WO2013116537A1 - A method to distinguish benign from malignant oncocytic cell tissue - Google Patents

A method to distinguish benign from malignant oncocytic cell tissue Download PDF

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Publication number
WO2013116537A1
WO2013116537A1 PCT/US2013/024174 US2013024174W WO2013116537A1 WO 2013116537 A1 WO2013116537 A1 WO 2013116537A1 US 2013024174 W US2013024174 W US 2013024174W WO 2013116537 A1 WO2013116537 A1 WO 2013116537A1
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protein
aqp4
tissue
malignant
cells
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French (fr)
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David E. Burstein
Eric GENDEN
Michael Rivera
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Mount Sinai School Of Medicine
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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
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
    • G01N33/57407—Specifically defined cancers
    • 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
    • G01N33/6872—Intracellular protein regulatory factors and their receptors, e.g. including ion channels
    • 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
    • C12Q2600/112—Disease subtyping, staging or classification
    • 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
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/56—Staging of a disease; Further complications associated with the disease

Definitions

  • oncocytic also called Hurthle cell
  • follicular neoplasms from cellular hyperplastic oncocytic nodules or foci of nodular oncocytic metaplasia in lymphocytic thyroiditis. It is also not possible to distinguish a benign from a malignant oncocytic (or Hurthle ceil) thyroid neoplasm based upon cytomorphology alone. Hurtihe cells are seen in both neoplastic and non-neoplastic conditions.
  • Oncocytic tumors constitute a distinctive group of lesions having distinctive granular cytoplasmic eosinophilia of the neoplastic cells. These cells are often referred to as oncocytes because they appear to be "swollen". Oncocytic tumors have been reported, with different frequencies, in virtually every organ.
  • Aquaporin 4 is an integral membrane protein that conducts water through the cell membrane, it is expressed in cells of the kidney, CNS and thy roid.
  • Human AQP4 protein sequence can be found, e.g., at GenBank Accession No. AAH22286; human aqp4 gene sequence can be found, e.g., at GenBank Accession No. NGJ329560.
  • Histone Hi.5 (or Hist I HIB) is a member of the histone family and functions as a "linker" molecule, playing a role in organizing nucleosomes into higher-order structures.
  • Human H I .5 protein sequence can be found, e.g., at GenBank Accession No. CAA58498; human HI .5 mRNA sequence can be found, e.g., at GenBank Accession No. NM__005322,
  • the invention provides a method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises immunostaining a sample of the nodule cells or tissue for the presence of Aquaporin 4 (AQP4) protein and identifying (i) the cells or tissue with more than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as benign and/or (u) the cells or tissue with less than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as malignant.
  • AQP4 Aquaporin 4
  • the method further comprises immunostaining the sample of the nodule cells or tissue for the presence of histone H1.5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI , 5 protein as malignant.
  • histone H1.5 HI .5
  • identifying i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI , 5 protein as malignant.
  • the invention provides a method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises immunostaining a sample of the nodule cells or tissue for the presence of histone HI .5 (HI.5) protein and identifying (i) the ceils or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
  • HI.5 histone HI .5
  • the invention provides a method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises detecting the presence or expression of Aquaporin 4 (AQP4) and/or histone HI.5 (HI .5) in a sample of the nodule cells or tissue.
  • the detection is performed by immunostaining for the presence of AQP4 protein and/or HI .5 protein.
  • the detection is performed by detecting expression of a.qp4 gene and/or HI .5 gene (e.g., using RT-PCR).
  • the method further comprises (a) identifying (i) the cells or tissue positive for the presence or expression of AQP4 as benign and/or (it) the cells or tissue negative for the presence or expression of AQP4 as malignant, and/or (b) identifying (i) the cells or tissue negative for the presence or expression of HI .5 as benign and/or (ii) the cells or tissue positive for the presence or expression of HI .5 as malignant.
  • the invention provides a method for determining if an oncocytic lesion is benign or malignant, which method comprises immunostaining a cell or tissue sample collected from a lesion in a subject for the presence of Aquaporin 4 (AQP4) protein and identifying (i) the cells or tissue with more than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as benign and/or (ii) the cells or tissue with less than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as malignant.
  • AQP4 Aquaporin 4
  • the method further comprises immunostaining the cell or tissue sample for the presence of histone HI .5 (HI , 5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
  • histone HI .5 HI , 5
  • identifying i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
  • the invention provides a method for determining if an oncocytic lesion is benign or malignant, which method comprises immunostaining a cell or tissue sample collected from a lesion in a subject for the presence of histone H I .5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived ceils showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for H I .5 protein as malignant.
  • H I .5 histone H I .5
  • the immuno taining for the presence of AQP4 protein can be performed, for example, using an anti-AQP4 antibody.
  • the immunos raining for the presence of HI .5 protein can be performed, for example, using an anti-Hi .5 antibody.
  • the sample of the nodule cells or tissue used in the methods of the invention is collected from a subject.
  • the methods further comprise informing the subject of the results of the determination.
  • the methods further comprise removing the lesion surgically if it is determined to be malignant.
  • the subject determined as having malignant thyroid nodules is further subjected to total thyroidectomy.
  • kits for distinguishing benign thyroid nodules from malignant thyroid nodules or for determining if an oncocytic lesion is benign or malignant comprising (i) a means for detecting the presence or expression of Aquaporin 4 (AQP4), (ii) a means for detecting the presence or expression of histone HI .5 (HI .5), and (iii) optionally instructions for use.
  • the means for detecting the presence of AQP4 is an anti-AQP4 antibody and the means for detecting the presence of Hi , 5 is an anti-Hi .5 antibody.
  • the means for detecting the expression of AQP4 is a primer pair specific for aqp4 mRNA and the means for detecting the expression of H1.5 is a primer pair specific for HI.5 mRNA.
