US20180306795A1 - Use of a Fibrinogen Capture Agent to Detect a Ciz1 B-Variant - Google Patents

Use of a Fibrinogen Capture Agent to Detect a Ciz1 B-Variant Download PDF

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US20180306795A1
US20180306795A1 US15/768,946 US201615768946A US2018306795A1 US 20180306795 A1 US20180306795 A1 US 20180306795A1 US 201615768946 A US201615768946 A US 201615768946A US 2018306795 A1 US2018306795 A1 US 2018306795A1
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ciz1
variant
fibrinogen
cancer
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Dawn Alison Coverley
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Cizzle Biotechnology Ltd
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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
    • G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
    • G01N33/57407—Specifically defined cancers
    • G01N33/57423—Specifically defined cancers of lung
    • A—HUMAN NECESSITIES
    • A21—BAKING; EDIBLE DOUGHS
    • A21D—TREATMENT, e.g. PRESERVATION, OF FLOUR OR DOUGH, e.g. BY ADDITION OF MATERIALS; BAKING; BAKERY PRODUCTS; PRESERVATION THEREOF
    • A21D8/00—Methods for preparing or baking dough
    • A21D8/02—Methods for preparing dough; Treating dough prior to baking
    • A21D8/04—Methods for preparing dough; Treating dough prior to baking treating dough with microorganisms or enzymes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/36—Blood coagulation or fibrinolysis factors
    • A61K38/363—Fibrinogen
    • 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
    • C07K14/745—Blood coagulation or fibrinolysis factors
    • C07K14/75—Fibrinogen
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N9/00—Enzymes; Proenzymes; Compositions thereof; Processes for preparing, activating, inhibiting, separating or purifying enzymes
    • C12N9/14—Hydrolases (3)
    • C12N9/24—Hydrolases (3) acting on glycosyl compounds (3.2)
    • C12N9/2402—Hydrolases (3) acting on glycosyl compounds (3.2) hydrolysing O- and S- glycosyl compounds (3.2.1)
    • C12N9/2405—Glucanases
    • C12N9/2408—Glucanases acting on alpha -1,4-glucosidic bonds
    • C12N9/2411—Amylases
    • C12N9/2414—Alpha-amylase (3.2.1.1.)
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Y—ENZYMES
    • C12Y302/00—Hydrolases acting on glycosyl compounds, i.e. glycosylases (3.2)
    • C12Y302/01—Glycosidases, i.e. enzymes hydrolysing O- and S-glycosyl compounds (3.2.1)
    • C12Y302/01133—Glucan 1,4-alpha-maltohydrolase (3.2.1.133), i.e. maltogenic alpha-amylase
    • 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
    • G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
    • G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
    • G01N33/5076—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics involving cell organelles, e.g. Golgi complex, endoplasmic reticulum
    • 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
    • G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer

Definitions

  • the present invention relates to assays and methods useful for the detection of Cip1-interacting zinc finger protein (Ciz1) in a sample.
  • the present invention relates to the use of such assays and methods for the diagnosis of cancer.
  • Cip1-interacting zinc finger protein 1 (as exemplified by NCBI Reference Sequence: NM_001131016.1) is required for cell proliferation. Ciz1 localises to nuclear matrix bound foci that form sites of DNA replication during early S phase and promotes the initiation of DNA replication in association with cell cycle regulators including cyclin A/cyclin dependent kinase (CDK)2, cyclin E/CDK2 and p21cip1.
  • CIZ1 is an oestrogen responsive gene that is itself a positive cofactor of the oestrogen receptor (ER), capable of enhancing the recruitment of ER to target chromatin. Ciz1 is alternatively spliced to produce conserved isoforms in mouse and man. Normal Ciz1 protein comprises at least two defined functional domains, a ‘replication’ domain and an ‘immobilisation’ domain.
  • Ciz1 exon 14 to generate a Ciz1 b-variant has been determined in various cancers, including small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), lymphomas, thyroid, kidney and liver cancer.
  • SCLC small cell lung cancer
  • NSCLC non-small cell lung cancer
  • lymphomas thyroid, kidney and liver cancer.
  • Excess expression of either the replication or immobilisation domain of Ciz1 has also been demonstrated in cancers, for example in NSCLC, breast, colon, kidney, liver, bladder and thyroid cancers.
  • a correlation of domain expression with the stage of the cancer has also been determined (see WO 2012/078208).
  • the present invention addresses the continued need to develop diagnostic tests and treatments that improve the survival rates of patients suffering from cancers such as lung cancer through novel biomarkers and targets.
  • the present inventors have determined that Ciz1 b-variant exists in a complex with fibrinogen. This has allowed the inventors to develop a novel assay for detecting the presence of Ciz1 b-variant in a subject.
  • Ciz1 b-variant may exist as peptide fragments. Furthermore, the present inventors have determined that Ciz1 b-variant and/or fibrinogen/Ciz1 b-variant complexes may exist in the exosomal compartment of a blood sample.
  • the finding that Ciz1 b-variant is complexed with fibrinogen has enabled the provision of a detection assay, in particular a diagnostic assay, which utilises the capture of fibrinogen or Ciz1 b-variant as an initial step in order to isolate the fibrinogen/Ciz1 b-variant complex.
  • the assay may involve the use a fibrinogen capture agent to isolate the fibrinogen/Ciz1 b-variant complex followed by the use of Ciz1 b-variant detection agent to detect the Ciz1 b-variant which may be within said isolated complex.
  • the assay may involve the use a Ciz1 b-variant capture agent to isolate the fibrinogen/Ciz1 b-variant complex followed by the use of fibrinogen detection agent to detect the fibrinogen which may be within said isolated complex.
  • the present invention relates to the use of a fibrinogen capture agent or a fibrinogen detection agent in an assay to detect a Ciz1 b-variant.
  • a capture agent refers to an agent which is used to isolate (i.e. enrich) the fibrinogen/Ciz1 b-variant complex from a sample.
  • the sample may be a sample which has been isolated from a subject.
  • the sample may be a blood sample (e.g. a plasma sample) which has been isolated from a subject.
  • a detection agent refers to an agent which is used to bind the fibrinogen/Ciz1 b-variant complex after it has been isolated (i.e. enriched) from a sample using a capture agent.
  • the detection agent is typically used after a capture step to determine the presence of the isolated (i.e. enriched) fibrinogen/Ciz1 b-variant complex.
  • the assay may be an enzyme-linked immunosorbent assay.
  • the fibrinogen capture agent or fibrinogen detection agent may be an antibody or a fragment thereof, non-protein scaffold, aptamer or Ciz1 b-variant peptide which specifically binds fibrinogen.
  • the fibrinogen capture agent or fibrinogen detection agent is an antibody or a fragment thereof which specifically binds fibrinogen.
  • the fibrinogen capture agent is a Ciz1 b-variant peptide which specifically binds fibrinogen.
  • the fibrinogen may be fibrinogen alpha chain.
  • the Ciz1 b-variant may be detected in a sample from a subject, for example a blood, urine, saliva or bronchoalveolar lavage sample.
  • the sample is a blood sample from a subject.
  • the sample is a plasma sample.
  • the Ciz1 b-variant may be detected by a method which comprises the following steps: a) capturing a fibrinogen/Ciz1 b-variant complex using a fibrinogen capture agent; and b) detecting Ciz1 b-variant using a Ciz1 b-variant detection agent; or a) capturing a fibrinogen/Ciz1 b-variant complex using a Ciz1 b-variant capture agent; and b) detecting fibrinogen using a fibrinogen detection agent.
