WO2011070174A1 - Methods and reagents for improved detection of amyloid beta peptides - Google Patents

Methods and reagents for improved detection of amyloid beta peptides Download PDF

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Publication number
WO2011070174A1
WO2011070174A1 PCT/EP2010/069474 EP2010069474W WO2011070174A1 WO 2011070174 A1 WO2011070174 A1 WO 2011070174A1 EP 2010069474 W EP2010069474 W EP 2010069474W WO 2011070174 A1 WO2011070174 A1 WO 2011070174A1
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WIPO (PCT)
Prior art keywords
neurodegenerative disease
peptide
parameter
lab42
amyloid beta
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PCT/EP2010/069474
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English (en)
French (fr)
Inventor
José Manuel Sarasa Barrio
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Araclon Biotech, S.L.
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Priority to ES10787797.9T priority Critical patent/ES2552627T3/es
Priority to MX2012006512A priority patent/MX2012006512A/es
Application filed by Araclon Biotech, S.L. filed Critical Araclon Biotech, S.L.
Priority to CA2782250A priority patent/CA2782250C/en
Priority to JP2012542576A priority patent/JP5745531B2/ja
Priority to AU2010329844A priority patent/AU2010329844B2/en
Priority to EP10787797.9A priority patent/EP2510359B1/en
Priority to CN201080062241.9A priority patent/CN102713633B/zh
Priority to US13/514,825 priority patent/US20120264642A1/en
Priority to DK10787797.9T priority patent/DK2510359T3/en
Priority to KR1020127018082A priority patent/KR101531949B1/ko
Priority to PL10787797T priority patent/PL2510359T3/pl
Priority to BR112012014060A priority patent/BR112012014060B8/pt
Priority to RU2012129184/15A priority patent/RU2554774C2/ru
Publication of WO2011070174A1 publication Critical patent/WO2011070174A1/en
Priority to IN5056DEN2012 priority patent/IN2012DN05056A/en
Priority to IL220276A priority patent/IL220276A/en
Priority to HK13102393.4A priority patent/HK1175242A1/xx
Priority to US16/985,387 priority patent/US20210011032A1/en

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    • 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
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
    • G01N33/6893—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids related to diseases not provided for elsewhere
    • G01N33/6896—Neurological disorders, e.g. Alzheimer's disease
    • 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
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/46—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans from vertebrates
    • G01N2333/47—Assays involving proteins of known structure or function as defined in the subgroups
    • G01N2333/4701—Details
    • G01N2333/4709—Amyloid plaque core protein

Definitions

  • the invention relates to the field of immunoassays and, more specifically, to the methods for increasing the sensitivity of immunoassays for the determination of amyloid beta peptides in biological fluids.
  • AD Alzheimer's disease
  • AD Alzheimer's disease
  • the plaques have central cores of amyloid deposits formed mainly by fibrils of a 40-42 amino acids peptide referred to amyloid ⁇ peptide ( ⁇ ) surrounded by degenerated neuritis and glial cells. This peptide results from the proteolytic processing of a precursor protein called ⁇ amyloid precursor protein ( ⁇ ).
  • AD can be classified according to the age of appearance as early onset (age under 60 years) and late onset (age above 60 years), according to the existence of an autosomic dominant inheritance, as familiar AD or sporadic AD.
  • Early onset familiar forms of AD can be associated to known mutation in the genes coding for ⁇ , presenilin 1 and presenilin 2 (located, respectively, on chromosomes 21, 14 and 1). These classifications are not mutually exclusive. The most frequent forms are sporadic late-onset forms.
  • diagnosis of AD is carried out using clinical criteria based on the presence of typical clinical hallmarks and the exclusion of other types of dementia using neuroimaging techniques and blood analysis. Using these criteria, diagnostic reliability is acceptable although, according to studies done using brain autopsy, between 10-20% of the patients diagnosed with AD suffered from a different disease. Moreover, the current diagnostic methods can only be carried out when the neurodegenerative process is so advanced that the patient suffers from severe dementia and the brain damages are so extensive that the number of therapeutic measures is limited. Definitive diagnosis requires pathologic examination of post-mortem brain tissue.
  • ⁇ accumulates in the brain of AD patients and is a central element in the pathogenesis of AD
  • this protein has been considered as the most suitable candidate as AD biomarker.
  • the use of ⁇ as plasma biomarker for AD faces the problem that the concentrations of the ⁇ peptides ( ⁇ (1-40) and ⁇ (1-42)) in serum are extremely low, so that there are no assays which are sensitive enough so as to allow reliable detection of said peptide species.
  • Many different assays have been used to determine levels of amyloid beta peptides in biological samples (see e.g. the methods described by Scheuner et al (Nature Med., 1996, 2:864-870); Tamaoka A et al.
  • WO200646644 describes an electrochemilumimscent (ECL) sandwich assay wherein the mAb 21F12 (which recognises amino acids 33-42 of ⁇ 42) is coupled to magnetic beads, which are then used to capture the ⁇ 42 peptide in the sample containing ⁇ 42 and further contacted with 3D6 mAb coupled to a ruthenium complex. The amount of 3D6 antibody bound is then detected by the luminescence emitted by the ruthenium complex when electrical energy is applied.
  • ECL electrochemilumimscent
  • the inventors are capable of detecting as low as 0.5 pg/mL of a ⁇ 42 standard.
  • the same assay is used to compare ⁇ 42 in plasma samples from AD patients and healthy controls, no significant differences could be observed between the two sets of patients, which led the inventors to conclude that the amount of intact ⁇ 42 in serum is very low due to degradation and turned to a competitive ELISA assay using 21F12 mAb which provides lower sensitivity levels in the range of ng/mL.
  • WO2009015696 describes a high-sensitivity ELISA sandwich assay wherein the detection antibody is contacted with a biotin-labeled reagent showing specificity for said antibody. The reagent is contacted with streptavidin which is coupled to peroxidase. Peroxidase activity is then detected by colorimetry using TMB or fluorescently using QuantaBlue.
  • WO2006053251 describes a method for the determination of amyloid beta peptide species in a sample comprising contacting a sample with a denaturing agent, extracting the peptide pool from the sample-denaturing agent mixture, separating the amyloid beta peptide species from the pool and determining the amount of amyloid beta peptide species. This method requires a step of separation of the peptides prior to the determination, which results in increased processing time and increased costs.
  • the invention relates to A method for the diagnosis in a subject of a neurodegenerative disease, for detecting a stage prior to a neurodegenerative disease or for distinguishing a neurodegenerative disease from a stage prior to said neurodegenerative disease comprising the steps of
  • the invention relates to a kit for determination of amyloid beta peptides in a biological sample comprising
  • Figure 1 A-F. Dot-plots of the measurements for (A) UP ⁇ 1-40, (B) DP ⁇ 1-40, (C) CBApi-40, (D) UP ⁇ 1-42, (E) DP ⁇ 1-42 and (F) CB ⁇ 1-42 obtained in the two external laboratories (Lab i and Lab2). Most points are close to the concordance line indicating a sub stantial to almo st p erfect degree o f agreement in the measurements. Bottom right inset in each plot indicates the concordance correlation coefficient (CCC) and the 95 % confidence intervals.
  • CCC concordance correlation coefficient
  • Figure 2 Direct markers of ⁇ 1-40 (A), of ⁇ 1-42 (B) and calculated markers of ⁇ - 40 and ⁇ 1-42 (C).
  • A Concentrations in pg/ml of ⁇ 1-40 free in serum (FP), total ⁇ 1-40 levels in plasma (incouding free ⁇ 1-40 and ⁇ 1-40 bound to plasma components) (TP) and ⁇ 1-40 bound to cells (CB) in healthy controls (HC), patients suffering mild cognitive impairment (MCI) and patients suffering Alzheimer's disease (AD).
  • A Concentrations in pg/ml of ⁇ 1-40 free in serum (FP), total ⁇ 1-40 levels in plasma (incouding free ⁇ 1-40 and ⁇ 1-40 bound to plasma components) (TP) and ⁇ 1-40 bound to cells (CB) in healthy controls (HC), patients suffering mild cognitive impairment (MCI) and patients suffering Alzheimer's disease (AD).
  • HC healthy controls
  • MCI mild cognitive impairment
  • AD Alzheimer's disease
  • FP total ⁇ 1-42 levels in plasma (incouding free ⁇ 1-42 and ⁇ 1-42 bound to plasma components)
  • CB ⁇ 1-42 bound to cells
  • HC healthy controls
  • MCI mild cognitive impairment
  • AD Alzheimer's disease
  • Numbers beside ⁇ indicates the value for outliers in the MCI and AD groups which, for the clarity of the representation, are not represented at the same scale of the ordinate axis.
  • Horizontal line represents the cutoff value between MCI and HC.
  • Figure 11 ROC curve for the 2ab40 + 3ab40 marker for patients with MCI/HC. Area under the curve is 0.830.
  • Figure 12 ROC curve for the 2ab42 + 3ab42 marker for patients with AD/HC. Area under the curve is 0.713.
  • Figure 13 ROC curve for the 2ab42 + 3ab42 marker for patients with MCI/HC. Area under the curve is 0.777.
  • Figure 14 ROC curve for the 2ab40 + 3ab40 + 2ab42 + 3ab42 marker with MCI/HC. Area under the curve is 0.848. DETAILED DESCRIPTION OF THE INVENTION
  • the authors of the present invention have found that, surprisingly, the dilution of the plasma with sample buffer results in an increase in the detectable levels of ⁇ 1-40 and ⁇ 1-42. Without wishing to be bound by any theory, it is believed that the dilution of the plasma results in a change in the ionic strength and in the molecular interactions within the sample leading to the release of ⁇ 1-40 and ⁇ 1-42 bound to plasma proteins and other components.
