US20150126385A1 - Biomarker-based methods and biochips for aiding the diagnosis of stroke - Google Patents

Biomarker-based methods and biochips for aiding the diagnosis of stroke Download PDF

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US20150126385A1
US20150126385A1 US14/361,880 US201214361880A US2015126385A1 US 20150126385 A1 US20150126385 A1 US 20150126385A1 US 201214361880 A US201214361880 A US 201214361880A US 2015126385 A1 US2015126385 A1 US 2015126385A1
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stroke
vcam
biomarkers
crp
fabp
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John LaMont
Ivan Mc Connell
Peter Fitzgerald
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Randox Laboratories Ltd
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    • G01N33/6803—General methods of protein analysis not limited to specific proteins or families of proteins
    • G01N33/6842—Proteomic analysis of subsets of protein mixtures with reduced complexity, e.g. membrane proteins, phosphoproteins, organelle proteins
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    • 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
    • G01N33/6863—Cytokines, i.e. immune system proteins modifying a biological response such as cell growth proliferation or differentiation, e.g. TNF, CNF, GM-CSF, lymphotoxin, MIF or their receptors
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    • C12Q2600/00—Oligonucleotides characterized by their use
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    • G01N2333/46—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans from vertebrates
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    • G01N2333/52—Assays involving cytokines
    • G01N2333/54—Interleukins [IL]
    • G01N2333/5412—IL-6
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    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/70503—Immunoglobulin superfamily, e.g. VCAMs, PECAM, LFA-3
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    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/70503—Immunoglobulin superfamily, e.g. VCAMs, PECAM, LFA-3
    • G01N2333/70525—ICAM molecules, e.g. CD50, CD54, CD102
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    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
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    • G01N2333/70542—CD106
    • G—PHYSICS
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    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
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    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/7056—Selectin superfamily, e.g. LAM-1, GlyCAM, ELAM-1, PADGEM
    • G01N2333/70564—Selectins, e.g. CD62
    • G—PHYSICS
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    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/70578—NGF-receptor/TNF-receptor superfamily, e.g. CD27, CD30 CD40 or CD95
    • G—PHYSICS
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    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/715—Assays involving receptors, cell surface antigens or cell surface determinants for cytokines; for lymphokines; for interferons
    • G01N2333/7151—Assays involving receptors, cell surface antigens or cell surface determinants for cytokines; for lymphokines; for interferons for tumor necrosis factor [TNF]; for lymphotoxin [LT]
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    • 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
    • G01N2800/2871—Cerebrovascular disorders, e.g. stroke, cerebral infarct, cerebral haemorrhage, transient ischemic event
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
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    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/60—Complex ways of combining multiple protein biomarkers for diagnosis

Definitions

  • Stroke is the third leading cause of death worldwide and can be defined as the rapidly developing loss of brain function(s) due to interruption in the blood supply to the brain. According to the World Health Organization, 15 million people per year suffer stroke worldwide, with 5 million dying and a further 5 million being permanently disabled. High blood pressure is estimated to be a contributing factor in 12.7 million of these 15 million stroke cases. In the UK, approximately 150,000 people have a stroke each year and stroke accounts for around 53,000 deaths per year. Stroke costs the economy an estimated £8 billion per year in England alone and stroke patients occupy approximately 20 percent of all acute hospital beds and 25 percent of long term beds. Stroke can be classified into three subtypes:
  • IS and TIA account for approximately 85% of all stroke cases and HS accounts for 15%.
  • appropriate treatment can be administered.
  • TPA tissue plasminogen activator
  • TPA tissue plasminogen activator
  • Such therapy is only warranted in IS and is detrimental in HS.
  • the nature of TIA does not require such therapy and blood thinners such as warfarin and aspirin are prescribed in such cases.
  • CT computerised tomography
  • a CT scan has good sensitivity for identifying HS patients (approximately 90% sensitivity) but poor sensitivity for identifying IS and TIA patients (approximately 20% sensitivity).
  • CT scanning is ineffective as a diagnostic technique.