  • the Ciz1 b-variant capture agent may be an antibody or a fragment thereof, or a non-protein scaffold which specifically binds Ciz1 b-variant.
  • the Ciz1 b-variant capture agent may be an antibody or a fragment thereof which specifically binds Ciz1 b-variant.
  • the present invention relates to a method of diagnosing cancer in a subject which comprises detecting a Ciz1 b-variant peptide in a sample from the subject, wherein the presence of Ciz1 b-variant peptide in the sample indicates that the subject has cancer and wherein the method comprises the step of capturing a fibrinogen/Ciz1 b-variant peptide complex from the sample.
  • the present invention relates to a method of diagnosing cancer in a subject which comprises detecting a Ciz1 b-variant peptide in a sample from the subject, wherein the presence of Ciz1 b-variant peptide in the sample indicates that the subject has cancer and wherein the Ciz1 b-variant peptide is the sequence shown as SEQ ID NO: 11 or a fragment thereof which comprises EVR as shown in positions 36 to 38 of SEQ ID NO: 11.
  • the present invention relates to method of detecting a Ciz1 b-variant peptide in a sample, for example detecting a Ciz1 b-variant peptide in a sample from a subject, wherein the method comprises the step of capturing a fibrinogen/Ciz1 b-variant peptide complex from the sample.
  • the method may comprise the steps of capturing a fibrinogen/Ciz1 b-variant complex using a fibrinogen capture agent; and detecting Ciz1 b-variant using a Ciz1 b-variant detection agent; or capturing a fibrinogen/Ciz1 b-variant complex using a Ciz1 b-variant capture agent; and detecting fibrinogen using a fibrinogen detection agent.
  • the step of detecting the Ciz1 b-variant peptide or fibrinogen may employ antibody-based arrays, enzyme linked immunosorbent assays (ELISA), non-antibody protein scaffolds, radioimmuno-assay (RIA), western blotting, aptamers or mass spectrometry.
  • ELISA enzyme linked immunosorbent assays
  • RIA radioimmuno-assay
  • western blotting aptamers or mass spectrometry.
  • the method may further comprise the step of releasing a Ciz1 b-variant peptide and/or a fibrinogen/Ciz1 b-variant peptide complex from an exosomal component of the sample.
  • Ciz1 b-variant peptide and/or fibrinogen/Ciz1 b-variant peptide complex may be released from the exosomal component by detergent treatment, such as SDS treatment.
  • the method may further comprise the step of enriching the exosomal fraction from the sample.
  • the step of enriching the exosomal fraction may comprise ultracentrifugation, ultrafiltration, continuous flow electrophoresis, chromatography or cross-flow ultrafiltration.
  • the cancer may be selected from lung, lymphoma, kidney, breast, liver, bladder, ovarian or thyroid cancer.
  • the cancer may be lung cancer.
  • the present invention further relates to a method for treating a subject with cancer comprising administering to the subject a cancer therapeutic; wherein the subject has been identified as having cancer by the method of the invention.
  • the present invention also provides an anticancer drug for use in treating cancer wherein the subject has been identified as having cancer by the method of the invention.
  • the present invention further provides an anticancer lung cancer drug for use in treating lung cancer wherein the subject has been identified as having lung cancer by the method of the invention.
  • the present invention provides the use of a detergent to release a Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex from an exosomal compartment of a sample.
  • the present invention relates to a method for detecting a Ciz1 b-variant in a sample which comprises the step of releasing the Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex from an exosomal compartment of the sample by treating the sample with detergent and detecting if the Ciz1 b-variant is present in the sample.
  • the method may further comprise the step of enriching the exosomal fraction from the sample prior to releasing the Ciz1 b-variant.
  • the step of enriching the exosomal fraction may comprise ultracentrifugation, ultrafiltration, continuous flow electrophoresis, chromatography or cross-flow ultrafiltration.
  • the present invention provides a kit comprising an agent which specifically binds fibrinogen and an agent which specifically binds Ciz1 b-variant.
  • the fibrinogen may fibrinogen alpha chain.
  • the agent which specifically binds fibrinogen and/or the agent which specifically binds Ciz1 b-variant may be an antibody or a fragment thereof, a non-protein scaffold or an aptamer.
  • the agent which specifically binds to fibrinogen may be a Ciz1 b-variant peptide.
  • the Ciz1 b-variant may be a Ciz1 b-variant peptide shown as SEQ ID NO: 11 or a fragment thereof which comprises EVR as shown in positions 36 to 38 of SEQ ID NO: 11.
  • FIG. 1 a) Ciz1 b-variant epitope-containing species, detected with splice junction-selective anti-Ciz1 rabbit polyclonal antibody 043. 043 was generated and validated as described for antibody 2B (Higgins et al.; (2012); PNAS; Nov 6; 109(45):E3128-35) and is capable of detection of Ciz1 b-variant by western blot in plasma from lung cancer patients. Western blots were performed and show Ciz1 b-variant in 0.5 ul of representative samples from 5 patients with lung carcinomas (various stages) and five from individuals with no disease.
  • Lane 1 untreated plasma (0.5 ul), lane 2 after low speed clearing spin (0.5 ul), lane 3 after high speed clearing spin (0.5 ul), lane 4 after addition of exosome reagent (0.5 ul equivalent), lane 5 high speed spin supernatant (SN, 0.5 ul equivalent), lane 6 high speed spin pellet (0.5 ul equivalent), lane 7 high speed spin pellet (P, 1 ul equivalent), lane 8 high speed spin pellet (2 ul equivalent).
  • Red arrows indicate key lanes, showing different partitioning of Ciz1 epitopes.
  • M molecular weight marker.
  • FIG. 2 Ciz1 Sequences
  • FIG. 3 Ciz1 b-variant ⁇ 65-70 kDa species is a Ciz1 b-variant peptide stably bound to a carrier protein, which may augment antigenicity of Ciz1 b-variant peptide.
  • Results show that normal plasma acquires Ciz1 b-variant signal at ⁇ 80 kDa upon addition of b-var peptide, but not a-var peptide.
  • Similar results were obtained using short b-variant peptide (DEEEIEVRSRDIS—SEQ ID NO: 2), when combined with either cancer or non-cancer plasma.
  • Western blot shows results with anti-Ciz1 b-variant monoclonal antibody (left) or anti-Ciz1 b-variant polyclonal antibody 043 (right).
  • Lane 1 B-var peptide only. Lane 2, B-var peptide+normal plasma. Lane 3, B-var peptide+lung cancer plasma. Lane 4, Normal plasma alone. Lane 5, Lung cancer plasma alone.
  • FIG. 4 Isolation using a two-dimensional gel approach shows that the carrier protein is Fibrinogen.
  • C cancer
  • N non-cancer
  • a cancer-specific signal at ⁇ 65 kDa is produced with anti-b variant antibodies, while in the absence of reducing agent cancer-specific signal is retarded to ⁇ 340 kDa.
  • First dimension gel (without reducing agent) is used to isolate Ciz1 b-variant epitope-containing ⁇ 340 kDa band.
  • FIG. 5 Reconstitution of Ciz1 b-variant epitope from purified fibrinogen and synthetic peptides.
  • Western blots of parallel gels are shown on the right, probed with two anti-b variant antibodies.
  • FIG. 6 Table 1: Ciz1 b-variant peptides comprising an exon 14b/exon 15 junction (specified by exclusion of VEEELCKQ—SEQ ID NO: 10) from NCBI Reference Sequence: NM_001131016.1.