  • the present invention is based on an unexpected discovery that immunostaining suspected follicular neoplasm for the presence of AQP4 and HI .5 can facilitate the distinction of benign oncocytic lesions from malignant oncocytic lesions, and especially can facilitate the distinction of benign oncocytic follicular lesions from oncocytic follicular carcinoma.
  • Samples of suspected follicular neoplasms, thyroid nodules and/or thyroid tissue can be obtained using any suitable method of surgery or biopsy, and their preparation can include tissue preparations, cellular preparations, cell blocks from cytologic aspirates, fine needle aspiration biopsies and other suitable methods know to the art.
  • the present invention is directed to methods for distinguishing benign oncocytic lesions including thyroid nodules from malignant thyroid nodules by detecting the presence or expression of Aquaporin 4 (AQP4) and/or liistone HI, 5 (Hi, 5).
  • the presence or expression of AQP4 and HI .5 can be determined by various methods known in the art. Non-limiting examples of such methods include, for example, quantitative (real-time) RT-PCR, Western blotting and imrnunohistochernistry.
  • malignant oncocytic lesions can be identified and distinguished from benign oncocytic lesions by immunostaining the suspected oncocytic cells to detect the presence of AQP4 and HI .5,
  • malignant oncocytic ceils are imrmmostained with anti-AQP4 antibodies less than about 20% of the oncocytes and thyroid follicular epithelium derived cells show positive membrane staining with anti-AQP4 antibodies
  • non-malignant cells more than about 20% of the immunosiained oncocytes and thyroid follicular epithelium derived cells show positive membrane staining with anti-AQP4 antibodies.
  • the anti-AQP4 and anti-H1.5 antibodies of the present invention may be provided as polyclonal antibodies, monoclonal antibodies (mAbs), recombinant antibodies, chimeric antibodies, CDR-grafted antibodies, fully human antibodies, single chain antibodies, and/or bispecific antibodies, as well as fragments, including variants and derivatives thereof, provided by known techniques, including, but not limited to enzymatic cleavage, peptide synthesis or recombinant techniques.
  • Polyclonal antibodies may be raised in animals by multiple subcutaneous (sc) or intraperitoneal (ip) injections of the relevant antigen and an adjuvant.
  • An improved antibody response may be obtained by conjugating the relevant antigen to a protein that is immunogenic in the species to be immunized, e.g., keyhole limpet hemocyanin, serum albumin, bovine thyroglobulin, or soybean trypsin inhibitor using a bifunctional or derivatizing agent, for example, maleimidobenzoyl sulfosuccinimide ester (conjugation through cysteine residues), N-hydroxysuccinimide (through lysine residues), glutaraldehyde, succinic anhydride or other agents known in the art.
  • a protein that is immunogenic in the species to be immunized e.g., keyhole limpet hemocyanin, serum albumin, bovine thyroglobulin, or soybean trypsin inhibitor
  • a bifunctional or derivatizing agent for example, maleimidobenzoyl sulfosuccinimide ester (conjugation through cysteine residues
  • Monoclonal antibodies may be made by the hybridoma method first described by Kohler et al, (Nature, 256:495-7, 1975), or may be made by recombinant DNA methods (see, e.g., U.S. Pat. No. 4,816,567).
  • the monoclonal antibodies may also be isolated from phage antibody libraries using the techniques described in, for example, Clackson et al., (Nature 352:624-628, 1991) and Marks et al, (J. Mol. Biol. 222:581- 597, 1991).
  • the present invention includes AQP4 and HI .5 binding antibodies and antibody fragments comprising any of the heavy or light chain sequences and which bind AQP4 or HI .5.
  • fragments refers to any 3 or more contiguous amino acids (e.g., 4 or more, 5 or more 6 or more, 8 or more, or even 10 or more contiguous amino acids) of the antibody and encompasses Fab, Fab', F(ab')2, and F(v) fragments, or the individual light or heavy chain variable regions or portion thereof.
  • These fragments can be produced from intact antibodies using well known methods, for example, by proteolytic cleavage with enzymes such as papain (to produce Fab fragments) or pepsin (to produce F(ab')2 fragments).
  • the encompassed antibodies and fragments may comprise one or more portions that do not bind AQP4 or HI .5 but instead are responsible for other functions, such as circulating half-life or detectable labeling.
  • the antibodies or fragments may comprise all or a portion of the constant region and may be of any isotype, including IgA (e.g., IgAl or IgA2), IgD, IgE, IgG (e.g. IgGl, IgG2, IgG3 or IgG4), or IgM.
  • antigen-binding compounds of the invention may include an epitope tag, a salvage receptor epitope, a label moiety, etc.
  • the constant region (when present) of the present antibodies and fragments may be of the ⁇ , j2, y3, y4, ⁇ , ⁇ 2, or ⁇ or ⁇ type, preferably of the ⁇ type, whereas the constant part of a human light chain may be of the ⁇ or ⁇ type (which includes the ⁇ , ⁇ 2 and ⁇ 3 subtypes) but is preferably of the ⁇ type.
  • Variants also include antibodies or fragments comprising a modified Fc region, wherein the modified Fc region comprises at least one amino acid modification relative to a wild-type Fc region.
  • the variant Fc region may be designed, relative to a comparable molecule comprising the wild-type Fc region, so as to bind Fc receptors with a greater or lesser affinity.
  • the binding specificity of AQP4/H1.5 antibodies and antigen-binding fragments thereof can be determined using in vitro assays known in the art (e.g., an antigen-specific ELISA).
  • Preferred antibodies or antigen-binding fragments thereof for use in accordance with the invention generally bind to AQP4 or HI .5 with high affinity (e.g., as determined with BIACORETM instrument for kinetic analysis of binding interactions).
  • a preferred antibody or fragment will bind AQP4 or HI .5 with an equilibrium binding dissociation constant (KD) of about 10 nM or less, about 5 nM or less, about 1 nM or less, about 500 pM or less, or more preferably about 250 pM or less, about 100 pM or less, about 50 pM or less, about 25 pM or less, about 10 pM or less, about 5 pM or less, about 3 pM or less about 1 pM or less, about 0.75 pM or less, about 0.5 pM or less, or about 0.3 pM or less.