  • Magnetic Resonance Imaging (MRI) has improved sensitivity for IS diagnosis (up to approximately 80%) but increased time requirements, machine accessibility, and high cost have limited its use for stroke diagnosis.
  • EP1419388 discloses data that distinguishes IS from HS and all stroke types from non-stroke controls. However, none have thus far found use in clinical practice and there is a real clinical need for biomarkers of all three stroke sub-types that have high sensitivity and specificity to enable accurate diagnosis.
  • the present invention provides a method for diagnosing stroke in a patient suspected of having a stroke, comprising determining the concentration of at least two biomarkers in an in vitro sample obtained from the patient and establishing the significance of the concentration of the biomarkers by comparing the concentration value for each biomarker with a corresponding control value, wherein the at least two biomarkers are selected from ICAM-1, L-selectin, P-selectin, VCAM-1, IL-6, sTNFR1, D-dimer and CRP, and wherein at least one of the two biomarkers is selected from ICAM-1, L-selectin, P-selectin and VCAM-1.
  • the present invention provides a substrate comprising probes for at least two biomarkers selected from ICAM-1, L-selectin, P-selectin, VCAM-1, IL-6, sTNFR1, D-dimer and CRP for use in a method according to the first aspect of the invention, wherein the substrate comprises a probe for at least one of ICAM-1, L-selectin, P-selectin and VCAM-1.
  • the invention is directed to the use of a substrate according to the second aspect in a method for diagnosing stroke according to the first aspect.
  • the present prevention provides a method of aiding the diagnosis of ischaemic stroke in a patient suspected of having a stroke, comprising
  • This method can be used to differentially diagnose between ischemic stroke and a transient ischaemic attack.
  • the present invention provides a substrate comprising probes for VCAM-1 and at least one other biomarker selected from h-FABP, IL-6 and CRP for use in a method according to the fourth aspect of the invention.
  • the invention is directed to the use of a substrate according to the fifth aspect in a method for diagnosing stroke according to the fourth aspect.
  • FIG. 1 is a graph showing the concentration of VCAM-1 for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 2 is a graph showing the concentration of ICAM-1 for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 3 is a graph showing the concentration of E-selectin for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 4 is a graph showing the concentration of P-selectin for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 5 is a graph showing the concentration of L-selectin for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 6 is a graph showing the concentration of IL-6 for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 7 is a graph showing the concentration of sTNFR1 for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 8 is a graph showing the concentration of NGAL for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 9 is a graph showing the concentration of D-dimer for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 10 is a graph showing the concentration of TM for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 11 is a graph showing the concentration of CRP for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 12 is a graph showing the concentration of h-FABP for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 13 is a graph showing the concentration of diluted CRP for all stroke patients, each stroke sub-type and the control subjects;
  • FIG. 14 is a ROC curve for VCAM-1 (all stroke v control).
  • FIG. 15 is a ROC curve for ICAM-1 (all stroke v control).
  • FIG. 16 is a ROC curve for P-selectin (all stroke v control).
  • FIG. 17 is a ROC curve for L-selectin (all stroke v control).
  • FIG. 18 is a ROC curve for IL-6 (all stroke v control).
  • FIG. 19 is a ROC curve for sTNFR1 (all stroke v control).
  • FIG. 20 is a ROC curve for CRP (all stroke v control).
  • FIG. 21 is a ROC curve for NGAL (all stroke v control).
  • FIG. 22 is a ROC curve for D-dimer (all stroke v control).
  • the present invention relates to biomarker-based methods and biochips that can be used for rapid diagnosis of stroke, and furthermore to aid discrimination between the three stroke sub-types: haemorrhagic stroke (HS), ischemic stroke (IS) and transient ischemic attack (TIA).
  • HS haemorrhagic stroke
  • IS ischemic stroke
  • TIA transient ischemic attack
  • stroke encompasses all three forms of stroke.
  • references herein to ‘a patient suspected of having a stroke’ or ‘having had a stroke’ include a patient who is suspected of currently suffering from a stroke or who is suspected of having previously had a stroke.
  • the stroke may have been a recent event, such an event having initiated the process of the individual seeking clinical help.