  • the increment in the measurements after dilution of the plasma might be due to the detection of ⁇ peptides released from proteins and other plasma components and could be interpreted as an estimation of the total level of ⁇ in plasma.
  • the levels of said amyloid beta peptides pools as well as the value of certain calculated parameters resulting from arithmetically combining the concentrations of the different pools with the concentrations of free amyloid beta peptides can be used for determining whether a patient suffers a neurodegenerative disease, whether a patient suffers a state prior to a neurodegenerative disease and to distinguish a neurodegenerative disease from a state prior to a neurodegenerative disease.
  • the invention relates to a method for the diagnosis in a subject of a neurodegenerative disease, for detecting a stage prior to a neurodegenerative disease or for distinguishing a neurodegenerative disease from a stage prior to said neurodegenerative disease comprising the steps of
  • diagnosing the neurodegenerative disease detecting a stage prior to a neurodegenerative disease or distinguishing a neurodegenerative disease from a stage prior to said neurodegenerative disease when there is an alteration in the value of the parameter or in the value of the calculated parameter with respect to the reference value.
  • diagnosis includes the assessment of a subject's susceptibility to a disease, determination as to whether a subject presently has the disease, and also the prognosis of a subject affected by the disease. As will be understood by persons skilled in the art, such assessment normally may not be correct for 100% of the subjects to be diagnosed, although it preferably is correct. The term, however, requires that a statistically significant part of the subjects can be identified as suffering from the disease or having a predisposition thereto. If a part is statistically significant it can be determined simply by the person skilled in the art using several well known statistical evaluation tools, for example, determination of confidence intervals, determination of p values, Student's t-test, Mann- Whitney test, etc.
  • the preferred confidence intervals are at least 50%, at least 60%, at least 70%, at least 80%, at least 90%), at least 95%.
  • the p values are preferably 0.2, 0.1 or 0.05.
  • the term "subject” relates to all the animals classified as mammals and includes but is not limited to domestic and farm animals, primates and humans, for example, human beings, non-human primates, cows, horses, pigs, sheep, goats, dogs, cats, or rodents.
  • the subject is a male or female human being of any age or race.
  • neurodegenerative disease refers to a condition or disorder in which neuronal cells are lost due to cell death bringing about a deterioration of cognitive functions or result in damage, dysfunction, or complications that may be characterized by neurological, neurodegenerative, physiological, psychological, or behavioral aberrations.
  • Suitable neurodegenerative diseases that can be diagnosed with the methods of the invention include, without limitation, age-related macular degeneration, Creutzfeldt- Jakob disease, Alzheimer's Disease, radiotherapy induced dementia, axon injury, acute cortical spreading depression, alpha-synucleinopathies, brain ischemia, Huntington's disease, permanent focal cerebral ischemia, peripheral nerve regeneration, post-status epilepticus model, spinal cord injury, sporadic amyotrophic lateral sclerosis and transmissible spongiform encephalopathy.
  • the neurodegenerative disease is Alzheimer's disease.
  • Alzheimer's Disease or "senile dementia” refers to a mental deterioration associated with specific degenerative brain disease that is characterized by senile plaques, neuritic tangles, and progressive neuronal loss which manifests clinically in progressive memory deficits, confusion, behavioral problems, inability to care for oneself, gradual physical deterioration and, ultimately, death.
  • stage prior to said neurodegenerative disease refers to a transitional situation which occurs between normal individuals and subjects suffering from a neurodegenerative disorders and which is characterized by the appearance of some of the signs and symptoms of the neurodegenerative disorders or by the appearance of a subset of the sign and symptoms observed in patients suffering the neurodegenerative disorder.
  • the stage prior to said neurodegenerative disease is mild cognitive impairment (hereinafter MCI) which refers to a transitional stage of cognitive impairment between normal aging and early Alzheimer's disease.
  • MCI mild cognitive impairment
  • the method of the invention comprises the determination of at least one parameter selected from the group of
  • amyloid beta peptide is used herein interchangeably with “Abeta”, “Abeta,” “beta AP,” “A beta peptide,” or “ ⁇ peptide” and refers to a family of peptides that are the principal chemical constituent of the senile plaques and vascular amyloid deposits (amyloid angiopathy) found in the brain in patients of Alzheimer's disease (AD), Down's Syndrome, and Hereditary Cerebral Hemorrhage with Amyloidosis of the Dutch-Type (HCHWA-D).
  • Amyloid beta peptides are fragments of beta-amyloid precursor protein (APP) which comprises a variable number of amino acids, typically 38-43 amino acids.
  • APP beta-amyloid precursor protein
  • Amyloid beta peptides are commonly expressed as " ⁇ (x-y)" wherein x represents the amino acid number of the amino terminus of the amyloid beta peptide and y represents the amino acid number of the carboxy terminus.
  • ⁇ (1-40) is an amyloid beta peptide whose amino terminus begin at amino acid number 1 and carboxy terminus ends at amino acid number 40, a sequence of which is given by SEQ ID NO: l .
  • amyloid beta peptides include that can be determined with the method of the present invention include, without limitation, ⁇ (1-38) (SEQ ID NO:2), ⁇ (1-39) (SEQ ID NO:3), ⁇ (1-40) (SEQ ID ⁇ : 1), ⁇ (1-41) (SEQ ID NO:4), and ⁇ (1-42) (SEQ ID NO;5), ⁇ (1-43) (SEQ ID NO:6), ⁇ (1 1-42) (SEQ ID NO:7), ⁇ (3-40) (SEQ ID NO:8), ⁇ (3-42) (SEQ ID NO:9), ⁇ (4-42) (SEQ ID NO: 10), ⁇ (6-42) (SEQ ID NO: 11), ⁇ (7-42) (SEQ ID NO: 12), A13(8-42) (SEQ ID NO: 13), ⁇ (9-42) (SEQ ID NO: 14), ⁇ (x-40), ⁇ (x-42) and ⁇ (x-38), as well as total amyloid beta peptide, which refers to a plurality of am
  • ⁇ (1-42) relates to a 42 amino acids peptide corresponding to amino acids 672 to 713 (SEQ ID NO :5) of APP and which is produced by the sequential proteolytic cleavage of the amyloid precursor protein (SEQ ID NO: 15) by the ⁇ - and ⁇ -secretases.
  • ⁇ (1-40) relates to a 40 amino acids peptide corresponding to amino acids 672 to 71 1 (SEQ ID NO: l) and which is produced by the sequential proteolytic cleavage of the amyloid precursor protein (SEQ ID NO: 15) by the ⁇ - and ⁇ - secretases.
  • biological sample includes (1) biological fluids such as whole blood, serum, plasma, urine, lymph, saliva, semen, sputum, tears, mucus, sweat, milk, brain extracts and cerebrospinal fluid; (2) blood components, such as plasma, serum, blood cells, and platelets; (3) extracts obtained from solid tissues or organs such as brain; and (4) extracts from cultures of human or animal cell lines or primary cells, such as primary human neurons, and primary neurons from transgenic mice harboring human APP genes, e.g., cells from a transgenic PDAPP animal (e.g., mouse), as well as a 293 human kidney cell line, a human neuroglioma cell line, a human HeLa cell line, a primary endothelial cell line (e.g., HUVEC cells), a primary human fibroblast line or a primary lymphoblast line (including endogenous cells derived from patients with APP mutations), a primary human mixed brain cell culture (including neurons, astrocytes
  • whole blood means blood from a human or animal containing both cellular components and liquid component. Whole blood can be in coagulated state or non- coagulated state. “Whole blood” also includes blood wherein portion or all of the cellular components, such as white blood cells or red blood cells, have been lysed.
  • plasma refers to the fluid component of the whole blood. Depending on the separation method used, plasma may be completely free of cellular components, or may contain various amounts of platelets and/or small amount of other cellular components.
  • serum refers to plasma without the clotting protein fibrinogen and other clotting factors.
  • free amyloid beta peptide refers to the amyloid beta peptides which are not associated to any component of the biological sample and which is readily available for binding to a specific antibody. This peptide may be determined by conventional immunological techniques by contacting the biological sample with an antibody specific for said peptide. In a preferred embodiment, the level of free amyloid peptide is determined in plasma.
  • amyloid beta peptide associated to macromolecular components refers to the amyloid beta peptide which is non-covalently bound or attached to molecules found in the biological sample under study. This peptide is usually not readily accessible for immunological detection and thus, requires a pretreatment of the biological sample in order to achieve the separation of the peptide from the components. Under these conditions, the amyloid beta peptide attached to macromolecular components will be released from said components and will become available for immunological detection using specific antibodies.
  • the total amount of free amyloid peptide after contacting the sample with the protein solubilising agent will be the aggregate level of free amyloid beta peptide originally present and the level of amyloid beta peptide which has been released upon treatment with the protein solubilising agent.
  • this can be typically done by determining the level of free amyloid beta peptide prior to the treatment with the protein solubilising agent and the level of free amyloid beta peptide after the treatment with the protein solubilising agent and substract the first value from the second value.
  • the parameter which is usually determined when the sample is treated so as to dissociate the amyloid peptide from macromolecular components corresponds to the addition of the free peptide present in the sample and the peptide associated to macromolecular components.
  • the macromolecular components of the sample which may bind amyloid beta peptides and which contribute to the pool of amyloid beta peptide associated to macromolecular components includes both proteins as well as lipids.