  • FIG. 7 Exon junction specific antibodies detect CIZ1b in lung cancer patient plasma.
  • Histogram shows quantified band intensities for the 65-70 kDa and 55 kDa entities, derived from triplicate samples, with standard deviation. Note that serum lacks the 65-70 kDa CIZ1b band.
  • FIG. 8 Effect of denaturation on CIZ1b epitope.
  • CIZ1b epitope generated by combining CIZ1b peptide (b66, Table 2) with normal (non-cancer) plasma (see FIG. 10 ), behaves similarly to endogenous epitope, dissociating from within a high molecular weight complex, to a ⁇ 70 kDa species, and then disappearing under maximally reducing conditions. Fibrinogen is detected with antibody AF4786.
  • ⁇ ME concentrations refer to multiples of the standard concentration used in SDS-PAGE of 200 mM.
  • FIG. 9 Deconstruction of CIZ1b biomarker and immunoassay design
  • A Schematic of results shown in FIG. 8 , illustrating the complexity of the native complex in which CIZ1b epitope (red bar, marked “*”) resides in plasma, and the disrupting effect of detergent and reducing agents.
  • CIZ1b is part of a complex in excess of 720 kDa, most likely encompassed within lipid vesicles.
  • SDS shifts the epitope to 340 kDa, and reducing agents shift it further to the mobility typically observed in standard SDS-PAGE gels (65-70 kDa). In the presence of excess reducing agent the western blot epitope is lost for both 2B and 043 CIZ1b antibodies.
  • B Schematic of sandwich ELISA format based on information summarised in A.
  • FIG. 10 Reconstitution of CIZ1b biomarker from purified components
  • Coomassie blue staining revealed 5 dominant bands including one at 70 kDa, which was isolated and digested with either trypsin (cancer plasma 1, C1) or AspN (cancer plasma 2, C2).
  • CIZ1b antibodies None are recognized by CIZ1b antibodies in western blot unless complexed with carrier protein.
  • CIZ1b66 peptide a new reactive species is created at ⁇ 80 kDa, while CIZ1b13 peptide increases antigenicity at the same mobility as the endogenous epitope in lung cancer plasmas (C, lane 1).
  • receiver operating characteristic curves indicate the relationship between true positive and false positive fraction (black points) and 95% confidence interval of the fitted ROC curve (grey points), and area under the curve (AUC) values in bold. Box and whisker plots display minimum and maximum, lower, median, and upper quartile, and outliers.
  • Cip1-interacting zinc finger protein (Ciz1) is a protein that in humans is encoded by the CIZ1 gene.
  • Ciz1 promotes initiation of mammalian DNA replication, where it helps coordinate the sequential functions of cyclin E- and A-dependent protein kinases (Coverley et al; J Cell Sci. 2005; 118(Pt 1):101-112). It interacts directly with cyclins E and A, CDK2, and cyclin-dependent kinase inhibitor p21 and also plays an indirect role in DNA replication by modulating the expression of genes, including cyclin D, that influence cell proliferation (den Hollander et al; Cancer Res. 2006; 66(22):11021-11029).
  • Ciz1 is often attached to the salt- and nuclease-resistant protein component of the nucleus referred to as the “nuclear matrix” and resides within foci that partially colocalize with sites of DNA replication (Ainscough; J Cell Sci. 2007; 120(Pt 1):115-124), implicating Ciz1 in the spatial organization of DNA replication.
  • Ciz1 Various splice variants of Ciz1 are known in the art. For example, as described in WO 2004/051269 and Rahman et al. (BMC Cancer; 2010; 10:482).
  • Ciz1 exon 14 has previously been demonstrated in various cancers ((WO 2012/017208) and (Higgins et al.; PNAS; Nov 6; 109(45):E3128-35)).
  • Ciz1 b-variant isoform is derived from a Ciz1 mRNA transcript which comprises a variant of exon 14 referred to herein as exon 14b (SEQ ID NO: 3).
  • Ciz1 exon 14b lacks 24 nucleotides at the 3′ end as compared to full length exon 14, referred to as exon 14a (SEQ ID NO: 4).
  • Ciz1 transcripts expressing exon 14b rather than exon 14a (a-variant) are referred to herein as Ciz1 b-variant, CIZ1b or simply b-variant.
  • Ciz1 exon 14b and 14a are shown as SEQ ID NO: 5 (LKSLEKEIAGQDEDHFITVDAVGCFEGDEEEEEDDEDEEEIE) and SEQ ID NO: 6 (LKSLEKEIAGQDEDHFITVDAVGCFEGDEEEEEDDEDEEEIEVEEELCKQ) respectively (see FIG. 2 ).
  • the sequence spanning a splice junction of exon 14b and exon 15 is therefore different to the sequence spanning a splice junction of exon 14a and exon 15.
  • the junction of exon 14b and exon 15 lacks the sequence VEEELCKQ (SEQ ID NO: 10) which is present at the junction between exon 14a and exon 15 in Ciz1 a-variant proteins.
  • Ciz1 b-variant peptides exist in a complex with fibrinogen.
  • Ciz1 b-variant peptides which span an exon 14b/exon 15 junction are able to bind to fibrinogen.
  • Ciz1 a-variant peptides are not able to bind to fibrinogen.
  • a Ciz1 b-variant peptide refers to a peptide which can be derived from a Ciz1 b-variant protein but not a Ciz1 a-variant protein.
  • a Ciz1 b-variant peptide refers to a portion of a Ciz1 b-variant protein which is derived from exons 14b and exon 15 of a Ciz1 b-variant protein and therefore lacks the sequence VEEELCKQ (SEQ ID NO: 10) at the splice junction.
  • a Ciz1 b-variant peptide comprises an exon 14b/exon 15 splice junction.
  • a ciz1 b-variant peptide comprises amino acid sequences derived from Ciz1 exon 14b (SEQ ID NO: 5) and Ciz1 exon 15 (SEQ ID NO: 7) and comprises the sequence EVR as shown in positions 36 to 38 of SEQ ID NO: 11.
  • Ciz1 b-variant peptides do not contain amino acids which are specific to Ciz1 a-variant proteins and therefore do not comprise the sequence VEEELCKQ (SEQ ID NO: 10).
  • Ciz1 b-variant peptide may be the Ciz1 b-variant peptide shown as SEQ ID NO: 11 or a fragment thereof which comprises EVR as shown in positions 36 to 38 of SEQ ID NO: 11.
  • the Ciz1 b-variant peptide may comprise at least 3, at least 5, at least 10, at least 20, at least 30, at least 40, at least 50 or at least 60 contiguous amino acids of SEQ ID NO: 11 and comprise EVR as shown in positions 36 to 38 of SEQ ID NO: 11.
  • the Ciz1 b-variant peptide may comprise or consist of from 3 to 60, 5 to 60, 5 to 50, 10 to 50, 10 to 40, 10 to 30, 15 to 30 or 10 to 20 contiguous amino acids of SEQ ID NO: 11 and comprise EVR as shown in positions 36 to 38 of SEQ ID NO: 11.
  • the Ciz1 b-variant peptide may comprise or consist of 10 to 20 contiguous amino acids of SEQ ID NO: 11 and comprise EVR as shown in positions 36 to 38 of SEQ ID NO: 11.
  • Ciz1 b-variant peptide may be a peptide shown in Table 1 (see FIG. 6 ).
  • the present invention relates to the use of a fibrinogen capture agent or a fibrinogen detection agent in an assay to detect Ciz1 b-variant.
