US20140234877A1 - Method for detecting a beta-specific antibodies in a biological sample - Google Patents

Method for detecting a beta-specific antibodies in a biological sample Download PDF

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US20140234877A1
US20140234877A1 US14/348,788 US201214348788A US2014234877A1 US 20140234877 A1 US20140234877 A1 US 20140234877A1 US 201214348788 A US201214348788 A US 201214348788A US 2014234877 A1 US2014234877 A1 US 2014234877A1
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aggregates
specific antibodies
antibodies
patient
sample
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Guenther Staffler
Andreas Mairhofer
Achim Schneeberger
Martina Lutterova
Walter Schmidt
Frank Mattner
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Affiris AG
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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
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/566—Immunoassay; Biospecific binding assay; Materials therefor using specific carrier or receptor proteins as ligand binding reagents where possible specific carrier or receptor proteins are classified with their target compounds
    • 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
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/564—Immunoassay; Biospecific binding assay; Materials therefor for pre-existing immune complex or autoimmune disease, i.e. systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, rheumatoid factors or complement components C1-C9
    • 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
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/46—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans from vertebrates
    • G01N2333/47—Assays involving proteins of known structure or function as defined in the subgroups
    • G01N2333/4701—Details
    • G01N2333/4709—Amyloid plaque core protein
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/28—Neurological disorders
    • G01N2800/2814—Dementia; Cognitive disorders
    • G01N2800/2821—Alzheimer

Definitions

  • the present invention relates to methods for detecting A ⁇ -specific antibodies in biological samples, especially in connection with Alzheimer's disease (AD).
  • AD Alzheimer's disease
  • AD is a complex progressive disorder that involves interacting pathological cascades, including amyloid- ⁇ aggregation and plaque formation in the brain, hyperphosphorylation of tau protein with formation of intraneuronal tangles. Concomitant to the aggregation and the hyperphosphorylation of these cerebral proteins inflammatory processes contribute to the loss of the synaptic integrity and progressive neurodegeneration.
  • amyloid ⁇ peptide (A ⁇ or A-beta) from a soluble form with mainly alpha-helical or random coil secondary structure to an aggregated form with beta-sheet secondary structure, that finally forms amyloid plaques in the brain, represents one of the first hallmarks of AD pathology.
  • a ⁇ amyloid ⁇ peptide
  • C- forms of A ⁇ , C- as well as N-terminally truncated or modified peptides, contribute to A ⁇ plaque formation in the brain.
  • the three major C-terminal variants of A ⁇ include the peptides A ⁇ 1-40 (consisting of 40 amino acids (aa) with Val-40 as last aa), A ⁇ l -42, and A ⁇ 1-43.
  • C-terminal truncated peptides Beside these major forms of C-terminal truncated peptides also other truncated forms exist that appear less frequently, namely A ⁇ 1-37, A ⁇ 1-38, and A ⁇ 1-39.
  • the N-terminal variants of A ⁇ consist of A ⁇ 3-40/42/43 and A ⁇ 11-40/42/43. In all these N-terminal truncated forms the glutamic acid holds the first position. This aa is not stable but rather undergoes a change to build the pyroglutamate (pE) resulting in the formation of A ⁇ p(E)3-40/42 and A ⁇ p(E)11-40/42.
  • pE residues are either formed spontaneously or enzymatically by enzymes known as glutaminyl cyclases.
  • AD Alzheimer's disease
  • AD Alzheimer's disease
  • the NIH-NINCDS working group kept the diagnosis of MCI (mild cognitive impairment) of the AD-type as an early stage of AD.
  • AD cerebrospinal fluid
  • the CSF of AD patients shows a typical pattern, namely reduction of A ⁇ 1-42 and elevation of total Tau (tTau) and phosphoTau (pTau).
  • the signature is present in AD patients but does not detect a change over time.
  • a population of patients at risk for AD i.e., MCI patients
  • the CSF shows the same expression pattern and amount of change as in patients with full-blown AD.
  • turning points i.e. the moment in a given patient when for example the A ⁇ physiology switches from normal to pathological.
  • the very same is true for any of the currently followed and not yet validated biomarkers.
  • the main reason for this is that there are only a few longitudinal studies assessing this issue because it is not easily possible to repeat CSF-, MRI-, amyloid-imaging examinations because of the risk they impose onto patients and/or the costs associated with them.
  • results obtained by ELISA or immunoprecipitation assays assessing IgG and/or IgM specific for various A ⁇ forms/aggregation states showed that AD- and MCI patients exhibit lower levels of serum A ⁇ auto-antibodies than healthy controls. Although these studies showed a difference in auto-antibody concentration, the used methods lack the sensitivity and specificity that would be necessary to use them as predictive diagnostic tool to identify AD- or MCI patients with high selectivity and specificity. Most of the methods used so far are based on ELISA technology. To increase the sensitivity in these assays some approaches use radioactive labelling of the A ⁇ 1-42 peptide.