  • the macromolecular components include, without limitation, blood proteins and lipids.
  • blood proteins include albumin, immunoglobulin G, immunoglobulin E, immunoglobulin M, immunoglobulin A, fibrinogen (fibrin and degradation products thereof), alpha- 1 antitrypsin, prealbumin, alpha 1 antitrypsin, alpha 1 acid glycoprotein, alpha 1 fetoprotein, Haptoglobin alpha 2, macroglobulin, ceruloplasmin, transferrin, C3/C4 Beta 2 microglobulin, beta lipoprotein, alpha, beta and gamma globulins, C-reactive protein (CRP), prothrombin, thyroxine-binding protein, transthyretin and the like.
  • CRP C-reactive protein
  • Exemplary blood lipids include free fatty acids, cholesterol, triglycerides, phospholipids, sphingolipids and the like.
  • the amount of amyloid beta pepetide associated to macromolecular components can be determined by contacting a cell-free sample of the biological sample with a protein solubilising agent under conditions adequate for inducing the release of said amyloid beta peptides from the macromolecular components.
  • contacting it is meant herein adding to the sample a sufficient amount of a solution comprising the protein solubilising agent so that the concentration of the protein solubilising agent in the mixture is sufficient to effectively solubilise the amyloid beta peptide which is bound to the proteins and cells in the sample.
  • the protein solubilising agent is found in solution in a buffer solution so that the addition of the protein solubilising agent does not result in a substantial modification in the pH of the sample.
  • protein solubilising agent refers to any compound of composition capable of altering the secondary, tertiary and/or quaternary structure of polypeptides while leaving the primary structure intact.
  • protein solubilising agents are capable increasing the solubility of proteins in a sample as well as of preventing inter- and intramolecular aggregation of proteins.
  • Proteins solubilising agents suitable for use in the present invention include, without limitation, detergents, chaotropic agents, reducing agents or mixtures thereof.
  • detergent is a synonym used for surfactants in general, and refers to amphipathic surface-active agents that, when added to a liquid, reduce surface tension of the liquid in comparison to the same liquid in the absence of the detergent. Detergents are also capable of preventing aggregation of proteins and of preventing non-specific interaction or binding of contaminants to a protein of interest. Detergents suitable for use in the present invention include, without limitation, non-ionic (neutral), anionic, cationic, or zwitterionic detergents.
  • non-ionic or neutral detergents include, without limitation, detergents of the Tween series, such as Tween® 20, Tween® 21, Tween® 40, Tween® 60, Tween® 61 , Tween® 65, Tween® 80, Tween® 81 , Tween® 85, detergents of the Span® series, such as Span® 20; detergents of the Tergitol series, such as Tergitol Type 15-S-12; detergents of the Brij® series, such as Brij® 35, Brij® 56, Brij® 72, Brij® 76, Brij® 92V, Brij® 97, Brij® 58P; detergents of the Tween series, such as Tween® 20, Tween® 21, Tween® 40, Tween® 60, Tween® 61, Tween® 65, Tween® 80, Tween® 81, Tween® 85; detergents of the riton® series, such as Triton® series,
  • anionic detergents include, without limitation, cholic acid and derivatives thereof, taurocholic acid, Triton X-200, Triton W-30, Triton- 30, Triton-770, dioctyl sulfo succinate, N 5 N- dimethyldodecylamine N-oxide, sodium 1-alkylsulfonates, N- lauroylsarcosine or fatty acid salts.
  • cationic detergents includes, without limitation, mono and di-methyl fatty amines, alkyl trimethyl ammonium salts, dialkyl dimethyl ammonium salts, alkyl amine acetates, trialkylammonium acetates, alkyldimethylbenzyl ammonium salts, dialkymethylbenzyl ammonium salts, alkylpyridinium halide and alkyl (alkyl substituted) pyridinium salts, alkylthiomethylpyridinium salts, alkylamidomethylpyridinium salts, alkylquinolinium salts, alkylisoquinolinium salts, N,N-alkylmethylpyrollidonium salts, 1,1-dialkylpiperidinium salts, 4,4- dialkylthiamorpholinium salts, 4,4-dialkylthiamorpholinium-l -oxide salts, methyl his (alkyl ethyl)-2-alkyl imidazolinium methyl
  • zwitterionic detergents include, without limitation, 3-[(3- cholamidopropyl)dimethylammonio]-l-propanesulfonate (CHAPS); 3-[(3- cholamidopropyl)dimethylammonio]-2-hydroxy-l-rhoropanesulfonate (CHAPSO); N- (alkyl C10-C16)-N,N-dimethylglycine betaine (EMPIGEN BB); Caprylyl sulfobetaine (SB3- 10); 3-[N,N-dimethyl(3-myristoylaminopropyl)ammonio]propanesulfonate (Amidosulfobetaine- 14; ASB- 14); N-tetradecyl-N,N-dimethyl-3-ammonio-l- propoanesulfonate(3-14 Detergent; ZWITTERGENT); N-dodecyl-N,N * -dimethyl-3-
  • the protein solubilising reagent is a detergent.
  • the detergent is Tween 20.
  • Tween 20 is used at a concentration of 0.5%.
  • a "chaotropic agent”, as used herein, relate to a compound or mixture of compounds which disrupt hydrogen bonds and hydrophobic interactions both between and within proteins. When used at high concentrations, chaotropic agents disrupt secondary protein structure and bring into solution proteins that are not otherwise soluble.
  • Suitable chaotropic agents include, without limitation, urea, guanidinium isothiocyanate, sodium thiocyanate (NaSCN), Guanidine HC1, guanidinium chloride, guanidinium thiocyanate, lithium tetrachloroacetate, sodium perchlorate, rubidium tetrachloroacetate, potassium iodide or cesium trifluoro acetate.
  • reducing agent refers to any compound or material which maintains sulfhydryl groups in the reduced state and reduces intra- or intermolecular disulfide bonds.
  • reducing agents suitable for the method of the present invention include both sulfhydryl or phosphine reducing agents.
  • sulfhydryl reductants include dithiothreitol (DTT), dithioerythritol (DTE), and ⁇ - mercaptoethanol.
  • phosphine reductants include tributylphosphine (TBP) and tris-carboxyethylphosphine (TCEP).
  • TBP tributylphosphine
  • TCEP tris-carboxyethylphosphine
  • the biological sample is first processed to remove the cellular fraction.
  • the cell-free sample is then contacted with the protein solubilising agent.
  • the sample is diluted using a buffer comprising the protein solubilising agent.
  • the sample is diluted 5-fold in a buffer solution comprising Tween 20.
  • a buffer solution is any substance or mixture of compounds in solution that is capable of neutralizing both acids and bases without appreciably changing the original acidity or alkalinity of the solution.
  • Suitable buffer solutions to be used in the method of the invention include, without limitation, Tris buffer solution, phosphate buffer solution, borate buffer solution, carbonate buffer solution, glycine- sodium hydroxide buffer solution, or the like.
  • the buffer solution is a phosphate buffer solution such as phosphate-buffered saline or PBS.
  • the amount of solution comprising the protein solubilising agent which is added to the biological sample is not essential as long as sufficient dissociation of the amyloid beta peptide is achieved.
  • the biological fluid may be diluted in the solution comprising the protein solubilising agent at a dilution of at least 1/2 (v/v), 1/3 (v/v), 1/4 (v/v), 1/5 (v/v), 1/6 (v/v), 1/7 (v/v), 1/8 (v/v), 1/9 (v/v), 1/10 (v/v), 1/20 (v/v), 1/50 (v/v), 1/60 (v/v), 1/80 (v/v), 1/90 (v/v), 1/100 (v/v) or more.
  • the solution containing the protein solubilising agent may comprise said selected protein solubilising agent (s) at a concentration ranging from 0.001% to 0.5% (w/v).
  • said biological fluid typically contains said surfactant(s) at less than 0.1%> (w/v), preferably less than 0.6%> (w/v), more preferably no more than 0.5% (w/v), most preferably no more than 0.45% (w/v) and even most preferably 0.5%>.
  • Suitable buffer systems for use in the present invention include Tris-HCl buffers including a salt such as NaCl or KCl and, optionally, BSA.
  • Tris-HCl buffers including a salt such as NaCl or KCl and, optionally, BSA.
  • Particular buffer systems include, without limitation,
  • Tris-HCl pH 8 50 mM Tris-HCl pH 8, 0.5M NaCl, 0.05 %; BSA, 0.05 % Tween-20, 1M GuHCl;
  • Tris-HCl pH 8 50 mM Tris-HCl pH 8, 0.5M NaCl; 0.05 %; BSA, 0.05 % Triton X-100
  • the preferred concentration is of 0.004-0.02%, more preferably of 0.005-0.01 % (w/v).
  • the contacting step is carried out preferably at a low temperature in order to inhibit proteolytic activities present in the sample. Suitable temperatures are of about 0-10 Degrees C, preferably of about 3-5 Degrees C, e.g., about 4 Degrees C.
  • both fluids may be mixed. Mixing may be carried out by stirring, preferably by shaking, more preferably by high speed shaking, most preferably by vortexing) for at least 5 seconds, preferably for at least 10 seconds, more preferably for at least 15 seconds (e.g., for 15-50 seconds).
  • Advantageous speeds for said mixing, stirring, shaking, high speed shaking or vortexing comprise a speed of at least 250 rpm, preferably of at least 500 rpm, more preferably of at least 1,000 rpm, most preferably of about 2,000-2,500 rpm.
