’aliquota di 6 µl (circa 400 µg di proteina totale) à ̈ stata riscaldata per 5’ a 95°C in presenza di 10 µl di dodecilsolfato di sodio (SDS) al 5% (p/v) e ditiotreitolo (DTT) al 2,5% (p/v), e quindi diluita a 330 µl con un tampone contenente urea (7 M), tiourea (2 M), acido 3[(3-Colamidopropil)dimetilammonio]-propansulfonico (CHAPS) al 4% (p/v), tampone IPG 3-10NL al 0,5% (v/v)(GE Healthcare, Uppsala, Sweden), e tracce di blu di bromofenolo [Hughes et al., 1992]. Il campione à ̈ stato quindi caricato su strisce per isoelettrofocalizzazione (IEF) da 18 cm IPG 3-10 non lineari (GE Healthcare) con reidratazione in gel (2 h a 0 V e 12 h a 30 V). E’ stata quindi effettuata una IEF a 20°C con apparato IPGphor (GE Healthcare), secondo il seguente protocollo: 500 V a 500 V/h, 1.000 V a 1.000 V/h con gradiente lineare; 8.000 V a 13.500 V/h con gradiente lineare; 8.000 V a 72.000 V/h. Prima dell’ elettroforesi denaturante in gel di poliacrilammide-SDS (SDS-PAGE), le strisce IPG sono state equilibrate due volte per 15’ in tampone Tris-HCl (50 mM) a pH 8,8, urea (6 M), glicerolo al 30% (v/v), SDS al 2% (p/v) e tracce di blu di bromofenolo, contenenti DTT al 1% (p/v) per il primo passaggio e iodoacetammide al 2,5% (p/v) per il secondo passaggio. E’ seguita quindi SDS-PAGE in un gel al 12,5% (1,5 mm di spessore), secondo il protocollo di Laemmli [1970], ma senza stacking gel, utilizzando un apparato Hoefer SE600 (GE Healthcare). La seconda dimensione à ̈ stata corsa a 60 mA/gel a 16°C, ed à ̈ stata interrotta quando il fronte del blu di bromofenolo ha raggiunto l’estremità inferiore del gel. Per la calibrazione dei pesi molecolari (PM) e dei punti isolelettrici (pI) sono state usate come standard proteine dal PM compreso tra i 15 ed i 100 kDa e dal pI compreso tra 4,5 e 8,5. I gel sono stati colorati con Coomassie brilliant blue R350 (Sigma, San Diego, US). Dopo la colorazione sono state acquisite immagini digitali dei gel utilizzando uno scanner ImageMaster Labscan V3.0 (GE Healthcare) e le immagini sono state analizzate con il software ImageMaster 2-DE Platinum (GE Healthcare). Per tutti i campioni di ciascun gruppo di individui à ̈ stato scelto un gel di riferimento, cioà ̈ un gel contenente il più alto numero di spot correttamente focalizzati per quel gruppo. Ciascun gel à ̈ stato poi sovrapposto virtualmente (“matching†) al rispettivo gel di riferimento. Gli spot presenti in più del 70% dei gel in un dato gruppo sono stati usati per creare un gel virtuale (“gel media†) che rappresenta il proteoma medio di ogni gruppo. I tre gel media sono stati successivamente sottoposti a matching reciproco per individuare gli spot condivisi fra le tre popolazioni di individui esaminate; la successiva analisi quantitativa à ̈ consistita nel paragonare i corrispettivi volumi percentuali (Vol%) di ciascuno di questi spot nelle tre popolazioni. Per ogni spot, il Vol% à ̈ stato calcolato come integrale del volume di ciascuno spot colorato con Coomassie (area dello spot moltiplicata per la sua intensità ) normalizzato sulla somma dei volumi di tutti gli spot presenti nel gel media di riferimento. Per individuare gli spot che variano consistentemente e significativamente fra le tre popolazioni, à ̈ stata condotta un’analisi ANOVA non parametrica (test di Kruskal-Wallis), seguita da un post-test di comparazione (test di Dunn), con una soglia di p ≤ 0,05. Gli spot così evidenziati sono elencati in Figura 1A e mostrati in Figura 2 (spot 65, 66, 110, 125, 182, 183, 87, 34, ovvero SEQ ID NO: 1-8, escluso lo spot 8). I valori medi di Vol% e le deviazioni standard per ciascuno degli spot sono riassunti in Figura 3, evidenziando le differenze fra i soggetti malati di SLA ed il resto dei soggetti considerati. La variabilità sperimentale tra replicati tecnici dello stesso campione à ̈ stata determinata paragonando i diversi Vol% ottenuti, e non à ̈ risultata essere in nessun caso superiore a 0,8 volte (variabilità media: 0,45 volte; variabilità minima: 0,2 volte).
Conclusa l’analisi quantitativa nel modo descritto, sono stati cercati quegli spot assenti nei gel dei soggetti con SLA e presenti negli altri, o viceversa (analisi qualitativa). Questo tipo di analisi ha messo in evidenza lo spot 8 (SEQ ID NO: 1), che rappresenta il miglior singolo marcatore di SLA identificato (Figura 1A, Figura 2; la magnificazione tridimensionale dello spot 8 colorato con Coomassie appare in Figura 4; i livelli del marcatore in oggetto negli individui analizzati sono mostrati in Figura 5).
Considerando tutti i 9 spot evidenziati, à ̈ stata condotta un’analisi discriminante post-test, per saggiare la loro capacità di classificare ogni individuo nella popolazione appropriata, sulla base dei Vol% misurati (software utilizzato: StatistiXL). La capacità di corretta predizione complessiva arriva all’89,8%, con l’assegnazione corretta di tutti i soggetti non affetti da SLA e del 81,5% dei pazienti con SLA. La stessa analisi ha portato alla formulazione della seguente funzione lineare (Diagnostic Function, DF):
DF = - 3.349 Vol%(182) 8.688 Vol%(183) - 1.146 Vol%(65) 5.536 Vol%(110) 1.652 Vol%(87) 2.630 Vol%(125) 3.026 Vol%(34) - 2.426 Vol%(66) 30.098 Vol%(8) - 2.38
in cui Vol%(n) indica il Vol% dello spot n, secondo la numerazione indicata sulla mappa 2DE in Figura 2. La corrispondenza tra la numerazione degli spot considerati per il calcolo della DF così come evidenziati in Figura 2 ed i loro rispettivi identificativi di sequenza (SEQ ID NO), utilizzati altrove nel presente brevetto, à ̈ mostrata nella Figura 1A. Il valore della DF per ognuno dei soggetti inclusi nello studio à ̈ riportato in Figura 6. Un valore positivo di questa funzione à ̈ chiaramente un parametro diagnostico di SLA, mentre un valore negativo tende ad essere associato a soggetti non affetti da SLA.
I valori medi della DF, le corrispondenti deviazioni standard e le dimensioni dei gruppi considerati sono stati presi come valori di input per la successiva Power Analysis, comprendente il calcolo del parametro Cohen’s D, che rende conto dell’effetto delle dimensioni del campione nella determinazione dell’effetto grandezza normalizzato, come descritto da Cohen [1992] e da Hedges e Olkin [1985]. La Power Analysis effettuata pertanto fornisce una misura della confidenza con cui lo stesso effetto grandezza può essere osservato sull’intera popolazione.
