Classifications

• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
  • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
  • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
  • C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
  • C12Q1/6886—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material for cancer
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q2600/00—Oligonucleotides characterized by their use
  • C12Q2600/118—Prognosis of disease development
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q2600/00—Oligonucleotides characterized by their use
  • C12Q2600/158—Expression markers

Definitions

• the present invention provides genes and gene sets the expression of which is important in the diagnosis and/or prognosis of breast cancer.
• Oncologists have a number of treatment options available to them, including different combinations of chemotherapeutic drugs that are characterized as "standard of care,” and a number of drugs that do not carry a label claim for particular cancer, but for which there is evidence of efficacy in that cancer. Best likelihood of good treatment outcome requires that patients be assigned to optimal available cancer treatment, and that this assignment be made as quickly as possible following diagnosis.
• RNA-based tests have not often been used because of the problem of RNA degradation over time and the fact that it is difficult to obtain fresh tissue samples from patients for analysis.
• Fixed paraffin-embedded tissue is more readily available and methods have been established to detect RNA in fixed tissue. However, these methods typically do not allow for the study of large numbers of genes (DNA or RNA) from small amounts of material. Thus, traditionally fixed tissue has been rarely used other than for immunohistochemistry detection of proteins.
• the present invention provides a set of genes, the expression of which has prognostic value, specifically with respect to disease-free survival.
• the present invention accommodates the use of archived paraffin-embedded biopsy material for assay of all markers in the set, and therefore is compatible with the most widely available type of biopsy material. It is also compatible with several different methods of tumor tissue harvest, for example, via core biopsy or fine needle aspiration. Further, for each member of the gene set, the invention specifies oligonucleotide sequences that can be used in the test.
• the invention concerns a method of predicting the likelihood of long- term survival of a breast cancer patient without the recunence of breast cancer, comprising detennining the expression level of one or more prognostic RNA transcripts or their expression products in a breast cancer tissue sample obtained from the patient, normalized against the expression level of all RNA transcripts or their products in the breast cancer tissue sample, or of a reference set of RNA transcripts or their expression products, wherein the prognostic RNA transcript is the transcript of one or more genes selected from the group consisting of: TP53BP2, GRB7, PR, CD68, Bcl2, KR.T14, IRS1, CTSL, EstRl, Chkl, IGFBP2, BAG1, CEGP1, STK15, GSTM1, FHIT, RIZ1, AD31, SURV, BBC3, IGF1R, p27, GATA3, ZNF217, EGFR, CD9, MYBL2, HIFl ⁇ , pS2, ErbB3, TOP2B, MDM2,
• the expression levels of at least two, or at least 5, or at least 10, or at least 15 of the prognostic RNA franscripts or their expression products are determined, h another embodiment, the method comprises the determination of the expression levels of all prognostic RNA transcripts or their expression products. h another particular embodiment, the breast cancer is invasive breast carcinoma.
• RNA is isolated from a fixed, wax-embedded breast cancer tissue specimen of the patient. Isolation may be performed by any technique known in the art, for example from core biopsy tissue or fine needle aspirate cells.
• the invention concerns an array comprising polynucleotides hybridizing to two or more of the following genes: ⁇ -Catenin, AIBl, AKTl, AKT2, ⁇ -actin, BAGl, BBC3, Bcl2, CCNBl, CCNDl, CD68, CD9, CDHl, CEGPl, Chkl, CIAPl, cMet.2, Contig 27882, CTSL, DR5, EGFR, EIF4E, EPHX1, ErbB3, EstRl, FBXO5, FHIT1 FRP1, GAPDH, GATA3, G-Catenin, GRB7, GRO1, GSTM1, GUS, HER2, fflFlA, HNF3A, IGF1R, IGFBP2, KLK
• the anay comprises polynucleotides hybridizing to the following genes: TP53BP2, GRB7, PR, CD68, Bcl2, KRT14, IRS1, CTSL, EstRl, Chkl, IGFBP2, BAGl, CEGPl, STK15, GSTM1, FHIT, RIZl, AIBl, SURV, BBC3, IGF1R, p27, GATA3, ZNF217, EGFR, CD9, MYBL2, HIFl ⁇ , pS2, RIZl, ErbB3, TOP2B, MDM2, RAD51C, KRT19, TS, Her2, KLK10, ⁇ -Catenin, ⁇ -Catenin, MCM2, PI3KC2A, IGFl, TBP, CCNBl, FBXO5 and DR5.
• the polynucleotides can be cDNAs, or ohgonucleotides, and the solid surface on which they are displayed may, for example, be glass.
• the invention concerns a method of predicting the likelihood of long-term survival of a patient diagnosed with invasive breast cancer, without the recurrence of breast cancer, comprising the steps of:
• NEGFB NEGFB; (h) CTSL2, GRB7, TOP2A, CC ⁇ B1, Bcl2, DIABLO, PRAME, EMS1, CA9, and
• EpCAM EpCAM; (i) EstRl, TP53BP2, PRAME, DIABLO, CTSL, PPMID, GRB7, DAPKl, BBC3, and
• IGFBP2 IGFBP2;
• AREG AREG
• BAGl TP53BP2, PRAME, EL6, CC ⁇ B 1 , PAH , AREG, tumor size, CA9, and Ki67
• CEGPl TP53BP2, PRAME, DIABLO, Bcl2, COX2, CC ⁇ E1, STK15, and AKT2, and FGF18;
• CA9 CA9; (aa) p27, TP53BP2, PRAME, DIABLO, Bcl2, COX2, CCNEl, STK15, AKT2, and ID1; (ab) RAD51, GRB7, CD68, TOP2A, CIAP2, CCNBl, BAGl, LL6, FGFR1, and TP53BP2;
• Catenin in a breast cancer tissue sample obtained from the patient, normalized against the expression levels of all RNA transcripts or their expression products in said breast cancer tissue sample, or of a reference set of RNA transcripts or their products;
• the invention concerns a method of predicting the likelihood of long-term survival of a patient diagnosed with estrogen receptor (ER)-positive invasive breast cancer, without the recurrence of breast cancer, comprising the steps of:
• the invention concerns a method of predicting the likelihood of long-term survival of a patient diagnosed with estrogen receptor (ER)-negative invasive breast cancer, without the recurrence of breast cancer, comprising determining the expression levels of the RNA transcripts or the expression products of genes of the gene set CCNDl; UP A;
• HNF3A HNF3A
• CDHl Her2; GRB7; AKT1; STMY3; ⁇ -Catenin; VDR; GRO1; KT14; KLKIO;
• the invention concerns a method of preparing a personalized genomics profile for a patient, comprising the steps of:
• the report may, for example, include prediction of the likelihood of long term survival of the patient and/or recommendation for a treatment modality of said patient.