  • the contacting step is carried out under conditions adequate for achieving partial or, preferably, full dissociation of the amyloid beta peptide from the protein and lipids present in the biological sample.
  • the conditions can be adequately determined by one of ordinary skills in the art by monitoring the amount of amyloid beta peptide which is detectable before the contacting step and progressively at different time points after the contacting step has taken place.
  • the time course experiment may be determined as described in example of the experimental part.
  • the level of amyloid beta peptide is determined by diluting a biological sample with a buffer containing the protein solubilising reagent, the level of free amyloid beta peptide obtained by immunological determination will have to be corrected in order to take into consideration the dilution factor previously applied to the biological sample.
  • the parameter which is determined in step (i) of the method of the invention is one or more of the parameter selected from the group of the level of free ABETA40 peptide in a biological sample of said subject (hereinafter known as lab40 or UP ⁇ (1-40)), the aggregate levels of free ABETA40 peptide in the biological sample and of ABETA40 peptide associated to components of said biological sample obtained as described above (hereinafter referred to as 2ab40 or DP ⁇ (1-40)), the level of free ABETA42 peptide in the biological sample (hereinafter known as lab42 or UP ⁇ (1-42)) and the aggregate levels of free ABETA42 peptide in the biological sample and of ABETA42 peptide associated to components of said biological sample obtained as described above (hereinafter referred to as 2ab42 or DP ⁇ (1-42)).
  • amyloid beta peptide associated to cells refers to amyloid beta peptide which is non-covalently associated to the surface of the cells present in the biological sample and which is unavailable for binding to antibodies added to the sample and hence, immunologically undetectable.
  • the biological sample is blood
  • the amyloid beta peptide is associated to red blood cells, white blood cells, including neutrophils, eosinophils, basophils, lymphocytes and monocytes, and platelets.
  • the amount of amyloid beta peptide associated to cells in a given sample can be determined and this value can be used alone or in combination with other parameters related to amylioid beta peptides in the methods of the invention.
  • the cellular fraction is first required to isolate the cellular fraction from the biological sample. This can be carried out using any technique known to the skilled person such as centrifugation, sedimentation, filtration and the like. Once the cell fraction of a biological sample has been isolated, the cells are contacted with a protein solubilising agent.
  • Suitable protein solubilising agent include detergents, chao tropic agents and reducing agents as defined above and are usually provided in a buffer solution at an adequate concentration. Suitable agents, buffer solutions and concentrations of agents in the buffer solution have been described above.
  • the contacting step is carried out essentially as explained above in the method for releasing the amyloid peptide which is attached to components (proteins and lipids) of the biological sample.
  • the protein solubilising agent is a detergent.
  • the detergent is Tween 20. Suitable concentrations of Tween 20 for use as protein solubilising agent are as defined above, i.e. between 0.004-0.02%, more preferably of 0.005-0.01 % (w/v).
  • the contacting step is carried out preferably at a low temperature in order to inhibit proteolytic activities present in the sample.
  • Suitable temperatures are of about 0-10 Degrees C, preferably of about 3-5 Degrees C, e.g., about 4 Degrees C.
  • the contacting step is carried out by resuspending the cellular fraction in the biological sample with the solution comprising the protein solubilising agent.
  • Said resuspension can be carried out by gentle pippeting up- and down, by stirring, preferably by shaking, more preferably by high speed shaking, most preferably by vortexing) for at least 5 seconds, preferably for at least 10 seconds, more preferably for at least 15 seconds (e.g., for 15-50 seconds).
  • Advantageous speeds for said mixing, stirring, shaking, high speed shaking or vortexing comprise a speed of at least 250 rpm, preferably of at least 500 rpm, more preferably of at least 1,000 rpm, most preferably of about 2,000-2,500 rpm.
  • the contacting step is carried out under conditions adequate for achieving partial or, preferably, full dissociation of the amyloid beta peptide from the cells present in the biological sample.
  • the conditions can be adequately determined by one of ordinary skills in the art by monitoring the amount of amyloid beta peptide which is detectable before the contacting step and progressively at different time points after the contacting step has taken place.
  • the time course experiment may be determined as described in example of the experimental part.
  • the parameter which is determined in step (i) of the method of the invention is one or more of the parameter selected from the group of the level of ABETA40 associated to cells present in the biological sample (hereinafter known as 3ab40 or CB ⁇ (1-40)) and the level of ABETA42 associated to cells present in the biological sample (hereinafter known as 3ab42 or CB ⁇ (1-42)).
  • the following step of the method of the invention comprises comparing the value of at least one of the parameters (b) or (c) or the value of a calculated parameter resulting from arithmetically combining one or more of the parameters (a) to (c) with a reference value corresponding to the value of said parameters (b) or (c) or said calculated parameter in a reference sample
  • (a), (b) and (c) have been defined in detail above and correspond, respectively, to the level of a free amyloid beta peptide in a biological sample of said subject (a), the aggregate levels of a free amyloid peptide in a biological sample of said subject and of said amyloid beta peptide associated to macro molecular components present in said biological sample (b) and the level of an amyloid beta peptide associated to cells in a biological sample of said subject (c).
  • the parameters which are used in step (ii) of the method of the invention are either direct parameters, i.e. parameters which can be determined directly as defined above and which correspond to those previously defined as 2ab40, 3ab40, 2ab42 and 3ab42.
  • direct parameters i.e. parameters which can be determined directly as defined above and which correspond to those previously defined as 2ab40, 3ab40, 2ab42 and 3ab42.
  • any arithmetic combination of two more parameters may yield calculated parameters with diagnostic value including additions, substrations, multiplications, divisions and combinations thereof.
  • Particular calculated markers for use int he method of the present invention include, without limitation, 2ab40/2ab42, 3ab40/3ab42, 2ab40/3ab40, 2ab42/3ab42, lab40 + 2ab40, lab40 + 3ab40, 2ab40 + 3ab40, lab40 + 2ab40 + 3ab40, lab42 + 2ab42, lab42 + 3ab42, 2ab42 + 3ab42, lab42 + 2ab42 + 3ab42, lab40 + 2ab40 + lab42 + 2ab42, lab40 + 3ab40 + lab42 + 3ab42, 2ab40 + 3ab40 + 2ab42 + 3ab42, lab40 + 2ab40 + 3ab40 + lab42 + 2ab42 + 3ab42, (lab40 + 2ab40)/(lab42 + 2ab42), (lab40 + 3ab40)/(lab42 + 3ab42), (2ab40 +
  • the calculated parameter results from the addition of the 2ab40 and 3ab40 parameters (hereinafter referred to as T40). In another preferred embodiment, the calculated parameter results from the addition of the 2ab42 and 3ab42 parameters (hereinafter referred to as T42). In yet another preferred embodiment, the calculated parameter results from the addition of the 2ab40, 3ab40, 2ab42 and 3ab42 parameters (hereinafter referred to as ⁇ - ⁇ ).
  • reference value refers to a value of the parameter which is being used for comparison and which has been determined in a subject not suffering from a neurodegenerative disease or without any history of neurodegenerative disease.
  • the subjects from which the reference values for the different parameters and calculated parameters are obtained are patients which show an absence of memory complains, normal performance in neuropsychological tests and absence of structural alterations in MRI.
  • reference values are selected which allow a sensitivity higher than 85% and a specificity higher than 75%.
  • the reference values are selected so as to obtain a sensitivity higher than 70% and an specificity higher than 70%.
  • the reference values allow obtaining a prediction with an accuracy or precision of at least 80%>.
  • step (iii) of the method of the invention the diagnosis of the neurodegenerative disease, the detection of a stage prior to a neurodegenerative disease or the distinction of a neurodegenerative disease from a stage prior to a neurodegenerative disease is carried out using a particular set of markers or calculated markers which provide particularly adequate specificity and sensitivity levels.
  • the diagnosis of a neurodegenerative disease is carried out by comparing the value of a parameter selected from the group of 3ab40 and 2ab42 or the value of a calculated parameter selected from the group of 2ab40 + 3ab40 and 2ab40 + 3ab40 + 2ab42 + 3ab42.
  • the detection of a stage prior to a neurodegenerative disease is carried out by comparing the value of a parameter selected from the group of 2ab40, 3ab40 and 2ab42 or the value of a calculated parameter selected from the group of 2ab40 + 3ab40, 2ab40 + 3ab40 + 2ab42 + 3ab42, lab40 + 2ab40 + 3ab40 + lab42 + 2ab42 + 3ab42, lab40 + 2ab40 + 3ab40, lab42 + 2ab42 + 3ab42, lab40 + lab42 + 2ab42 + 3ab42, lab40 + 2ab40 + lab42 + 2ab42 and lab40 + 3ab40 + lab42 + 3ab42.
  • the distinguishing of a neurodegenerative disease from a stage prior to said neurodegenerative disease is carried out by comparing the value of a parameter selected from the group of 3ab40 and 2ab42 or by comparing the value of a calculated parameter selected from the group of 2ab40 + 3ab40, 2ab40 + 3ab40 + 2ab42 + 3ab42 and lab40 + 2ab40 + lab42 + 2ab42.
  • Table 1 Summary of preferred methods of the invention according to the parameter and the cut-off value.
  • the diagnosing of a neurodegenerative disease is carried out when there is an alteration in the value of the parameter or in the value of the calculated parameter with respect to the reference value.
  • alteration refers to an statistically significant increase or decrease in the value of the parameter under consideration with respect to the reference value.
  • statically significant relate to a statistical analysis of the probability that there is a non-random association between two or more results, endpoints or outcome, i.e. that there is a certain degree of mathematical assurance that the value of the parameter is associated with a particular patient population with respect to the reference value.