  • subject and “patient” may be used interchangeably herein and refer to a mammal including a non-primate (e.g. a cow, pig, horse, dog, cat, rat and mouse) and a primate (e.g. a monkey and human).
  • a non-primate e.g. a cow, pig, horse, dog, cat, rat and mouse
  • a primate e.g. a monkey and human
  • the subject or patient is a human.
  • biomarker refers to a molecule present in a biological sample obtained from a patient, the concentration of which in said sample may be indicative of a pathological state.
  • biomarkers that have been found to be useful in diagnosing stroke and stroke sub-types, either alone or in combination with other diagnostic methods, or as complementary biomarkers in combination with other biomarkers, are described herein.
  • complementary biomarker refers to a biomarker that can be used in conjunction with other stroke biomarkers to support diagnosis.
  • biomarker normal or ‘background’ concentrations may exhibit slight variation due to, for example, age, gender or ethnic/geographical genotypes.
  • the cut-off value used in the methods of the invention may also slightly vary due to optimization depending upon the target patient/population.
  • the biological sample obtained from a patient is preferably a blood, serum or plasma sample.
  • the term ‘in vitro’ has its usual meaning in the art and refers to a sample that has been removed from a patient's body.
  • a blood sample is taken from the patient for analysis, whole blood, serum or plasma is analysed.
  • Analysis of the blood sample can be by way of several analytical methodologies such as mass spectrometry linked to a pre-separation step such as chromatography.
  • the preferred methodology is based on immuno-detection. Immuno-detection technology is also readily incorporated into transportable or hand-held devices for use outside of the clinical environment.
  • a quantitative immunoassay such as a Western blot or ELISA can be used to detect the amount of protein.
  • a preferred method of analysis comprises using a multi-analyte biochip which enables several proteins to be detected and quantified simultaneously. 2D Gel Electrophoresis is also a technique that can be used for multi-analyte analysis.
  • a first aspect of the invention provides a method for diagnosing stroke in a patient suspected of having a stroke, comprising determining the concentration of at least two biomarkers in an in vitro sample obtained from the patient and establishing the significance of the concentration of the biomarkers by comparing the concentration value for each biomarker with a corresponding control value, wherein the at least two biomarkers are selected from ICAM-1, L-selectin, P-selectin, VCAM-1, IL-6, sTNFR1, D-dimer and CRP, and wherein at least one of the two biomarkers is selected from ICAM-1, L-selectin, P-selectin and VCAM-1.
  • the at least two biomarkers are selected from (i) ICAM-1 or VCAM-1 and (ii) L-selectin or P-selectin, and more preferably they are ICAM-1 and L-selectin. Combinations of three or more biomarkers are also preferred as they show the highest sensitivity and specificity.
  • the method further comprises determining the sample concentration of one or more biomarkers selected from IL-6, sTNFR1, D-dimer and CRP.
  • the method may also further comprise determining the sample concentration of h-FABP.
  • stroke refers to ‘all stroke’ (i.e. all three stroke sub-types).
  • Preferred biomarker combinations are those listed in Table 1 or Table 2. These tables provide sensitivity, specificity and AUC data for different biomarker combinations for stoke v control.
  • VCAM-1 Lsel D-dimer NGAL 93.9 90.0 0.968 142.
  • Psel Lsel IL-6 NGAL 93.9 85.0 0.953 147.
  • ICAM1 + FABP 92.9 93.3 0.964 3.
  • PSel + FABP 95.9 91.7 0.981 4.
  • LSel + FABP 91.8 95.0 0.970 5.
  • VCAM1 + ICAM1 + FABP 92.9 93.3 0.965 6.
  • VCAM1 + PSel + FABP 95.9 91.7 0.983 7.
  • VCAM1 + Lsel + FABP 92.9 96.7 0.971 8.
  • VCAM1 + IL6 + FABP 90.8 95.0 0.961 9.
  • VCAM1 + CRP + FABP 89.8 95.0 0.960 10.
  • VCAM1 + DDimer + FABP 90.8 95.0 0.963 11.
