JP2020528274A - 形質細胞疾患の検出方法 - Google Patents
形質細胞疾患の検出方法 Download PDFInfo
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Abstract
Description
本出願は、2017年7月21日に出願された米国仮出願第62/535,419号明細書の利益と優先権を主張し、その内容を参照により本明細書に援用される。
2018年7月16日に作成されたサイズが276KBの「LBIO−002_001WO Seq Listing.txt」という名前のテキストファイルの内容は、参照によりその全体が本明細書に援用される。
冠詞「a」及び「an」(単数形)は、本開示において、冠詞の文法的対象の1又は複数(すなわち、少なくとも1つ)を示すために使用される。例として、「要素」(単数形)とは、1つの要素又は複数の要素を意味する。
n=15の末梢血単核細胞サンプルからの生のプローブ強度(n=1,354,896個の特徴)を用いて、GSE7116の転写プロファイルを使用して、対照と多発性骨髄腫とを最もよく識別する遺伝子を特定した。外れ値を除去後、合計31の標的転写産物(26遺伝子、5スプライスバリアント)及び1つのハウスキーピング遺伝子が、可能性がある骨髄腫のマーカーとして公平な方法で特定された(表2、図1)。これらの遺伝子は、多発性骨髄腫細胞株IM−9(通常の2倍体核型)及びMM1R(デキサメタゾン耐性)で発現され、形質転換されたBリンパ芽球によって産生されることが実証された。
試験セット1では、対照(n=23)から活動性骨髄腫疾患の患者(n=57)を区別するための試験の有用性に関するデータが表3に含まれている。図2Bには、受信者動作曲線解析及び測定基準が含まれている。スコアは0.99の曲線下面積(AUC)を示した。測定基準としては、感度が>95%、特異度が100%、PPVが100%、NPVが88.5%である。全体の精度は96%である。したがって、このツールにより、対照と侵攻性かつ安定性骨髄腫疾患を区別できる。
効果的な治療法(n=40)により、スコアは59±14から35±12に低下し、これは完全寛解に関連していた(図6)。MRDグループの評価により、早期の時点(1年以内)に再発したすべてのスコアが高い(>40)10人の患者が特定された。したがって、MyelomXスコアにより、MRDを生化学的に定義し、進行性疾患を有し、早期の時点で再発する人を特定できる。
治療系(n=23)では、ボルテモジブ(bortemozib)(プロテアソーム阻害剤−PI)による3か月間の治療により、治療反応者のMyelomXスコアが64±9から23±12(p<0.0001)に有意に減少したが、PI治療不応性では変化しなかった(60±9、p=NS)(図7)。これは、骨髄腫におけるプロテアソーム阻害剤療法の有効性を測定するためにMyelomXスコアを使用できること、スコアの減少が治療介入への応答と相関し、非反応者を正確に特定できることを示す。
両方のデータセットのMyelomXスコアの精度を識別する混同マトリックスは、表4に含まれている。診断として、スコアは活動性疾患を識別するために97%の精度である。MRDを決定するには、全体で75%の精度であるが、1年以内に再発しない対象の場合、100%の精度である。治療反応者の場合、スコアは反応者を識別するために87%の精度であり、治療に失敗している対象又は不応性の対象の場合、97%の精度である。
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本発明は、上記の特定の実施形態に関連して説明されたが、その多くの代替、改変、及びその他の変更は、当業者には明らかであろう。そのような全ての代替、改変、及び変更は、本発明の精神及び範囲に含まれることが意図されている。
Claims (32)
- 必要とする対象において形質細胞疾患を検出する方法であって、
前記対象の試験サンプルから、前記試験サンプルを少なくとも32個のバイオマーカーの発現を検出するために特異的な複数の薬剤と接触させることにより、前記少なくとも32個のバイオマーカーの発現レベルを決定すること、前記少なくとも32個のバイオマーカーは、ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、UBE2J1、及び少なくとも1つのハウスキーピング遺伝子を含むこと;
ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、及びUBE2J1の各発現レベルを前記少なくとも1つのハウスキーピング遺伝子の発現レベルに対して正規化することにより、ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、及びUBE2J1の各正規化された発現レベルを取得すること;
各正規化された発現レベルをアルゴリズムに入力してスコアを生成すること;
前記スコアを第一の所定のカットオフ値と比較すること;及び