• the invention concerns a method for amplification of a gene listed in Tables 5A and B by polymerase chain reaction (PCR), comprising performing said PCR by using an amplicon listed in Tables 5A and B and a primer-probe set listed in Tables 6A-F.
• PCR polymerase chain reaction
• the invention concerns a PCR amplicon listed in Tables 5A and
• the invention concerns a PCR primer-probe set listed in Tables 6A-F.
• the invention further concerns a prognostic method comprising: (a) subjecting a sample comprising breast cancer cells obtained from a patient to quantitative analysis of the expression level of the R ⁇ A transcript of at least one gene selected from the group consisting of GRB7, CD68, CTSL, Chkl, ALBl, CC ⁇ B1, MCM2, FBXO5, Her2, STK15, SURV, EGFR, MYBL2, HIFl ⁇ , and TS, or their product, and
• the invention concerns a prognostic method comprising: (a) subjecting a sample comprising breast cancer cells obtained from a patient to quantitative analysis of the expression level of the RNA transcript of at least one gene selected from the group consisting of TP53BP2, PR, Bcl2, KRT14, EstRl, IGFBP2, BAGl, CEGPl, KLKIO, ⁇ -Catenin, ⁇ -Catenin, DR5, PI3KCA2, RAD51C, GSTM1, FHIT, RIZl, BBC3, TBP, p27, IRSl, IGFIR, GATA3, ZNF217, CD9, pS2, ErbB3, TOP2B, MDM2, IGFl, and KRT19, and
• the invention further concerns a kit comprising one or more of (1) extraction buffer/reagents and protocol; (2) reverse transcription buffer/reagents and protocol; and (3) qPCR buffer/reagents and protocol suitable for performing any of the foregoing methods.
• Table 1 is a list of genes, expression of which correlate with breast cancer survival. Results from a retrospective clinical trial. Binary statistical analysis.
• Table 2 is a list of genes, expression of which correlates with breast cancer survival in estrogen receptor (ER) positive patients. Results from a retrospective clinical trial. Binary statistical analysis.
• Table 3 is a list of genes, expression of which correlates with breast cancer survival in estrogen receptor (ER) negative patients. Results from a retrospective clinical trial. Binary statistical analysis.
• Table 4 is a list of genes, expression of which correlates with breast cancer survival. Results from a retrospective clinical trial. Cox proportional hazards statistical analysis.
• Tables 5 A and B show a list of genes, expression of which correlate with breast cancer survival. Results from a retrospective clinical trial.
• the table includes accession numbers for the genes, and amplicon sequences used for PCR amplification.
• Tables 6A-6F The table includes sequences for the forward and reverse primers (designated by “f” and “r”, respectively) and probes (designated by “p") used for PCR amplification of the amplicons listed in Tables 5A-B.
• microarray refers to an ordered anangement of hybridizable array elements, preferably polynucleotide probes, on a substrate.
• polynucleotide when used in singular or plural, generally refers to any polyribonucleotide or polydeoxribonucleotide, which may be unmodified RNA or DNA or modified RNA or DNA.
• polynucleotides as defined herein include, without limitation, single- and double-stranded DNA, DNA including single- and double- stranded regions, single- and double-stranded RNA, and RNA including single- and double- stranded regions, hybrid molecules comprising DNA and RNA that maybe single-stranded or, more typically, double-stranded or include single- and double-stranded regions.
• polynucleotide refers to triple-stranded regions comprising RNA or DNA or both RNA and DNA.
• the strands in such regions may be from the same molecule or from different molecules.
• the regions may include all of one or more of the molecules, but more typically involve only a region of some of the molecules.
• One of the molecules of a triple-helical region often is an oligonucleotide.
• polynucleotide specifically includes cDNAs.
• the term includes DNAs (including cDNAs) and RNAs that contain one or more modified bases.
• DNAs or RNAs with backbones modified for stability or for other reasons are "polynucleotides" as that term is intended herein.
• DNAs or RNAs comprising unusual bases, such as inosine, or modified bases, such as tritiated bases are included within the term “polynucleotides” as defined herein.
• polynucleotide embraces all chemically, enzymatically and/or metabolically modified forms of unmodified polynucleotides, as well as the chemical forms of DNA and RNA characteristic of viruses and cells, including simple and complex cells.
• oligonucleotide refers to a relatively short polynucleotide, including, without limitation, single-stranded deoxyribonucleotides, single- or double-stranded ribonucleotides, RNA:DNA hybrids and double-stranded DNAs.
• Ohgonucleotides such as single-stranded DNA probe ohgonucleotides, are often synthesized by chemical methods, for example using automated oligonucleotide synthesizers that are commercially available.
• ohgonucleotides can be made by a variety of other methods, including in vitro recombinant DNA-mediated techniques and by expression of DNAs in cells and organisms.
• differentially expressed gene refers to a gene whose expression is activated to a higher or lower level in a subject suffering from a disease, specifically cancer, such as breast cancer, relative to its expression in a normal or control subject.
• the terms also include genes whose expression is activated to a higher or lower level at different stages of the same disease. It is also understood that a differentially expressed gene may be either activated or inhibited at the nucleic acid level or protein level, or may be subject to alternative splicing to result in a different polypeptide product. Such differences may be evidenced by a change in mRNA levels, surface expression, secretion or other partitioning of a polypeptide, for example.