  • the present invention relates to the use of a fibrinogen binding agent in an assay to detect Ciz1 b-variant.
  • the fibrinogen binding agent may be an antibody or a fragment thereof, non-protein scaffold or aptamer which specifically binds fibrinogen.
  • the present invention provides the use of an antibody or a fragment thereof, which binds fibrinogen in an assay to detect Ciz1 b-variant.
  • Fibrinogen is involved in blood clotting, fibrinolysis, cellular and matrix interactions, the inflammatory response, wound healing and neoplasia.
  • Fibrinogen molecules are elongated 45 nm structures that consist of two outer D domains, each connected by a coiled-coil segment to a central E domain.
  • the molecule is comprised of two sets of three polypeptide chains termed ⁇ , ⁇ , and ⁇ , which are joined together in the N-terminal E domain by five symmetrical disulfide bridges.
  • Non-symmetrical disulfide bridges form a ‘disulfide ring’ in this region (Mosesson; 2005; Journal of Thrombosis and Haemostasis; 3(8); 1894-1940).
  • fibrinogen molecules results in the formation of an insoluble fibrin matrix. Conversion of fibrinogen to fibrin is triggered by thrombin, which cleaves fibrinopeptides A and B from ⁇ and ⁇ chains, and thus exposes the N-terminal polymerization sites responsible for the formation of the soft clot.
  • the soft clot is converted into the hard clot by factor XIIIA which catalyzes the epsilon-(gamma-glutamyl)lysine cross-linking between ⁇ chains (stronger) and between ⁇ chains (weaker) of different monomers.
  • the ⁇ -chain consists of 610, the ⁇ -chain 461, and the major ⁇ -chain form, ⁇ A, 411 residues.
  • Each fibrinogen ⁇ -chain contains an N-terminal fibrinopeptide A (FPA) sequence, cleavage of which by thrombin initiates fibrin assembly by exposing a polymerization site termed EA.
  • FPA fibrinopeptide A
  • EA polymerization site termed polymerization site termed EA.
  • One portion of EA is at the N-terminus of the fibrin ⁇ -chain comprising residues 17-20 gly-pro-arg-val (GPRV), and another portion is located in the fibrin ⁇ -chain between residues 15 and 42.
  • GPRV gly-pro-arg-val
  • Each EA-site combines with a constitutive complementary-binding pocket (Da) in the D domain of neighbouring molecules that is located between ⁇ 337 and ⁇ 379.
  • the initial EA:Da associations cause fibrin molecules to align in a staggered overlapping end-to-middle domain arrangement to form double-stranded twisting fibrils. Fibrils also undergo lateral associations to create multi-stranded fibres (Mosesson; as above).
  • An example fibrinogen ⁇ protein is the human fibrinogen ⁇ protein having the UniProtKB accession number P02671. This exemplified sequence is 866 amino acids in length of which amino acids 1 to 19 form a signal peptide.
  • An example fibrinogen ⁇ protein is the human fibrinogen ⁇ protein having the UniProtKB accession number P02675. This exemplified sequence is 491 amino acids in length of which amino acids 1 to 30 form a signal peptide.
  • An example fibrinogen ⁇ protein is the human fibrinogen ⁇ protein having the UniProtKB accession number P02679. This exemplified sequence is 453 amino acids in length of which amino acids 1 to 26 form a signal peptide.
  • fibrinogen may refer to a complex comprising two ⁇ chains, two ⁇ chains and two ⁇ chains or a sub-complex thereof (e.g. which does not include all the chains of the full fibrinogen complex).
  • the present inventors have determined that Ciz1 b-variant peptides are capable of binding to the fibrinogen ⁇ chain.
  • the present assays and methods may involve the capture or detection of the fibrinogen ⁇ chain.
  • the present assays and methods may involve the detection of fibrinogen (e.g. fibrinogen ⁇ chain) following the capture of Ciz1 b-variant in the fibrinogen/Ciz1 b-variant complex.
  • a ‘fibrinogen/Ciz1 b-variant complex’ as referred to herein may comprise other peptides and/or proteins aside from the fibrinogen and/or Ciz1 b-variant peptide.
  • a capture agent refers to an agent which is used to isolate (i.e. enrich) the fibrinogen/Ciz1 b-variant complex from a sample.
  • the sample may be a sample which has been isolated from a subject.
  • the sample may be a blood sample (e.g. a plasma sample) which has been isolated from a subject.
  • a ‘fibrinogen capture agent’ refers to an entity which is capable of binding to a fibrinogen/Ciz1 b-variant complex.
  • a ‘fibrinogen capture agent’ is an entity which is capable of specifically binding to fibrinogen and is used to isolate (i.e. enrich) the fibrinogen/Ciz1 b-variant complex from a sample. Such specific binding may enable the isolation/enrichment of fibrinogen from a sample.
  • the fibrinogen capture agent may be capable of specifically binding to a fibrinogen ⁇ chain.
  • the fibrinogen capture agent may be an antibody or a fragment thereof, non-protein scaffold, aptamer or Ciz1 b-variant peptide which specifically binds fibrinogen.
  • a detection agent refers to an agent which is used to bind the fibrinogen/Ciz1 b-variant complex after it has been isolated (i.e. enriched) from a sample using a capture agent.
  • the detection agent is typically used after a capture step to determine the presence of the isolated (i.e. enriched) fibrinogen/Ciz1 b-variant complex.
  • a ‘fibrinogen detection agent’ refers to an entity which is capable of binding to a fibrinogen.
  • a ‘fibrinogen detection agent’ is an entity which is capable of specifically binding to fibrinogen. Such specific binding enables the detection of fibrinogen following the capture of Ciz1 b-variant in the fibrinogen/Ciz1 b-variant complex.
  • the fibrinogen capture agent or fibrinogen detection agent may be capable of specifically binding to a fibrinogen ⁇ chain.
  • the fibrinogen detection agent may be an antibody or a fragment thereof, non-protein scaffold, or aptamer which specifically binds fibrinogen.
  • the fibrinogen detection agent may be labelled with an entity which enables it to be detected in an assay as described herein.
  • the fibrinogen detection agent may be labelled with a fluorescent entity or an enzyme-substrate label as described herein.
  • An antibody or a fragment thereof refers to any portion of an antibody which retains the ability to bind to the same antigen target as the parental antibody—e.g. a fibrinogen antibody or a fragment thereof is able to bind to fibrinogen.
  • Fibrinogen antibodies are known in the art. For example, sheep anti-fibrinogen pAb (AF4786 R&D systems), ab58207 (Abcam); Anti-Fibrinogen, clone 85D4 (Cat. No. F9902; Sigma Aldrich); and Fibrinogen Antibody (MFB-HB) (Cat. No. MA1-35371; Life Technologies).
  • Fibrinogen ⁇ chain antibodies are also known in the art.
  • EPR2918 (ab108616; Abcam); Fibrinogen Antibody (5C5) (LF-MA0108; Pierce); and EPR2919 (TA307697; Origene).
  • the present invention also encompasses methods which comprise the step of detecting Ciz1 b-variant or capturing Ciz1 b-variant/fibrinogen complex by contacting the Ciz1 b-variant with an antibody or fragment thereof that binds to the Ciz1 b-variant.
  • An antibody which specifically binds a Ciz1 b-variant peptide may be generated as previously described for antibody 2B (Higgins et al; 2012; PNAS; Nov 6; 109(45):E3128-35).
  • the antibody may be a chimeric antibody.