  • a ⁇ -specific antibodies is reduced in disease entities with an A ⁇ component in their pathophysiology, namely Parkinson's dementia (PDD), Dementia with Lewy Bodies (DLB), Cerebral Amyloid Angiopathy (CAA), chronic head trauma (e.g., boxing). Investigation of the level of A ⁇ -aggregate-specific antibodies in these diseases could add to the present understanding of the processes that result in the reduction of the serum concentration of A ⁇ -aggregate-specific antibodies in AD.
  • PDD Parkinson's dementia
  • DLB Dementia with Lewy Bodies
  • CAA Cerebral Amyloid Angiopathy
  • boxing chronic head trauma
  • test would be a highly disease-specific biomarker and, as a result, should be helpful in differentiating AD from the aforementioned disease entities. Assuming the second scenario, the test could qualify for the identification of patients whose disease is driven by A ⁇ pathology.
  • biomarkers and methods for diagnosing AD are disclosed, especially antibodies against pGlu A ⁇ .
  • Funke et al. (Curr. Alz. Res., 6 (3) (2009): 285-289) discussed whether the detection of A ⁇ aggregates in body fluids is a suitable method for early diagnosis of AD.
  • Maetzler et al. (J. Alz. Dis. (1) (2011): 171-179) reported that autoantibodies against amyloid and glial-derived antigens are increased in serum and cerebrospinal fluid of Lewy body-associated dementias.
  • Funke et al. (Rejuv. Res. 13 (2-3) (2010): 206-209) disclosed a single-particle detection system for A ⁇ aggregates.
  • Fukumoto et al. (Faseb J., 1 (24) (2010): 2716-2726) disclosed that high-molecular weight ⁇ -amyloid oligomers are elevated in cerebrospinal fluid of AD patients.
  • AD Alzheimer's disease
  • immune-based therapies were designed to remove amyloid-beta peptide from the brain. These therapy concepts gave positive results in animal models of the disease.
  • Clinical trials of active amyloid-beta vaccination of patients with Alzheimer's disease were discontinued after some patients developed Meningoencephalitis.
  • New immunotherapies using humoral and cell-based approaches are currently being investigated for the treatment and prevention of Alzheimer's disease and also other related diseases.
  • biomarkers which monitor or evidence immune responses of the patients during treatment and development of the disease.
  • the present invention provides a method for detecting A ⁇ -specific antibodies in a biological sample comprising the following steps:
  • detecting the A ⁇ -specific antibodies bound to the A ⁇ -aggregates by a single particle detection technique, preferably by fluorescence activated cell sorting FACS.
  • a ⁇ -specific antibodies With the present invention, a new method to detect A ⁇ -specific antibodies is disclosed which can be used as diagnostic tool which is extremely helpful in monitoring the development of clinical trials using an immunotherapeutic approach to treat AD.
  • the present method is based on the invention that not just single A ⁇ peptides are used as capturing tools for the A ⁇ -specific antibodies, but that instead A ⁇ -aggregates are used and that thereby generated antibody-A ⁇ -aggregate complexes are detected using a single particle detection technique.
  • a ⁇ -aggregates (derived from different A ⁇ truncated and modified versions) are generated e.g. by overnight incubation.
  • a ⁇ -aggregates are incubated with serum samples derived either from healthy donors (HD) or from AD patients to allow binding of present antibodies (both IgG and IgM).
  • Antibodies bound to A ⁇ -aggregates can be detected by any suitable method available to a person skilled in the art, e.g. by using a labelled secondary antibody which recognises the A ⁇ -specific antibody bound to the A ⁇ -aggregates.
  • a phycoerythrin (PE)-labelled secondary antibody can be used.
  • the immune complexes comprising the A ⁇ -specific antibody bound to the A ⁇ -aggregates (and optionally one or more detection agents, such as secondary antibodies) are measured using a single particle detection technique, such as FACS (fluorescence activated cell sorting)-analysis also known as flow cytometry.
  • FACS fluorescence activated cell sorting
  • the reactivity of IgM-antibodies after demasking revealed an increased level of IgM in AD patients.
  • data are provided showing that the present method has a much higher capacity to detect A ⁇ -specific antibodies and thus has a much higher power to monitor changes of A ⁇ -specific antibody concentrations in serum samples of AD compared to methods published so far. Given these facts, the method according to the present invention fulfils the theoretical prerequisites of an appropriate method to follow the clinical response of a given patient to treatment.