  • IL6 + DDimer+ FABP 89.8 93.3 0.963 30.
  • IL6 + sTNFRI + FABP 89.8 91.7 0.963 32.
  • LSel + DDimer + FABP 90.8 93.3 0.973 33.
  • LSel + NGAL + FABP 95.9 93.3 0.989 34.
  • FABP + CRP + NGAL 95.9 93.3 0.985 37.
  • Biomarker concentrations can be determined by contacting the sample with a substrate having probes specific for each of the biomarkers included in the combination of biomarkers. Interactions between a biomarker and its respective probe can be monitored and quantified using various techniques that are well-known in the art. Biomarker concentrations are preferably measured in ng/ml.
  • a solid state device is used in the methods of the present invention, preferably the Biochip Array Technology system (BAT) (available from Randox Laboratories Limited). More preferably, the Evidence Evolution and Evidence Investigator apparatus (available from Randox Laboratories) may be used to determine the levels of biomarkers in the sample.
  • BAT Biochip Array Technology system
  • the Evidence Evolution and Evidence Investigator apparatus available from Randox Laboratories may be used to determine the levels of biomarkers in the sample.
  • Control values are derived from the concentration of corresponding biomarkers in a biological sample obtained from an individual or individuals who have not undergone a stroke. Such individual(s) who have not undergone stroke may be, for example, healthy individuals, individuals suffering from diseases other than stroke. Alternatively, the control values may correspond to the concentration of each of the biomarker in a sample obtained from the patient prior to the stroke event.
  • corresponding biomarkers means that concentrations of the same combination of biomarkers that are determined in respect of the patient's sample are also used to determine the control values. For example, if the concentration of ICAM-1 and L-selectin in the patient's sample is determined, then the concentration of ICAM-1 and L-selectin in the control sample will also be determined.
  • each of the patient and control biomarker concentration values is inputted into one or more statistical algorithms to produce an output value that indicates whether a stroke has occurred.
  • cut-off concentrations or values are derived using a statistical technique; various different methods are available for developing statistical algorithms and are well-known to those skilled in the art.
  • a standard method of biomarker statistical analysis is to use univariate methods to compare biomarker levels in various groups and highlight those biomarkers whose concentrations significantly differ across and between particular groups.
  • ROC receiver operating characteristics
  • a suitable mathematical model such as logistic regression equation
  • the logistic regression equation might include other variables such as age and gender of patient.
  • the ROC curve can be used to assess the accuracy of the logistic regression model.
  • the logistic regression equation can be used independently or in an algorithm to aid clinical decision making. Although a logistic regression equation is a common mathematical/statistical procedure used in such cases and is preferred in the context of the present invention, other mathematical/statistical procedures can also be used.
  • a logistic regression equation applicable to the present invention (at a classification cut-off value of 0.5) for the biomarker combination ICAM-1, L-selectin, D-dimer and sTNFR1 for indication of stroke versus non-stroke (control) in a patient suspected of having had or currently experiencing a stroke is calculated as follows:
  • [ICAM-1], [L-selectin], [D-dimer] and [sTNFRI] are the concentrations of ICAM-1, L-selectin, D-dimer and sTNFRI measured in a blood sample taken from the patient (see number 118 of Table 1 for AUC value).
  • the patient should be treated accordingly.
  • thrombolytic therapy such as tissue plasminogen activator (TPA) can be administered to break-down clots.
  • TPA tissue plasminogen activator
  • blood thinners such as warfarin and aspirin may be prescribed.
  • the method according to the first aspect of the invention may optionally include carrying out additional steps for differentially diagnosing between IS and TIA as defined in the fourth aspect of this invention.
  • a second related aspect of the invention provides a substrate comprising probes for at least two biomarkers selected from ICAM-1, L-selectin, P-selectin, VCAM-1, IL-6, sTNFR1, D-dimer and CRP for use in a method for diagnosing stroke in a patient according to the first aspect of the invention, wherein the substrate comprises a probe for at least one of ICAM-1, L-selectin, P-selectin and VCAM-1.