• Differential gene expression may include a comparison of expression between two or more genes or their gene products, or a comparison of the ratios of the expression between two or more genes or their gene products, or even a comparison of two differently processed products of the same gene, which differ between normal subjects and subjects suffering from a disease, specifically cancer, or between various stages of the same disease.
• Differential expression includes both quantitative, as well as qualitative, differences in the temporal or cellular expression pattern in a gene or its expression products among, for example, normal and diseased cells, or among cells which have undergone different disease events or disease stages.
• “differential gene expression” is considered to be present when there is at least an about two-fold, preferably at least about four-fold, more preferably at least about six-fold, most preferably at least about ten-fold difference between the expression of a given gene in normal and diseased subjects, or in various stages of disease development in a diseased subject.
• the phrase "gene amplification” refers to a process by which multiple copies of a gene or gene fragment are formed in a particular cell or cell line.
• the duplicated region (a stretch of amplified DNA) is often refened to as "amplicon.”
• amplicon usually, the amount of the messenger RNA (mRNA) produced, i.e., the level of gene expression, also increases in the proportion of the number of copies made of the particular gene expressed.
• diagnosis is used herein to refer to the identification of a molecular or pathological state, disease or condition, such as the identification of a molecular subtype of head and neck cancer, colon cancer, or other type of cancer.
• prognosis is used herein to refer to the prediction of the likelihood of cancer-attributable death or progression, including recunence, metastatic spread, and drug resistance, of a neoplastic disease, such as breast cancer.
• prediction is used herein to refer to the likelihood that a patient will respond either favorably or unfavorably to a drug or set of drugs, and also the extent of those responses, or that a patient will survive, following surgical removal or the primary tumor and/or chemotherapy for a certain period of time without cancer recurrence.
• the predictive methods of the present invention can be used clinically to make treatment decisions by choosing the most appropriate treatment modalities for any particular patient.
• the predictive methods of the present invention are valuable tools in predicting if a patient is likely to respond favorably to a treatment regimen, such as surgical intervention, chemotherapy with a given drug or drug combination, and/or radiation therapy, or whether long-term survival of the patient, following carbony and/or termination of chemotherapy or other treatment modalities is likely.
• long-term survival is used herein to refer to survival for at least 3 years, more preferably for at least 8 years, most preferably for at least 10 years following surgery or other treatment.
• tumor refers to all neoplastic cell growth and proliferation, whether malignant or benign, and all pre-cancerous and cancerous cells and tissues.
• cancer and “cancerous” refer to or describe the physiological condition in mammals that is typically characterized by unregulated cell growth. Examples of cancer include but are not limited to, breast cancer, colon cancer, lung cancer, prostate cancer, hepatocellular cancer, gastric cancer, pancreatic cancer, cervical cancer, ovarian cancer, liver cancer, bladder cancer, cancer of the urinary tract, thyroid cancer, renal cancer, carcinoma, melanoma, and brain cancer.
• the "pathology" of cancer includes all phenomena that compromise the well-being of the patient. This includes, without limitation, abnormal or uncontrollable cell growth, metastasis, interference with the normal functioning of neighboring cells, release of cytokines or other secretory products at abnormal levels, suppression or aggravation of inflammatory or immunological response, neoplasia, premahgnancy, malignancy, invasion of surrounding or distant tissues or organs, such as lymph nodes, etc.
• “Stringency” of hybridization reactions is readily determinable by one of ordinary skill in the art, and generally is an empirical calculation dependent upon probe length, washing temperature, and salt concentration. In general, longer probes require higher temperatures for proper annealing, while shorter probes need lower temperatures. Hybridization generally depends on the ability of denatured DNA to reanneal when complementary strands are present in an environment below their melting temperature. The higher the degree of desired homology between the probe and hybridizable sequence, the higher the relative temperature which can be used. As a result, it follows that higher relative temperatures would tend to make the reaction conditions more stringent, while lower temperatures less so. For additional details and explanation of stringency of hybridization reactions, see Ausubel et al., Cunent Protocols in Molecular Biology. Wiley Interscience Publishers, (1995).
• “Stringent conditions” or “high stringency conditions”, as defined herein, typically: (1) employ low ionic strength and high temperature for washing, for example 0.015 M sodium chloride/0.0015 M sodium citrate/0.1% sodium dodecyl sulfate at 50°C; (2) employ during hybridization a denaturing agent, such as formamide, for example, 50% (v/v) formamide with 0.1 % bovine serum albumin 0.1 % Ficoll 0.1 % polyvinylpyrrolidone/5 OmM sodium phosphate buffer at pH 6.5 with 750 mM sodium chloride, 75 mM sodium citrate at 42°C; or (3) employ 50% formamide, 5 x SSC (0.75 M NaCl, 0.075 M sodium citrate), 50 mM sodium phosphate (pH 6.8), 0.1% sodium pyrophosphate, 5 x Denhardt's solution, sonicated salmon sperm DNA (50 ⁇ g/ml), 0.1% SDS, and 10% dextran sulfate
• Modely stringent conditions may be identified as described by Sambrook et al., Molecular Cloning: A Laboratory Manual, New York: Cold Spring Harbor Press, 1989, and include the use of washing solution and hybridization conditions (e.g., temperature, ionic strength and %SDS) less stringent that those described above.
• washing solution and hybridization conditions e.g., temperature, ionic strength and %SDS
• moderately stringent conditions is overnight incubation at 37°C in a solution comprising: 20% formamide, 5 x SSC (150 mM NaCl, 15 mM trisodium citrate), 50 mM sodium phosphate (pH 7.6), 5 x Denhardt's solution, 10% dextran sulfate, and 20 mg/ml denatured sheared salmon sperm DNA, followed by washing the filters in 1 x SSC at about 37-50°C.