  • Chimeric antibodies may be produced by transplanting antibody variable domains from one species (for example, a mouse) onto antibody constant domains from another species (for example a human).
  • the antibody may be a full-length, classical antibody.
  • the antibody may be an IgG, IgM or IgA molecule.
  • the antibody may be a functional antibody fragment.
  • Specific antibody fragments include, but are not limited to, (i) the Fab fragment consisting of VL, VH, CL and CH1 domains, (ii) the Fd fragment consisting of the VH and CH1 domains, (iii) the Fv fragment consisting of the VL and VH domains of a single antibody, (iv) the dAb fragment, which consists of a single variable domain, (v) isolated CDR regions, (vi) F(ab')2 fragments, a bivalent fragment comprising two linked Fab fragments (vii) single chain Fv molecules (scFv), wherein a VH domain and a VL domain are linked by a peptide linker which allows the two domains to associate to form an antigen binding site, (viii) bispecific single chain Fv dimers, and (ix) “diabodies” or “triabodies”, multivalent or multispecific fragments constructed by gene fusion.
  • the antibody fragments may be modified.
  • the antibody described herein may be a multispecific antibody, and notably a bispecific antibody, also sometimes referred to as “diabodies”. These are antibodies that bind to two (or more) different antigens. Diabodies can be manufactured in a variety of ways known in the art, e.g., prepared chemically or from hybrid hybridomas.
  • the antibody may be a minibody. Minibodies are minimized antibody-like proteins comprising a scFv joined to a CH3 domain. In some cases, the scFv can be joined to the Fc region, and may include some or all of the hinge region.
  • the antibody may be a domain antibody (also referred to as a single-domain antibody or nanobody). This is an antibody fragment containing a single monomeric single variable antibody domain.
  • single-domain antibodies include, but are not limited to, VHH fragments originally found in camelids and VNAR fragments originally found in cartilaginous fishes. Single-domain antibodies may also be generated by splitting the dimeric variable domains from common IgG molecules into monomers.
  • the antibody may be a synthetic antibody (also referred to as an antibody mimetic).
  • Antibody mimetics include, but are not limited to, Affibodies, DARPins, Anticalins, Avimers, Versabodies and Duocalins.
  • Aptamers that specifically recognize fibrinogen or Ciz1 b-variant may be synthesized using standard nucleic acid synthesis techniques or selected from a large random sequence pool, for example using the Systematic Evolution of Ligands by Exponential Enrichment (SELEX) technique.
  • SELEX Systematic Evolution of Ligands by Exponential Enrichment
  • Aptamers can be single strand DNA or RNA sequences that fold in a unique 3D structure having a combination of stems, loops, quadruplexes, pseudoknots, bulges, or hairpins.
  • the molecular recognition of aptamers results from intermolecular interactions such as the stacking of aromatic rings, electrostatic and van der Waals interactions, or hydrogen bonding with a target compound.
  • the specific interaction between an aptamer and its target is complemented through an induced fit mechanism, which requires the aptamer to adopt a unique folded structure to its target.
  • Aptamers can be modified to be linked with labeling molecules such as dyes, or immobilized on the surface of beads or substrates for different applications.
  • Aptamers may be paired with nanotechnology, microarray, microfluidics, mass spectrometry and other technologies for quantification in a given sample.
  • a fibrinogen capture agent or a Ciz1 b-variant capture agent will be immobilised on a support, such as an array, or be captured on a solid support, such as beads.
  • a sample to be tested is then incubated with the support comprising the capture agent such that Ciz1 b-variant/fibrinogen complex can be isolated/enriched from the sample.
  • Supports eg. solid supports
  • Materials such as glass, silica, plastic, nylon or nitrocellulose. When attached to a solid support it is preferably rigid and have a planar surface.
  • the fibrinogen capture agent or Ciz1 b-variant capture agent may comprise a moiety that can be captured on a solid surface, such as a biotin moiety which can be captured by streptavidin beads. In such embodiments, capture to a support can occur follow incubation of the capture agent with a sample.
  • Ciz1 b-Variant Detecting Ciz1 b-Variant or Capturing a Ciz1 b-Variant
  • the Ciz1 b-variant may be a Ciz1 b-variant peptide as described herein.
  • Ciz1 b-variant may be detected using a variety of suitable methods and techniques known in the art.
  • the method may comprise the following steps: a) capturing a fibrinogen/Ciz1 b-variant complex using a fibrinogen capture agent; and b) detecting Ciz1 b-variant using a Ciz1 b-variant detection agent.
  • the method may comprise the following steps: a) capturing a fibrinogen/Ciz1 b-variant complex using a Ciz1 b-variant capture agent; and b) detecting fibrinogen using a fibrinogen detection agent.
  • a ‘Ciz1 b-variant capture agent’ refers to an entity which is capable of binding to a Ciz1 b-variant and is used to isolate (i.e. enrich) the fibrinogen/Ciz1 b-variant complex from a sample.
  • a ‘Ciz1 b-variant capture agent’ is an entity which is capable of specifically binding to Ciz1 b-variant. Such specific binding enables the isolation/enrichment of the fibrinogen/Ciz1 b-variant complex from a sample.
  • the Ciz1 b-variant capture agent may be an antibody or a fragment thereof, non-protein scaffold, aptamer or Ciz1 b-variant peptide which specifically binds fibrinogen.
  • a Ciz1 b-variant/fibrinogen complex may be captured using an antibody or fragment thereof that binds to the Ciz1 b-variant peptide.
  • An antibody which specifically binds a Ciz1 b-variant peptide may be generated as previously described for antibody 2B (Higgins et al; 2012; PNAS; Nov 6; 109(45):E3128-35).
  • a ‘Ciz1 b-variant detection agent’ refers to an entity which is capable of binding to a Ciz1 b-variant and is used to bind the fibrinogen/Ciz1 b-variant complex after it has been isolated (i.e. enriched) from a sample using a capture agent.
  • a ‘Ciz1 b-variant detection agent’ is an entity which is capable of specifically binding to Ciz1 b-variant. Such specific binding enables the detection of Ciz1 b-variant following the capture of the fibrinogen/Ciz1 b-variant complex.
  • the Ciz1 b-variant detection agent may be an antibody or a fragment thereof, non-protein scaffold, or aptamer which specifically binds Ciz1 b-variant.
  • the Ciz1 b-variant detection agent may be labelled with an entity which enables it to be detected in an assay as described herein.
  • the Ciz1 b-variant detection agent may be labelled with a fluorescent entity or an enzyme-substrate label as described herein.
  • methods for detecting Ciz1 b-variant may employ antibody-based arrays, enzyme linked immunosorbent assays (ELISA), non-antibody protein scaffolds, radioimmuno-assay (RIA), western blotting, aptamers or mass spectrometry.
  • ELISA enzyme linked immunosorbent assays
  • RIA radioimmuno-assay
  • western blotting aptamers or mass spectrometry.
  • An ELISA may be performed according to general methods which are known in the art.
  • the ELISA may be a sandwich or competitive ELISA.
  • a sandwich ELISA may comprise the following steps:
  • the present methods comprise the step of capturing a fibrinogen/Ciz1 b-variant complex using a fibrinogen capture agent or a Ciz1 b-variant capture agent as described herein.
  • the present methods comprise a sandwich ELISA which comprises the steps of capturing a fibrinogen/Ciz1 b-variant complex using a Ciz1 b-variant capture agent as described herein and detecting the fibrinogen/Ciz1 b-variant complex using a fibrinogen detection agent as described herein.