  • the substrate may further comprise a probe for h-FABP.
  • the substrate has at least two probes immobilised thereon, more preferably three, four or more probes, wherein each probe is specific to an individual biomarker.
  • the term ‘specific’ means that the probe binds only to one of the biomarkers of the invention, with negligible binding to other biomarkers of the invention or to other analytes in the biological sample being analysed. This ensures that the integrity of the diagnostic assay and its result using the biomarkers of the invention is not compromised by additional binding events.
  • the substrate can be any substance able to support one or more probes, but is preferably a biochip.
  • a biochip is a planar substrate that may be, for example, mineral or polymer based, but is preferably ceramic.
  • identifying the various biomarkers/proteins of the invention it will be apparent to the skilled person that as well as identifying the full length protein, the identification of a fragment or several fragments of a protein is possible, provided this allows accurate identification of the protein.
  • a preferred probe of the invention is a polyclonal or monoclonal antibody, other probes such as aptamers, molecular imprinted polymers, phages, short chain antibody fragments and other antibody-based probes may be used.
  • a substrate according to the second aspect is used in the method according to the first aspect of the invention.
  • kits comprising probes for at least two biomarkers selected from ICAM-1, L-selectin, P-selectin, VCAM-1, IL-6, sTNFR1, D-dimer and CRP, additional reagents, substrate/reaction surfaces and/or instructions for use.
  • Such kits can be used to diagnose stroke in a patient a according to the first aspect of the invention.
  • a fourth aspect of the present invention provides a method of aiding the diagnosis of ischaemic stroke in a patient suspected of having a stroke, comprising
  • ii) establishing the significance of the concentration of the biomarkers by comparing the concentration value for each biomarker with a corresponding control value, wherein the corresponding control value is the concentration value for the corresponding biomarker determined from an in vitro sample obtained from a transient ischaemic attack patient or patients.
  • this method can be used to differentially diagnose between ischemic stroke and a transient ischaemic attack.
  • biomarkers or biomarker combinations can be used alone or as complementary biomarkers.
  • Preferred biomarker combinations can be identified from the data in Table 4.
  • the control values can be established by measuring the concentration of the biomarkers VCAM-1 and one or more h-FABP, IL-6 and CRP in one or more patients clinically diagnosed as having, or having had, a TIA.
  • the diagnosis may be derived using techniques such as clinician examination and neuroimaging analysis (which would rule out the possibility of HS).
  • Biomarker concentrations can be determined by contacting the sample with a substrate having probes specific for each of the biomarkers included in the combination of biomarkers. Interactions between biomarker and its respective probe can be monitored and quantified using various techniques that are well-known in the art.
  • each of the patient and control biomarker concentration values is inputted into one or more statistical algorithms to produce an output value that indicates whether ischemic stroke has occurred.
  • the following concentrations support the diagnosis of IS in the patient: h-FABP about 10 ng/ml; VCAM-1 ⁇ about 570 ng/ml; CRP ⁇ about 30 ⁇ g/ml; and IL-6 ⁇ about 12 ⁇ g/ml.
  • biomarker normal or ‘background’ concentrations may exhibit slight variation due to, for example, age, gender or ethnic/geographical genotypes.
  • the cut-off value used may also slightly vary due to optimisation depending upon the target patient/population.
  • the cut-off concentrations or values are usually derived using statistical techniques.
  • a standard method of biomarker statistical analysis is to use univariate methods to compare biomarker levels in various groups and highlight those biomarkers whose concentrations significantly differ between particular groups. This is followed by Receiver Operator Characteristic (ROC) analysis.
  • ROC Receiver Operator Characteristic
  • a ROC curve is a preferred method of assessing the accuracy of a diagnostic test. It also provides a measure of the predictive power of the test in the form of the area under the curve (AUC), which can have values of 0.5 to 1.0.
  • AUC area under the curve
  • a test with a sensitivity of about 80% or more and a specificity of about 80% or more is regarded in the art as a test of potential use, although these values vary according to the clinical application.
  • a logistic regression equation can be derived for any test involving two or more biomarkers.