  • the present invention was developed for the analysis of A ⁇ -specific antibodies in human samples. It is therefore a preferred embodiment to detect human A ⁇ -specific antibodies, preferably human IgG or IgM antibodies, especially human IgG antibodies.
  • human A ⁇ -specific antibodies preferably human IgG or IgM antibodies, especially human IgG antibodies.
  • the detection of A ⁇ -specific antibodies in human is known in principle in the art; however, the role as a possible biomarker could not be verified. As shown with the present invention, this was also due to the analytical insufficiency of the detection methods available in the art. Due to the superiority of the method according to the present invention, the availability of these antibodies in human samples as biomarkers especially for monitoring AD immunotherapy is enabled.
  • the present method is therefore specifically suited to detect antibodies in biological samples. Accordingly, in a preferred embodiment of the present method, the A ⁇ -specific antibodies to be detected and quantified are antibodies.
  • the present method uses A ⁇ -aggregates as probe for binding the A ⁇ -specific antibodies from the samples.
  • a ⁇ -aggregates are known in principle in the art, it was not realised that the use of such aggregates in the analysis of A ⁇ -specific antibodies, especially in human samples, could significantly improve such methods, also in combination with the single particles detection techniques, such as FACS. Due to the use of such aggregates, the detection with single particles detection techniques (which are established techniques in various different fields and for different questions) is possible for analysing A ⁇ -specific antibodies in human samples (such as blood) which are usually very complex and difficult to handle.
  • the dimensions of the aggregates to be used according to the present invention are standardised for analytical use. This can be done by establishing certain parameters during production of the aggregates. Depending on the conditions applied during generation of the aggregates, the size of the aggregates can be adjusted. Preferred sizes of the A ⁇ -aggregates according to the present invention are from 50 nm to 15 ⁇ m, preferably from 100 nm to 10 ⁇ m, especially from 200 nm to 5 ⁇ m (defined by the length of the aggregates (i.e. the longest extension).
  • a preferred method to provide aggregates suitable for the present invention comprises the step of incubating A ⁇ -1-42 peptides, A ⁇ -1-43 peptides, A ⁇ -3-42 or A ⁇ -p(E)3-42 peptides or less preferably to A ⁇ -peptides that are truncated at the C-terminus such as A ⁇ -1-40 peptide, at a pH of 2 to 9 for at least 20 min, preferably at least 1 h, especially at least 4 h.
  • the duration of incubation is one of the parameters to adjust the size of the aggregates: the longer the incubation, the larger are the aggregates. Typical incubation times are from 10 min to 24 h.
  • aggregates may also be sorted and “sieved” to arrive at the desired size, if needed, e.g. by fractionated centrifugation and similar techniques.
  • the samples wherein the A ⁇ -specific antibodies are to be detected are contacted with the A ⁇ -aggregates to achieve binding of the A ⁇ -specific antibodies possibly present (and reactive vis-a-vis A ⁇ -aggregates) in the samples.
  • the concentration of the A ⁇ -aggregates has therefore to be adjusted in order to provide enough binding positions for the antibodies. Accordingly, the concentration of the A ⁇ -aggregates for binding the antibodies in the sample is preferably in the range of 0.001 to 1 ⁇ M, preferably 0.01 to 0.1 ⁇ M.
  • the optimal concentration is also dependent on the nature of antibodies to be bound, the nature of the sample, the planned contact time and the size of the aggregates.
  • biological sample is human blood or a sample derived from human blood, preferably human serum or human plasma; human cerebrospinal fluid or human lymph.
  • sample sources also serial and routine testing may be established (especially for samples derived from blood).
  • Preferred contact times which allow proper binding of the antibodies in the sample to the aggregates are at least 10 min (e.g. 10 min to 48 h), preferably from 15 min to 24 h, especially from 30 min to 2 h.
  • the A ⁇ -specific antibodies which have a binding capacity to the A ⁇ -aggregates will be bound during contact with the A ⁇ -aggregates.
  • the A ⁇ -specific antibodies which are masked in the sample i.e. those antibodies which are already bound to a binding partner (e.g. an A ⁇ -comprising structure, or endogenous A ⁇ peptides)) will not be detected by the method according to the present invention (absent such specific sample pre-treatment).
  • the samples are demasked, i.e. the A ⁇ -specific antibodies are “freed” from any binding to binding partners present in the sample previous to the contact with the A ⁇ -aggregates according to the present invention.
  • This allows detection of all A ⁇ -specific antibodies in the sample and not only detection of those antibodies which are not bound to a binding partner in the sample (“free” or “reactive” antibodies).
  • the present method is, as stated above, also suitable for determining the overall amount of A ⁇ -specific antibodies in a sample, i.e. the free (or “reactive”)antibodies as well as those antibodies which are already bound (e.g. to A ⁇ structures) in the sample. This can be helpful in establishing the difference (A) of reactive vs.