Per quel che riguarda i biomarcatori di progressione della malattia, à ̈ stato utilizzato un approccio diverso. Si à ̈ partiti dalla considerazione che un candidato marcatore di progressione deve avere un Vol% molto variabile tra i pazienti considerati, poiché i prelievi sono stati effettuati a distanza temporale diversa dall’esordio clinico. Quindi tutti gli spot identificati nei pazienti con SLA sono stati preliminarmente ordinati per coefficiente di variazione dei loro Vol%, cioà ̈ per la loro deviazione standard normalizzata come frazione del valore medio. Solo quegli spot che presentavano un coefficiente di variazione uguale o maggiore del 100% sono stati esaminati ulteriormente. Nessuno degli spot evidenziati mediante ANOVA come biomarcatori di malattia ha passato questo filtro, come peraltro ci si aspettava (un biomarcatore di malattia tende ad essere costante fra i malati). Tuttavia, il Vol% dello spot 101 à ̈ risultato essere negativamente correlato con il tempo dall’esordio sintomatico, o “onset†(espresso in mesi) in ognuno di quei 5 pazienti per cui erano disponibili due prelievi a tempi diversi (uno del 2004 ed uno del 2006/2007), come illustrato in Figura 7: lo spot 101 à ̈ pertanto considerato un potenziale biomarcatore di progressione della SLA.
Una volta individuati i biomarcatori nella maniera descritta, si à ̈ proceduto a stabilirne l’identità con tecniche di spettrometria di massa. In particolare, gli spot individuati sono stati tagliati manualmente dai gel corrispondenti e decolorati per una notte con una soluzione contenente etanolo al 40% in bicarbonato di ammonio (25 mM); sono quindi stati lavati due volte con bicarbonato di ammonio (25 mM), tre volte con acetonitrile, e quindi essiccati. Ogni frammento di gel à ̈ stato reidratato in bicarbonato di ammonio (25 mM) contenente 0,6 µg di tripsina porcina modificata, ed à ̈ stata condotta una digestione proteasica per una notte a 37°C. I peptidi risultanti sono stati estratti per sonicazione in bicarbonato di ammonio (25 mM), caricati su colonna ZORBAX 300 SB C18 RP (75 µm x 150 mm, particelle da 3,5 µm, Agilent, Milano, Italia) ed eluiti con un gradiente di acetonitrile dal 5% all’80% (contenente acido formico al 0,1%) ad un flusso di 0,3 ml/min, utilizzando un sistema HP 1100 nanoLC accoppiato a spettrometro di massa a trappola ionica XCT-Plus nanospray-ion trap (Agilent)(altrove abbreviato in LC-ESI MS/MS). I parametri utilizzati per lo spettrometro di massa erano i seguenti: ampiezza di scansione = 100-2.200 m/z; velocità di scansione = 8.100 m/z per s; flusso del gas secco = 5 l/min; temperatura secca = 300°C; capillare = 1,8 kV; skimmer = 40 V; target di controllo di carica ionica (ion charge control, ICC) = 125.000; tempo massimo di accumulo = 300 ms. I peptidi carichi positivamente sono stati automaticamente isolati e frammentati, e gli spettri sono stati deconvoluti utilizzando il software DataAnalysis (Bruker Daltonics, Bremen, Germany). I dati di massa ottenuti con LC-ESI MS/MS sono stati utilizzati per una ricerca sul database di sequenze proteiche NCBI non-redundant tramite l’algoritmo di ricerca Mascot (http://www.matrixscience.com - tolleranza di massa di picco monisotopico: 1,8 Da per lo ione parentale o 0,8 Da per i frammenti; massimo numero di siti non tagliati per peptide pari a 3). Sono state considerate come modificazioni consentite la carbammidometilazione delle cisteine e l’ossidazione delle metionine. I risultati con un punteggio Mowse superiore a 47 sono stati considerati significativi (p < 0,05).
L’identità proteica dei biomarcatori così ottenuta à ̈ riportata in Figura 1 e indicata con i corrispondenti identificativi di sequenza (SEQ ID NO). Come risulta chiaramente, vi à ̈ una prevalenza di frammenti di albumina (SEQ ID NO: 1-4). La sequenza amminoacidica minima di questi frammenti à ̈ riportata in Figura 1A ed esemplificata graficamente in Figura 8 in confronto alla sequenza dell’albumina intera, identificata dall’Accession number 28592, che risulta essere la sequenza di riferimento per l’albumina serica umana, sequenza amminoacidica di cui il presente studio ha individuato frammenti quali biomarcatori in oggetto al presente brevetto.
Per sequenza minima dei frammenti si intende la sequenza ottenuta esaminando i peptidi derivanti dalla digestione triptica di un frammento, ordinando i peptidi sulla base della sequenza della proteina di origine, e ricavando la sequenza compresa tra l’amminoacido N-terminale del primo peptide e l’amminoacido C-terminale dell’ultimo. Questa sequenza à ̈ sicuramente compresa all’interno del frammento di interesse, ma non la esaurisce, potendosi avere ulteriori aminoacidi sia all’N-terminale sia al C terminale compresi tra i siti di taglio triptico riscontrati ed il sito triptico successivo (in direzione N- o C-terminale). Pertanto, benchà ̈ i frammenti corrispondenti allo spot 66 ed allo spot 8 in Figura 1A (evidenziati nella mappa bidimensionale in Figura 2) possiedano la stessa sequenza minima (SEQ ID NO: 1), essi sono distinti probabilmente al C-terminale (dato che entrambe le sequenze minime iniziano all’estremità N-terminale dell’albumina matura). In particolare, poiché immediatamente a valle della sequenza minima identificata sono presenti molti residui acidi, à ̈ probabile che il frammento corrispondente allo spot 66 abbia qualche residuo C-terminale acido in più rispetto al frammento corrispondente allo spot 8, in accordo con il suo punto isoelettrico più acido (Figura 2, Figura 8).
La frammentazione dell’albumina in vivo à ̈ alterata in molte condizioni, tra cui postumi del trapianto di cellule staminali ematopoietiche [Kaiser et al., 2004], tossicità pancreatica esocrina [Walgren et al., 2007], rigetto corneale acuto [Funding et al., 2005], sepsi da meningococco [Holland et al., 2001], nefropatie diabetiche [Yagame et al., 1995], ischemia cardiaca, infiammazione acuta, endotossicosi ed invecchiamento [Bito et al., 2005]. Per quel che riguarda il SNC e le malattie neurodegenerative, determinati frammenti di albumina sono già stati riportati come biomarcatori: per es., alcuni frammenti C-terminali di albumina presenti nel FCS costituiscono dei biomarcatori specifici di MA [Finehout et al., 2007]. Inoltre, in un modello murino di distrofia muscolare uno specifico frammento serico di albumina à ̈ stato trovato aumentato di 2,8 volte [Doran et al., 2006]. Poiché la SLA à ̈ caratterizzata da un’estesa attivazione delle proteasi seriche [Ilzecka et al., 2001; Demestre et al., 2006] e da un forte stress ossidativo [Barber et al., 2006], à ̈ del tutto ragionevole che alcuni meccanismi degradativi specifici della malattia producano specifici frammenti di albumina, come quelli inclusi nel set di biomarcatori descritto in Figura 1A e rappresentati in Figura 8 contro la sequenza dell’albumina intera.