  • KD equilibrium binding dissociation constant
  • immunohistochemistry (IHC) detection of AQP4 or HI .5 may be utilized.
  • This staining method is based on immunoenzymatic reactions using monoclonal or polyclonal antibodies to detect specific proteins such as tissue antigens.
  • immunohistochemistry protocols include detection systems that allow visualization of the markers (e.g., via light microscopy or an automated scanning system) for qualitative or quantitative analyses.
  • Various immunoenzymatic staining methods are known in the art for detecting a protein of interest. For example, immunoenzymatic interactions may be visualized using different enzymes such as peroxidase, alkaline phosphatase, or different chromogens such as DAB, AEC, or Fast Red.
  • Antibodies and detectable labels may be provided in multiple layers in order to increase the flexibility of a detection system, and to enhance the signal from a target (AQP4 or HI .5).
  • AQP4 or HI .5 may first be bound by a primary antibody, which, in turn, is capable of binding many secondary antibodies or even tertiary antibodies, which, in their turn, bind to the probe. This method, thus, increases the number of probes that recognize each antigen target by adding extra layers of molecular interactions between the probe and target.
  • a primary antibody that recognizes the target molecule e.g., AQP4 or HI.5
  • a tissue sample e.g., thyroid nodule tissue sample
  • a secondary antibody directed against the primary antibody and labeled e.g., with biotin or an enzyme
  • the primary antibody, which recognizes the target molecule can be labeled and a secondary antibody is not necessary. If the labeled antibody is labeled with biotin, the biotin label can be detected, e.g., using enzyme- labeled avidin or streptavidin.
  • the methods of the present invention may be accomplished using any suitable method or system of immunohistochemistry or immunocytochemistry, as will be apparent to one skilled in the art, including automated systems, quantitative IHC, semiquantitative IHC, and manual methods.
  • quantitative immunohistochemistry refers to an automated method of scanning and scoring samples that have undergone immunohistochemistry to identify and quantitate the presence of a specified biomarker such as AQP4 or HI.5.
  • the score given to the sample may be a numerical representation of the intensity of the immunohistochemical staining of the sample, and represents the amount of target biomarker present in the sample.
  • Optical Density (OD) is a numerical score that represents intensity of staining.
  • semi-quantitative immunohistochemistry refers to scoring of immunohistochemical results by the human eye, where a trained operator ranks results numerically (e.g., as 1+, 2+, or 3+).
  • Such systems may include automated staining (e.g, the Benchmark system, Ventana Medical Systems, Inc.) and microscopic scanning, computerized image analysis, serial section comparison (to control for variation in the orientation and size of a sample), digital report generation, and archiving and tracking of samples (such as slides on which tissue sections are placed).
  • Cellular imaging systems are commercially available that combine conventional light microscopes with digital image processing systems to perform quantitative analysis on cells and tissues, including immunostained samples (e.g, CAS-200 system, Becton, Dickinson & Co.).
  • IHC techniques require a series of steps which may be conducted on a tissue section mounted on a glass slide or other planar support.
  • histological materials there are two categories of histological materials: (a) preparations comprising fresh tissues and/or cells, which are not fixed with aldehyde-based fixatives, and (b) fixed and embedded tissue specimens, often archive material.
  • Many methods for fixing and embedding tissue specimens are known (e.g., alcohol fixation).
  • the most widely used fixing/embedding technique employs formalin-fixation and subsequent paraffin embedding (FFPE).
  • a typical FFPE IHC staining procedure may involve the steps of: cutting and trimming tissue, fixation, dehydration, paraffin infiltration, cutting in thin sections, mounting onto glass slides, baking, deparaffination, rehydration, antigen retrieval, blocking steps, applying primary antibody, washing, applying secondary antibody-enzyme conjugate, washing, applying enzyme chromogen substrate, washing, counter staining, cover slipping, and microscope examination.
  • the method of the invention is useful in deciding which thyroid nodules should be dissected or removed in thyroid surgery.
  • Most surgeons and endocrinologists recommend total or near total thyroidectomy in virtually all cases of thyroid carcinoma.
  • a less aggressive approach may be taken (lobectomy with removal of the isthmus).
  • a lymph node dissection within the anterior and lateral neck may be indicated in patients with well differentiated (papillary or follicular) thyroid cancer if the lymph nodes can be palpated. All patients with medullary carcinoma of the thyroid require total thyroidectomy and aggressive lymph node dissection.
  • indicators of benign phenotypes according to the method of the invention may result in non-surgical follow-up or more limited surgery, for example, a partial thyroidectomy.
  • indicators pointing toward malignancy may result in more extensive surgery, e.g. a total thyroidectomy.
  • AQP4 Concentration: 0.53 mg ' ml, dilution: 1 :3000
  • Histone HI .5 concentration 0.5 ⁇ &' ⁇ , dilution 1 :800
  • the cell or tissue sample including cells or tissue fixed in precipitating fixatives, like ethanoi or methanol, or in cross-linking fixatives like formalin or paraformaldehyde, was subjected to peroxide-induced blockage of endogenous peroxidase activity, then subjected to citrate based antigen retrieval using a pressure cooker for 4 minutes at 125 degrees C followed by slow cooling.
  • precipitating fixatives like ethanoi or methanol
  • cross-linking fixatives like formalin or paraformaldehyde
  • Samples may include cell smears or other cell preparations, paraffin embedded cell block, formalin-fixed paraffin embedded tissue sample.
  • Staining for HI .5 was considered positive if >30% of oncocytes and thyroid follicular epithelium derived ceils showed nuclear staining.