  • non-reactive antibodies in a sample a parameter which might also of significant importance for AD diagnosis.
  • a demasking step prior to performance of the present method is in particular preferred, thus the difference (A) of reactive vs. non-reactive antibodies in the sample will be defined and used as relevant parameter.
  • the method according to the present invention applies a single particle detection technique.
  • Such techniques allow identifying and quantifying (“count”) the number and amount of “positive” binding results of the A ⁇ -specific antibody to the A ⁇ -aggregates.
  • a preferred embodiment of this technology is FACS which is an established technique in the present field.
  • Other detection methods to be used to detect the antibodies bound to the A ⁇ -aggregates are e.g. Luminex or mass cytometry.
  • sample preparation may be performed as described in Material and Methods following sample preparation A ⁇ -aggregates recognized by specific A ⁇ -specific antibodies may be detected by a secondary antibody coupled to fluorescent-dyed microspheres which can be detected in multiplex detecting systems e.g. a Luminex reader (Binder et al., Lupus15 (2005):412-421).
  • sample preparation may also be performed as described in Material and Methods of the example section below. Sample preparation is done as described. Following sample preparation A ⁇ -aggregates recognized by specific Abs may be detected by a secondary antibody coupled to stable isotopes of transition elements which can be detection by atomic mass spectrometry. The sample can then be sprayed through an argon plasma filled inductive coil heated to a temperature of >5,500 K. The sample is vaporized and ionized into its atomic constituents, and the number of the isotope-tagged antibody is quantified by time-of-flight mass spectrometry (Janes et al., Nat. Biotechnol. 29 (2011): 602-604).
  • a ⁇ -aggregates or antibody/serum binding partner
  • Hybcelltechnology and the Surface Plasmon Resonance technology.
  • serum samples can be spotted on the surface of the Hybcell (a rotating cylinder) and incubation can be performed with directly fluorescence-labelled preincubated A ⁇ -aggregates or alternatively with a fluorescence-labelled monoclonal A ⁇ -specific second antibody.
  • Antibodies bound to A ⁇ -aggregates are detected with a laser (Ronacher, Anagnostics Technical Note ANA-TN-005 (2010)).
  • a reverse setup can be applied: the preincubated A ⁇ -aggregates can be immobilized on a chip surface.
  • the binding of A ⁇ -specific antibodies from serum to the A ⁇ -aggregates on the chip can be detected by increase of mass on the chip surface and therefore no labelling of the binding partners is necessary.
  • a serial injection of anti-IgG-AB is possible (Cannon et al., Anal. Biochem. 328 (2004): 67-75).
  • a capture antibody can be used instead of directly immobilizing A ⁇ -aggregates to the chip surface.
  • an A ⁇ -specific antibody is immobilized on the chip surface followed by the injection of preincubated A ⁇ -aggregates. After the capturing of the aggregates serum is injected and reactivity is measured by increase of mass.
  • Detection of the binding of A ⁇ -specific antibodies to the A ⁇ -aggregates according to the present invention can be performed by any suitable method known e.g. Fluorescence Spectroscopy (Missailidis et al., Methods in Molecular Biology 248 (2003): 431-441) for detecting the A ⁇ -specific antibodies bound to the A ⁇ -aggregates by a secondary antibody (e.g. a secondary labelled anti-IgG- or anti-IgM-antibody).
  • a secondary antibody e.g. a secondary labelled anti-IgG- or anti-IgM-antibody
  • Detection of autoantibodies bound to aggregates can also be performed using substrates specifically binding antibodies such as Protein A or Protein G. Another possibility is to precipitate A ⁇ -aggregate specific autoantibodies using the A ⁇ -aggregates, wash the complex and biotinylate the antibodies. Subsequently streptavidin can then be used as second step reagent.
  • the particles having A ⁇ -aggregate like surfaces are beads with A ⁇ -aggregates immobilised on their surface, especially magnetic beads.
  • a ⁇ -specific (auto)antibodies in human patients undergoing immunotherapy are provided as markers for AD status.
  • AD patients are tested before the onset of AD treatment.
  • the A ⁇ -specific antibodies are tested in the course of the therapy (e.g. an AD vaccination therapy with a specific A ⁇ vaccine, preferably a mimotope vaccine).
  • the amount of A ⁇ -specific antibodies should then raise in the AD patients. This rise proofs the successful elicitation of an immune response on antibody level. If therefore, this level is modified in a patient with AD or subjects with a risk of developing AD or being suspected to have AD, such modification level correlates with success of AD immunotherapy.