Un altro biomarcatore identificato, corrispondente allo spot 182 (Figura 1A e Figura 2; SEQ ID NO: 6), à ̈ una glicoforma di transferrina. Va ricordato che nei pazienti con SLA la transferrina si accumula nei corpi di Bunina [Mizuno et al., 2006], che la proteina SOD1 modula l’espressione del recettore della transferrina [Danzeisen et al., 2006], ed infine che difetti nell’espressione di alsina causano l’accumulo intracellulare di transferrina in colture di motoneuroni [Jacquier et al., 2006]. Se considerata singolarmente, e non in combinazione con gli altri biomarcatori descritti nella presente invenzione, la transferrina avrebbe limitato valore come biomarcatore di SLA, in quanto glicoforme di transferrina sono coinvolte in modo aspecifico in diverse malattie neurodegenerative e non [Zeman et al., 2000; Brettschneider et al., 2008]. Tuttavia abbiamo verificato che l’inclusione di questi due spot nel set di biomarcatori identificato aumenta il potere diagnostico globale del set, probabilmente poiché esistono - come già ricordato - alcuni meccanismi che portano all’alterazione della transferrina nei pazienti con SLA.
Un altro biomarcatore identificato, corrispondente allo spot 183 (SEQ ID NO: 7), à ̈ la catena costante delle IgM. Il coinvolgimento delle IgM nella SLA à ̈ ben documentato e basato principalmente su evidenze serologiche da pazienti. Titoli elevati di IgM anti-ganglioside GM1 si trovano comunemente in pazienti con neuropatie periferiche e sindromi neuromotorie [Pestronk, 1991]. Più recentemente sono stati dosati elevati titoli di IgM anche contro i gangliosidi GM2 e GD2 [Mizutani et al., 2003]. La risposta immune che talora si riscontra a livello serico contro le proteine dei neurofilamenti à ̈ di tipo IgM [Couratier et al., 1998]. In generale, quindi, il frammento di IgM identificato come marcatore nella SLA potrebbe derivare dalla risposta immune IgM-correlata, riportata in più di uno studio su pazienti di SLA.
Un altro biomarcatore identificato con il metodo descritto à ̈ risultato essere la catena A del fibrinogeno gamma (spot 125, SEQ ID NO: 5). Sebbene il fibrinogeno non sia sintetizzato nel SNC, in quest’ultimo, specialmente in condizioni infiammatorie, si producono molecole correlate col fibrinogeno, come ad es. proteine della coagulazione e della cascata fibrinolitica, così come recettori per la fibrina e messaggeri intracellulari attivati dalla fibrina [discussi in Akassoglou e Strickland, 2002]. Studi recenti hanno dimostrato che i macrofagi nel SNC e le cellule di Schwann nel sistema nervoso periferico sono i due citotipi più spesso coinvolti nei fenomeni correlati con la fuoriuscita extravasale del fibrinogeno e dei suoi prodotti di degradazione. Nella sclerosi multipla la perdita di regolazione della cascata fibrinolitica à ̈ connessa strettamente alla patogenesi attraverso molti processi biochimici diversi [Adams et al., 2004]. Inoltre, nel FCS di pazienti con MA un aumento della catena A del fibrinogeno gamma riveste un ruolo di biomarcatore di malattia, sebbene questo aumento possa essere dovuto semplicemente al danneggiamento della barriera ematoencefalica [Lee et al., 2007].
L’ultimo biomarcatore di SLA identificato (spot 87; SEQ ID NO: 8) à ̈ risultato essere una forma di clusterina (Apo J). In aree di attiva neurodegenerazione del midollo spinale à ̈ stato dimostrato attraverso ibridazione in situ un aumento del messaggero per la clusterina [Grewal et al., 1999]. La clusterina può avere un ruolo complesso nei processi neurodegenerativi: oltre alla sua attività di inibitore del complesso di ancoraggio alla membrana cellulare, questa glicoproteina multifunzionale può promuovere l’aggregazione cellulare e funzionare da chaperon molecolare, prevenendo l’aggregazione di proteine denaturate. L’innalzamento del livello di RNA messaggero della clusterina e della proteina stessa sono riscontrabili nel danno ischemico cerebrale ed in molte malattie neurologiche, fra cui MA, sclerosi multipla ed epilessia. In alcune cellule l’induzione dell’espressione della clusterina à ̈ associata con l’apoptosi; cellule non neurali ingegnerizzate in modo da produrre ridotte quantità di clusterina sono maggiormente sensibili allo stress ossidativo [Grewal et al., 1999].
Per quanto riguarda il biomarcatore di progressione della SLA, l’analisi mediante spettrometria di massa LC-ESI MS/MS lo ha identificato come il componente 3 del Complemento, in particolare un frammento della porzione c (catena a’ di C3c; SEQ ID NO: 9). Frammenti di C3c sono stati già identificati tramite 2DE come marcatori periferici di SLA [Goldknopf et al., 2006]: tuttavia i frammenti riportati da Goldknopf et al. non coincidono con lo specifico frammento descritto nella presente invenzione, come risulta evidente dal pI completamente differente (e quindi dalla diversa posizione nelle mappe 2DE ottenute da siero o da plasma, di cui un esempio à ̈ riportato in Figura 9). Inoltre C3c non à ̈ mai stato implicato nella progressione della malattia, e quindi il frammento di C3c corrispondente allo spot 101 costituisce un biomarcatore realmente nuovo di progressione della SLA.
A questo punto, dovrebbe essere evidente agli esperti del campo che ogni combinazione dei biomarcatori descritti, con differente potere statistico, può essere usata per la diagnosi differenziale della SLA rispetto ad altre malattie neurodegenerative, così come per una valutazione della sua progressione. Inoltre, ogni combinazione di tali biomarcatori può essere usata congiuntamente ad altri biomarcatori, per ottenere un potere predittivo ed una potenza statistica migliori. Ad esempio, à ̈ possibile utilizzare i biomarcatori descritti, ed in particolare i loro Vol% valutati mediante 2DE, in combinazione con i marcatori serici di SLA scoperti da Goldknopf et al. [2006], sia per la diagnosi sia per la valutazione dello stato di avanzamento della malattia. E’ evidente che tali combinazioni rientrano nello scopo e nell’ambito del presente brevetto, così come ogni altra combinazione con altri tipi di biomarcatori e/o marcatori fisiologici e/o diagnostici.
Descrizione di una o più forme di attuazione
La procedura diagnostica oggetto della presente invenzione può esplicarsi attraverso diverse forme di attuazione.