  • a competitive ELISA may comprise the following steps:
  • the enzyme generally catalyses a chemical alteration of the chromogenic substrate that can be detected.
  • the enzyme may catalyse a colour change in a substrate, or may alter the fluorescence or chemiluminescence of the substrate.
  • Examples of enzymatic labels include peroxidase such as horseradish peroxidase (HRPO), alkaline phosphatase, beta-galactosidase, glucoamylase, lysozyme, saccharide oxidases (e.g., glucose oxidase, galactose oxidase, and glucose-6-phosphate dehydrogenase), heterocyclic oxidases (such as uricase and xanthine oxidase), lactoperoxidase, microperoxidase, and the like.
  • HRPO horseradish peroxidase
  • alkaline phosphatase beta-galactosidase
  • glucoamylase lysozyme
  • saccharide oxidases e.g., glucose oxidase, galactose oxidase, and glucose-6-phosphate dehydrogenase
  • heterocyclic oxidases such as uricase and
  • Detecting a Ciz1 b-variant peptide may comprise contacting said Ciz1 b-variant peptide with an antibody or fragment thereof that binds to the Ciz1 b-variant peptide.
  • An antibody which specifically binds a Ciz1 b-variant peptide may be generated as previously described for antibody 2B (Higgins et al; 2012; PNAS; Nov 6; 109(45):E3128-35).
  • the b-variant specific antibody may bind to an epitope comprising the EVR sequence shown in positions 36 to 38 of SEQ ID NO: 11.
  • the antibody specifically binds to an amino acid sequence comprising DEEEIEVRSRDIS (SEQ ID NO: 2) but does not specifically bind to an amino acid sequence comprising DEEEIEVEEELCKQVRSRDIS (SEQ ID NO: 9).
  • the sequence bound by a b-variant specific antibody may be present in both Ciz1 exon 14a (SEQ ID NO: 6) and Ciz1 exon 14b (SEQ ID NO: 5).
  • the b-variant specific antibody may be unable to bind to Ciz1 a-variant because the presence of the VEEELCKQ sequence (SEQ ID NO: 10) prevents the antibody binding.
  • the antibodies may bind to sequences present in both Ciz1 exon 14a and Ciz1 exon 14b, because the sequences are presented in a b-variant specific conformation or structure.
  • the b-variant specific antibody may bind to an epitope formed by a Ciz1 b-variant peptide/fibrinogen complex.
  • Ciz1 b-variant binding may expose epitopes which comprise amino acid sequences which are common between Ciz1 exon 14a (SEQ ID NO: 6) and Ciz1 exon 14b (SEQ ID NO: 5) in a conformation which is unique to the fibrinogen/Ciz1 b-variant.
  • Such conformational epitopes will therefore not be present in Ciz1 a-variant.
  • the present invention utilises a sample isolated from a subject.
  • This sample may be referred to as a ‘test sample’.
  • the present methods are typically practiced outside of the human or animal body, e.g. on a sample that was previously obtained from the subject to be tested.
  • the sample may be a blood, urine, saliva or bronchoalveolar lavage sample.
  • the sample is a blood sample.
  • the blood sample may be a whole blood sample.
  • the blood sample may be a blood fraction, for example a plasma sample.
  • vena blood samples can be collected from patients using a needle and deposited into plastic tubes.
  • the collection tubes may, for example, contain anticoagulants, spray-coated silica, or a polymer gel for separation.
  • Plasma can be separated by centrifugation at 1300 RCF for 10 min at room temperature and stored in small plastic tubes at ⁇ 80° C.
  • the sample is a blood sample, in particular a plasma sample.
  • the blood sample is treated with anticoagulants (e.g. heparin) following collection.
  • anticoagulants e.g. heparin
  • the present methods may comprise treating the sample with a detergent in order to release the Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex.
  • detergent examples include, but are not limited to, sodium dodecyl sulfate (SDS) and polysorbate 20.
  • SDS sodium dodecyl sulfate
  • polysorbate 20 examples of detergent include, but are not limited to, sodium dodecyl sulfate (SDS) and polysorbate 20.
  • the sample may be treated with about 1 to 5%, preferably 1 to 2% SDS.
  • the present methods may further comprise treating the sample with a reducing agent in order to further purify the Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex.
  • a reducing agent include, but are not limited to, Dithiothreitol (DTT)—which may be used at a concentration of about 10 mM DTT, for example.
  • the present methods may comprise the step of releasing Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex from the exosomal compartment of a sample.
  • the present methods may comprise the step of releasing Ciz1 b-variant peptides from the exosomal compartment of a sample.
  • Exosomes are nanometer-sized (30-100 nm) vesicles found in many biological fluids, such as urine, blood (in both plasma and serum), ascites, and cerebrospinal fluid. They originate as internal vesicles of multi-vesicular bodies (MVBs) in cells and were first described as products of circulating blood cells, such as erythrocytes and lymphocytes.
  • MVBs multi-vesicular bodies
  • Exosomes are surrounded by a phospholipid membrane containing relatively high levels of cholesterol, sphingomyelin, and ceramide and containing detergent-resistant membrane domains (lipid rafts) (Mathivanan et al., 2010; J Proteomics 73:1907-1920).
  • Exosomes are characterized by the presence of proteins involved in membrane transport and fusion, such as Rab, GTPases, annexins, and flotillin, components of the endosomal sorting complex required for transport (ESCRT) complex such as Alix, tumor susceptibility gene 101 (TSG101), heat shock proteins (HSPs), integrins, and tetraspanins, including CD63, CD81, and CD82 (van der Pol et al.; 2012; 64(3); 676-705).
  • proteins involved in membrane transport and fusion such as Rab, GTPases, annexins, and flotillin
  • ESCRT endosomal sorting complex required for transport
  • Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex from an exosomal compartment refers to disrupting the structural integrity of the exosome such that Ciz1 b-variant epitopes which were previously concealed within the internal structure of the exosomes are exposed for binding.
  • releasing Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex from an exosomal compartment may refer to treating a sample with a detergent.
  • detergent include, but are not limited to, sodium dodecyl sulfate (SDS) and polysorbate 20.
  • the sample may be treated with a detergent at a concentration which is suitable to release Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex from an exosomal compartment.
  • a detergent at a concentration which is suitable to release Ciz1 b-variant and/or a fibrinogen/Ciz1 b-variant complex from an exosomal compartment.
  • the sample may be treated with about 1 to 5%, preferably 1 to 2% SDS.
  • the present methods may involve enriching an exosomal fraction from a sample.
  • enriching an exosomal fraction is synonymous to purifying or isolating an exosomal fraction.
  • Exosomes may be purified by methods known in the art such as ultracentrifugation (Pisitkun et al (2004) PNAS 101:13368-13373) or ultrafiltration (Cheruvanky et al (2007) Am. J. Physiol. Renal Physiol. 292:F1657-F1661). Methods are also known involving continuous flow electrophoresis and chromatography procedures which may precede centrifugation (Taylor and Gercel-Taylor (2005) Br J Cancer 92:305-311). Cross-flow ultrafiltration may also be used as part of the exosome purification method (Lamparski et al (2002) J Immunol. Methods 270:211-226).
  • Exosomes can be isolated from a multitude of cell line and body fluids by combining differential centrifugation, membrane filtration, concentration, rate zonal centrifugation and immunocapture, exosomes (Simpson et al.; Proteomics, 8 (2008), pp. 4083-4099).