  • the logistic regression equation may include other variables, such as the age and gender of the patient.
  • the ROC curve can be used to assess the accuracy of the logistic regression model.
  • the logistic regression equation can be used independently or in an algorithm to aid clinical decision making. Although a logistic regression equation is a common mathematical/statistical tool, other mathematical/statistical procedures are well known in the art and can be used in accordance with the present invention.
  • the outcome of carrying out the method according to this aspect of the invention will be a diagnosis of either IS or TIA and the patient should then be treated accordingly. If as a result of carrying out the method of the invention it is determined that the patient has suffered an IS, appropriate treatment such as thrombolytic therapy (e.g. tissue plasminogen activator (TPA)) can be administered to break-down clots. This may be administered in conjunction with other appropriate therapies, as determined by a physician. If as a result of carrying out the method of the invention it is determined that the patient has suffered a TIA, blood thinners such as warfarin and aspirin may be prescribed and administered.
  • thrombolytic therapy e.g. tissue plasminogen activator (TPA)
  • TPA tissue plasminogen activator
  • blood thinners such as warfarin and aspirin may be prescribed and administered.
  • a related fifth aspect of the invention provides a substrate comprising probes for VCAM-1 and at least one other biomarker selected from h-FABP, IL-6 and CRP for use in a method for aiding the diagnosis of ischaemic stroke in a patient according to the present invention.
  • the substrate comprises at least two, preferably three or four probes, each probe specific to an individual biomarker.
  • the term ‘specific’ means that the probe binds only to one of the biomarkers of the invention, with negligible binding to other biomarkers of the invention or to other analytes in the biological sample being analysed. This ensures that the integrity of the diagnostic assay and its result using the biomarkers of the invention is not compromised by additional binding events.
  • the substrate can be any substance able to support one or more probes, but is preferably a biochip.
  • a biochip is a planar substrate that may be, for example, mineral or polymer based, but is preferably ceramic.
  • identifying the various biomarkers/proteins of the invention it will be apparent to the skilled person that as well as identifying the full length protein, the identification of a fragment or several fragments of a protein is possible, provided this allows accurate identification of the protein.
  • a preferred probe of the invention is a polyclonal or monoclonal antibody, other probes such as aptamers, molecular imprinted polymers, phages, short chain antibody fragments and other antibody-based probes may be used.
  • a solid state device is used in the methods of the present invention, preferably the Biochip Array Technology system (BAT) (available from Randox Laboratories Limited). More preferably, the Evidence Evolution and Evidence Investigator apparatus (available from Randox Laboratories) may be used to determine the levels of biomarkers in the sample.
  • BAT Biochip Array Technology system
  • the Evidence Evolution and Evidence Investigator apparatus available from Randox Laboratories may be used to determine the levels of biomarkers in the sample.
  • a substrate according to the fifth aspect is used in the method according to the fourth aspect of the invention.
  • kits comprising probes for VCAM-1 and at least one other biomarker selected from h-FABP, IL-6 and CRP, additional reagents, substrate/reaction surfaces and/or instructions for use.
  • Such kits can be used to diagnose IS in a patient according to the third aspect of the invention.
  • a further aspect of the invention is directed to the use of one or more of h-FABP, sTNFR1, IL-6, D-dimer, L-selectin, P-selectin, ICAM-1, VCAM-1 and CRP as complementary biomarkers of stroke or stroke sub-type.
  • complementary biomarkers they may be used for stroke/stroke sub-type diagnosis in conjunction with proteins such as DJ-1, BNP, S100 ⁇ , MMP-9, MCP-1, ApoC1, ApoC3, von Willebrand factor, NMDA receptors, ADMA and Lp-PLA2.
  • the following proteins were tested against EDTA plasma samples of blood obtained from the patients of the study group: ICAM-1, VCAM-1, E-selectin, L-selectin, P-selectin, IL-6, h-FABP, CRP, D-dimer, sTNFR1, TM and NGAL.