  • the statistical significance of the alteration in the values can be determined using p- value, For instance, when using p-value, a parameter is identified as showing a significant alteration when the p-value is less than 0.1, preferably less than 0.05, more preferably less than 0.01, even more preferably less than 0.005, the most preferably less than 0.001.
  • the value of the parameter under consideration can be assigned as being “increased” when the value above the reference value is of at least 1.1-fold, 1.5-fold, 5- fold, 10-fold, 20-fold, 30-fold, 40-fold, 50-fold, 60-fold, 70-fold, 80-fold, 90-fold, 100- fold or even more compared with the reference value.
  • a parameter value can be considered as being “decreased” when it is at least 0.9-fold, 0.75-fold, 0.2- fold, 0.1-fold, 0.05-fold, 0.025-fold, 0.02-fold, 0.01-fold, 0.005-fold or even less compared with reference value.
  • the alteration in the value of the parameter or in the value of the calculated parameter with respect to the reference value is an increase.
  • the concentration of amyloid beta peptide can be determined using one or more techniques chosen from Western blot, immunoprecipitation, enzyme-linked immunosorbent assay (ELISA), surface plasmon resonance, precipitin reaction, a gel diffusion immunodiffusion assay, radioimmunoassay (RIA), fluorescent activated cell sorting (FACS), two-dimensional gel electrophoresis, capillary electrophoresis, mass spectroscopy (MS), matrix- assisted laser desorption/ionization-time of flight-MS (MALDI-TOF), surface- enhanced laser desorption ionization-time of flight (SELDI-TOF), high performance liquid chromatography (HPLC), fast protein liquid chromatography (FPLC), multidimensional liquid chromatography (LC) followed by tandem mass spectrometry (MS/MS), thin- layer chromatography, protein chip expression analysis and laser densiometry.
  • ELISA enzyme-linked immunosorbent assay
  • RIA radioimmunoassay
  • FACS fluorescent activated cell sorting
  • the determination of the at least one or more of lab40, lab42, 2ab40, 2ab42, 3ab40 and 3ab42 is carried out by an immunological method.
  • immunological method when applied to a determination, relates to any method which involves the use of one or more antibodies specific for a target substance in order to determine the amount/concentration of said target substance excluding other substances found in the sample.
  • Suitable immunological methods include, without limitation, Western blot, immunoprecipitation, enzyme-linked immunosorbent assay (ELISA), surface plasmon resonance, radioimmunoassay (RIA).
  • Antibodies molecules suitable for use in the immunological methods of the invention include, without limitation:
  • Fab' fragments contain the constant domain of the light chain and the first constant domain (CHI) of the heavy chain and has one antigen-binding site only. Fab' fragments differ from Fab fragments by the addition of a few residues at the carboxy terminus of the heavy chain CH 1 domain including one or more cysteines from the antibody hinge region.
  • Fv is the minimum antibody fragment which contains a complete antigen- recognition and antigen-binding site. This region consists of a dimer of one heavy chain and one light chain variable domain in tight, non-covalent- association. It is in this configuration that the three hypervariable regions (CDRs) of each variable domain interact to define an antigen-binding site on the surface of the VH - VL dimer. Collectively, the six hypervariable regions confer antigen-binding specificity to the antibody. However, even a single variable domain (or half of an Fv comprising only three hypervariable regions specific for an antigen) has the ability to recognize and bind antigen, although at a lower affinity than the entire binding site.
  • Single-chain FV or "scFv” antibody fragments comprise the VL and VH, domains of antibody, wherein these domains are present in a single polypeptide chain.
  • the VL and VH regions are connected by a polypeptide linker which enables the scFv to form the desired structure for antigen binding.
  • “Diabodies” comprise a heavy-chain variable domain (VH) connected to a light chain variable domain (VL) on the same polypeptide chain (VH-VL) connected by a peptide linker that is too short to allow pairing between the two domains on the same chain. This forces pairing with the complementary domains of another chain and promotes the assembly of a dimeric molecule with two functional antigen binding sites.
  • Bispecific antibodies are single, divalent antibodies (or immunotherapeutically effective fragments thereof) which have two differently specific antigen binding sites.
  • the two antigen sites may be coupled together chemically or by genetic engineering methods known in the art.
  • All these antibody fragments can be further modified using conventional techniques known in the art, for example, by using amino acid deletion(s), insertion(s), substitution(s), addition(s), and/or recombination (and/or any other modification(s) (e.g. posttranslational and chemical modifications, such as glycosylation and phosphorylation) known in the art either alone or in combination.
  • modification(s) e.g. posttranslational and chemical modifications, such as glycosylation and phosphorylation
  • Antibodies comprise both polyclonal and monoclonal antibodies.
  • various hosts including goats, rabbits, rats, mice, camels, dromedaries, llamas, humans, birds and others may be immunized by injection with a peptide corresponding to a fragment of ⁇ 40 or ⁇ 42 which has immunogenic properties.
  • various adjuvants may be used to increase immunological response.
  • adjuvants include, but are not limited to, Freund's, mineral gels such as aluminium hydroxide, and surface active substances such as lysolecithin, polyanions, peptides, oil emulsions, KLH, and dinitrophenol.
  • BCG Bacilli Calmette-Guerin
  • Cory b acterium parvum are especially preferable.
  • the antigen is a peptide, it may be useful to conjugate it to a protein that is immunogenic in the species to be immunized.
  • the antigen can be conjugated to keyhole limpet hemocyanin (KLH), Blue Carrier (hemocyanin isolated from Concholepas concholepas), bovine thyroglobulin, or soybean trypsin inhibitor, using a bifunctional or derivatizing agent, e.g., maleimidobenzoyl sulfosuccinimide ester (conjugation through cysteine residues), N- hydroxysuccinimide (through lysine residues), glutaraldehyde, succinic anhydride or SOCl 2 .
  • KLH keyhole limpet hemocyanin
  • Blue Carrier hemocyanin isolated from Concholepas concholepas
  • bovine thyroglobulin or soybean trypsin inhibitor
  • a bifunctional or derivatizing agent e.g., maleimidobenzoyl sulfosuccinimide ester (conjugation through cysteine residues), N- hydroxysucc
  • monoclonal antibodies For the production of monoclonal antibodies, conventional techniques can be used. For instance, monoclonal antibodies may be made using the hybridoma method first described by Kohler et al, Nature, 256:495 (1975) using the procedure described in detail in units 1 1.4 to 1 1.1 1 of Ausubel, F.M. et al. (Current Protocols in Molecular Biology, John Wiley & Sons Inc; ring-bound edition, 2003). Alternatively, monoclonal antibodies can be isolated by recombinant DNA procedures from antibody phage libraries generated using the techniques described in McCafferty et al, Nature, 348:552- 554 (1990).
  • Polyclonal antibodies can be used directly as an antiserum obtained from immunised hosts after bleeding and removal of the fibrin clot.
  • Monoclonal antibodies can be used directly as the supernatant of the hybridoma culture or as ascites fluid after implantation of the hybridoma in the peritoneal cavity of a suitable host.
  • the immunoglobulin molecules either polyclonal or monoclonal, can be purified prior to their use by conventional means such as affinity purification using peptides derived from amyloid beta peptides, non-denaturing gel purification, HPLC or RP-HPLC, size exclusion, purification on protein A column, or any combination of these techniques.
  • Suitable antibodies for carrying out the immunological methods of the invention include, without limitation:
  • Antibodies which recognise a region from the N-terminal region of amyloid beta peptides such as antibodies specific for the epitopes located within amino acids 1 to 16, 1 to 17, 13 to 28, 15 to 24, 1 to 5 and 1 to 1 1 of ⁇ 40 or ⁇ 42.
  • the determination of the amount of amyloid beta peptide is carried out by ELISA.
  • ELISA enzyme-linked immunosorbent assay and relates to an assay by which an unknown amount of target substance (the amyloid beta peptide) is affixed to a surface, and then a specific antibody is washed over the surface so that it can bind to the antigen. This antibody is linked to an enzyme, and in the final step a substance is added that the enzyme can convert to some detectable signal.
  • ELISA assays are known and can be applied to the method of the invention, including direct ELISA, sandwich ELISA, competitive ELISA and ELISA reverse method & device (ELISA-R m&d).
  • Direct ELISA is carried out by contacting the test sample comprising the amyloid beta peptide with a solid support which has been previously coated with a concentrated solution of a non-interacting protein or reagent (bovine serum albumin, casein).
  • a non-interacting protein or reagent bovine serum albumin, casein.
  • an antibody specific for amyloid beta peptide is added under conditions adequate for binding onto the amyloid beta peptide.
  • the antibody which is bound is then detected with a secondary antibody which is coupled to a detectable tag or to a substrate modifying enzyme.
  • the signal resulting from the detectable tag or from the substrate is then proportional to the amount of antibody bound to the support which, in turn, correlates directly with the amount of amyloid beta peptide in the sample.
  • Competitive ELISA assay includes a first step wherein the test sample comprising an unknown amount of amyloid beta peptide is contacted with a first antibody as defined above.
  • the antibody-antigen complexes are added to an antigen coated well. Once the support is washed to remove any non-specifically bound complexes, the amount of first antibody is detected with a second antibody which is coupled to a detectable moiety. In this type of assays, the higher the original antigen concentration, the weaker the eventual signal.
  • An alternative competitive ELISA assay is that which includes an enzyme-linked antigen rather than enzyme-linked antibody. The labeled antigen competes for primary antibody binding sites with the sample antigen (unlabeled).