レポートを作成すること、前記レポートは、前記スコアが前記第一の所定のカットオフ値以上の場合に、前記対象の形質細胞疾患の存在を特定すること、又は前記スコアが前記第一の所定のカットオフ値未満の場合に、前記対象に形質細胞疾患が存在しないことを判定すること、前記第一の所定のカットオフ値は0〜100の段階で20であること、
を含む、前記方法。 - 前記形質細胞疾患が、意義不明の単クローン性γグロブリン血症(MGUS)又は骨髄腫である、請求項1に記載の方法。
- 前記少なくとも1つのハウスキーピング遺伝子は、ALG9、SEPN、YWHAQ、VPS37A、PRRC2B、DOPEY2、NDUFB11、ND4、MRPL19、PSMC4、SF3A1、PUM1、ACTB、GAPD、GUSB、RPLP0、TFRC、MORF4L1、18S、PPIA、PGK1、RPL13A、B2M、YWHAZ、SDHA、HPRT1、TOX4、及びTPT1からなる群から選択される、請求項1又は2に記載の方法。
- 90%を超える感度を有する、請求項1から3の何れか一項に記載の方法。
- 90%を超える特異性を有する、請求項1から4の何れか一項に記載の方法。
- 前記少なくとも32個のバイオマーカーのうちの少なくとも1個がRNA、cDNA、又はタンパク質である、請求項1から5の何れか一項に記載の方法。
- 前記バイオマーカーがRNAである場合、前記RNAが逆転写されてcDNAが生成され、前記生成されたcDNAの発現レベルが検出される、請求項6に記載の方法。
- 前記バイオマーカーと標識プローブ又はプライマーとの複合体を形成することにより、前記バイオマーカーの発現レベルが検出される、請求項1から7の何れか一項に記載の方法。
- 前記バイオマーカーがタンパク質である場合、前記タンパク質と標識抗体との複合体を形成することにより、前記タンパク質が検出される、請求項6に記載の方法。
- 前記標識が蛍光標識である、請求項9に記載の方法。
- 前記バイオマーカーがRNA又はcDNAである場合、前記RNA又はcDNAと標識核酸プローブ又はプライマーとの複合体を形成することにより、前記RNA又はcDNAが検出される、請求項6に記載の方法。
- 前記標識が蛍光標識である、請求項11に記載の方法。
- 前記RNA又はcDNAと前記標識核酸プローブ又はプライマーとの前記複合体がハイブリダイゼーション複合体である、請求項11に記載の方法。
- 前記試験サンプルが血液、血清、血漿、又は新生物組織(neoplastic tissue)である、請求項1から13の何れか一項に記載の方法。
- 前記第一の所定のカットオフ値が、腫瘍性疾患のない対象から得られた複数の参照サンプルに由来する、請求項1から14の何れか一項に記載の方法。
- 前記参照サンプルが血液、血清、血漿、又は非新生物組織である、請求項15に記載の方法。
- 形質細胞疾患を有すると特定された前記対象を薬物療法で治療することをさらに含む、請求項1から16の何れか一項に記載の方法。
- 治療を必要とする前記対象が、形質細胞疾患と診断された対象、少なくとも1つの形質細胞疾患の症状を有する対象、又は形質細胞疾患を発症する素因や家族歴を有する対象である、請求項1から17の何れか一項に記載の方法。
- 対象がヒトである、請求項1から18の何れか一項に記載の方法。
- 前記アルゴリズムが、XGB、RF、glmnet、cforest、CART、treebag、knn、nnet、SVM−radial、SVM−linear、NB、NNET、mlp、又はロジスティック回帰モデリングである、請求項1から19の何れか一項に記載の方法。
- 対象における形質細胞疾患が安定性であるか進行性であるかを判定する方法であって、
前記対象の試験サンプルから、前記試験サンプルを少なくとも32個のバイオマーカーの発現を検出するために特異的な複数の薬剤と接触させることにより、前記少なくとも32個のバイオマーカーの発現レベルを決定すること、前記少なくとも32個のバイオマーカーは、ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、UBE2J1、及び少なくとも1つのハウスキーピング遺伝子を含むこと;
ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、及びUBE2J1の各発現レベルを前記少なくとも1つのハウスキーピング遺伝子の発現レベルに対して正規化することにより、ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、及びUBE2J1の各正規化された発現レベルを取得すること;
各正規化された発現レベルをアルゴリズムに入力してスコアを生成すること;
前記スコアを第二の所定のカットオフ値と比較すること;及び
レポートを作成すること、前記レポートは、前記スコアが前記第二の所定のカットオフ値以上の場合に、前記形質細胞疾患が進行性であることを特定すること、又は前記スコアが前記第二の所定のカットオフ値未満の場合に、前記形質細胞疾患が安定性であることを特定すること、前記第二の所定のカットオフ値は0〜100の段階で40であること、