A mero titolo di esempio, nel paragrafo successivo si illustra una forma di attuazione basata sul prelievo di campioni ematici dai soggetti da testare, sulla quantificazione mediante 2DE dei biomarcatori identificati, sul calcolo di una funzione diagnostica per individuare la presenza della SLA e sulla valutazione dello stato di avanzamento della malattia mediante confronto della quantità di C3c alla 2DE tra prelievi diacronici.
Come descritto nel paragrafo dedicato alle varianti del metodo proposto, resta inteso che la procedura dettagliatamente descritta qui di seguito à ̈ una fra le molte possibili procedure che sfruttano lo stesso set di biomarcatori, le quali procedure devono considerarsi nel loro complesso rientranti nello spirito e nell’ambito del presente brevetto.
In particolare, la presente invenzione si basa sulla scoperta di un set di biomarcatori per la SLA, il cui ammontare à ̈ correlato con la presenza della malattia (tutti i biomarcatori indicati in Figura 1A, eccetto quindi il marcatore C3c) o alla sua progressione (solo C3c, Figura 1B). La quantità di questi biomarcatori può essere valutata mediante 2DE, come descritto precedentemente, ma à ̈ evidente agli esperti del settore che un qualunque altro metodo di valutazione del livello di uno o più dei biomarcatori riportati in Figura 1 rientra pienamente nello scopo e nello spirito della presente domanda di brevetto. A puro titolo di esempio, i biomarcatori possono essere quantificati attraverso una o più delle seguenti tecniche alternative:
1. Western Blotting
2. Enzyme-Linked ImmunoadSorbent Assay (ELISA) 3. High Pressure Liquid Chromatography (HPLC) 4. Spettrometria di massa
Inoltre, una variante pienamente nello scopo della presente domanda di brevetto consiste nel far uso di qualunque combinazione numerica dell’ammontare di alcuni o di tutti i biomarcatori descritti, al fine di calcolare una differente funzione diagnostica (lineare o non lineare) oppure di derivare un qualunque parametro statistico in modo da ottenere un punteggio utile per la diagnosi di SLA o per la valutazione della sua progressione.
E’ inteso inoltre che qualunque combinazione dei presenti biomarcatori con altri metodi diagnostici di SLA o di altre malattie neurologiche à ̈ da ritenersi parte integrante della presente domanda di brevetto.
Infine va osservato come, sebbene l’utilizzo di campioni di sangue umano sia preferibile all’utilizzo di altro materiale biologico, la ricerca e l’utilizzo di una qualunque combinazione dei biomarcatori indicati in Figura 1 in campioni biologici diversi dal sangue umano à ̈ da ritenersi parte integrante della presente domanda di brevetto.
Funzionamento della procedura diagnostica
Allo scopo di diagnosticare la SLA in un dato individuo, o di valutare lo stato di avanzamento della malattia, nei seguenti paragrafi sarà descritto:
(1) un metodo di quantificazione dei biomarcatori oggetto del presente brevetto;
(2) un metodo di diagnosi di SLA basato sulla quantificazione di cui al punto precedente;
(3) un metodo di valutazione dello stato di avanzamento di SLA basato sulla quantificazione del biomarcatore C3c ottenuta con la procedura di cui al punto (1).
(1). QUANTIFICAZIONE DEI BIOMARCATORI
Il plasma degli individui di interesse à ̈ ottenuto mediante metodi standard. Una volta preparati i campioni di plasma (per centrifugazione a 4°C per 10’ a 400 g), per ognuno di essi va effettuato un esperimento di 2DE ed il relativo replicato tecnico, secondo la procedura di Jacobs et al. [2001] con alcune modifiche. In breve, un’aliquota di 6 µl (circa 400 µg di proteina totale) per ciascun campione à ̈ riscaldata per 5’ a 95°C in presenza di 10 µl di SDS al 5% (p/v) e DTT al 2,5% (p/v), e quindi diluita a 330 µl con un tampone contenente urea (7 M), tiourea (2 M), CHAPS al 4% (p/v), tampone IPG 3-10 NL al 0,5% (v/v), e tracce di blu di bromofenolo [Hughes et al., 1992]. Il campione à ̈ quindi caricato su strisce da 18 cm IPG 3-10 non lineari con reidratazione in gel (2 h a 0 V e 12 h a 30 V). Va quindi effettuata la IEF a 20°C con apparato IPGphor (GE Healthcare) o equivalente, secondo il seguente protocollo: 500 V a 500 V/h, 1.000 V a 1.000 V/h con gradiente lineare, 8.000 V a 13.500 V/h con gradiente lineare, 8.000 V a 72.000 V/h. Prima della SDS-PAGE le strisce IPG vengono equilibrate due volte per 15’ in Tris-HCl (50 mM) a pH 8,8, urea (6 M), glicerolo al 30% (v/v), SDS al 2% (p/v) e tracce di blu di bromofenolo, contenenti DTT al 1% (p/v) per il primo passaggio e iodoacetammide al 2,5% (p/v) per il secondo passaggio. Segue quindi SDS-PAGE con gel al 12,5% (1,5 mm di spessore), secondo il protocollo di Laemmli [1970], ma senza stacking gel, utilizzando un apparato Hoefer SE600 (GE Healthcare) o equivalente. La seconda dimensione viene corsa a 60 mA/gel a 16°C, e va interrotta quando il fronte del blu di bromofenolo ha raggiunto l’estremità inferiore del gel. Per la calibrazione dei PM e dei pI possono usarsi proteine come standard di PM (15-100 kDa) e di pI (pH 4,5-8,5). I gel vanno quindi colorati con Coomassie brilliant blue R350 (Sigma). Dopo la colorazione le immagini digitali dei gel vengono acquisite utilizzando uno scanner ImageMaster Labscan V3.0 (GE Healthcare) o equivalente, e le immagini vengono analizzate con il software ImageMaster 2-DE Platinum (GE Healthcare) o equivalente. Per identificare gli spot diagnostici sul gel in esame, l’immagine del gel viene sovrapposta con il gel di riferimento opportuno (Figura 2). Per ogni spot diagnostico si ricava il Vol% mediante analisi densitometrica, come rapporto percentuale della densità dello spot normalizzata sul totale della densità di tutti gli spot allineati tra il gel in esame ed il gel di riferimento.
(2) DIAGNOSI DI SLA
(2.1). Calcoli
A partire dai Vol% degli spot individuati in Figura 1 si calcola la seguente funzione diagnostica DF:
DF = - 3.349 Vol%(182) 8.688 Vol%(183) - 1.146 Vol%(65) 5.536 Vol%(110) 1.652 Vol%(87) 2.630 Vol%(125) 3.026 Vol%(34) - 2.426 Vol%(66) 30.098 Vol%(8) - 2.38
dove resta inteso che la numerazione di ciascuno spot mostrato a titolo esemplificativo evidenziato sulla mappa 2DE in Figura 1 corrisponde all’identificativo di sequenza mostrato in Figura 1A per ciascuno spot, ovvero: spot 8 e SPOT 66 = SEQ ID NO 1;
spot 110 = SEQ ID NO 2;
spot 65 = SEQ ID NO 3;
spot 34 = SEQ ID NO 4;
spot 125 = SEQ ID NO 5;
spot 182 = SEQ ID NO 6;
spot 183 = SEQ ID NO 7;
spot 87 = SEQ ID NO 8.