  • ELISA reverse method & device uses an innovative solid phase constituted of an immunosorbent polystyrene rod with 4-12 protruding ogives; the entire device is suitable to be introduced in a test tube containing the collected sample and the following steps (washing, incubation in conjugate and incubation in chromogenous) are easily carried out by immerging the ogives in microwells of standard microplates pre- filled with reagents, sealed and stored until their use.
  • the ELISA assay is an ELISA sandwich assay.
  • the ELISA sandwich assay involves coating a support with a first antibody specific for amyloid beta peptide, applying the sample containing the amyloid beta peptide which will result in the binding of the amyloid beta peptide to the first antibody and applying a second antibody also specific for amyloid beta peptide, wherein said second antibody is usually coupled to a detectable tag or to a substrate-modifying enzyme.
  • the signal generated by the tag or by the converted substrate is the proportional to the amount of antigen in the sample.
  • the first antibody will be referred to as "capture antibody”, meaning that this antibody is used to retrieve from a sample all molecular species to which the antibody specifically binds.
  • capture antibody There is practically no limitation with regard to the type of antibody that can be used as capture antibody as long as it contains at least one antigen binding site specific for ⁇ 40 and/or ⁇ 42. Thus, any of the antibodies mentioned above may be used as capture antibody.
  • the second antibody will be referred to as "detection antibody", since this antibody will be used to detect the amount of antigen which has been retained by the capture antibody.
  • detection antibody there is practically no limitation with regard to the type of antibody that can be used as detection antibody.
  • the detection antibody (i) must bind to a region of the antigen which is not covered by the capture antibody and (ii) must contain not only the antigen binding site but also either a detectable tag, a substrate-modifying enzyme or an additional region or regions that can be specifically detected by a reagent showing high affinity binding for said antibody, so as to allow detection of the antibody which is bound to the antigen captured by the capture antibody.
  • said additional regions which can be specifically bound by said reagent correspond to the constant region of the immunoglobulin molecule.
  • the capture antibody is an antibody specific against the N- terminal region of the amyloid beta peptides.
  • said capture antibody is an antibody specific against an epitope located within amino acids 1 to 16 of Abeta40 or Abeta42.
  • a particularly preferred capture antibody is the 6E10 monoclonal antibody as described by Kim, K.S. (Neuroscience Res. Comm. 1988, 2: 121-130).
  • the detection antibody is an antibody specific against an epitope located in the C-terminal region of the amyloid beta peptide. As explained above, the mature of the detection antibody may be adequately chosen by one of ordinary skills in the art depending on the number of amyloid beta species that are to be detected.
  • the capture antibody can be an antibody which recognises the N-terminal region of ⁇ 40 (and also of ⁇ 42, since both peptides have identical N-terminal regions) and the detection antibody can be an antibody which recognises specifically the C-terminal region of ⁇ 40 without giving any cross-reaction with ⁇ 42.
  • ⁇ 40 can be specifically detected using a capture antibody which recognises the C-terminal region of ⁇ 40 without giving any cross-reaction with ⁇ 42 and a detection antibody which recognises a region of ⁇ 40 which is common to both ⁇ 40 and ⁇ 42, preferably the N-terminal region of ⁇ 42/ ⁇ 40.
  • the capture antibody can be an antibody which recognises the N-terminal region of ⁇ 42 (and also of ⁇ 40, since both peptides have identical N-terminal regions) and the detection antibody can be an antibody which recognises specifically the C-terminal region of ⁇ 42 without giving any cross-reaction with ⁇ 40.
  • ⁇ 42 can be specifically detected using a capture antibody which recognises the C-terminal region of ⁇ 42 and a detection antibody which recognises a region of ⁇ 42 which is common to both ⁇ 42 and ⁇ 40.
  • the capture antibody can be an antibody which recognises the N-terminal region common to ⁇ 42 and ⁇ 40 and the detection antibody can be a combination of at least two antibodies, wherein the first antibody recognises specifically the C-terminal region of ⁇ 42 without giving any cross-reaction with ⁇ 40 and the second antibody recognises specifically the C- terminal region of ⁇ 40 without giving any cross-reaction with ⁇ 42.
  • capture antibody can be an antibody which recognises the N-terminal region common to ⁇ 42 and ⁇ 40 and the detection antibody can be an antibody that recognises the C- terminal region of both ⁇ 40 and ⁇ 42.
  • ⁇ 42 and ⁇ 40 can be simultaneously detected using as capture antibody a mixture of at least two antibodies comprising a first antibody which recognises specifically the C-terminal region of ⁇ 42 without giving any cross-reaction with ⁇ 40 and a second antibody which recognises specifically the C-terminal region of ⁇ 40 without giving any cross-reaction with ⁇ 42 and a detection antibody which recognises the N-terminal region common to both ⁇ 42 and ⁇ 40.
  • ⁇ 42 and ⁇ 40 can be simultaneously detected using as capture antibody an antibody which recognises the C-terminal region of both ⁇ 40 and ⁇ 42 and a detection antibody which recognises the N-terminal region common to both ⁇ 42 and ⁇ 40.
  • Antibodies specific for ⁇ 40 and ⁇ 42 and methods for their preparation have been described in detail in WO2004024770 and WO2004098631 , whose contents are incorporated herein by reference.
  • the detection and/or the capture antibodies may have been affinity-purified using a polypeptide which comprises the sequence of the polypeptide used for their preparation.
  • the detection antibody may be directly coupled to a detectable tag or to an substrate-modifying enzyme.
  • a reagent which shows affinity for the detection antibody may be used, in which case, it is said reagent which is labelled with a detectable tag or with a substrate-modifying enzyme instead of the detection antibody.
  • the antibody-binding reagent may be coupled to a first member of a binding pair, in which case, it is the second member of a binding pair which can be coupled to a detectable tag or to a substrate-modifying enzyme.
  • the antibody-binding reagent may non-covalently bind to a particular type(s), a particular class(es) and/or a particular subclass(es) of an antibody or antibody fragments.
  • the antibody-binding reagent may non-covalently bind to an antibody specific for a particular antigen.
  • the antibody-binding reagent binds non-covalently to the Fc region or to the F(ab) region of the detection antibody.
  • Preferred antibody-binding reagents include protein A, protein G, protein V, protein L, an anti-Fc antibody or antibody-binding fragment and an Fc receptor (FcR) or an antibody-binding fragment thereof.
  • Non-limiting examples of antibodies which can be non-covalently bound to the detection antibody include monoclonal antibodies, polyclonal antibodies, multispecific antibodies, human antibodies, humanized antibodies, chimeric antibodies, single domain antibodies, single chain Fvs (scFv) single chain antibodies, Fab fragments, F(ab') fragments, disulfide-linked Fvs (sdFv), intrabodies, and anti-idiotypic (anti- Id) antibodies, and epitope-binding fragments of any of the above.
  • Fc receptors include FcyRI, FcyRIIA, FcyRIIB, FcyRIIC, FcyRIIIAa, FcyRIIIB, FcsRIa, ⁇ and FcyRII ⁇ .
  • Suitable binding pairs include for use in detection include:
  • ⁇ hapten or antigen/antibody e.g. digoxin and anti-digoxin antibodies
  • biotin or biotin analogues e.g. aminobiotin, iminobiotin or desthiobiotin
  • avidin e.g. avidin, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, avidin, or streptavidin,
  • biotin or biotin analogues e.g. aminobiotin, iminobiotin or desthiobiotin
  • oligonucleotides that selectively bind to proteins/, transcription factors.
  • nucleic acid or nucleic acid analogue/complementary nucleic acid ⁇ nucleic acid or nucleic acid analogue/complementary nucleic acid
  • ⁇ receptor/ligand e.g., steroid hormone receptor/steroid hormone.
  • first and second member of a binding pair is relative and that each of the above members can be seen as first or second members of the binding pair.
  • first member of a binding pair is biotin or a functionally equivalent variant thereof and the second member of the binding pair is avidin, streptavidin or a functionally equivalent variant thereof.
  • the second member of the binding pair is streptavidin.
  • Suitable detectable tags include, without limitation, fluorescent moieties (e.g., fluorescein, rhodamine, phycoerythrin, coumarin, oxazine, resorufin, cyanine and derivatives thereof), luminescent moieties (e.g., QdotTM nanoparticles supplied by the Quantum Dot Corporation, Palo Alto, CA).
  • fluorescent moieties e.g., fluorescein, rhodamine, phycoerythrin, coumarin, oxazine, resorufin, cyanine and derivatives thereof
  • luminescent moieties e.g., QdotTM nanoparticles supplied by the Quantum Dot Corporation, Palo Alto, CA.
  • Suitable substrate-modifying enzymes are those capable of generating a detectable signal, for example, upon addition of an activator, substrate, amplifying agent and the like.
  • Enzymes which are suitable as detectable tags for the present invention and the corresponding substrates include:
  • Chromogenic substrates Substrats based on p-nitrophenyl phosphate (p- NPP), 5-bromo-4-chloro-3-indolyl phosphate/nitroblue tetrazolium
  • o Fluorogenic substrates 4-methylumbelliferyl phosphate (4-MUP), 2-(5 ' - chloro-2'-phosphoryloxyphenyl)-6-chloro-4-(3H)-quinazolinone (CPPCQ), 3,6-fluorescein diphosphate (3,6-FDP), Fast Blue BB, Fast Red TR, or Fast Red Violet LB diazonium salts
  • ABTS 2,2-azinobis(3-ethylbenzothiazoline- 6-sulfonic acid)
  • OPT o-phenylenediamine
  • TMB 3,3',5,5'- tetramethylbenzidine
  • DMAB 3- dimethylaminobenzoic acid
  • MBTH 3-methyl-2- benzothiazolinehydrazone
  • AEC 3-amino-9-ethylcarbazole
  • DAB 3,3'-diaminobenzidine tetrahydro chloride
  • o Fluorogenic susbtrates 4-hydroxy-3-methoxyphenylacetic acid, reduced phenoxazines and reduced benzothiazines, including Amplex Red reagent, Amplex UltraRed and reduced dihydroxanthenes.