  • Exosomes can be detected and/or purified on the basis of their expression of exosomal markers such as tumour susceptibility gene (TSG101), aqua-porin ⁇ 2 (AQP2), neuron-specific enolase (NES), annexin V, podocalyxin (PODXL) and CD9.
  • exosomes may be captured on to a microplate, for example by immunoaffinity capture.
  • Characterization of isolated exosomes is typically performed using electron microscopy, FACS, LC-MS/MS, Western blotting or ELISA (Simpson et al.; as above) and (van Niel et al; J Biochem (Tokyo), 140 (2006), pp. 13-21).
  • the present invention relates to a method of diagnosing cancer in a subject.
  • cancer or “cancerous” refers to cells having the capacity for autonomous growth, i.e., an abnormal state or condition characterized by rapidly proliferating cell growth.
  • the term is meant to include all types of cancerous growths or oncogenic processes, metastatic tissues or malignantly transformed cells, tissues, or organs, irrespective of histopathologic type or stage of invasiveness.
  • cancer includes malignancies of the various organ systems, such as those affecting, for example, lung, breast, thyroid, lymphoid, gastrointestinal, reproductive and genito-urinary tract, as well as adenocarcinomas which include malignancies such as most colon cancers, renal-cell carcinoma, prostate cancer and/or testicular tumours, non-small cell carcinoma of the lung, cancer of the small intestine and cancer of the esophagus.
  • the cancer may be lung cancer, lymphoma, kidney cancer, breast cancer, liver cancer, bladder cancer, ovarian or thyroid cancer.
  • the cancer is lung cancer.
  • the lung cancer may be small cell lung cancer.
  • the lung cancer may be non-small cell lung cancer.
  • the subject may be a human or animal subject.
  • the subject is a human.
  • the subject may have or be at risk of cancer, as described herein.
  • At risk of cancer refers to a subject who is not showing any symptoms of the disease.
  • the subject may have a predisposition for, or be thought to be at risk of developing, cancer.
  • the present invention relates to a method for treating a subject with cancer comprising administering to the subject a cancer therapeutic; wherein the subject has been identified as having cancer by a method of the present invention.
  • the present invention provides an anticancer drug for use in treating cancer wherein the subject has been identified as having cancer by a method of the present invention.
  • the present invention relates to an anticancer lung cancer drug for use in treating lung cancer wherein the subject has been identified as having lung cancer by a method of the present invention.
  • Treating refers to the therapeutic use of a cancer therapeutic or anticancer agent.
  • the cancer therapeutic or anticancer agent may be administered to a subject having an existing disease or condition in order to lessen, reduce or improve at least one symptom associated with the disease and/or to slow down, reduce or block the progression of the disease.
  • an ‘anticancer drug’ is synonymous with a cancer therapeutic and refers to an entity which may be used to treat cancer.
  • the anti-cancer drug may be a cytokine or haematopoietic factor including, but not limited to, IL-1, IL-2, IL-4, IL-5, IL-13, IL-6, CSF-1, M-CSF, GM-CSF, IFN ⁇ , IFN ⁇ , IFN ⁇ , IL-10, IL-12, VEGF, bone morphogenic proteins, FGFs, TNF and TGF ⁇ .
  • a cytokine or haematopoietic factor including, but not limited to, IL-1, IL-2, IL-4, IL-5, IL-13, IL-6, CSF-1, M-CSF, GM-CSF, IFN ⁇ , IFN ⁇ , IFN ⁇ , IL-10, IL-12, VEGF, bone morphogenic proteins, FGFs, TNF and TGF ⁇ .
  • the anticancer drug may be a chemotherapeutic agent, which may be a cytotoxic drug.
  • a chemotherapeutic agent contemplated includes, without limitation, alkylating agents, nitrosoureas, ethylenimines/methylmelamine, alkyl sulfonates, antimetabolites, pyrimidine analogs, epipodophylotoxins, enzymes such as L-asparaginase; biological response modifiers such as IFN ⁇ , IL-2, G-CSF and GM-CSF; platinium coordination complexes such as cisplatin and carboplatin, anthracenediones, substituted urea such as hydroxyurea, methylhydrazine derivatives including N-methylhydrazine (MIH) and procarbazine, adrenocortical suppressants such as mitotane (o,p′-DDD) and aminoglutethimide; hormones and antagonists including adrenocorticosteroid antagonist
  • the anticancer drug may be a siRNA or shRNA.
  • the anticancer drug may be an anticancer lung cancer drug.
  • An anticancer lung cancer drug refers to an entity which may be used to treat lung cancer.
  • the present invention provides a kit comprising an agent which specifically binds fibrinogen and an agent which specifically binds Ciz1 b-variant.
  • the agent which specifically binds fibrinogen may be a fibrinogen capture agent as described herein.
  • the agent which specifically binds Ciz1 b-variant may be a Ciz1 b-variant detection agent as described herein.
  • the antibody 043 was generated and validated as described previously for antibody 2B (Higgins et al; PNAS 2012; Nov 6; 109(45):E3128-35)).
  • the antibody was capable of detecting of Ciz-1 b-variant polypeptide by western blot in plasma from lung cancer patients (see FIG. 1 a ).
  • Plasma from lung cancer patients was separated into the exosomal compartment and soluble compartment using Invitrogen Total Exosome Isolation Kit (Catalog Number 4484450) used as recommended by the manufacturer. Fractions were separated by SDS-PAGE and probed with 043 antibody or with ‘generic’ CIZ1 antibodies that recognize an epitope elsewhere in the protein (data shown in FIG. 1 b is generated with NB100-74624 (Nov4), Novus Biologicals).
  • the Ciz1 b-variant epitope containing species migrated with relative mobility of ⁇ 70 kDa.
  • the Ciz1 b-variant epitope containing species co-fractionated with the exosomal fraction in lung cancer patients see FIG. 1 b , red and blue arrows indicate lanes showing different partitioning of Ciz1 isoforms.
  • the Ciz1 b-variant epitope containing species partly partitions with the non-exosomal fraction (type 2, FIG. 1 c ). Plasma from these patients gave a positive signal in Ciz1 b-variant sandwich ELISA without any pre-treatment to dissolve exosomes.
  • the Ciz1 b-variant epitope may be accessed by treating plasma (type 1) with detergent prior to assay ( FIG. 1 e,f ).
  • the antibody 2B ( FIGS. 3 a ) and 043 ( FIG. 1 a ) recognise Ciz1 b-variant in the region of the unique junction between exon 14b and 15. They do not react with a species with relative mobility of ⁇ 70 kDa in normal plasma ( FIG. 3B , C), but do weakly react with synthetic b-variant peptide ( FIG. 3B , C). However when combined, synthetic b-variant peptides and normal plasma generate a new, highly reactive species of ⁇ 80 kDa. Similar results are obtained with a synthetic b-variant peptide of a different length ( FIG. 3 e ), quantitatively generating epitope ( FIG. 3 f ).
  • CIZ1b was carried out with anti-peptide rabbit polyclonal antibody 2B, which was raised against a short unique peptide spanning the alternatively spliced 14b-15 junction ( FIG. 7A ), with sequence DEEEIE V RSRDIS (SEQ ID NO: 2—junction indicated by underlined valine).
  • the strategy for generation, validation and purification was described previously (Higgins et al., as above).
  • the western blot reactivity profile for 2B includes a 65-70 kDa entity in SDS-PAGE of plasma from lung cancer patients, plus a 55 kDa entity in plasma from all people ( FIG. 7B ).