• the skilled artisan will recognize how to adjust the temperature, ionic strength, etc. as necessary to accommodate factors such as probe length and the like.
• expression threshold and “defined expression threshold” are used interchangeably and refer to the level of a gene or gene product in question above which the gene or gene product serves as a predictive marker for patient survival without cancer recunence.
• the threshold is defined experimentally from clinical studies such as those described in the Example below.
• the expression threshold can be selected either for maximum sensitivity, or for maximum selectivity, or for minimum enor. The determination of the expression threshold for any situation is well within the knowledge of those skilled in the art.
• Gene Expression profiling In general, methods of gene expression profiling can be divided into two large groups: methods based on hybridization analysis of polynucleotides, and methods based on sequencing of polynucleotides.
• the most commonly used methods known in the art for the quantification of mRNA expression in a sample include northern blotting and in situ hybridization (Parker & Barnes, Methods in Molecular Biology 106:247-283 (1999)); RNAse protection assays (Hod, Biotechniques 13:852-854 (1992)); and reverse transcription polymerase chain reaction (RT-PCR) (Weis et al, Trends in Genetics 8:263-264 (1992)).
• antibodies may be employed that can recognize specific duplexes, including DNA duplexes, RNA duplexes, and DNA-RNA hybrid duplexes or DNA-protein duplexes.
• Representative methods for sequencing-based gene expression analysis include Serial Analysis of Gene Expression (SAGE), and gene expression analysis by massively parallel signature sequencing (MPSS).
• RT-PCR Reverse Transcrivtase PCR
• the first step is the isolation of mRNA from a target sample.
• the starting material is typically total RNA isolated from human tumors or tumor cell lines, and conesponding normal tissues or cell lines, respectively.
• RNA can be isolated from a variety of primary tumors, including breast, lung, colon, prostate, brain, liver, kidney, pancreas, spleen, thyrnus, testis, ovary, uterus, etc., tumor, or tumor cell lines, with pooled DNA from healthy donors.
• mRNA can be extracted, for example, from frozen or archived paraffin-embedded and fixed (e.g. formalin-fixed) tissue samples.
• RNA isolation can be performed using purification kit, buffer set and protease from commercial manufacturers, such as Qiagen, according to the manufacturer's instructions. For example, total RNA from cells in culture can be isolated using Qiagen RNeasy mini-columns.
• RNA isolation kits include MasterPureTM Complete DNA and RNA Purification Kit (EPICENTRE®, Madison, WI), and Paraffin Block RNA Isolation Kit (Ambion, Inc.).
• Total RNA from tissue samples can be isolated using RNA Stat-60 (Tel-Test).
• RNA prepared from tumor can be isolated, for example, by cesium chloride density gradient centrifugation.
• the first step in gene expression profiling by RT-PCR is the reverse transcription of the RNA template into cDNA, followed by its exponential amplification in a PCR reaction.
• the two most commonly used reverse transcriptases are avilo myeloblastosis virus reverse transcriptase (AMV-RT) and Moloney murine leukemia virus reverse transcriptase (MMLV-RT).
• AMV-RT avilo myeloblastosis virus reverse transcriptase
• MMLV-RT Moloney murine leukemia virus reverse transcriptase
• the reverse transcription step is typically primed using specific primers, random hexamers, or oligo-dT primers, depending on the circumstances and the goal of expression profiling.
• extracted RNA can be reverse-transcribed using a GeneAmp RNA PCR kit (Perkin Elmer, CA, USA), following the manufacturer's instructions.
• the derived cDNA can then be used as a template in the subsequent PCR reaction.
• the PCR step can use a variety of thermostable DNA-dependent DNA polymerases, it typically employs the Taq DNA polymerase, which has a 5 '-3' nuclease activity but lacks a 3 '-5' proofreading endonuclease activity.
• TaqMan® PCR typically utilizes the 5 '-nuclease activity of Taq or Tth polymerase to hydrolyze a hybridization probe bound to its target amplicon, but any enzyme with equivalent 5' nuclease activity can be used.
• Two oligonucleotide primers are used to generate an amplicon typical of a PCR reaction.
• a third oligonucleotide, or probe is designed to detect nucleotide sequence located between the two PCR primers.
• the probe is non-extendible by Taq DNA polymerase enzyme, and is labeled with a reporter fluorescent dye and a quencher fluorescent dye. Any laser-induced emission from the reporter dye is quenched by the quenching dye when the two dyes are located close together as they are on the probe.
• the Taq DNA polymerase enzyme cleaves the probe in a template-dependent manner.
• the resultant probe fragments disassociate in solution, and signal from the released reporter dye is free from the quenching effect of the second fluorophore.
• One molecule of reporter dye is liberated for each new molecule synthesized, and detection of the unquenched reporter dye provides the basis for quantitative interpretation of the data.
• TaqMan® RT-PCR can be performed using commercially available equipment, such as, for example, ABI PRISM 7700TM Sequence Detection SystemTM (Perkin-Efmer-Applied Biosystems, Foster City, CA, USA), or Lightcycler (Roche Molecular Biochemicals, Mannheim, Germany), h a prefened embodiment, the 5' nuclease procedure is run on a realtime quantitative PCR device such as the ABI PRISM 7700TM Sequence Detection SystemTM.
• the system consists of a thermocycler, laser, charge-coupled device (CCD), camera and computer.
• the system amplifies samples in a 96-well format on a thermocycler.
• laser-induced fluorescent signal is collected in real-time through fiber optics cables for all 96 wells, and detected at the CCD.
• the system includes software for running the instrument and for analyzing the data.
• 5'-Nuclease assay data are initially expressed as Ct, or the threshold cycle.
• Ct fluorescence values are recorded during every cycle and represent the amount of product amplified to that point in the amplification reaction. The point when the fluorescent signal is first recorded as statistically significant is the threshold cycle (C t ).
• C t The point when the fluorescent signal is first recorded as statistically significant is the threshold cycle (C t ).