  • Staining for AQP4 was considered positive is >20% of oncocytes and thyroid follicular epithelium derived cells were highlighted in a membranous pattern. Normal thyroid is characteristically AQP4-positive and HI .5 negative. All cases of NI! and 82% (9/1 1) of LT cases stained positive for AQP4. In cases of Nil with extensive oncocytic metaplasia staining for AQP4 was particularly intense. HI .5 stained negative in all cases of NH and LT.
  • markers of benign phenotypes may result in non- urgical follow-up or more limited surgery, for example, a partial thyroidectomy.
  • indicators pointing toward malignancy may result in more extensive surgery, e.g. a total thyroidectomy.
  • the method of the invention is useful in deciding which thyroid nodules should b dissected or removed in thyroid surgery.

Abstract

The invention is directed to methods for distinguishing benign thyroid nodules from malignant thyroid nodules by detecting the presence or expression of Aquaporin 4 (AQP4) and/or histone H1.5 (H1.5).

Description

A METHOD TO DISTINGUISH BENIGN FROM MALIGNANT
ONCOCYTIC CELL TISSUE
Cross Reference To Related Applications
This application claims priority from U.S. Provisional Application Serial No. 61/592,999, filed on January 31, 2012, which is incorporated herein by reference in its entirety.
Background of the Invention
The accurate pre-operative diagnosis of follicular patterned lesions of the thyroid on fine needle aspiration specimens remains elusive. Frequently, it is difficult to distinguish oncocytic (also called Hurthle cell) follicular neoplasms from cellular hyperplastic oncocytic nodules or foci of nodular oncocytic metaplasia in lymphocytic thyroiditis. It is also not possible to distinguish a benign from a malignant oncocytic (or Hurthle ceil) thyroid neoplasm based upon cytomorphology alone. Hurtihe cells are seen in both neoplastic and non-neoplastic conditions. Thus such cells are present in hurthle cell carcinoma, a neoplastic condition and hashimoios thyroiditis, a nonneoplastic condition. Up to 1.0% of individuals have thyroid nodules. Any example of nodular goiter, lymphocytic thyroiditis, oncocytic adenoma and carcinomas constitute in composite a sizable patient population. This can present a problem for the surgeon in deciding which nodules to remove surgically in order to eliminate malignant lesions without needlessly removing benign hyperplastic tissue. Oncocytic tumors constitute a distinctive group of lesions having distinctive granular cytoplasmic eosinophilia of the neoplastic cells. These cells are often referred to as oncocytes because they appear to be "swollen". Oncocytic tumors have been reported, with different frequencies, in virtually every organ.
Aquaporin 4 (AQP ) is an integral membrane protein that conducts water through the cell membrane, it is expressed in cells of the kidney, CNS and thy roid. Human AQP4 protein sequence can be found, e.g., at GenBank Accession No. AAH22286; human aqp4 gene sequence can be found, e.g., at GenBank Accession No. NGJ329560.
Histone Hi.5 (or Hist I HIB) is a member of the histone family and functions as a "linker" molecule, playing a role in organizing nucleosomes into higher-order structures. Human H I .5 protein sequence can be found, e.g., at GenBank Accession No. CAA58498; human HI .5 mRNA sequence can be found, e.g., at GenBank Accession No. NM__005322,
Summary of the Invention
There is a great need in the art to distinguish benign thyroid nodules from malignant thyroid nodules. The present invention addresses this and other needs.
In one embodiment, the invention provides a method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises immunostaining a sample of the nodule cells or tissue for the presence of Aquaporin 4 (AQP4) protein and identifying (i) the cells or tissue with more than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as benign and/or (u) the cells or tissue with less than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as malignant. In one specific embodiment, the method further comprises immunostaining the sample of the nodule cells or tissue for the presence of histone H1.5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI , 5 protein as malignant.
In another embodiment, the invention provides a method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises immunostaining a sample of the nodule cells or tissue for the presence of histone HI .5 (HI.5) protein and identifying (i) the ceils or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
In a. further embodiment, the invention provides a method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises detecting the presence or expression of Aquaporin 4 (AQP4) and/or histone HI.5 (HI .5) in a sample of the nodule cells or tissue. In one specific embodiment, the detection is performed by immunostaining for the presence of AQP4 protein and/or HI .5 protein. In another specific embodiment, the detection is performed by detecting expression of a.qp4 gene and/or HI .5 gene (e.g., using RT-PCR). In one specific embodiment, the method further comprises (a) identifying (i) the cells or tissue positive for the presence or expression of AQP4 as benign and/or (it) the cells or tissue negative for the presence or expression of AQP4 as malignant, and/or (b) identifying (i) the cells or tissue negative for the presence or expression of HI .5 as benign and/or (ii) the cells or tissue positive for the presence or expression of HI .5 as malignant.
In yet another embodiment, the invention provides a method for determining if an oncocytic lesion is benign or malignant, which method comprises immunostaining a cell or tissue sample collected from a lesion in a subject for the presence of Aquaporin 4 (AQP4) protein and identifying (i) the cells or tissue with more than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as benign and/or (ii) the cells or tissue with less than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as malignant. In one specific embodiment, the method further comprises immunostaining the cell or tissue sample for the presence of histone HI .5 (HI , 5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
In another embodiment, the invention provides a method for determining if an oncocytic lesion is benign or malignant, which method comprises immunostaining a cell or tissue sample collected from a lesion in a subject for the presence of histone H I .5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived ceils showing positive nuclear staining for HI .5 protein as benign and/or (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for H I .5 protein as malignant. In the methods of the invention, the immuno taining for the presence of AQP4 protein can be performed, for example, using an anti-AQP4 antibody. The immunos raining for the presence of HI .5 protein can be performed, for example, using an anti-Hi .5 antibody.
In one embodiment, the sample of the nodule cells or tissue used in the methods of the invention is collected from a subject. In one specific embodiment, the methods further comprise informing the subject of the results of the determination. In one specific embodiment, the methods further comprise removing the lesion surgically if it is determined to be malignant. In one specific embodiment, the subject determined as having malignant thyroid nodules is further subjected to total thyroidectomy.