  • the proteins were detected and quantified using multiplexed biochips incorporating biomarker-specific antibodies and the Evidence Investigator (Randox Laboratories Ltd, Crumlin, UK). The simultaneous immunoassays were performed according to manufacturer's instructions. A nine-point calibration curve and three reference controls were assayed for each biomarker to allow validation of results. For CRP IS vs TIA analysis, samples were diluted tenfold.
  • the Kruskal-Wallis test (significance limit 0.05) was used to identify analytes that were differentially expressed across the four groups (IS, HS, TIA and C). Post-hoc comparisons between the different groups were carried out using the Holm's sequential Bonferroni adjustment. Mann-Whitney test was used to compare ‘All Stroke’ and ‘Control’. The results are shown in FIGS. 1-13 .
  • Tables 1 and 2 detail the sensitivity, specificity and statistical power (AUC) of exemplary combinations of biomarkers for diagnosing stroke (all stroke v control).
  • AUC sensitivity, specificity and statistical power
  • the diagnosis will be of either an IS or TIA i.e. it will not be able to discriminate between these two stroke subtypes. Therefore, the specificity of the test should be as close to 100% as possible.
  • the sensitivity of the test should be of sufficient magnitude to be of value to the patient and be economically viable.
  • Table 3 shows the statistical analysis of analyte concentrations in patients who suffered TIA, IS and HS using Mann-Whitney and Kruskal-Wallis tests.
  • Table 4 shows the ROC curve analysis (sensitivity and specificity values) of individual and grouped biomarkers for IS vs TIA. As can be seen, each of the biomarkers has 100% specificity and equal or greater sensitivity than the commonly used CAT scan. This facilitates clinical diagnosis and informs subsequent treatment decisions of suspected stroke patients in an economical and expeditious manner.
  • a biological fluid sample is taken from the individual and tested for all stroke types using biomarkers of the invention—a positive stroke result is confirmed and further stratified into HS or IS/TIA following examination of the individual by a clinician and analysis using a CAT scan. If HS is ruled out, a further biomarker test is implemented to delineate IS/TIA.
  • at the hospital examination by a clinician is preceded by stroke biomarker analysis of a biological fluid sample taken from the individual in association with a CAT scan examination—if HS is ruled out, a further biomarker test is implemented to delineate IS/TIA.
  • IL-6 interleukin-6 ICAM-1—intracellular adhesion molecule-1
  • VCAM-1 vascular cell adhesion molecule-1
  • CRP C-reactive protein
  • h-FABP human fatty acid binding protein s
  • TNFR soluble TNF ⁇ receptor
  • TM thrombomodulin
  • NGAL neurotrophil-associated gelatinase lipocalin
  • MMP-9 matrix metalloproteinase-9
  • ADMA asymmetric dimethylarginine
  • Lp-PLA2 lipoprotein-associated phospholipase A2

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018229144A1 (fr) * 2017-06-14 2018-12-20 Randox Laboratories Ltd Combinaisons destinées à être utilisées dans le diagnostic d'accident vasculaire cérébral
WO2018229051A1 (fr) 2017-06-13 2018-12-20 Roche Diagnostics Gmbh Protéine 3 de liaison à l'acide gras permettant l'évaluation de la fibrillation auriculaire (af)

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB201309928D0 (en) * 2013-06-04 2013-07-17 Randox Lab Ltd Method
JP6312302B2 (ja) * 2014-01-06 2018-04-18 公益財団法人ヒューマンサイエンス振興財団 脳梗塞の診断マーカー
GB2563414A (en) * 2017-06-14 2018-12-19 Randox Laboratories Ltd Improvements in stroke diagnostics
JP6499342B2 (ja) * 2018-03-19 2019-04-10 隆樹 日和佐 脳梗塞の診断マーカー
KR102299968B1 (ko) * 2019-11-19 2021-09-09 경북대학교 산학협력단 혈액성분 분리용 다중필터 및 그를 이용한 질병 진단키트