  • a “modified” level may be a modification of the absolute number of the A ⁇ -specific antibodies or a modification of the reactivity of the totality of the A ⁇ -specific antibodies (e.g. of a given class of A ⁇ -specific antibodies (IgG, IgM, etc.). For example, increased reactive A ⁇ -specific IgG correlates with and is a marker for successful AD vaccination. On the other hand, with IgM, changes of the level of (non-reactive; i.e. bound or masked) A ⁇ -specific IgM into the other direction have a marker function with respect to AD.
  • the “initial” level of reactive A ⁇ -specific IgG when the “initial” level of reactive A ⁇ -specific IgG is set to 100%, a significant increase in reactive A ⁇ -specific IgG, e.g. an increase to 125% and higher, to 150% and higher or to 200% and higher, is indicative of a successful immunotherapy.
  • the “initial” level of A ⁇ -specific IgM when the “initial” level of A ⁇ -specific IgM is set to 100%, an increase in total IgM (reactive+unreactive) of at least 30%, e.g. at least 50% or at least 100%, in a blood sample indicates development of AD.
  • the detected amount of A ⁇ -specific antibodies is correlated to other AD status tests, especially Mini-Mental State examinations (MMSEs).
  • MMSEs Mini-Mental State examinations
  • results of an MMSE before the onset of a vaccination strategy for this patient can be compared to later MMSEs made throughout the treatment course (and thereafter) to observe no deterioration or even amelioration (indicating successful AD immunotherapy) or deterioration (indicating unsuccessful immunotherapy).
  • the MMSEs can be correlated to the course of antibody detection according to the present invention: increase of antibody amount (indicating successful AD immunotherapy) or decrease of antibody amount (indicating unsuccessful immunotherapy).
  • the method according to the present invention is therefore specifically suitable for monitoring a given AD patient with respect to the development of the treatment of the disease, especially for correlating the diagnostic results according to the present invention with other diagnostic tools for determination of the AD status and/or for monitoring the effectiveness of therapeutic interventions.
  • the method is performed at least twice on samples of the same patient taken at a different time.
  • the detected amounts of A ⁇ -specific antibodies are correlated to MMSE results of the same patient at the same times the samples were taken from the patient.
  • a ⁇ -specific antibodies in the sample for defined disease status (e.g. “healthy”, mild AD, advanced AD, or according to the MMSE scale).
  • the threshold values of course depend on the sample and on the exact detection system, but may be developed for any standardised way in which the present invention is performed.
  • the A ⁇ -specific IgG concentration in serum of healthy persons is usually between 1000 and 5000 ng/ml whereas the IgG concentration of AD patients is usually much lower, e.g. in the range of 250 to 1500 ng/ml. Most of AD patients have less than 1000 ng/ml.
  • the detection of an amount of A ⁇ -specific antibodies in the sample which is lower than a threshold level is indicative of AD, wherein the threshold level is 1500 ng/ml or lower, preferably 1000 ng/ml or lower, especially 750 ng/ml or lower.
  • the threshold level is 1500 ng/ml or lower, preferably 1000 ng/ml or lower, especially 750 ng/ml or lower.
  • rise of this IgG concentration in the course of AD treatment, especially AD treatment by immunotherapy indicates successful immunotherapy. For example, if the level rises from under 750 ng/ml to over 1000 ng/ml or even over 1500 ng/ml, this would indicate successful immunotherapy.
  • the present method is therefore specifically suited for using in connection with AD immunotherapy of a given patient in a monitoring manner over time.
  • the present invention is also usable for immunotherapies with respect to all pathologies connected to or being related to A ⁇ (“A ⁇ pathologies”), especially to pathologies where A ⁇ deposits are occurring in the course of the disease.
  • a ⁇ pathologies are Parkinson's dementia (PDD), Dementia with Lewy Bodies (DLB), Cerebral Amyloid Angiopathy (CAA), Inclusion body myositis (IBM; especially sporadic IBM (sIBM)), or chronic head trauma (e.g., boxing) (see e.g.
  • WO 2004/062556 A WO 2009/103105 A, WO 2009/149485 A, WO 2009/149486 A, WO 2009/149487 A, WO 2011/020133 A, WO2006/005707 A, WO2006/005706 A, WO 2005/025651 A, etc.).
  • the present method is therefore preferably used for the monitoring of AD patients, especially AD patients who are treated with medicaments for curing or ameliorating AD.
  • the present method can be successfully applied for observing patients in clinical trials for AD vaccines (e.g. with AD mimotopes according to WO 2004/062556 A, WO2006/005707 A, WO2009/149486 A and WO 2009/149485 A; or with A ⁇ -derived vaccines according to WO 99/27944 A) or A ⁇ -targeting disease-modifying drugs.
  • the present invention it is in principle made possible to detect changes in the immunological set-up of patients with respect to A ⁇ -specific antibodies. This makes patients eligible for early stage treatment regimens and/or prevention (or delay) strategies for AD, especially vaccinations.