Resta inteso inoltre che ogni altra funzione (per es. una funzione lineare differente o una funzione non lineare) delle quantità dei biomarcatori indicate, determinate come descritto oppure per mezzo di Western Blotting, ELISA o altre metodiche, può essere usata al posto della funzione descritta, e rientra nello spirito del presente brevetto.
(2.2). Valutazione dei risultati
Come mostrato in Figura 6, il valore di DF tende ad essere positivo in presenza di SLA. Si assume quindi che, nel caso la quantificazione dei biomarcatori proposti porti ad un valore di DF > 0, il soggetto sotto esame sia affetto da SLA.
Gli esperti del campo non faranno fatica a riconoscere che, qualora si usi una funzione differente, bisognerà selezionare un diverso valore di soglia, ma l’informazione in ingresso, connessa in qualsiasi modo ad uno o più dei biomarcatori riportati, à ̈ la stessa ed à ̈ coperta dal presente brevetto.
(3) PROGRESSIONE DELLA MALATTIA
(3.1). Calcoli
Per identificare lo spot 101 sul gel in esame, lo stesso gel viene sovrapposto all’immagine di un gel di riferimento (Figura 9). Il Vol% dello spot 101 à ̈ quindi calcolato come descritto precedentemente.
(3.2). Valutazione
Man mano che aumenta il tempo trascorso dall’esordio clinico della malattia, il Vol% dello spot 101 à ̈ atteso diminuire nei pazienti di SLA (Figura 7). Quindi, un confronto del Vol% di questo spot con il corrispondente valore ottenuto in un momento antecedente à ̈ informativo sulla progressione della malattia. Come evidente agli esperti nel campo, la misura dell’ammontare di proteina corrispondente allo spot 101 (C3c) attraverso ogni altro mezzo può rimpiazzare la stima del Vol% dello spot 101, senza uscire dall’ambito del presente brevetto.
Vantaggi
Gli esperti nel campo e coloro che si occupano di SLA riconosceranno immediatamente i vantaggi di un test diagnostico quale quello descritto e dei corrispondenti biomarcatori, che possiedono le seguenti qualità :
1. maggiore obiettività rispetto a metodi clinici di diagnosi, essendo il test legato ad un aspetto molecolare della malattia ed alla misura di parametri quantitativi per la diagnosi;
2. maggiore accuratezza dei biomarcatori proposti rispetto ad altri, perché selezionati eliminando marcatori di infiammazione generica;
3. semplicità di prelievo dei campioni richiesti e della diagnosi, perché la misura si basa su biomarcatori ematici, piccoli volumi di sangue e sul calcolo di un unico valore per la diagnosi di SLA;
4. possibilità di sviluppo di metodologie semplificate di diagnosi, poiché i biomarcatori individuati possono essere rilevati con tecniche diverse dalla 2DE;
5. possibilità di follow-up a livello quantitativo della malattia e delle terapie, perché uno dei biomarcatori individuati cambia il proprio livello lungo il decorso della malattia.
Varianti
Ciò che à ̈ stato sin qui descritto à ̈ un esempio privilegiato dell’invenzione insieme con qualche possibile variazione. I termini, le descrizioni e le figure usate sono riportati a puro titolo illustrativo e non implicano limitazioni negli scopi e nell’oggetto del presente brevetto. Gli esperti della materia riconosceranno che molte varianti sono possibili nello spirito e nell’ambito di applicazione della presente invenzione, nella cui descrizione ogni termine à ̈ stato usato nel più ampio senso possibile, senza alcuna limitazione salvo quando esplicitamente indicato.
In particolare, la presente invenzione si basa sulla scoperta di un set di biomarcatori per la SLA, il cui ammontare à ̈ connesso alla presenza della patologia (tutti i biomarcatori indicati in Figura 1A, eccetto quindi il marcatore C3c) o alla sua progressione (solo C3c, Figura 1B). Questi biomarcatori possono essere quantificati mediante 2DE, come descritto precedentemente, ma à ̈ evidente agli esperti del settore che un qualunque altro metodo di valutazione dell’ammontare di uno o più dei biomarcatori riportati in Figura 1 rientra pienamente nello scopo e nello spirito della presente domanda di brevetto. A puro titolo di esempio, i biomarcatori possono essere quantificati attraverso una o più delle seguenti tecniche alternative:
1. Western Blotting
2. ELISA
3. HPLC
4. Spettrometria di massa.
Una variante pienamente nello scopo della presente domanda di brevetto consiste inoltre nel far uso di qualunque combinazione numerica dell’ammontare di alcuni o tutti i biomarcatori descritti, al fine di calcolare una differente funzione diagnostica (lineare o non lineare) oppure di ottenere un qualunque parametro statistico che fornisca un punteggio utile per la diagnosi di SLA o per la valutazione della sua progressione.
E’ inteso inoltre che qualunque combinazione dei presenti biomarcatori con altri metodi diagnostici di SLA o di altre malattie neurodegenerative à ̈ da ritenersi parte integrante della presente domanda di brevetto.
Infine, va osservato come, sebbene l’utilizzo di campioni di sangue umano sia preferibile all’utilizzo di altro materiale biologico, la ricerca e l’utilizzo di una qualunque combinazione dei biomarcatori indicati in Figura 1 in campioni biologici diversi dal sangue umano à ̈ da ritenersi parte integrante della presente domanda di brevetto.