  • Glycosidases o Chromogenic substrates: o-nitrophenyl-P-D-galactoside (o-NPG), p- nitrophenyl-P-D-g a l a ct o s i d e an d 4- methylumbelliphenyl-P-D- galactoside (MUG) for ⁇ -D-galactosidase.
  • o-NPG o-nitrophenyl-P-D-galactoside
  • UMG 4- methylumbelliphenyl-P-D- galactoside
  • Fluorogenic substrates resorufin ⁇ -D-galactopyranoside, fluorescein digalactoside (FDG), fluorescein diglucuronide, 4-methylumbelliferyl ⁇ -
  • D-galactopyranoside carboxyumbelliferyl ⁇ -D-galactopyranoside and fluorinated coumarin ⁇ -D- galactopyranosides.
  • Luminiscent substrates luciferin.
  • kits which are suitable for practicing the method of the invention.
  • the invention provides a kit for determination of amyloid beta peptides in a biological sample comprising
  • the protein solubilising agent reagent is a detergent.
  • the detergent is Tween20.
  • the at least an antibody against the amyloid beta peptide is selected from the group of
  • the kit of the invention comprises an antibody against the N-terminal region of the amyloid beta peptide which is directed against an epitope located within amino acids 1 to 16 of ABETA40 and ABETA42.
  • the kit of the invention comprises an antibody against the C- terminal region of the amyloid beta peptide which is directed against a peptide is selected from the group of:
  • the kit of the invention further comprises a solid support.
  • support or “surface” refers to a solid phase which is a porous or non-porous water insoluble material that can have any one of a number of shapes, such as strip, rod, particles, including latex particles, magnetic particles, microparticles, beads, membranes, microtiter wells and plastic tubes. In principle, any material is suitable as solid support provided that is able to bind sufficient amounts of the capturing antibody.
  • Solid phase material is determined based upon desired assay format performance characteristics.
  • Materials suitable for the solid support include polymeric materials, particularly cellulosic materials and materials derived from cellulose, such as fibre containing papers, e.g., filter paper, chromatographic paper, glass fiber paper, etc.; synthetic or modified naturally occurring polymers, such as nitrocellulose, cellulose acetate, poly (vinyl chloride), polyacrylamide, cross linked dextrane, agarose, polyacrylate, polyethylene, polypropylene, poly(4-methylbutene), polystyrene, polymethacrylate, poly(ethylene terephthalate), nylon, polyvinyl butyrate), etc.; either used by themselves or in conjunction with other materials; glass such as, e.g., glass available as bioglass, ceramics, metals, and the like.
  • Non-crosslinked polymers of styrene and carboxylated styrene or styrene functionalized with other active groups such as amino, hydro xyl, halo and the like are preferred.
  • copolymers of substituted styrenes with dienes such as butadiene will be used.
  • the solid support and the antibody may be separately provided in the kit or, alternatively, the support may be delivered already precoated with the capture antibody. In this case, the support may have been treated with a blocking solution after the binding of the capture antibody.
  • Additional components of the kit may include:
  • the kit of the invention comprises two antibodies which may be used in an ELISA sandwich assay.
  • one of the antibodies, the capture antibody is immobilised onto a solid support.
  • the immobilisation can be carried out prior to the binding of the target polypeptide to be detected or once the peptide/protein is bound to the capture antibody.
  • a solid support it is convenient to block the excess of protein binding sites on the carrier prior to the addition of the sample containing the target polypeptide to be determined.
  • blocking or quenching of the peptide-binding sites on the support is carried out using the same buffer which is used for washing the complexes after each binding reaction (e.g.
  • Tris-HCl, pH 8, PBS or TBS optionally, comprising Tween 20 supplemented with a macro molecular compound (e.g. bovine serum albumin, non-fat dry milk, western blocking reagent, caseine, lactoalbumine, ovoalbumine) in concentrations from about 0.05% to 10%, preferably 1 to 5%, more preferably around 3%.
  • a macro molecular compound e.g. bovine serum albumin, non-fat dry milk, western blocking reagent, caseine, lactoalbumine, ovoalbumine
  • concentrations from about 0.05% to 10%, preferably 1 to 5%, more preferably around 3%.
  • ⁇ education level is expressed as 0: no studies. 1: Primary Education. 2: Secondary Education. 3: University Education. 1 Kruskal-Wallis U-Test, contrasts with Mann- Whitney U-Test. H, M, and A mean significant with regard to HC, MCI and AD respectively.
  • AD group Specific inclusion criteria for the AD group were a diagnosis of probable AD (NINCDS-ADRDA criteria), a CDR of 1 point, a MMSE between 16 and 24 points and more than 3 points in Scheltens scale for medial temporal atrophy.
  • Sample preparation Blood is collected from a subject and a pellet of Roche CompleteMini is added (protease inhibitors) to each of 10 ml.
  • the blood is either directly spun or is preserved at 4°C and is centrifugated on the same day of the assay.
  • Plasma is separated from the cell fraction and the plasma is collected and split in aliquots of 0.5 ml in Eppendorf tubes. The aliquots can be kept at -80°C.
  • Free amyloid in plasma (lab40 and lab42) is determined directly in undiluted clarified plasma obtained as explained below. These parameters are hereinafter referred to as lab40 or UP (undiluted plasma) ⁇ (1-40) for ⁇ (1-40) and as lab42 or UP ⁇ (1-42) for AP(l-42).
  • Total plasma amyloid corresponding to the amyloid free in plasma plus the amyloid associated to plasma components, is determined in samples obtained by diluting 150 ⁇ of plasma in 300 ⁇ of dilution buffer (PBS containing 0.5% Tween-20). These parameters are hereinafter referred to as 2ab40 or DP (diluted plasma) ⁇ (1-40) for ⁇ (1-40) and as 2ab42 or DP ⁇ (1-42) for ⁇ (1-42).
  • Cell-bound amyloid beta is determined by diluting the plasma cell fraction v/v 1/5 in dilution sample (PBS containing 0.5% Tween-20). These parameters are hereinafter referred to as 3ab40 or CB (cell bound) ⁇ (1-40) for ⁇ (1-40) and as 3ab42 or CB ⁇ (1-42) ⁇ ⁇ (1-42).
  • the samples were diluted 1 ⁇ 2, 1/3, 1 ⁇ 4, 1/5 and 1/10. It was observed that the absorbance of the simple decreased when diluted 1/4 and above. The best dilutions are 1/2 and 1/3.
  • the samples can be clarified by centrifugation for a 13.000 rpm in order to remove particulate components which may interfere with the immunological detection.
  • the supernatant can be collected and tested directly or diluted as described above.
  • the samples can be sonicated for 5'-10'.
  • the sonicated samples can be used directly in the ELISA assays or can be spinned for 1 ' at 13000 rpm and the supernatant be used directly in ELISA assays.
  • the sonicated samples can also be diluted using the adequate buffers as defined in the previous examples.
  • Sepharosa 4B-IgGK column was prepared by reacting CNBr- activated sepharose with IgGlk using the following procedure:
  • the resin was washed with 1 mM HC1 (60 ml for each 300 mg resin)
  • the ligand was mixed with the acid-washed resin and incubated overnight at 4 a C with constant shaking (alternatively, the incubation can be carried out for 2 h at room temperature).
  • the resin was washed with three cycles using alternatively 0.1M Tris- HC1 pH 8 + 0.5M NaCl / 0.1M sodium acetate pH 4 + 0.5M NaCl.
  • the treatment of the sample comprises the steps of:
  • the agarose is remover by centrifugation (5' a 1000 rpm)
  • the treated sample 100 ⁇ of the treated sample is added to wells in a microtiter plates onto which a capture antibody specific for the N-terminus of the amyloid beta peptides has been adsorbed and incubated overnight at 4°C.
  • the amount of amyloid beta peptide present in the clarified sample is determined by ELISA assay by adding to the wells anti-AB40 or anti- AI342 specific antiserum (1/4000) for lh at room temperature and constant shaking.
  • the samples are then incubated with a 1/5000 dilution of a biotynilated anti-rabbit for lh at room temperature and constant shaking. - The samples are then incubated with 1/4000 of peroxidase-coupled streptavidin for 1 h at room temperature and shaking
  • the developing reaction was stopped with stop solution and the absorbance read at 450 nm.
  • IgG is removed using a protein A column (Protein A Sepharose 4 Fast Flow, Amersham Biosciences) following the manufacturer's instructions.
  • the samples were concentrated with microcon having a cut-off of 10000.
  • the amyloid peptides are recovered in the flow through whereas high molecular weight proteins are recovered in the retentate.
  • Tween-20 is the detergent providing a higher increased in absorbacen values. No effect was observed when the concentration of
  • Tween-20 was increased from 0.05% to 0.1%.
  • BSA No differences in absorbance levels were observed when the BSA concentration was increased from 0.05 % to 0.5%.
  • Amyloid peptides appear to associate to IgG but not to albumin.
  • Amyloid peptides appear mainly in the retentate.