  • the present invention relates to a kit for performing the method according to the present invention comprising
  • the kit according to the present invention may further contain means for detecting A ⁇ -aggregates being bound to A ⁇ -specific antibodies, preferably secondary antibodies, especially labelled secondary antibodies, e.g. anti-IgG- or anti-IgM-antibodies).
  • Further components can be standard samples, positive and/or negative controls, instructions for use and suitable packaging means (e.g. stable boxes, coloured vials, etc.).
  • FIG. 1 shows the size determination of A ⁇ -aggregates using FACS-analysis.
  • Thioflavin T positive A ⁇ 1-42 aggregates can be detected using flow cytometry and are depicted as a homogenous population in the FL1-FITC A (log-scale)- and FSC-A (log-scale) channel in the dot blot (A).
  • the size distribution (defined by FCS-A signal) of A ⁇ -aggregates was determined using commercially available calibrated size beads (1, 2, 4, 6, 10, and 15 ⁇ m) as shown in FSC-A-histogram (B).
  • FIG. 2 shows detection of monoclonal antibody reactivity to A ⁇ -aggregates using FACS-based assay.
  • the A ⁇ 1-42 monoclonal antibody 3A5 binds specifically to A ⁇ 1-42 aggregates (A) but does not interact with A ⁇ 3p(E)3-42 aggregates (C).
  • the A ⁇ p(E)3-42 specific antibody D129 binds A ⁇ p(E)3-42 but not A ⁇ 1-42 aggregates (B+D).
  • Reactivity was determined using a secondary anti immunoglobulin-PE-labelled antibody in FL2-PE-channel. Fluorescence intensity as shown in B and C represents background staining as seen when aggregates are incubated with PE-labelled secondary antibody alone.
  • FIG. 3 shows the comparison of assay sensitivity for three different methods.
  • A A ⁇ 1-42 aggregates were incubated with a dilution series of IVIG and reactivity was determined in FL-2 channel using flow cytometry.
  • B IVIG titration on Maxisorp ELISA plates coated with A ⁇ 1-42 over night at pH9.2.
  • C Label free detection of different concentrations of IVIG interacting with mainly biotinylated A ⁇ 1-42 immobilized on SA-Chip using surface plasmon resonance (BiaCore). Please note that for comparison all results are given in fold-background signal.
  • FIG. 4 shows the correlation of IgG reactivity with Mini-Mental State examination (MMSE) scores.
  • MMSE Mini-Mental State examination
  • FIG. 5A shows the determination of A ⁇ -specific IgM auto-antibody reactivity in indicated serum samples. Control sera from healthy donors, or sera derived from AD-patients were subjected to the described FACS assay. Fluorescence intensity of A ⁇ -aggregates was evaluated in FL2-PE channel and is expressed as Median Fluorescence Intensity (MFI).
  • FIG. 5B shows a ROC curve analysis. IgM specific anti-A ⁇ 1-42 reactivity from sera derived from AD patients with sera derived from healthy donors was compared.
  • FIG. 6 shows the determination of A ⁇ -specific IgM auto-antibody reactivity in indicated serum samples after antibody demasking.
  • Control sera from healthy donors (HI), or sera derived from AD-patients were subjected to the described demasking procedure and subsequent FACS assay.
  • Fluorescence intensity of A ⁇ -aggregates was evaluated in FL2-PE channel and is expressed as Median Fluorescence Intensity (MFI).
  • MFI Median Fluorescence Intensity
  • FIG. 7 shows a ROC curve analysis. IgM specific anti-A ⁇ 1-42 reactivity from sera derived from AD patients with sera derived from healthy donors was compared after auto-antibody demasking.
  • FIG. 8 shows absolute MFI values representing A ⁇ aggregate-specific IgG antibodies before, during and after vaccinations in patients treated with an AFFITOPE-vaccine.
  • a ⁇ 1-42-reactivity of sera derived from patients immunized with (Patient A) and without ALUM (Patient B) are shown. Fluorescence intensity of A ⁇ aggregates were evaluated in FL2-PE channel and are expressed as MFI.
  • FIG. 9 shows the statistical Analysis of immunoreactivity against A ⁇ 1-42-aggregates expressed in median MFI values from patients immunized with AFFITOPE-vaccine with and without Alum. Due to one extreme in the adjuvanted group a Mann-Whitney-test was performed (non-normal distribution) (A) After removal of the extreme normal distribution was given and a Student's t-test was performed (B) Both test were statistically significant (p ⁇ 0, 05).
  • the Biacore system offers a variety of chips that can be used for immobilization.
  • a streptavidin (SA) coated chip was used.