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<120> BIOMARCATORI PER LA DIAGNOSI E PER RILEVARE LA PROGRESSIONE DI MALATTIE NEURODEGENERATIVE, IN PARTICOLARE DELLA SCLEROSI LATERALE AMIOTROFICA
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50 55 60
Lys Val Ala Gln Leu Glu Ala Gln Cys Gln Glu Pro Cys Lys Asp Thr
65 70 75 80
Val Gln Ile His Asp Ile Thr Gly Lys Asp Cys Gln Asp Ile Ala Asn
85 90 95
Lys Gly Ala Lys Gln Ser Gly Leu Tyr Phe Ile Lys Pro Leu Lys Ala
100 105 110
Asn Gln Gln Phe Leu Val Tyr Cys Glu Ile Asp Gly Ser Gly Asn Gly
115 120 125
Trp Thr Val Phe Gln Lys Arg Leu Asp Gly Ser Val Asp Phe Lys Lys
130 135 140
Asn Trp Ile Gln Tyr Lys Glu Gly Phe Gly His Leu Ser Pro Thr Gly
145 150 155 160
Thr Thr Glu Phe Trp Leu Gly Asn Glu Lys Ile His Leu Ile Ser Thr
165 170 175
Gln Ser Ala Ile Pro Tyr Ala Leu Arg Val Glu Leu Glu Asp Trp Asn
180 185 190
Gly Arg
210> 6
<211> 650
<212> PRT
<213> Homo sapiens
<220>
<223> polipeptide dello spot 182
<400> 6
Trp Cys Ala Val Ser Glu His Glu Ala Thr Lys Cys Gln Ser Phe Arg
1 5 10 15
Asp His Met Lys Ser Val Ile Pro Ser Asp Gly Pro Ser Val Ala Cys
20 25 30 Val Lys Lys Ala Ser Tyr Leu Asp Cys Ile Arg Ala Ile Ala Ala Asn
35 40 45
Glu Ala Asp Ala Val Thr Leu Asp Ala Gly Leu Val Tyr Asp Ala Tyr
50 55 60
Leu Ala Pro Asn Asn Leu Lys Pro Val Val Ala Glu Phe Tyr Gly Ser
65 70 75 80
Lys Glu Asp Pro Gln Thr Phe Tyr Tyr Ala Val Ala Val Val Lys Lys
85 90 95
Asp Ser Gly Phe Gln Met Asn Gln Leu Arg Gly Lys Lys Ser Cys His
100 105 110
Thr Gly Leu Gly Arg Ser Ala Gly Trp Asn Ile Pro Ile Gly Leu Leu
115 120 125
Tyr Cys Asp Leu Pro Glu Pro Arg Lys Pro Leu Glu Lys Ala Val Ala
130 135 140
Asn Phe Phe Ser Gly Ser Cys Ala Pro Cys Ala Asp Gly Thr Asp Phe
145 150 155 160
Pro Gln Leu Cys Gln Leu Cys Pro Gly Cys Gly Cys Ser Thr Leu Asn
165 170 175
Gln Tyr Phe Gly Tyr Ser Gly Ala Phe Lys Cys Leu Lys Asp Gly Ala
180 185 190
Gly Asp Val Ala Phe Val Lys His Ser Thr Ile Phe Glu Asn Leu Ala
195 200 205
Asn Lys Ala Asp Arg Asp Gln Tyr Glu Leu Leu Cys Leu Asp Asn Thr
210 215 220
Arg Lys Pro Val Asp Glu Tyr Lys Asp Cys His Leu Ala Gln Val Pro
225 230 235 240
Ser His Thr Val Val Ala Arg Ser Met Gly Gly Lys Glu Asp Leu Ile
245 250 255
Trp Glu Leu Leu Asn Gln Ala Gln Glu His Phe Gly Lys Asp Lys Ser
260 265 270
Lys Glu Phe Gln Leu Phe Ser Ser Pro His Gly Lys Asp Leu Leu Phe
275 280 285
Lys Asp Ser Ala His Gly Phe Leu Lys Val Pro Pro Arg Met Asp Ala
290 295 300
Lys Met Tyr Leu Gly Tyr Glu Tyr Val Thr Ala Ile Arg Asn Leu Arg
305 310 315 320
Glu Gly Thr Cys Pro Glu Ala Pro Thr Asp Glu Cys Lys Pro Val Lys
325 330 335
Trp Cys Ala Leu Ser His His Glu Arg Leu Lys Cys Asp Glu Trp Ser
340 345 350
Val Asn Ser Val Gly Lys Ile Glu Cys Val Ser Ala Glu Thr Thr Glu
355 360 365
Asp Cys Ile Ala Lys Ile Met Asn Gly Glu Ala Asp Ala Met Ser Leu
370 375 380
Asp Gly Gly Phe Val Tyr Ile Ala Gly Lys Cys Gly Leu Val Pro Val
385 390 395 400
Leu Ala Glu Asn Tyr Asn Lys Ser Asp Asn Cys Glu Asp Thr Pro Glu
405 410 415
Ala Gly Tyr Phe Ala Val Ala Val Val Lys Lys Ser Ala Ser Asp Leu
420 425 430
Thr Trp Asp Asn Leu Lys Gly Lys Lys Ser Cys His Thr Ala Val Gly
435 440 445
Arg Thr Ala Gly Trp Asn Ile Pro Met Gly Leu Leu Tyr Asn Lys Ile
450 455 460
Asn His Cys Arg Phe Asp Glu Phe Phe Ser Glu Gly Cys Ala Pro Gly
465 470 475 480
Ser Lys Lys Asp Ser Ser Leu Cys Lys Leu Cys Met Gly Ser Gly Leu
485 490 495
Asn Leu Cys Glu Pro Asn Asn Lys Glu Gly Tyr Tyr Gly Tyr Thr Gly
500 505 510
Ala Phe Arg Cys Leu Val Glu Lys Gly Asp Val Ala Phe Val Lys His
515 520 525
Gln Thr Val Pro Gln Asn Thr Gly Gly Lys Asn Pro Asp Pro Trp Ala
530 535 540
Lys Asn Leu Asn Glu Lys Asp Tyr Glu Leu Leu Cys Leu Asp Gly Thr
545 550 555 560
Arg Lys Pro Val Glu Glu Tyr Ala Asn Cys His Leu Ala Arg Ala Pro
565 570 575
Asn His Ala Val Val Thr Arg Lys Asp Lys Glu Ala Cys Val His Lys
580 585 590
Ile Leu Arg Gln Gln Gln His Leu Phe Gly Ser Asn Val Thr Asp Cys
595 600 605
Ser Gly Asn Phe Cys Leu Phe Arg Ser Glu Thr Lys Asp Leu Leu Phe
610 615 620
Arg Asp Asp Thr Val Cys Leu Ala Lys Leu His Asp Arg Asn Thr Tyr
625 630 635 640
Glu Lys Tyr Leu Gly Glu Glu Tyr Val Lys
<210> 7
<211> 327
<212> PRT
<213> Homo sapiens
<220>
<223> polipeptide dello spot 183
<400> 7
Tyr Ala Ala Thr Ser Gln Val Leu Leu Pro Ser Lys Asp Val Met Gln
1 5 10 15
Gly Thr Asp Glu His Val Val Cys Lys Val Gln His Pro Asn Gly Asn
20 25 30 Lys Glu Lys Asn Val Pro Leu Pro Val Ile Ala Glu Leu Pro Pro Lys
35 40 45
Val Ser Val Phe Val Pro Pro Arg Asp Gly Phe Phe Gly Asn Pro Arg
50 55 60
Lys Ser Lys Leu Ile Cys Gln Ala Thr Gly Phe Ser Pro Arg Gln Ile
65 70 75 80
Gln Val Ser Trp Leu Arg Glu Gly Lys Gln Val Gly Ser Gly Val Thr
85 90 95
Thr Asp Gln Val Gln Ala Glu Ala Lys Glu Ser Gly Pro Thr Thr Tyr
100 105 110
Lys Val Thr Ser Thr Leu Thr Ile Lys Glu Ser Asp Trp Leu Ser Gln
115 120 125