• RT-PCR is usually performed using an internal standard. The ideal internal standard is expressed at a constant level among different tissues, and is unaffected by the experimental treatment.
• RNAs most frequently used to normalize patterns of gene expression are mRNAs for the housekeeping genes glyceraldehyde-3-phosphate-dehydrogenase (GAPDH) and ⁇ -actin.
• GPDH glyceraldehyde-3-phosphate-dehydrogenase
• RT-PCR measures PCR product accumulation through a dual-labeled fluorigenic probe (i.e., TaqMan® probe).
• Real time PCR is compatible both with quantitative competitive PCR, where internal competitor for each target sequence is used for normalization, and with quantitative comparative PCR using a normalization gene contained within the sample, or a housekeeping gene for RT-PCR.
• quantitative competitive PCR where internal competitor for each target sequence is used for normalization
• quantitative comparative PCR using a normalization gene contained within the sample, or a housekeeping gene for RT-PCR.
• RNA isolation, purification, primer extension and amplification are given in various published journal articles ⁇ for example: T.E. Godfrey et al,. J. Molec. Diagnostics 2: 84-91 [2000]; K. Specht et al., Am. J. Pathol. 158: 419-29 [2001] ⁇ .
• a representative process starts with cutting about 10 ⁇ m thick sections of paraffin-embedded tumor tissue samples. The RNA is then extracted, and protein and DNA are removed. After analysis of the RNA concentration, RNA repair and/or amplification steps may be included, if necessary, and RNA is reverse transcribed using gene specific promoters followed by RT-PCR.
• PCR primers and probes are designed based upon infron sequences present in the gene to be amplified.
• the first step in the primer/probe design is the delineation of infron sequences within the genes. This can be done by publicly available software, such as the DNA BLAT software developed by Kent, W.J., Genome Res. 12(4):656-64 (2002), or by the BLAST software including its variations. Subsequent steps follow well established methods of PCR primer and probe design.
• PCR primer design The most important factors considered in PCR primer design include primer length, melting temperature (Tm), and G/C content, specificity, complementary primer sequences, and 3'-end sequence.
• optimal PCR primers are generally 17-30 bases in length, and contain about 20-80%, such as, for example, about 50-60% G+C bases. Tm's between 50 and 80 °C, e.g. about 50 to 70 °C are typically prefened.
• RNA can be isolated from a variety of primary tumors or tumor cell lines.
• mRNA can be extracted, for example, from frozen or archived paraffin-embedded and fixed (e.g. formalin- fixed) tissue samples, which are routinely prepared and preserved in everyday clinical practice.
• a specific embodiment of the microanay teclmique, PCR amplified inserts of cDNA clones are applied to a substrate in a dense array.
• Preferably at least 10,000 nucleotide sequences are applied to the substrate.
• the microarrayed genes, immobilized on the microchip at 10,000 elements each, are suitable for hybridization under stringent conditions. Fluorescently labeled cDNA probes may be generated through incorporation of fluorescent nucleotides by reverse transcription of RNA extracted from tissues of interest.
• Labeled cDNA probes applied to the chip hybridize with specificity to each spot of DNA on the array. After stringent washing to remove non-specifically bound probes, the chip is scanned by confocal laser microscopy or by another detection method, such as a CCD camera. Quantitation of hybridization of each arrayed element allows for assessment of conesponding mRNA abundance. With dual color fluorescence, separately labeled cDNA probes generated from two sources of RNA are hybridized pairwise to the anay. The relative abundance of the transcripts from the two sources conesponding to each specified gene is thus determined simultaneously. The miniaturized scale of the hybridization affords a convenient and rapid evaluation of the expression pattern for large numbers of genes.
• Microanay analysis can be performed by commercially available equipment, following manufacturer's protocols, such as by using the Affymetrix GenChip technology, or h cyte's microanay technology.
• Serial analysis of gene expression is a method that allows the simultaneous and quantitative analysis of a large number of gene transcripts, without the need of providing an individual hybridization probe for each transcript.
• a short sequence tag (about 10-14 bp) is generated that contains sufficient information to uniquely identify a transcript, provided that the tag is obtained from a unique position within each transcript.
• many transcripts are linked together to form long serial molecules, that can be sequenced, revealing the identity of the multiple tags simultaneously.
• the expression pattern of any population of franscripts can be quantitatively evaluated by determining the abundance of individual tags, and identifying the gene corresponding to each tag. For more details see, e.g. Nelculescu et al, Science 270:484-487 (1995); and Nelculescu et al, Cell 88:243-51 (1997).
• Mass ARRAY Technolosv The MassARRAY (Sequenom, San Diego, California) technology is an automated, high-throughput method of gene expression analysis using mass spectrometry (MS) for detection.
• MS mass spectrometry
• the cD ⁇ As are subjected to primer extension.
• the cD ⁇ A-derived primer extension products are purified, and dipensed on a chip array that is pre-loaded with the components needed for MALTI-TOF MS sample preparation.
• the various cD ⁇ As present in the reaction are quantitated by analyzing the peak areas in the mass spectrum obtained.
• the free ends of the cloned templates on each microbead are analyzed simultaneously, using a fluorescence-based signature sequencing method that does not require D ⁇ A fragment separation. This method has been shown to simultaneously and accurately provide, in a single operation, hundreds of thousands of gene signature sequences from a yeast cD ⁇ A library.
• Immunohistochemistry hnmunohistochemistry methods are also suitable for detecting the expression levels of the prognostic markers of the present invention.
• antibodies or antisera preferably polyclonal antisera, and most preferably monoclonal antibodies specific for each marker are used to detect expression.
• the antibodies can be detected by direct labeling of the antibodies themselves, for example, with radioactive labels, fluorescent labels, hapten labels such as, biotin, or an enzyme such as horse radish peroxidase or alkaline phosphatase.
• unlabeled primary antibody is used in conjunction with a labeled secondary antibody, comprising antisera, polyclonal antisera or a monoclonal antibody specific for the primary antibody. Immunohistochemistry protocols and kits are well known in the art and are commercially available.