In conjunction with the above methods, the invention also provides kits for distinguishing benign thyroid nodules from malignant thyroid nodules or for determining if an oncocytic lesion is benign or malignant comprising (i) a means for detecting the presence or expression of Aquaporin 4 (AQP4), (ii) a means for detecting the presence or expression of histone HI .5 (HI .5), and (iii) optionally instructions for use. In one specific embodiment, the means for detecting the presence of AQP4 is an anti-AQP4 antibody and the means for detecting the presence of Hi , 5 is an anti-Hi .5 antibody. In another specific embodiment, the means for detecting the expression of AQP4 is a primer pair specific for aqp4 mRNA and the means for detecting the expression of H1.5 is a primer pair specific for HI.5 mRNA.
Detailed Description of the Invention
The present invention is based on an unexpected discovery that immunostaining suspected follicular neoplasm for the presence of AQP4 and HI .5 can facilitate the distinction of benign oncocytic lesions from malignant oncocytic lesions, and especially can facilitate the distinction of benign oncocytic follicular lesions from oncocytic follicular carcinoma.
Samples of suspected follicular neoplasms, thyroid nodules and/or thyroid tissue can be obtained using any suitable method of surgery or biopsy, and their preparation can include tissue preparations, cellular preparations, cell blocks from cytologic aspirates, fine needle aspiration biopsies and other suitable methods know to the art. The present invention is directed to methods for distinguishing benign oncocytic lesions including thyroid nodules from malignant thyroid nodules by detecting the presence or expression of Aquaporin 4 (AQP4) and/or liistone HI, 5 (Hi, 5).
The presence or expression of AQP4 and HI .5 can be determined by various methods known in the art. Non-limiting examples of such methods include, for example, quantitative (real-time) RT-PCR, Western blotting and imrnunohistochernistry.
For example, according to the invention, malignant oncocytic lesions can be identified and distinguished from benign oncocytic lesions by immunostaining the suspected oncocytic cells to detect the presence of AQP4 and HI .5, When malignant oncocytic ceils are imrmmostained with anti-AQP4 antibodies less than about 20% of the oncocytes and thyroid follicular epithelium derived cells show positive membrane staining with anti-AQP4 antibodies, while in non-malignant cells more than about 20% of the immunosiained oncocytes and thyroid follicular epithelium derived cells show positive membrane staining with anti-AQP4 antibodies. When malignant oncocytic cells are imrmmostained with anti-H1.5 antibodies, more than about 30% of oncocytes and thyroid follicular epithelium derived ceils show positive nuclear staining with anti-H1.5 antibodies, while in non-malignant cells less than about 30% of oncocytes and thyroid follicular epithelium derived cells show positive nuclear staining with anti-Hi .5 antibodies.
For clarification, when counting immunosiained ceils for the purpose of calculating the percentage of ceils in a thyroid cell or tissue sample that are positively stained for the presence of either AQP4 or HI .5, only thyroid follicular epithelium derived cells and oncocytes are counted. Other cells which may be present, including but not limited to macrophages and lymphocytes, are not included in either the numerator or denominator that determines the percentage of immunostaining.
The anti-AQP4 and anti-H1.5 antibodies of the present invention may be provided as polyclonal antibodies, monoclonal antibodies (mAbs), recombinant antibodies, chimeric antibodies, CDR-grafted antibodies, fully human antibodies, single chain antibodies, and/or bispecific antibodies, as well as fragments, including variants and derivatives thereof, provided by known techniques, including, but not limited to enzymatic cleavage, peptide synthesis or recombinant techniques. Polyclonal antibodies may be raised in animals by multiple subcutaneous (sc) or intraperitoneal (ip) injections of the relevant antigen and an adjuvant. An improved antibody response may be obtained by conjugating the relevant antigen to a protein that is immunogenic in the species to be immunized, e.g., keyhole limpet hemocyanin, serum albumin, bovine thyroglobulin, or soybean trypsin inhibitor using a bifunctional or derivatizing agent, for example, maleimidobenzoyl sulfosuccinimide ester (conjugation through cysteine residues), N-hydroxysuccinimide (through lysine residues), glutaraldehyde, succinic anhydride or other agents known in the art.
Monoclonal antibodies may be made by the hybridoma method first described by Kohler et al, (Nature, 256:495-7, 1975), or may be made by recombinant DNA methods (see, e.g., U.S. Pat. No. 4,816,567). The monoclonal antibodies may also be isolated from phage antibody libraries using the techniques described in, for example, Clackson et al., (Nature 352:624-628, 1991) and Marks et al, (J. Mol. Biol. 222:581- 597, 1991).
The present invention includes AQP4 and HI .5 binding antibodies and antibody fragments comprising any of the heavy or light chain sequences and which bind AQP4 or HI .5. The term fragments as used herein refers to any 3 or more contiguous amino acids (e.g., 4 or more, 5 or more 6 or more, 8 or more, or even 10 or more contiguous amino acids) of the antibody and encompasses Fab, Fab', F(ab')2, and F(v) fragments, or the individual light or heavy chain variable regions or portion thereof. These fragments can be produced from intact antibodies using well known methods, for example, by proteolytic cleavage with enzymes such as papain (to produce Fab fragments) or pepsin (to produce F(ab')2 fragments).
The encompassed antibodies and fragments may comprise one or more portions that do not bind AQP4 or HI .5 but instead are responsible for other functions, such as circulating half-life or detectable labeling. The antibodies or fragments may comprise all or a portion of the constant region and may be of any isotype, including IgA (e.g., IgAl or IgA2), IgD, IgE, IgG (e.g. IgGl, IgG2, IgG3 or IgG4), or IgM. In addition to, or instead of, comprising a constant region, antigen-binding compounds of the invention may include an epitope tag, a salvage receptor epitope, a label moiety, etc. The constant region (when present) of the present antibodies and fragments may be of the γΐ, j2, y3, y4, μ, β2, or δ or ε type, preferably of the γ type, whereas the constant part of a human light chain may be of the κ or λ type (which includes the λι, λ2 and λ3 subtypes) but is preferably of the κ type.