  • SA streptavidin
  • C-terminally biotinylated A ⁇ peptides purchased from Anaspec
  • a maximum of response units ⁇ 1500RU was immobilized onto flow cells whereas flow cell 1 was left empty and used as reference.
  • free biotin was used to saturate free SA binding sites on all four flow cells.
  • Different A ⁇ peptides purchased from rPeptide were diluted in 100 mM NaHCO 3 (pH 9.2) at a concentration of 5 ⁇ g/ml and coated on Maxisorp 96-well plates overnight. To prevent unspecific binding plates were blocked using 1% BSA/PBS at 37° C. for 1 h.
  • the ELISA was performed with a serial dilution of human sera samples (starting with a dilution of 1:10) or with adding IVIG in concentrations ranging from 1 mg/ml down to 10 ⁇ g/ml diluted in binding buffer (PBS/0.1% BSA/0.1% Tween20) at 37° C. for 1 h.
  • lyophilized ⁇ -amyloid peptides Prior to analysis, the lyophilized ⁇ -amyloid peptides were subjected to a disaggregation procedure.
  • lyophilized A ⁇ species were dissolved in 1% NH 4 OH (pH 11).
  • Dissolved A ⁇ peptides were subsequently aliquoted and stored at ⁇ 20° C.
  • the different A ⁇ -species were incubated at a concentration of 20 ⁇ M in an aqueous solution (pH 5) at 37° C. on shaker (350 rpm) overnight in an Eppendorf tube.
  • the formation of A ⁇ -aggregates could be confirmed by Thioflavin T (ThT) staining in FACS (FSC/FL1).
  • Aggregated A ⁇ -species were diluted to 0.15 ⁇ M in sterile filtered 0.5% BSA and pre-incubated for 30 min in a final volume of 95 ⁇ l on a 96-well plate. 5 ⁇ l of pre-diluted human plasma or Abs (in 0.5% BSA/PBS) was added to 95 ⁇ l of A ⁇ -aggregate-solution. The final dilution of plasma ranged from 1:1000 up to 1:10.000. For monoclonal antibodies, concentrations below 0.5 ⁇ g/ml were used.
  • Samples were incubated for another 45 or 60 min at RT on shaker (350 rpm) and measured on FACS Canto equipped with high-throughput sampler (HTS). Aggregates were gated in FSC/SSC and mean respectively median fluorescence intensity (MFI) was measured and evaluated in FL2-PE channel, and reactivity of ThT to A ⁇ -aggregates was measures and evaluated in FL1-FITC channel, using FACS Diva software.
  • MFI median fluorescence intensity
  • a ⁇ -aggregates including A ⁇ oligomers, fibrils and fibrillar aggregates
  • a ⁇ oligomers, fibrils and fibrillar aggregates The formation of A ⁇ -aggregates (including A ⁇ oligomers, fibrils and fibrillar aggregates) from monomeric A ⁇ has been intensively investigated under multiple conditions in the recent years. It has been found that aggregation of A ⁇ peptides is very much dependent on different conditions including pH, temperature, buffer composition and protein concentration. Aggregation starts with the formation of ⁇ -hairpins from monomers leading to soluble oligomers. Conformational transition into parallel ⁇ -sheets then leads to the formation of fibrils and fibrillar aggregates, which can be precipitated by centrifugation.
  • a ⁇ 40 and A ⁇ 42 aggregates produced at pH 7.4 comprise fibrils with a 5 nm wide filament with a slight tendency to laterally associate into bundles (into 15 to 25 nm wide filaments).
  • the length of such a single fibril lies in the range of sub-micrometer (50-100 nm) up to 10-15 ⁇ m as determined by transmission electron microscopy.
  • One characteristic of these A ⁇ fibrils is that they specifically intercalate with a fluorescent dye, the Thioflavin T (ThT).
  • a ⁇ -aggregates of different A ⁇ -peptide variants (A ⁇ 1-42, A ⁇ 3-40, and A ⁇ p(E)3-40), which intercalate with ThT, were generated. These A ⁇ -aggregates can be detected using FACS-analysis. As described in MM for this purpose seedless soluble A ⁇ peptides were incubated for 20 h at 37° C. at a concentration of 20 ⁇ M. As shown in FIG. 1A (upper panel) a clear homogenous population of ThT positive (measured as FL1 (FITC) positive signals) the FACS assay developed according to the present invention allows the analysis of the in vitro generated A ⁇ -aggregates.