• proteome is defined as the totality of the proteins present in a sample (e.g. tissue, organism, or cell culture) at a certain point of time.
• Proteomics includes, among other things, study of the global changes of protein expression in a sample (also refened to as "expression proteomics").
• Proteomics typically includes the following steps: (1) separation of individual proteins in a sample by 2-D gel elecfrophoresis (2-D PAGE); (2) identification of the individual proteins recovered from the gel, e.g. my mass spectrometry or N-terminal sequencing, and (3) analysis of the data using bioinfonnatics.
• Proteomics methods are valuable supplements to other methods of gene expression profiling, and can be used, alone or in combination with other methods, to detect the products of the prognostic markers of the present invention.
• RNA isolation, purification, primer extension and amplification The steps of a representative protocol for profiling gene expression using fixed, paraffin-embedded tissues as the RNA source, including mRNA isolation, purification, primer extension and amplification are given in various published journal articles ⁇ for example: T.E. Godfrey et al. J. Molec. Diagnostics 2: 84-91 [2000]; K. specht et al., Am. J. Pathol. 158: 419-29 [2001] ⁇ . Briefly, a representative process starts with cutting about 10 ⁇ m thick sections of paraffin-embedded tumor tissue samples. The RNA is then extracted, and protein and DNA are removed.
• RNA repair and/or amplification steps may be included, if necessary, and RNA is reverse transcribed using gene specific promoters followed by RT-PCR. Finally, the data are analyzed to identify the best treatment option(s) available to the patient on the basis of the characteristic gene expression pattern identified in the tumor sample examined.
• An important aspect of the present invention is to use the measured expression of certain genes by breast cancer tissue to provide prognostic information. For this purpose it is necessary to conect for (normalize away) both differences in the amount of RNA assayed and variability in the quality of the RNA used. Therefore, the assay typically measures and incorporates the expression of certain normalizing genes, including well known housekeeping genes, such as GAPDH and Cypl. Alternatively, normalization can be based on the mean or median signal (Ct) of all of the assayed genes or a large subset thereof (global nonnalization approach). On a gene-by-gene basis, measured normalized amount of a patient tumor mRNA is compared to the amount found in a breast cancer tissue reference set.
• Ct mean or median signal
• the number (N) of breast cancer tissues in this reference set should be sufficiently high to ensure that different reference sets (as a whole) behave essentially the same way. If this condition is met, the identity of the individual breast cancer tissues present in a particular set will have no significant impact on the relative amounts of the genes assayed.
• the breast cancer tissue reference set consists of at least about 30, preferably at least about 40 different FPE breast cancer tissue specimens. Unless noted otherwise, normalized expression levels for each mRNA/tested tumor/patient will be expressed as a percentage of the expression level measured in the reference set. More specifically, the reference set of a sufficiently high number (e.g. 40) of tumors yields a distribution of normalized levels of each mRNA species.
• the level measured in a particular tumor sample to be analyzed falls at some percentile within this range, which can be determined by methods well known in the art.
• reference to expression levels of a gene assume normalized expression relative to the reference set although this is not always explicitly stated.
• a Phase II Study of Gene Expression in 79 Malignant Breast Tumors A gene expression study was designed and conducted with the primary goal to molecularly characterize gene expression in paraffin-embedded, fixed tissue samples of invasive breast ductal carcinoma, and to explore the conelation between such molecular profiles and disease-free survival.
• Each representative tumor block was characterized by standard histopathology for diagnosis, semi-quantitative assessment of amount of tumor, and tumor grade.
• a total of 6 sections (10 microns in thickness each) were prepared and placed in two Costar Brand Microcentrifuge Tubes (Polypropylene, 1.7 mL tubes, clear; 3 sections in each tube). If the tumor constituted less than 30% of the total specimen area, the sample may have been crudely dissected by the pathologist, using gross microdissection, putting the tumor tissue directly into the Costar tube.
• Gene Expression Analysis was extracted and purified from fixed, paraffin-embedded tissue samples, and prepared for gene expression analysis as described in section 9 above.
• ABI PRISM 7900TM Molecular assays of quantitative gene expression were performed by RT-PCR, using the ABI PRISM 7900TM Sequence Detection SystemTM (Perkin-Elmer-Applied Biosystems, Foster City, CA, USA).
• ABI PRISM 7900TM consists of a thermocycler, laser, charge-coupled device (CCD), camera and computer. The system amplifies samples in a 384-well format on a thermocycler. During amplification, laser-induced fluorescent signal is collected in real-time through fiber optics cables for all 384 wells, and detected at the CCD. The system includes software for running the instrument and for analyzing the data. Analysis and Results
• Tumor tissue was analyzed for 185 cancer-related genes and 7 reference genes.
• the threshold cycle (CT) values for each patient were normalized based on the median of the 7 reference genes for that particular patient.
• Clinical outcome data were available for all patients from a review of registry data and selected patient charts. Outcomes were classified as:
• Table 1 lists the 47 genes for which the p-value for the differences between the groups was ⁇ 0.10.
• the first column of mean expression values pertains to patients who neither had a metastatic recunence of nor died from breast cancer.
• the second column of mean expression values pertains to patients who either had a metastatic recunence of or died from breast cancer.
• the expression of any of the following genes in breast cancer above a defined expression threshold indicates a reduced likelihood of survival without cancer recunence following surgery: Grb7, CD68, CTSL, Chkl, Her2, STK15, AJBl, SURV, EGFR, MYBL2, HIFl ⁇ .
• the expression of any of the following genes in breast cancer above a defined expression threshold indicates a better prognosis for survival without cancer recurrence following surgery: TP53BP2, PR, Bcl2, KRT14, EstRl, IGFBP2, BAGl, CEGPl, KLKIO, ⁇ Catenin, GSTM1, FHIT, Rizl, IGFl, BBC3, IGFR1, TBP, p27, LRSl, IGFIR, GATA3, CEGPl, ZNF217, CD9, pS2, ErbB3, TOP2B, MDM2, RAD51, and KRT19.