Variants also include antibodies or fragments comprising a modified Fc region, wherein the modified Fc region comprises at least one amino acid modification relative to a wild-type Fc region. The variant Fc region may be designed, relative to a comparable molecule comprising the wild-type Fc region, so as to bind Fc receptors with a greater or lesser affinity.
The binding specificity of AQP4/H1.5 antibodies and antigen-binding fragments thereof can be determined using in vitro assays known in the art (e.g., an antigen- specific ELISA).
Preferred antibodies or antigen-binding fragments thereof for use in accordance with the invention generally bind to AQP4 or HI .5 with high affinity (e.g., as determined with BIACORE™ instrument for kinetic analysis of binding interactions). For example, but not necessarily, a preferred antibody or fragment will bind AQP4 or HI .5 with an equilibrium binding dissociation constant (KD) of about 10 nM or less, about 5 nM or less, about 1 nM or less, about 500 pM or less, or more preferably about 250 pM or less, about 100 pM or less, about 50 pM or less, about 25 pM or less, about 10 pM or less, about 5 pM or less, about 3 pM or less about 1 pM or less, about 0.75 pM or less, about 0.5 pM or less, or about 0.3 pM or less.
In the methods of the invention, immunohistochemistry (IHC) detection of AQP4 or HI .5 may be utilized. This staining method is based on immunoenzymatic reactions using monoclonal or polyclonal antibodies to detect specific proteins such as tissue antigens. Typically, immunohistochemistry protocols include detection systems that allow visualization of the markers (e.g., via light microscopy or an automated scanning system) for qualitative or quantitative analyses. Various immunoenzymatic staining methods are known in the art for detecting a protein of interest. For example, immunoenzymatic interactions may be visualized using different enzymes such as peroxidase, alkaline phosphatase, or different chromogens such as DAB, AEC, or Fast Red. Antibodies and detectable labels may be provided in multiple layers in order to increase the flexibility of a detection system, and to enhance the signal from a target (AQP4 or HI .5). For instance, AQP4 or HI .5 may first be bound by a primary antibody, which, in turn, is capable of binding many secondary antibodies or even tertiary antibodies, which, in their turn, bind to the probe. This method, thus, increases the number of probes that recognize each antigen target by adding extra layers of molecular interactions between the probe and target. For example, a primary antibody that recognizes the target molecule (e.g., AQP4 or HI.5) can be introduced to a tissue sample (e.g., thyroid nodule tissue sample) followed by incubation and then a wash to remove unbound antibody. These steps can be followed by incubation with a secondary antibody directed against the primary antibody and labeled (e.g., with biotin or an enzyme). Alternatively, the primary antibody, which recognizes the target molecule, can be labeled and a secondary antibody is not necessary. If the labeled antibody is labeled with biotin, the biotin label can be detected, e.g., using enzyme- labeled avidin or streptavidin.
The methods of the present invention may be accomplished using any suitable method or system of immunohistochemistry or immunocytochemistry, as will be apparent to one skilled in the art, including automated systems, quantitative IHC, semiquantitative IHC, and manual methods. As used herein, quantitative immunohistochemistry refers to an automated method of scanning and scoring samples that have undergone immunohistochemistry to identify and quantitate the presence of a specified biomarker such as AQP4 or HI.5. The score given to the sample may be a numerical representation of the intensity of the immunohistochemical staining of the sample, and represents the amount of target biomarker present in the sample. For example, Optical Density (OD) is a numerical score that represents intensity of staining. As used herein, semi-quantitative immunohistochemistry refers to scoring of immunohistochemical results by the human eye, where a trained operator ranks results numerically (e.g., as 1+, 2+, or 3+).
Various automated sample processing, scanning, and analysis systems suitable for use with immunohistochemistry are available in the art. Such systems may include automated staining (e.g, the Benchmark system, Ventana Medical Systems, Inc.) and microscopic scanning, computerized image analysis, serial section comparison (to control for variation in the orientation and size of a sample), digital report generation, and archiving and tracking of samples (such as slides on which tissue sections are placed). Cellular imaging systems are commercially available that combine conventional light microscopes with digital image processing systems to perform quantitative analysis on cells and tissues, including immunostained samples (e.g, CAS-200 system, Becton, Dickinson & Co.).
IHC techniques require a series of steps which may be conducted on a tissue section mounted on a glass slide or other planar support. In general, there are two categories of histological materials: (a) preparations comprising fresh tissues and/or cells, which are not fixed with aldehyde-based fixatives, and (b) fixed and embedded tissue specimens, often archive material. Many methods for fixing and embedding tissue specimens are known (e.g., alcohol fixation). However, the most widely used fixing/embedding technique employs formalin-fixation and subsequent paraffin embedding (FFPE). A typical FFPE IHC staining procedure may involve the steps of: cutting and trimming tissue, fixation, dehydration, paraffin infiltration, cutting in thin sections, mounting onto glass slides, baking, deparaffination, rehydration, antigen retrieval, blocking steps, applying primary antibody, washing, applying secondary antibody-enzyme conjugate, washing, applying enzyme chromogen substrate, washing, counter staining, cover slipping, and microscope examination.