Ser Met Phe Thr Cys Arg Val Asp His Arg Gly Leu Thr Phe Gln Gln
130 135 140
Asn Ala Ser Ser Met Cys Val Pro Asp Gln Asp Thr Ala Ile Arg Val
145 150 155
160
Phe Ala Ile Pro Pro Ser Phe Ala Ser Ile Phe Leu Thr Lys Ser Thr
165 170 175
Lys Leu Thr Cys Leu Val Thr Asp Leu Thr Thr Tyr Asp Ser Val Thr
180 185 190
Ile Ser Trp Thr Arg Gln Asn Gly Glu Ala Val Lys Thr His Thr Asn
195 200 205
Ile Ser Glu Ser His Pro Asn Ala Thr Phe Ser Ala Val Gly Glu Ala
210 215 220
Ser Ile Cys Glu Asp Asp Trp Asn Ser Gly Glu Arg Phe Thr Cys Thr
225 230 235 240
Val Thr His Thr Asp Leu Pro Ser Pro Leu Lys Gln Thr Ile Ser Arg
245 250 255
Pro Lys Gly Val Ala Leu His Arg Pro Asp Val Tyr Leu Leu Pro Pro
260 265 270
Ala Arg Glu Gln Leu Asn Leu Arg Glu Ser Ala Thr Ile Thr Cys Leu
275 280 285
Val Thr Gly Phe Ser Pro Ala Asp Val Phe Val Gln Trp Met Gln Arg
290 295 300
Gly Gln Pro Leu Ser Pro Glu Lys Tyr Val Thr Ser Ala Pro Met Pro
305 310 315 320
Glu Pro Gln Ala Pro Gly Arg
325
<210> 8
<211> 393
<212> PRT
<213> Homo sapiens
<220>
<223> polipeptide dello spot 87
<400> 8
Glu Ile Gln Asn Ala Val Asn Gly Val Lys Gln Ile Lys Thr Leu Ile
1 5 10 15
Glu Lys Thr Asn Glu Glu Arg Lys Thr Leu Leu Ser Asn Leu Glu Glu
20 25 30 Ala Lys Lys Lys Lys Glu Asp Ala Leu Asn Glu Thr Arg Glu Ser Glu
35 40 45
Thr Lys Leu Lys Glu Leu Pro Gly Val Cys Asn Glu Thr Met Met Ala
50 55 60
Leu Trp Glu Glu Cys Lys Pro Cys Leu Lys Gln Thr Cys Met Lys Phe
65 70 75 80
Tyr Ala Arg Val Cys Arg Ser Gly Ser Gly Leu Val Gly Arg Gln Leu
85 90 95
Glu Glu Phe Leu Asn Gln Ser Ser Pro Phe Tyr Phe Trp Met Asn Gly
100 105 110
Asp Arg Ile Asp Ser Leu Leu Glu Asn Asp Arg Gln Gln Thr His Met
115 120 125
Leu Asp Val Met Gln Asp His Phe Ser Arg Ala Ser Ser Ile Ile Asp
130 135 140
Glu Leu Phe Gln Asp Arg Phe Phe Thr Arg Glu Pro Gln Asp Thr Tyr
145 150 155 160
His Tyr Leu Pro Phe Ser Leu Pro His Arg Arg Pro His Phe Phe Phe
165 170 175
Pro Lys Ser Arg Ile Val Arg Ser Leu Met Pro Phe Ser Pro Tyr Glu
180 185 190
Pro Leu Asn Phe His Ala Met Phe Gln Pro Phe Leu Glu Met Ile His
195 200 205
Glu Ala Gln Gln Ala Met Asp Ile His Phe His Ser Pro Ala Phe Gln
210 215 220
His Pro Pro Thr Glu Phe Ile Arg Glu Gly Asp Asp Asp Arg Thr Val
225 230 235 240
Cys Arg Glu Ile Arg His Asn Ser Thr Gly Cys Leu Arg Met Lys Asp
245 250 255
Gln Cys Asp Lys Cys Arg Glu Ile Leu Ser Val Asp Cys Ser Thr Asn
260 265 270
Asn Pro Ser Gln Ala Lys Leu Arg Arg Glu Leu Asp Glu Ser Leu Gln
275 280 285
Val Ala Glu Arg Leu Thr Arg Lys Tyr Asn Glu Leu Leu Lys Ser Tyr
290 295 300
Gln Trp Lys Met Leu Asn Thr Ser Ser Leu Leu Glu Gln Leu Asn Glu
305 310 315 320
Gln Phe Asn Trp Val Ser Arg Leu Ala Asn Leu Thr Gln Gly Glu Asp
325 330 335
Gln Tyr Tyr Leu Arg Val Thr Thr Val Ala Ser His Thr Ser Asp Ser
340 345 350
Asp Val Pro Ser Gly Val Thr Glu Val Val Val Lys Leu Phe Asp Ser
355 360 365
Asp Pro Ile Thr Val Thr Val Pro Val Glu Val Ser Arg Lys Asn Pro
370 375 380
Lys Phe Met Glu Thr Val Ala Glu Lys
385 390
<210> 9
<211> 319
<212> PRT
<213> Homo sapiens
<220>
<223> polipeptide dello spot 101
<400> 9
Glu Asn Glu Gly Phe Thr Val Thr Ala Glu Gly Lys Gly Gln Gly Thr
1 5 10 15
Leu Ser Val Val Thr Met Tyr His Ala Lys Ala Lys Asp Gln Leu Thr
20 25 30 Cys Asn Lys Phe Asp Leu Lys Val Thr Ile Lys Pro Ala Pro Glu Thr
35 40 45
Glu Lys Arg Pro Gln Asp Ala Lys Asn Thr Met Ile Leu Glu Ile Cys
50 55 60
Thr Arg Tyr Arg Gly Asp Gln Asp Ala Thr Met Ser Ile Leu Asp Ile
65 70 75 80
Ser Met Met Thr Gly Phe Ala Pro Asp Thr Asp Asp Leu Lys Gln Leu
85 90 95
Ala Asn Gly Val Asp Arg Tyr Ile Ser Lys Tyr Glu Leu Asp Lys Ala
100 105 110
Phe Ser Asp Arg Asn Thr Leu Ile Ile Tyr Leu Asp Lys Val Ser His
115 120 125
Ser Glu Asp Asp Cys Leu Ala Phe Lys Val His Gln Tyr Phe Asn Val
130 135 140
Glu Leu Ile Gln Pro Gly Ala Val Lys Val Tyr Ala Tyr Tyr Asn Leu
145 150 155
160
Glu Glu Ser Cys Thr Arg Phe Tyr His Pro Glu Lys Glu Asp Gly Lys
165 170 175
Leu Asn Lys Leu Cys Arg Asp Glu Leu Cys Arg Cys Ala Glu Glu Asn
180 185 190
Cys Phe Ile Gln Lys Ser Asp Asp Lys Val Thr Leu Glu Glu Arg Leu
195 200 205
Asp Lys Ala Cys Glu Pro Gly Val Asp Tyr Val Tyr Lys Thr Arg Leu
210 215 220
Val Lys Val Gln Leu Ser Asn Asp Phe Asp Glu Tyr Ile Met Ala Ile
225 230 235 240
Glu Gln Thr Ile Lys Ser Gly Ser Asp Glu Val Gln Val Gly Gln Gln
245 250 255
Arg Thr Phe Ile Ser Pro Ile Lys Cys Arg Glu Ala Leu Lys Leu Glu
260 265 270
Glu Lys Lys His Tyr Leu Met Trp Gly Leu Ser Ser Asp Phe Trp Gly
275 280 285
Glu Lys Pro Asn Leu Ser Tyr Ile Ile Gly Lys Asp Thr Trp Val Glu
290 295 300
His Trp Pro Glu Glu Asp Glu Cys Gln Asp Glu Glu Asn Gln Lys
310 315
Claims (14)
- RIVENDICAZIONI 1. Polipeptide avente sequenza con almeno il 90% di identità con SEQ ID NO: 1, SEQ ID NO: 2, SEQ ID NO: 3, SEQ ID NO: 4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7, SEQ ID NO: 8 o SEQ ID NO: 9.