• ER positive patients 57 patients with normalized CT for estrogen receptor (ER) >0 (i.e., ER positive patients) were subjected to separate analysis.
• a t test was performed on the two groups of patients classified as either no recurrence and no breast cancer related death at three years, or recunence or breast cancer-related death at three years, and the p-values for the differences between the groups for each gene were calculated.
• the first column of mean expression values pertains to patients who neither had a metastatic recurrence nor died from breast cancer.
• the second column of mean expression values pertains to patients who either had a metastatic recunence of or died from breast cancer.
• CT threshold value
• IGFR1; BC12; TP53BP2 GATA3; BBC3; RAD51C; BAGl; IGFBP2; PR; CD9; CEGPl; DR5; p27; RIZl; ErbB3 TOP2B; ELF4E have also been identified as indicators of good prognosis in the previous analysis, not limited to ER-positive breast cancer.
• ER negative patients Twenty patients with normalized CT for estrogen receptor (ER) ⁇ 1.6 (i.e., ER negative patients) were subjected to separate analysis. A t test was performed on the two groups of patients classified as either no recunence and no breast cancer related death at three years, or recurrence or breast cancer-related death at three years, and the p-values for the differences between the groups for each gene were calculated. Table 3 lists the genes where the p-value for the differences between the groups was ⁇ 0.118. The first column of mean expression values pertains to patients who neither had a metastatic recunence nor died from breast cancer. The second column of mean expression values pertains to patients who either had a metastatic recurrence of or died from breast cancer.
• Cox model provides the relative risk (RR) of recunence or death for a unit change in the expression of the gene.
• RR relative risk
• any threshold value will define subgroups of patients with respectively increased or decreased risk.
• Table 4 The third column, with the heading: exp(coef), shows RR values.
• stepwise entry of each individual gene into the model is performed, where the first gene entered is preselected from among those genes having significant univariate p-values, and the gene selected for entry into the model at each subsequent step is the gene that best improves the fit of the model to the data.
• This analysis can be performed with any total number of genes, h the analysis the results of which are shown below, stepwise entry was performed for up to 10 genes.
• Multivariate analysis is performed using the following equation:
• Ct(geneC) + coefficients for genes that are predictors of beneficial outcome are positive numbers and coefficients for genes that are predictors of unfavorable outcome are negative numbers.
• the "Ct" values in the equation are ⁇ Cts, i.e. reflect the difference between the average normalized Ct value for a population and the normalized Ct measured for the patient in question.
• the convention used in the present analysis has been that ⁇ Cts below and above the population average have positive signs and negative signs, respectively (reflecting greater or lesser mRNA abundance).
• the relative risk (RR) calculated by solving this equation will indicate if the patient has an enhanced or reduced chance of long-term survival without cancer recurrence.
• Multivariate gene analysis of 79 patients with invasive breast carcinoma A multivariate stepwise analysis, using the Cox Proportional Hazards Model, was performed on the gene expression data obtained for all 79 patients with invasive breast carcinoma. The following ten-gene sets have been identified by this analysis as having particularly strong predictive value of patient survival :
• IGFBP2 IGFBP2, GRB7, PRAME, DIABLO, CTSL, ⁇ -Catenin, PPMID, Chkl, WISP1, and
• AIB1 NMJ306534 GCGGCGAGTTTCCGATTTAAAGCTGAGCTGCGAGGAAAATGGCGGCGGGAGGATCAAAATACTTGCTGGATGGTGGACTCA
• AKT2 NMJ301626 TCCTGCCACCCTTCAAACCTCAGGTCACGTCCGAGGTCGACACAAGGTACTTCGATGATGAATTTACCGCC
• CCNE1 N NMM_C3I00112233a8 A / AAGAAGATGATGACCGGGTTTACCCAAACTCAACGTGCAAGCCTCGGATTATTGCACCATCCAGAGGCTC .
• CTSL NMJ-01912 GGGAGGCTTATCTCACTGAGTGAGCAGAATCTGGTAGACTGCTCTGGGCCTCAAGGCAATGAAGGCTGCAATGG
• DAPK1 NMJ.04938 CGCTGACATCATGAATGTTCCTCGACCGGCTGGAGGCGAGTTTGGATATGACAAAGACACATCGTTGCTGAAAGAGA
• EGFR NM_005228 TGTCGATGGACTTCCAGAACCACCTGGGCAGCTGCCAAAAGTGTGATCCAAGCTGTCCCAAT
• EMS1 NM_005231 GGCAGTGTCACTGAGTCCTTGAAATCCTCCCCTGCCCCGCGGGTCTCTGGATTGGGACGCACAGTGCA
• EPHX1 • NM_000120 ACCGTAGGCTCTGCTCTGAATGACTCTCCTGTGGGTCTGGCTGCCTATATTCTAGAGAAGTTTTCCACCTGGACCA
• FGFR1 NM_023109 CACGGGACATTCACCACATCGACTACTATAAAAAGACAACCAACGGCCGACTGCCTGTGAAGTGGATGGCACCC
• FRP1 NM 003012 TTGGTACCTGTGGGTTAGCATCAAGTTCTCCCCAGGGTAGAATTCAATCAGAGCTCCAGTTTGCATTTGGATGTG
• G-Catenin NM 002230 TCAGCAGCAAGGGCATCATGGAGGAGGATGAGGCCTGCGGGCGCCAGTACACGCTCAAGAAAACCACC
• HNF3A NM_004498 TCCAGGATGTTAGGAACTGTGAAGATGGAAGGGCATGAAACCAGCGACTGGAACAGCTACTACGCAGACACGC
• IGF1 NM_00061S TCCGGAGCTGTGATCTAAGGAGGCTGGAGATGTATTGCGCACCCCTCAAGCCTGCCAAGTCAGCTCGCTCTGTCCG
• IGF1R NM_000875 GCATGGTAGCCGMGATTTCACAGTCAAAATCGGAGATTTTGGTATGACGCGAGATATCTATGAGACAGACTATTACCGGAAA.