In accordance with the present invention there may be employed conventional molecular biology, microbiology, and recombinant DNA techniques within the skill of the art. Such techniques are explained fully in the literature. See, e.g., Sambrook, Fritsch & Maniatis, Molecular Cloning: A Laboratory Manual, Second Edition. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory Press, 1989 (herein "Sambrook et al, 1989"); DNA Cloning: A Practical Approach, Volumes I and II (D.N. Glover ed. 1985); Oligonucleotide Synthesis (M.J. Gait ed. 1984); Nucleic Acid Hybridization [B.D. Hames & S.J. Higgins eds. (1985)]; Transcription And Translation [B.D. Hames & S.J. Higgins, eds. (1984)]; Animal Cell Culture [R.I. Freshney, ed. (1986)]; Immobilized Cells And Enzymes [IRL Press, (1986)]; B. Perbal, A Practical Guide To Molecular Cloning (1984); Ausubel, F.M. et al. (eds.). Current Protocols in Molecular Biology. John Wiley & Sons, Inc., 1994. These techniques include site directed mutagenesis as described in Kunkel, Proc. Natl. Acad. Sci. USA 82: 488- 492 (1985), U. S. Patent No. 5,071, 743, Fukuoka et al. , Biochem. Biophys. Res. Commun. 263 : 357-360 (1999); Kim and Maas, BioTech. 28: 196-198 (2000); Parikh and Guengerich, BioTech. 24: 4 28-431 (1998); Ray and Nickoloff, BioTech. 13 : 342-346 (1992); Wang et al, BioTech. 19: 556-559 (1995); Wang and Malcolm, BioTech. 26: 680-682 (1999); Xu and Gong, BioTech. 26: 639-641 (1999), U.S. Patents Nos. 5,789, 166 and 5,932, 419, Hogrefe, Strategies 14. 3: 74-75 (2001), U. S. Patents Nos. 5,702,931, 5,780,270, and 6,242,222, Angag and Schutz, Biotech. 30: 486-488 (2001), Wang and Wilkinson, Biotech. 29: 976-978 (2000), Kang et al, Biotech. 20: 44-46 (1996), Ogel and McPherson, Protein Engineer. 5: 467-468 (1992), Kirsch and Joly, Nuc. Acids. Res. 26: 1848-1850 (1998), Rhem and Hancock, J. Bacteriol. 178: 3346-3349 (1996), Boles and Miogsa, Curr. Genet. 28: 197-198 (1995), Barrenttino et al, Nuc. Acids. Res. 22: 541-542 (1993), Tessier and Thomas, Meths. Molec. Biol. 57: 229-237, and Pons et al, Meth. Molec. Biol. 67: 209-218.
The method of the invention is useful in deciding which thyroid nodules should be dissected or removed in thyroid surgery. Most surgeons and endocrinologists recommend total or near total thyroidectomy in virtually all cases of thyroid carcinoma. In some patients with small papillary carcinomas, a less aggressive approach may be taken (lobectomy with removal of the isthmus). A lymph node dissection within the anterior and lateral neck may be indicated in patients with well differentiated (papillary or follicular) thyroid cancer if the lymph nodes can be palpated. All patients with medullary carcinoma of the thyroid require total thyroidectomy and aggressive lymph node dissection.
For example, indicators of benign phenotypes according to the method of the invention (positive AQP4; negative HI .5) may result in non-surgical follow-up or more limited surgery, for example, a partial thyroidectomy. In contrast, indicators pointing toward malignancy (negative AQP4, positive HI .5) may result in more extensive surgery, e.g. a total thyroidectomy.
Certain embodiments of methods and compositions provided herein are further illustrated by the following examples. The examples are provided for illustrative purposes only. They are not to be construed as limiting the scope or content of the invention in any way.
Example !.
The following study was carried out to evaluate the differences in AQP4 and HI .5 expression in various encapsulated follicular neoplasms and non-neoplastic lesions of the thyroid in surgical pathology specimens.
Tissue specimens were selected that were previously diagnosed as Oncocytic follicular adenoma (OA, n= 1 ), Oncocytic follicular carcinoma (OC, n=15), nodular hyperplasia (NH, n=14), and lymphocytic thyroiditis (LT, n=1 .1 ). All cases were reviewed to confirm the original diagnosis. Immunohistochemical analysis with rabbit produced antibodies to AQP4 (concentration: 0.53 mg'ml, dilution: 1 :3000) and Histone HI .5 (concentration 0.5 μ&'ηιΐ, dilution 1 :800) was performed on a representative section from each case.
The cell or tissue sample, including cells or tissue fixed in precipitating fixatives, like ethanoi or methanol, or in cross-linking fixatives like formalin or paraformaldehyde, was subjected to peroxide-induced blockage of endogenous peroxidase activity, then subjected to citrate based antigen retrieval using a pressure cooker for 4 minutes at 125 degrees C followed by slow cooling. Samples were then incubated with respective antibody (anii~aqp4 (HPA014784 from SIGMA), or anti- Histone HI .5 (ab 18208) from Abeam), washed to remove non-specific staining, exposed to secondary reagents (UltraVision Quanto Detection - System HRP DAB, Thermo- Fisher)and chromogen such as diaminobenzidine to produce a color reaction in any ceil expressing aqp4 , or expressing histone HI.5
Samples may include cell smears or other cell preparations, paraffin embedded cell block, formalin-fixed paraffin embedded tissue sample.
Staining for HI .5 was considered positive if >30% of oncocytes and thyroid follicular epithelium derived ceils showed nuclear staining. Staining for AQP4 was considered positive is >20% of oncocytes and thyroid follicular epithelium derived cells were highlighted in a membranous pattern. Normal thyroid is characteristically AQP4-positive and HI .5 negative. All cases of NI! and 82% (9/1 1) of LT cases stained positive for AQP4. In cases of Nil with extensive oncocytic metaplasia staining for AQP4 was particularly intense. HI .5 stained negative in all cases of NH and LT. 91% (10 of 1 1) of OA stained positive for AQP4 while only 9% (1/1 1 ) were positive for HI.5. In contrast, 73 % (1 1/15) of OC were AQP4-negative, while 53% (8/15) of OC were positive for HI.5
This combination of markers is useful in the pre-operaiive assessment of oncocytic follicular lesions. For example, indicators of benign phenotypes (positive AQP4; negative HI .5) may result in non- urgical follow-up or more limited surgery, for example, a partial thyroidectomy. In contrast, indicators pointing toward malignancy (negative AQP4, positive Hi .5) may result in more extensive surgery, e.g. a total thyroidectomy.