- 2. Polipeptide avente SEQ ID NO: 1, SEQ ID NO: 2, SEQ ID NO: 3, SEQ ID NO: 4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7, SEQ ID NO: 8 o SEQ ID NO: 9.
- 3. Uso di un polipeptide secondo la rivendicazione 1 o 2, come biomarcatore.
- 4. Uso secondo la rivendicazione 3, per la diagnosi in vitro o per rilevare la progressione di una malattia neurodegenerativa in un individuo.
- 5. Uso secondo la rivendicazione 3 o 4, in cui detta malattia neurodegenerativa à ̈ la sclerosi laterale amiotrofica.
- 6. Uso di un polipeptide secondo la rivendicazione 3 o 5 avente sequenza: SEQ ID NO: 1, SEQ ID NO: 2, SEQ ID NO: 3, SEQ ID NO: 4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7 o SEQ ID NO: 8 per la diagnosi in vitro di una malattia neurodegenerativa in un individuo.
- 7. Uso di un polipeptide secondo la rivendicazione 4 o 5 avente sequenza SEQ ID NO: 9 per rilevare la progressione di una malattia neurodegenerativa in un individuo.
- 8. Uso secondo la rivendicazione 6 o 7, in cui detta malattia neurodegenerativa à ̈ la sclerosi laterale amiotrofica.
- 9. Uso secondo una qualsiasi delle rivendicazioni da 3 a 8, in cui detto biomarcatore à ̈ utilizzato in combinazione con almeno un altro biomarcatore.
- 10. Metodo per la diagnosi in vitro o per rilevare la progressione di una malattia neurodegenerativa in un individuo comprendente le fasi di: - isolamento di un campione biologico dall’individuo; - quantificazione del livello di uno o più polipeptidi secondo la rivendicazione 1 o 2 in detto campione biologico; - confronto di detto livello con un livello di riferimento.
- 11. Metodo secondo la rivendicazione 10, in cui detta malattia neurodegenerativa à ̈ la sclerosi laterale amiotrofica.
- 12. Metodo secondo la rivendicazione 10 o 11, in cui detto campione organico à ̈ un fluido biologico.
- 13. Metodo secondo la rivendicazione 12, in cui detto fluido biologico à ̈ selezionato nel gruppo costituito da sangue, plasma, siero e liquido cerebrospinale.
- 14. Metodo secondo la rivendicazione precedente, in cui la quantificazione di uno o più polipeptidi secondo le rivendicazioni 1 e 2 à ̈ effettuata mediante una tecnica selezionata nel gruppo costituito da elettroforesi bidimensionale, densitometria, Western Blotting, ELISA, HPLC, spettrometria di massa e protein chip.
Priority Applications (5)
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ITTO2008A000870A IT1392551B1 (it) | 2008-11-25 | 2008-11-25 | Biomarcatori per la diagnosi e per rilevare la progressione di malattie neurodegenerative, in particolare della sclerosi laterale amiotrofica |
EP09796795A EP2356138A2 (en) | 2008-11-25 | 2009-11-25 | Biomarkers for diagnosing and detecting the progression of neurodegenerative disorders, in particular of amyotrophic lateral sclerosis |
PCT/IB2009/007580 WO2010061283A2 (en) | 2008-11-25 | 2009-11-25 | Biomarkers for diagnosing and detecting the progression of neurodegenerative disorders, in particular of amyotrophic lateral sclerosis |
US13/131,223 US20130196924A1 (en) | 2008-11-25 | 2009-11-25 | Biomarkers for diagnosing and detecting the progression of neurodegenerative disorders, in particular of amyotrophic lateral sclerosis |
EP11193436A EP2481749A1 (en) | 2008-11-25 | 2009-11-25 | Biomarkers for diagnosing and detecting the progression of neurodegenerative disorders, in particular of amyotrophic lateral sclerosis |
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ITTO2008A000870A IT1392551B1 (it) | 2008-11-25 | 2008-11-25 | Biomarcatori per la diagnosi e per rilevare la progressione di malattie neurodegenerative, in particolare della sclerosi laterale amiotrofica |
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EP (2) | EP2356138A2 (it) |
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AU2009205956B2 (en) | 2008-01-18 | 2015-07-02 | President And Fellows Of Harvard College | Methods of detecting signatures of disease or conditions in bodily fluids |
US20120053073A1 (en) | 2010-07-23 | 2012-03-01 | President And Fellows Of Harvard College | Methods for Detecting Signatures of Disease or Conditions in Bodily Fluids |
WO2012012717A1 (en) | 2010-07-23 | 2012-01-26 | President And Fellows Of Harvard College | Methods of detecting prenatal or pregnancy-related diseases or conditions |
CN103124795A (zh) | 2010-07-23 | 2013-05-29 | 哈佛大学校长及研究员协会 | 利用吞噬细胞检测疾病或病症的方法 |
EP2596116A4 (en) | 2010-07-23 | 2014-03-19 | Harvard College | METHODS FOR DETECTION OF AUTOIMMUNE OR IMMUNE-RELATED DISEASES / PATHOLOGIES |
US20140187744A1 (en) * | 2011-08-10 | 2014-07-03 | Nipro Corporation | Bilirubin Excretion Enhancer |
WO2013188828A1 (en) | 2012-06-15 | 2013-12-19 | Harry Stylli | Methods of detecting diseases or conditions using circulating diseased cells |
US20150275298A1 (en) | 2012-06-15 | 2015-10-01 | Harry Stylli | Methods of detecting diseases or conditions |
NZ771629A (en) | 2013-03-09 | 2022-12-23 | Harry Stylli | Methods of detecting cancer |
US11585814B2 (en) | 2013-03-09 | 2023-02-21 | Immunis.Ai, Inc. | Methods of detecting prostate cancer |
EP3693742B1 (en) | 2014-09-11 | 2022-04-06 | Harry Stylli | Methods of detecting prostate cancer |
US11313862B2 (en) * | 2016-03-03 | 2022-04-26 | Toagosei Co., Ltd. | Method for diagnosing amyotrophic lateral sclerosis using signal peptide as indicator |
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Also Published As
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EP2356138A2 (en) | 2011-08-17 |
EP2481749A1 (en) | 2012-08-01 |
IT1392551B1 (it) | 2012-03-09 |
WO2010061283A3 (en) | 2010-07-22 |
WO2010061283A8 (en) | 2011-07-07 |
WO2010061283A2 (en) | 2010-06-03 |
US20130196924A1 (en) | 2013-08-01 |
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