• IGFBP2 NM_000597 GTGGACAGCACCATGAACATGTTGGGCGGGGGAGGCAGTGCTGGCCGGAAGCCCCTCAAGTCGGGTATGAAGG
• P14ARF S78535 CCCTCGTGCTGATGCTACTGAGGAGCCAGCGTCTAGGGCAGCAGCCGCTTCCTAGAAGACCAGGTCATGATG p27 NM_004064 CGGTGGACCACGAAGAGTTAACCCGGGACTTGGAGAAGCACTGCAGAGACATGGAAGAGGCGAGCC
• PI3KC2A ATACCAATCACCGCACAAACCCAGGCTATTTGTTAAGTCCAGTCACAGCGCAAAGAAACATATGCGGAGAAAATGCTAGTGTG
• T1MP 1 NM-.003254 TCCCTGCGGTCCCAGATAGCCTGAATCCTGCCCGGAGTGGAACTGAAGCCTGCACAGTGTCCACCCTGTTCCCAC
• T0P2A NM-.001067 AATCCAAGGGGGAGAGTGATGACTTCCATATGGACTTTGACTCAGCTGTGGCTCCTCGGGCAAAATCTGTAC
• T0P2B NM-.001068 TGTGGACATCTTCCCCTCAGACTTCCCTACTGAGCCACCTTCTCTGCCACGAACCGGTCGGGCTAG
• TP53BP2 NM_005426 GGGCCAAATATTCAGAAGCTTTTATATCAGAGGACCACCATAGCGGCCATGGAGACCATCTCTGTCCCATCATACCCATCC
• VDR NM_000376 GCCCTGGATTTCAGAAAGAGCCAAGTCTGGATCTGGGACCCTTTCCTTCCTTGCCTGGCTTGTAACT
• VEGF NM_003376 CTGCTGTCTTGGGTGCATTGGAGCCTTGCCTTGCTGCTCTACCTCCACCATGCCAAGTGGTCCCAGGCTGC
• VEGFB NMJ303377 TGACGATGGCCTGGAGTGTGTGCCCACTGGGCAGCACCAAGTCCGGATGCAGATCCTCATGATCCGGTACC
• WISP1 NM_003882 AGAGGCATCCATGAAGTTCACACTTGCGGGCTGCATCAGCACACGCTCCTATCAACCCAAGTACTGTGGAGTTTG .
• YB-1 NM_004559 AGACTGTGGAGTTTGATGTTGTTGAAGGAAAAGGGTGCGGAGGCAGCAAATGTTACAGGTCCTGGTGGTGTTCC
• AKT1 NM_005163 S4776/AKT1.p3 CAGCCCTGGACTACCTGCACTCGG 24
• CTSL NM_001912 S1304/CTSL.r2 CCATTGCAGCCTTCATTGC 19
• CTSL NM_001912 S4899/CTSL.p2 TTGAGGCCCAGAGCAGTCTACCAGATTCT 29
• CTSL2 NM_001333 S4355/CTSL2.r1 ACCATTGCAGCCCTGATTG 19
• CTSL2 NM_001333 S4356/CTSL2.p1 CTTGAGGACGCGAACAGTCCACCA 24
• DAPK1 NM_004938 S1768/DAPK1.f3 CGCTGACATCATGAATGTTCCT 22
• DAPK1 NM_004938 S1769/DAPK1.r3 TCTCTTTCAGCAACGATGTGTCTT ' 24
• DAPK1 NM_004938 S4927/DAPK1.p3 TCATATCCAAACTCGCCTCCAGCCG 25
• DIABLO NM_019887 S0808/DIABLO.f1 CACAATGGCGGCTCTGAAG 19
• DIABLO NM_019887 S4813/DIABLO.p1 AAGTTACGCTGCGCGACAGCCAA 23
• EPHX1 NM_000120 S1866/EPHX1.r2 TGGTCCAGGTGGAAAACTTC 20
• FGF18 NM_003862 S1665/FGF18.f2 CGGTAGTCAAGTCCGGATCAA 21
• FGF18 NM_003862 S4914/FGF18.p2 CAAGGAGACGGAATTCTACCTGTGC ' 25 FGFR1 NM_023109 S0818/FGFR1.f3 CACGGGACATTCACCACATC 20 •
• FRP1 NM_003012 S1805/FRP1.r3 CACATCCAAATGCAAACTGG 20
• GUS NM_000181 S0141/GUS.r1 CACGCAGGTGGTATCAGTCT 20
• HIF1A NM_001530 S1207/HIF1A.f3 TGAACATAAAGTCTGCAACATGGA 24
• IGFBP2 NM_000597 S4837/IGFBP2.p1 CTTCCGGCCAGCACTGCCTC 20
• S0436/Ki-67.f2 CGGACTTTGGGTGCGACTT 19
• PAH NM_000602 S0211/PAI.1.f3 CCGCAACGTGGTTTTCTCA 19
• PAH NM_000602 S0213/PAH .r3 TGCTGGGTTTCTCCTCCTGTT 21
• PAH NM_000602 S5066/PAI1.p3 CTCGGTGTTGGCCATGCTCCAG 22
• PDGF.Rb NM_002609 S1347/PDGFRb.r3 GGGTGGCTCTCACTTAGCTC 20
• TP53BP2 NM_005426 S1931/TP53BP.f2 GGGCCAAATATTCAGAAGC 19
• TP53BP2 NM_005426 S1932 TP53BP.r2 GGATGGGTATGATGGGACAG 20
• TRAIL NM_003810 S4980tTRAIL.p1 AAGTACACGTAAGTTACAGCCACACA ' 26
• VDR NM_000376 S4962/VDR.p2 CAAGTCTGGATCTGGGACCCTTTCC 25
• VEGF NMJD03376 S0286 ⁇ /EGF..1 CTGCTGTCTTGGGTGCATTG 20

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