  • the cancer-specific 65-70 kDa species is the CIZ1b biomarker that is referred to here and by Higgins et al. In contrast to plasma, this protein could not be detected in serum samples from the same lung cancer patients ( FIG. 7C ), suggesting that CIZ1b biomarker is sequestered in coagulated blood. Notably the 55 kDa generic band co-migrates with CIZ1 spec7), identifying the 55 kDa species as a variant or proteolytic fragment of full-length hCIZ1 (which has a predicted full length MW of 99 kDa, NCBI Reference Sequence: NM_012127.2).
  • the width of the bands detected via exon 8 and exon 17 is different, possibly because the exon 8 epitope lies within an alternatively spiced region, while detection via exon 17 would reveal species with or without alternative splicing at exon 8.
  • detection via exon 17 would reveal species with or without alternative splicing at exon 8.
  • at least one form of the CIZ1 protein is present in the circulatory system in cancer and non-cancer plasma samples alike, suggesting it to be part of normal physiology.
  • Exon 17 and exon 8 epitopes are not present in the 65-70 kDa species recognised by CIZ1b antibody 2B in cancer patients, which means that sequences both upstream and downstream of the CIZ1b epitope are missing from this protein.
  • the data suggest that the 65-70 kDa species is either a complicated CIZ1 splice variant, or an SDS-stable complex between a CIZ1b fragment of CIZ1 and a carrier protein ( FIG. 7D ).
  • a further set of rabbit antibodies was generated using the same immunisation protocol as for 2B (see Higgins et al., as above). This yielded antibody 043, which cleanly and uniquely reacts with the 65-70 kDa band in cancer patients ( FIG. 7B ).
  • 043 provides a detection tool with applications in other assay formats, including ELISA.
  • the lack of recognition of the 55 kDa species suggests less contribution of junction flanking sequences to its epitope compared to 2B, and suggests that the 55 kDa species does not contain the CIZ1b junction.
  • CIZ1b is a potent circulating biomarker for lung cancer with significant potential for application in clinical practise. To realise this potential it must be robust enough to withstand variations in sample processing and collection regimes that occur in busy hospitals. Therefore, the stability of the 65-70 kDa cancer-selective CIZ1b species in plasma and whole blood was tested, and compared with the 55 kDa species, using antibody 2B. The data show stability in isolated plasma over at least 6 hours when incubated at 37° C., with gradual decay in both species thereafter. Similarly there was relatively little change during an hour at temperatures up to 50° C., and stability over at least 3 freeze-thaw cycles. Furthermore, when whole blood was left on the bench for up to 24 hours prior to fractionation there was no loss of signal, all of which indicate it to be a robust biomarker suitable for application in a range of clinical settings.
  • fractionation of plasma to enrich for the exosomal compartment differentially partitioned the 55 kDa species (detected via exon 17) and 65-70 kDa species (detected via 043), with the 65-70 kDa species detected exclusively in the pellet, which is a complex fraction that includes exosomes.
  • the 340 kDa species was isolated from two independent lung cancer patient plasmas ( FIG. 10A ), followed by further separation in the presence of reducing agent ( FIG. 10B ).
  • the 65-70 kDa band corresponding to the cancer-specific western blot signal was excised and digested with either trypsin or Asp-N endoprotease, for identification by mass spectrometry (MS).
  • MS mass spectrometry
  • Mascot database searching returned a single significant identification (P ⁇ 0.05), corresponding to Uniprot P02671; human fibrinogen alpha chain.
  • the endogenous fibrinogen molecule is a hexameric glycoprotein with a pre-cleavage formula mass of 326 kDa and relative mobility of ⁇ 340 kDa, comprised of two sets of three different chains ( ⁇ , ⁇ , and ⁇ ) of 67, 51 and 45 kDa respectively.
  • CIZ1b was not identified in the 65-70 kDa band after digestion with either enzyme.
  • a short synthetic CIZ1b peptide (b13) and long CIZ1b peptide (b66, Table 2) were digested with Asp-N, which generates the diagnostic fragment DEEEIEVRSR (SEQ ID NO: 16) by cutting either side of the CIZ1b exon junction.
  • the peptide was positively identified post digestion of b13 and b66 by MALDI-MS/MS, though at low intensity relative to other peptides in the digest.
  • DEEEIEVRSR SEQ ID NO: 16
  • SRM targeted selection reaction monitoring
  • the peptide is highly acidic, which is likely to reduce ionization efficiency in positive-mode MS, so that even with SRM a small drop in abundance could fall below the limit of detection. It was concluded if the spiked peptide could not be reliably detected at physiologically relevant levels it was unlikely to be possible to detect endogenous CIZ1b, and so followed alternative approaches were followed.
  • CIZ1b peptide but not CIZ1a, generated 043 and 2B-reactive epitope of comparable mobility to the endogenous epitope (65 70 kDa), which is far in excess of the relative molecular mass of free peptide and not present in either of the individual components of the reaction (peptide lanes 6, 7, or plasma lane 3).
  • CIZ1b peptide forms an SDS/DTT-resistant complex with a carrier protein in human plasma, recreating the CIZ1b biomarker recognised by 2B and 043.
  • CIZ1b peptide A molar equivalent of the much longer CIZ1b peptide (b66, Table 2) reconstituted reactive epitope less efficiently, and was detectable only by 2B ( FIG. 10C lane 2, and at higher concentration). With this peptide the reconstituted signal migrated with greater relative molecular mass, at ⁇ 80 kDa, consistent with the increased size of the contributing peptide. Importantly reconstituted CIZ1b epitope, like endogenous epitope, resists standard denaturing SDS-PAGE conditions (10 mM DTT, 2% SDS, 90° C.), but is dissociated by a more aggressive reducing environment.
  • the cancer specific epitope is composed of a relatively short fragment of CIZ1 encompassing the exon14b/15 junction, mounted on fibrinogen alpha chain, which itself makes up most of the mass of the 65-70 kDa species.
  • epitope reconstitution experiments were performed with purified human fibrinogen ( FIG. 10D ).
  • reactive epitope was generated at the mobility of fibrinogen complex (340 kDa in non-reducing gels) and the specificity of the signal was confirmed by lack of reactivity with equivalent CIZ1a peptide.
  • Direct ELISA using human fibrinogen complexed with molar equivalents of CIZ1a and CIZ1b peptides FIG.
  • the CIZ1b-fibrinogen alpha chain complex ELISA was performed as a sandwich ELISA after partial denaturation of 5 ul of plasma in 100 ul of 0.5% tween20, 1% SDS in PBS, supplemented with 0.5 mM PMSF (protease inhibitors) and incubation at 20° C. for 30 mins with repeated vortexing. Plates (Nunc Maxisorb 442404) were coated with 1 ug of 043 CIZ1b pAb protein A fraction, overnight at 4° C. in 100 ul of 50 mM carbonate pH 9.6, then blocked for two hours at room temperature with 300 ul of filtered 1% BSA in PBS.
  • fibrinogen capture antibody was chicken IgY (1 ug/well, Genway 15-288-22856), and analyte concentration was reduced five orders of magnitude by serial dilution.
  • human IgG in direct ELISA 0.5 ul of plasma was coated directly onto plates in 100 ul of 50 mM carbonate buffer pH 9.6, blocked, washed and detected with anti-IgG (Jackson Immuno Research 709-035-149).
  • the present sandwich ELISA format is suitable for high-throughput application on hospital platforms, and can reliably quantify circulating CIZ1b biomarker, and can be used to identify patients with early stage lung cancer.

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