The method of the invention is useful in deciding which thyroid nodules should b dissected or removed in thyroid surgery.
Table A: Results of Trial
Figure imgf000013_0001
& *
The present invention is not to be limited in scope by the specific embodiments described herein. Indeed, various modifications of the invention in addition to those described herein will become apparent to those skilled in the art from the foregoing description. Such modifications are intended to fall within the scope of the appended claims.
All patents, applications, publications, test methods, literature, and other materials cited herein are hereby incorporated by reference in their entirety as if physically present in this specification.

Claims

What we claim is:
1. A method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises immunos aining a sample of the nodule cells or tissue for the presence of Aquaporiii 4 (AQP4) protein and identifying (i) the ceils or tissue with more than 20% of oncocytes and thyroid follicular epithelium deri ved cells showing positive membrane staining for AQP4 protein as benign and (ii) the ceils or tissue with less than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as malignant.
2. The method of claim 1, further comprising immunostaining the sample of the nodule cells or tissue for the presence of histone HI.5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI, 5 protein as benign and (ii) the ceils or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI, 5 protein as malignant,
3. A method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises immunostaining a sample of the nodule cells or tissue for the presence of histone HI .5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
4. The method of claim I, wherein the immunostaining for the presence of AQP4 protein is performed using an anti-AQP4 antibody.
5. The method of claim 2, wherein the immunostaining for the presence of HI, 5 protein is performed using an anti-Hi .5 antibody and the immunostaining for the presence of AQP4 protein is performed using an anti-AQP4 antibody.
6. The method of claim 3. wherein the immunostaining for the presence of IT 1.5 protein is performed using an anti-H1.5 antibody.
7. The method of claim 1, wherein the sample of the nodule cells or tissue had been collected from a subject.
8. The method of claim 3, wherein the sample of the nodule cells or tissue had been collected from a subject.
9. The method of claim 7, wherein the subject determined as having malignant thyroid nodules is further subjected to total thyroidectomy.
10. The method of claim 8, wherein the subject determined as having malignant thyroid nodules is further subjected to total thyroidectomy.
1 1. A method for distinguishing benign thyroid nodules from malignant thyroid nodules, which method comprises detecting the presence or expression of Aquaporin 4 (AQP4) and/or histone HI.5 (H I .5) in a sample of the nodule cells or tissue.
12. The method of claim 1 1 , wherein the detection is performed by immunostaining for the presence of AQP4 protein and/or HI .5 protein.
13. The method of claim 12, wherein the immunostaining for the presence of AQP4 protein is performed using an aiiti-AQP4 antibody and the immunostaining for the presence of HI, 5 protein is performed using an anti-H1.5 antibody,
14. The method of claim 11 , wherein the detection is performed by detecting expression of aqp4 gene and/or Hi , 5 gene.
15. The method of claim 14, wherein gene expression is detected using RT-PCR.
16. The method of claim 11, further comprising
(a) identifying (i) the cells or tissue positive for the presence or expression of AQP4 as benign and (ii) the cells or tissue negative for the presence or expression of AQP4 as malignant, and/or
(b) identifying (i) the ceils or tissue negative for the presence or expression of H I.5 as benign and (ii) the ceils or tissue positive for the presence or expression of HI .5 as malignant.
17. The method of claim 1 1. wherein the sample of the nodule cells or tissue had been collected from a subject.
18. The method of claim 17, wherein the subject determined as having malignant thyroid nodules is further subjected to total thyroidectomy.
1 . A method for determining if an oncocytic lesion is benign or malignant, which method comprises immunostaining a cell or tissue sample collected from a lesion in a subject for the presence of Aquaporin 4 (AQP4) protein and identifying (i) the cells or tissue with more than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as benign and (ii) the ceils or tissue with less than 20% of oncocytes and thyroid follicular epithelium derived cells showing positive membrane staining for AQP4 protein as malignant.
20. The method of claim 19, further comprising immunostaining the ceil or tissue sample for the presence of histone HI , 5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for Hi.5 protein as benign and (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
21. The method of claim 19, wherein the immunostaining for the presence of AQP4 protein is performed using an anti-AQP4 antibody.
22. The method of claim 20, wherein the immunostaining for the presence of HI .5 protein is performed using an anti-Hi, 5 antibody and the immunostaining for the presence of AQP4 protein is performed using an anti--AQP4 antibody.
23. The method of claim 19 which comprises informing the subject of the results of the determination.
24. The method of claim 19 which comprises removing the lesion surgically if it is determined to be malignant.
25. A method for determining if an oncocytic lesion is benign or malignant, which method comprises immunostaining a cell or tissue sample collected from a lesion in a subject for the presence of histone Hi.5 (HI .5) protein and identifying (i) the cells or tissue with less than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as benign and (ii) the cells or tissue with more than 30% of oncocytes and thyroid follicular epithelium derived cells showing positive nuclear staining for HI .5 protein as malignant.
26. The method of claim 25, wherein the immunostaining for the presence of H I .5 protein is performed using an anti-Hi .5 antibody.
27. The method of claim 25 which comprises informing the subject of the results of the determination.
28. The method of claim 25 which comprises removing the lesion surgically if it is determined to be malignant.
29. A kit for distinguishing benign thyroid nodules from malignant thyroid nodules or for determining if an oncocytic lesion is benign or malignant comprising (i) a means for detecting the presence or expression of Aqisaporin 4 (AQP4), (ii) a means for detecting the presence or expression of istone HI .5 (HI .5), and (iii) optionally instructions for use.
30. The kit of claim 29, wherein the means for detecting the presence of AQP4 is an anti-AQP4 antibody and the means for detecting the presence of HI .5 is an ami -HI , 5 antibody.
31. The kit of claim 30, wherein the means for detecting the expression of AQP4 is a primer pair specific for aqp4 mRNA and the means for detecting the expression of HI .5 is a primer pair specific for HI , 5 mRNA.
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