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5474796A (en) * 1991-09-04 1995-12-12 Protogene Laboratories, Inc. Method and apparatus for conducting an array of chemical reactions on a support surface
US6879010B2 (en) * 2001-10-02 2005-04-12 Royce Technologies Llc Ceramic biomolecule imaging chip
US7392140B2 (en) * 2003-09-23 2008-06-24 Prediction Sciences, Llc Cellular fibronectin as a diagnostic marker in stroke and methods of use thereof

Family Cites Families (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5879010A (en) 1997-07-22 1999-03-09 Green Tweed Of Delaware, Inc. Seal assembly with mechanically joined anti-extrusion rings
GB9929140D0 (en) 1999-12-10 2000-02-02 Univ Geneve Diagnostic assay for stroke
AU2001280996A1 (en) 2000-08-04 2002-02-18 Cis Biotech, Inc. Rapid multiple panel of biomarkers in laboratory blood tests for tia/stroke
AUPR005600A0 (en) * 2000-09-12 2000-10-05 University Of Sydney, The Diagnostic assay
US7427490B2 (en) * 2001-08-20 2008-09-23 Biosite Incorporated Diagnostic markers of stroke and cerebral injury and methods of use thereof
US7713705B2 (en) * 2002-12-24 2010-05-11 Biosite, Inc. Markers for differential diagnosis and methods of use thereof
US20030199000A1 (en) * 2001-08-20 2003-10-23 Valkirs Gunars E. Diagnostic markers of stroke and cerebral injury and methods of use thereof
US20040253637A1 (en) * 2001-04-13 2004-12-16 Biosite Incorporated Markers for differential diagnosis and methods of use thereof
EP2341350B1 (fr) * 2003-09-20 2017-11-08 Electrophoretics Limited Methode de diagnostic de troubles associes a des lesions cerebrales basee sur la detection de dj-1
US7634360B2 (en) * 2003-09-23 2009-12-15 Prediction Sciences, LL Cellular fibronectin as a diagnostic marker in stroke and methods of use thereof
US20050181386A1 (en) * 2003-09-23 2005-08-18 Cornelius Diamond Diagnostic markers of cardiovascular illness and methods of use thereof
US20060099608A1 (en) * 2004-03-29 2006-05-11 Medstar Research Institute Methods of diagnosing cardiovascular disease
WO2007124439A2 (fr) * 2006-04-21 2007-11-01 Rules-Based Medicine, Inc. Procédés et kits de diagnostic d'un accident vasculaire cérébral
MX2009013137A (es) * 2007-06-06 2010-04-30 Domantis Ltd Metodos para seleccionar polipeptidos resistentes a la proteasa.
WO2010012834A1 (fr) 2008-08-01 2010-02-04 Bio-Rad Pasteur Méthode de diagnostic in vitro de l'accident vasculaire cérébral
US20110263821A1 (en) * 2008-10-24 2011-10-27 B.R.A.H.M.S. Gmbh Prognosis and risk assessment in stroke patients by determining the level of marker peptides
EP2206726A1 (fr) * 2009-01-08 2010-07-14 Universite Joseph Fourier Outils non invasifs pour la détection de plaques athérosclérotique vulnérables
AU2009339152B2 (en) 2009-01-30 2015-11-19 Bio-Rad Europe Gmbh Method for the in vitro diagnosis of stroke

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5474796A (en) * 1991-09-04 1995-12-12 Protogene Laboratories, Inc. Method and apparatus for conducting an array of chemical reactions on a support surface
US6879010B2 (en) * 2001-10-02 2005-04-12 Royce Technologies Llc Ceramic biomolecule imaging chip
US7392140B2 (en) * 2003-09-23 2008-06-24 Prediction Sciences, Llc Cellular fibronectin as a diagnostic marker in stroke and methods of use thereof

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
Ng and Ilag, J. Cell Mol. Med. 6: 329-340 (2002). *

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018229051A1 (fr) 2017-06-13 2018-12-20 Roche Diagnostics Gmbh Protéine 3 de liaison à l'acide gras permettant l'évaluation de la fibrillation auriculaire (af)
WO2018229144A1 (fr) * 2017-06-14 2018-12-20 Randox Laboratories Ltd Combinaisons destinées à être utilisées dans le diagnostic d'accident vasculaire cérébral

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