  • a ⁇ -peptide variants A ⁇ 1-42, A ⁇ 3-40, and A ⁇ p(E)3-40
  • a ⁇ -aggregates defined by forward scatter FSC-A
  • FSC-A forward scatter FSC-A
  • calibrated size beads ranging from 1 to 15 ⁇ m
  • Flow Cytometry Size Calibration Kit Cat. #F-13838 by Molecular probes
  • FIG. 1 lower panel Using this analysis it was shown that the size of generated A ⁇ -aggregates ranged as expected from sub-micrometer range up to 10 ⁇ m in which most of the generated aggregates range from ⁇ 200 nm up to 3 ⁇ m.
  • a ⁇ -aggregates allow the binding of A ⁇ -specific antibodies and to determine whether such an interaction can be monitored using the here described FACS-based assay
  • a ⁇ 1-42 as well as A ⁇ p(E)3-42 aggregates were generated and were incubated with monoclonal antibodies specific either for A ⁇ 1-42 (3A5) or specific for A ⁇ p(E)3-42 (D129).
  • the monoclonal antibody 3A5 binds exclusively A ⁇ 1-42 aggregates whereas mAb D129 interacts only with the N-terminally truncated pyroglutamated A ⁇ species. This shows that the described FACS-based assay allows the detection of A ⁇ specific antibodies in a specific manner.
  • IVIG intravenous immunoglobulin
  • IgG IgG fraction extracted from plasma derived from healthy donors (human plasma from at least 1000 donors). It has been shown that IVIG preparations contain naturally occurring antibodies (auto-antibodies) specific for A ⁇ -peptides.
  • the aim of this experiment was to define and compare the detection limits of three independent detection methods (Biacore, ELISA and the FACS-based assay) for A ⁇ -reactivity of IVIG (IVIG-Subcuvia, purchased from Baxter, Austria).
  • a ⁇ 1-42 was therefore either immobilized on to the chip surface or onto Maxisorp microtiter plates for SPR or ELISA measurements, respectively.
  • a ⁇ 1-42 aggregates were generated for FACS analysis.
  • different IVIG dilutions were applied to the individual systems and either R max values in case of SPR, OD values in case of ELISA or fluorescence intensity (MFI values) in case of FACS assay were defined.
  • the FACS-based assay provided signals that were much higher than signals delivered by the other two detection methods. Not only the 1000 ⁇ g/ml (24 times BG), or 100 ⁇ g/ml (11 fold BG), but also 10 ⁇ g/ml (5 fold BG), and 1 ⁇ g/ml (almost 2 fold BG) of IVIG dilution resulted in a signal which was clearly above background. This indicates that the newly developed FACS-based assay to detect A ⁇ -specific auto-antibodies is at least 100 times more sensitive than conventional assays such as ELISA or Biacore.
  • MMSE Mini-Mental State examination
  • a ⁇ -specific auto-antibodies mainly of the IgM isotype, can be occupied with the A ⁇ antigen to build an immune complex that is stable and is circulating in the human blood (WO 2010/128139 A1; Marcello et al., 2009; Lindhagen-Persson et al., PLoS ONE 5 (2010): e13928).
  • a ⁇ antigens potentially bound to the auto-antibodies may block the reactivity of these antibodies to the in vitro generated A ⁇ -aggregates.
  • the individual sera were subjected to a demasking procedure as described in material and methods.
  • a ⁇ -1-42 aggregates were specifically induced and used for detection of antibodies specific for A ⁇ present in IVIG. These bigger molecules offer multiple antibody binding sites.
  • the resulting avidity effect (the sum of multiple synergistic low affine antibody-antigen interactions) can account for the higher sensitivity of this assay and by leading to the detection of low-affine antibodies within the IVIG fraction.
  • Reactivity of IVIG to A ⁇ -aggregates can also be explained by the existence of an epitope solely present on the aggregated form of A ⁇ .
  • An AFFITOPE-vaccine as claimed in EP 1 583 774 B1 and EP 1 679 319 B1 that is able to induce antibodies specifically targeting A ⁇ -peptides was tested in a clinical study containing two arms. Patients of cohort one were immunized with the AFFITOPE-vaccine containing an adjuvant and patients in cohort two were immunized with the AFFITOPE-vaccine lacking an adjuvant as immune response enhancer. In contrast to the non-adjuvanted vaccine, where an increase of A ⁇ -specific IgG antibodies cannot be expected, the adjuvanted vaccine should have the capacity to induce antibodies targeting A ⁇ .
  • Values shown in FIG. 8 depict the mean values of the two measurements over time.
  • FIG. 8 exemplarily the development of an A ⁇ -specific IgG antibody response in a patient derived from cohort one (patient A) and a patient immunized with a vaccine lacking the adjuvant (cohort two—patient B) are depicted.
  • MFI signals of immune sera 2 and 3 from patient A are significantly higher than fluorescence signal derived from pre-serum, indicative for increased A ⁇ -specific IgGs.
  • immune sera derived from patient B did not result in increased fluorescence signals.

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