を含む、前記方法。 - 前記形質細胞疾患が、意義不明の単クローン性γグロブリン血症(MGUS)又は骨髄腫である、請求項21に記載の方法。
- 前記少なくとも1つのハウスキーピング遺伝子は、ALG9、SEPN、YWHAQ、VPS37A、PRRC2B、DOPEY2、NDUFB11、ND4、MRPL19、PSMC4、SF3A1、PUM1、ACTB、GAPD、GUSB、RPLP0、TFRC、MORF4L1、18S、PPIA、PGK1、RPL13A、B2M、YWHAZ、SDHA、HPRT1、TOX4、及びTPT1からなる群から選択される、請求項21又は22に記載の方法。
- 形質細胞疾患を有する対象の疾患再発のリスクを判定する方法であって、
治療後の前記対象の試験サンプルから、前記試験サンプルを少なくとも32個のバイオマーカーの発現を検出するために特異的な複数の薬剤と接触させることにより、前記少なくとも32個のバイオマーカーの発現レベルを決定すること、前記少なくとも32個のバイオマーカーは、ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、UBE2J1、及び少なくとも1つのハウスキーピング遺伝子を含むこと;
ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、及びUBE2J1の各発現レベルを前記少なくとも1つのハウスキーピング遺伝子の発現レベルに対して正規化することにより、ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、及びUBE2J1の各正規化された発現レベルを取得すること;
各正規化された発現レベルをアルゴリズムに入力してスコアを生成すること;
前記スコアを第三の所定のカットオフ値と比較すること;及び
レポートを作成すること、前記レポートは、前記スコアが前記第三の所定のカットオフ値以上の場合に、前記対象は疾患再発のリスクが高いことを特定すること、又は前記スコアが前記第三の所定のカットオフ値未満の場合に、前記対象は疾患再発のリスクは低いことを特定すること、前記第三の所定のカットオフ値は0〜100の段階で40であること、
を含む、前記方法。 - 前記形質細胞疾患が、意義不明の単クローン性γグロブリン血症(MGUS)又は骨髄腫である、請求項24に記載の方法。
- 前記少なくとも1つのハウスキーピング遺伝子は、ALG9、SEPN、YWHAQ、VPS37A、PRRC2B、DOPEY2、NDUFB11、ND4、MRPL19、PSMC4、SF3A1、PUM1、ACTB、GAPD、GUSB、RPLP0、TFRC、MORF4L1、18S、PPIA、PGK1、RPL13A、B2M、YWHAZ、SDHA、HPRT1、TOX4、及びTPT1からなる群から選択される、請求項24又は25に記載の方法。
- 形質細胞疾患を有する対象による治療に対する反応を判定する方法であって、
第一の時点で前記対象の第一の試験サンプルから、前記第一の試験サンプルを少なくとも31個のバイオマーカーの発現を検出するために特異的な複数の薬剤と接触させることにより、前記少なくとも31個のバイオマーカーの第一の発現レベルを決定すること、前記少なくとも31個のバイオマーカーは、ASXL1、BHLHE40、BTG2、COPA、FBXW7、GNA13、IL8、JMJD1C、LARS2、MALAT1、MBNL1、MCL1、NFKBIZ(2つのスプライスバリアント)、NR4A1(2つのスプライスバリアント)、PDE4B、P1AS2、PRKAA1(2つのスプライスバリアント)、SCYL2(2つのスプライスバリアント)、SMARCD2、SP1(2つのスプライスバリアント)、SRSF5、TAGAP、TANK、TLE4、TSC22D3、及びUBE2J1を含むこと;
第二の時点で前記対象の第二の試験サンプルから、前記第二の試験サンプルを前記少なくとも31個のバイオマーカーの発現を検出するために特異的な複数の薬剤と接触させることにより、前記少なくとも31個のバイオマーカーの第二の発現レベルを決定すること、前記第二の時点は、前記第一の時点後であり、前記対象への前記治療の実施後であること;
前記第一の発現レベルを前記第二の発現レベルと比較すること;及び
レポートを作成すること、前記レポートは、前記第一の発現レベルと比較して前記第二の発現レベルが有意に低下した場合、前記対象が前記治療に反応性を有することを特定すること、
を含む、前記方法。 - 前記第一の時点が、前記対象への前記治療の実施前である、請求項27に記載の方法。
- 前記第一の時点が、前記対象への前記治療の実施後である、請求項27に記載の方法。
- 前記治療が標的療法を含む、請求項27から29の何れか一項に記載の方法。
- 前記標的療法がプロテアソーム阻害剤を含む、請求項30に記載の方法。
- 前記第二の発現レベルが前記第一の発現レベルよりも少なくとも25%低い場合、前記第一の発現レベルと比較して前記第二の発現レベルが有意に減少している、請求項27から31の何れか一項に記載の方法。
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