  • the signal can be amplified using biotin-streptavidin.
  • a blocking solution 50 mM Tris-HCl, pH 8, 0,2% Tween-20, 0,5% BSA
  • the plates can be treated, after blocking, with 100 ⁇ of a 50 mM Tris-HCl pH 8 solution containing 20 mg/ml trehalose.
  • the plates were left to evaporate until a white halo characteristic of trehalose appears.
  • the plates so treated could be kept at 4°C covered with aluminium foil and are stable for two years.
  • the samples of the standard curve were prepared from a 200 pg/ml stock solution of the peptides AB40 y AB42 on plates coated with the 6E10 mAb and treated with trehalose. From these solutions, serial dilutions 1 :2 in SDB were made so as to give concentrations of 200, 100, 50, 25, 12.5, 6.25 and 3.125 pg/ml.
  • test samples 100 ⁇ of each diluted or undiluted sample is added diluted or undiluted in SDB (1/1.000.000) and incubated overnight at 4°C (or for 2h at 37°C).
  • SDB diluted or undiluted in SDB (1/1.000.000)
  • the samples for determining free plasma amyloid, total plasma amyloid and cell bound-amyloid in the test samples are prepared as described in example 1 and added to the wells of the ELISA plates using the same conditions as for the samples of the standard sample.
  • Detection antibody (a polyclonal antibody prepared against a peptide corresponding to the C-terminal region of the ⁇ 42 peptide or a polyclonal antibody prepared against a peptide corresponding to the C-terminal region of the ⁇ 40 peptide, depending on whether ⁇ 42 or ⁇ 40 is to be detected) was added diluted in SDB. 100 ⁇ are added to each well and were then incubated for 1 h at room temperature. Next, 100 ⁇ of a 1/5000 dilution in SDB of a biotin-labelled anti-rabbit IgG antibody (SIGMA) were then added and incubated for lh at room temperature with shaking.
  • SIGMA biotin-labelled anti-rabbit IgG antibody
  • the concentration values (pg/ml) values obtained from the samples used for the determination of total plasma amyloid (free plasma amyloid together with amyloid bound to the plasma components) was corrected in order to compensate for the dilution carried out during the preparation step. Since the dilution was typically a 1 :3 dilution (see Example 1), the pg/ml obtained from the absorbance readouts had to be multiplied by three in order to determine the real aggregate concentration of amyloid free in plasma and amyloid bound to plasma components. Likewise, the pg/ml obtained from the absorbance values obtained from the samples used for the determination of cell- bound amyloid were also corrected in order to compensate for the dilution carried out during the preparation step.
  • the pg/ml obtained from the absorbance readouts had to be multiplied by five in order to determine the real concentration of amyloid bound to cells.
  • the washing solution contained 50 mM de Tris-HCl pH 8, 0,05% Tween-20 and 150 mM NaCl (filtered before use).
  • Fluorescent ELISA Sandwich Assay The plate was coated with 6E10 in bicarbonate buffer (5 ⁇ g/ml) overnight at 4°C. The plate was then blocked 3h at room temperature with shaking (300 ⁇ /well). The test and standard curve samples were then added to the plates and incubated overnight at 4°C. A 1/4000 dilution of the detection antibody (anti-AB40 o anti-AB42 serum) was added to each well and incubated for lh at room temperature with shaking. Serial dilutions of the FITC-coupled anti-antibody (dilutions 1/1000, 1/5000, 1/10000) were added and incubated for lh at room temperature in the dark. The fluorescence was using an excitation wavelength of 485 nm and an emission wavelength of 528.
  • the assay is carried out using the Quanta-Blu (PIERCE) fluorescent substrate, which increases the sensitivity of the ELISA assay.
  • Maximal excitation is 325 nm and maximal emission is 420 nm. It can be detected in the excitation range of 315- 340 nm and 370-470 nm emission range.
  • the QuantaBlu Working Solution is prepared by mixing 9 parts of QuantaBlu Substrate Solution with 1 part of QuantaBlu Stable Peroxidase Solution (solution stable for 24 h at room temperature). It can be incubated from 1 ,5 minutes to 90 minutes at room temperature and can be read stopping the reaction or without stopping (a blue colour is produced).
  • the plate is coated with 6E10 mAb in bicarbonate buffer (5 ⁇ g/ml) overnight at 4°C and then blocked for 3h at room temperature with shaking (300 ⁇ /well).
  • bicarbonate buffer 5 ⁇ g/ml
  • Different standard curves then prepared with the following concentrations of ⁇ 42 and ⁇ 40 peptides:
  • the detection antibody (anti-AB40 o anti-AI342 serum) is added (diluted at 1/4000) for lh at room temperature with shaking.
  • the HRP-coupled anti-rabbit IgG 1/1000 is then added and incubated for lh at room temperature with shaking.
  • ⁇ of Quanta-Blue Working Solution is added and then incubated for 30', 60' and 90 ' at room temperature in the darkness.
  • the fluorescence is then read (Excitation: 360/40 nm; Emission: 460/40 nm) at 30', 60' and 90' without stopping the reaction or stopping the reaction with STOP solution.
  • a lyophilised sample of human AJ340 was reconstituted to 10 ⁇ g/mL. From the stock solution, the samples were prepared containing the following concentrations (in pg/mL): 25,000 pg/ml, 2,500 pg/ml, 25 pg/ml, 12.5pg/ml, 6.25 pg/ml, 3.125 pg/ml, 1.56 pg/ml, 0.78 pg/ml. The samples were prepared in the presence of 1 mM of the protease inhibitor AEBSF. The samples were then processed according to the method defined in the previous examples.
  • a lyophilised sample of human AJ342 was reconstituted to 10 ⁇ g/mL. From the stock solution, samples were prepared containing the following concentrations (in pg/mL): 25,000 pg/ml, 2,500 pg/ml, 25 pg/ml, 12.5pg/ml, 6.25 pg/ml, 3.125 pg/ml, 1.56 pg/ml, 0.78 pg/ml. The samples were prepared in the presence of 1 mM of the protease inhibitor AEBSF. The samples were then processed according to the method defined in the previous examples.
  • EXAMPLE 7 Statistical analysis Inter-laboratory reproducibility of the measurements from the 16 randomly chosen samples was assessed by the concordance correlation coefficient (CCC) which evaluates the agreement between the three readings, our own and those reported by the two external laboratories, from the same sample by measuring the variation from the 45 degrees line through the origin (the concordance line) 21 .
  • CCC concordance correlation coefficient
  • the degree to which samples of the same individual obtained at different days resemble each other (intra-subject reproducibility) was assessed by the intraclass correlation coefficient (ICC).
  • the degree of agreement estimated by these correlation coefficients was described as poor (0.21 to 0.40), moderated (0.41 to 0.60), substantial (0.61 to 0.80) and almost perfect (0.81 to 1.00).
  • the ⁇ levels in the different diagnostic groups were compared using Mann- Whitney U-test.
  • Sensitivity It is the probability of correctly classifying a sick individual, i.e., the probability of obtaining a positive result for a sick subject in the test.
  • the sensitivity is, therefore, the capacity of the test to detect the disease.
  • Specificity It is the probability of correctly classifying a healthy individual, i.e probability of obtaining a negative result for a healthy subject. In other words, specificity can be designed as the capacity to detect healthy people.
  • Positive Predictive Value It is the probability of having the disease if a positive result is obtained in the test.
  • the positive predictive value can therefore be estimated from the proportion of patients with a positive result in the test who finally were sick:
  • Negative Predictive Value It is the probability of a subject with a negative result in the test really being healthy. It is estimated by dividing the number of true negatives by the total of patients with a negative result in the test:
  • the concept of likelihood ratio, probability ratio, or odds ratio is also considered.
  • the latter measure the likelier a specific (positive or negative) result is according to the presence or absence of disease.
  • Positive likelihood ratio or positive odds ratio it is calculated by dividing the probability of a positive result in sick patients by the probability of a positive result among the healthy ones. It is, in short, the ratio between the fraction of true positives (sensitivity) and the fraction of false positives (1 -specificity):
  • Negative likelihood ratio or negative odds ratio it is calculated by dividing the probability of a negative result in the presence of disease by the probability of a negative result in the absence thereof. It is therefore calculated as the ratio between the fraction of false negatives (1 -sensitivity) and the fraction of true negatives (specificity): — Sensitivity
  • the ROC curve is presented by means of a graph, and the area under the ROC curve with 95% CI, the real classification according to the parameter of the (sick/healthy) patients, and the value of sensitivity, specificity, positive predictive value and negative predictive value with 95% CI are presented by means of tables. All the statistical tests have been performed with a significance level of 0.05.
  • H, M, and A mean significant (p ⁇ 0.05) with regard to HC, MCI and AD respectively. * means p ⁇ 0.01.
  • Table 10 List of direct and calculated parameters which were analyzed during of the study.
  • Table 12 Summary of methods showing better sensitivity, specificity and accuracy levels. The most preferred methods are given in white characters on a black background. The second best methods are shown using a light grey background. The methods provided particularly useful for detecting mild cognitive impairment from healthy patients using the lab40 marker (figure 4), the 2ab40 marker (figure 5), the 3ab40 marker (figure 6), the lab42 marker (figure 7), the 2ab42 marker (figure 8), the 3ab42 marker (figures 9 and 10), the 2ab40 + 3ab40 marker (figure 11), the 2ab42 + 3ab42 marker (figure 12), the 2ab42 + 3ab42 (figure 13) and the 2ab40 + 3ab40 + 2ab42 + 3ab42 (figure 14).

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