WO2024017334A1 - Procédé de diagnostic et de traitement d'une maladie positive pour rdaa, et kit - Google Patents

Procédé de diagnostic et de traitement d'une maladie positive pour rdaa, et kit Download PDF

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WO2024017334A1
WO2024017334A1 PCT/CN2023/108404 CN2023108404W WO2024017334A1 WO 2024017334 A1 WO2024017334 A1 WO 2024017334A1 CN 2023108404 W CN2023108404 W CN 2023108404W WO 2024017334 A1 WO2024017334 A1 WO 2024017334A1
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alk
seq
amino acid
acid sequence
positive
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PCT/CN2023/108404
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刘伦旭
查正宇
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贝达药业股份有限公司
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/50—Pyridazines; Hydrogenated pyridazines
    • A61K31/501—Pyridazines; Hydrogenated pyridazines not condensed and containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents

Definitions

  • the present disclosure relates to the field of biomedical technology, specifically to the diagnosis and treatment of diseases, especially the specific application of ALK inhibitors in the treatment of RDAA-positive diseases.
  • ALK anaplastic lymphoma kinase
  • ALK is a type of receptor tyrosine kinase, and its mutations are associated with the occurrence of various cancers. Mutated forms of ALK include Alk gene rearrangements; activating mutations of the Alk gene; gene copy number variations, etc.
  • ALK gene rearrangement can lead to the occurrence of lymphoma, lung cancer, neuroblastoma, myofibroblastoma and other cancers, the most common of which are anaplastic large cell lymphoma (ALCL) and non-small cell lung cancer (NSCLC).
  • ALK gene rearrangement positivity accounts for only 6.7% of NSCLC patients and 50% of adult patients with ALCL.
  • Treatment options and prognosis assessments vary for different types of cancer. For example, patients with tumors that are positive for ALK gene rearrangement can be treated with ALK inhibitors. However, for tumor patients with wild-type ALK (i.e., ALK gene rearrangement negative), no relevant cancer-promoting mechanism has been discovered, and there is no effective targeted therapy.
  • the present disclosure provides methods for diagnosing and/or treating RDAA-positive diseases; anti-RNase1 antibodies or antigen-binding portions thereof, anti-ALK phosphorylated antibodies or antigen-binding portions thereof used therein; methods for diagnosing RDAA-positive diseases; Kit, equipment; use of a combination of a reagent for detecting ALK gene rearrangement, a reagent for detecting ALK phosphorylation level, and a reagent for detecting RNase1 expression level in preparing a kit for detecting RDAA-positive diseases.
  • a method for diagnosing and/or treating a disease may be provided, which at least includes the following steps:
  • ALK anaplastic lymphoma kinase
  • a method for diagnosing and/or treating diseases can be provided, which at least includes the following steps:
  • an ALK inhibitor in the preparation of a medicament for the treatment of non-small cell lung cancer and/or pancreatic ductal adenocarcinoma.
  • an anti-RNase1 antibody or an antigen-binding portion thereof comprising:
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 1 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 2, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 3 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO: 4, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 5, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 6 chain CDR3;
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 9 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 10
  • light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 11
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 17 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 18, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 19 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO:20, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO:21, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO:22 chain CDR3;
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 25 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 26, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 27 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO: 28, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 29, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 30 chain CDR3; or
  • an anti-ALK phosphorylated antibody or an antigen-binding portion thereof comprising:
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 105 Light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 106, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 107 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO: 108, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 109, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 110 Chain CDR3.
  • a kit comprising:
  • a combination of a reagent for detecting ALK phosphorylation level and a reagent for detecting RNase1 expression level in preparing a kit for detecting RDAA-positive disease in patients with negative RDAA-positive disease can be provided.
  • the use of a combination of a reagent for detecting the expression level of ALK gene rearrangement, a reagent for detecting ALK phosphorylation level, and a reagent for detecting RNase1 expression level in preparing a kit for detecting RDAA-positive diseases can be provided.
  • patients with the RDAA-positive disease have negative ALK gene rearrangement test results, Rnase1 expression levels in plasma of ⁇ 418ng/ml or positive immunohistochemical staining results for Rnase1, and positive immunohistochemical staining for ALK phosphorylation. Histochemical staining results.
  • the use of an ALK inhibitor in preparing a medicament for treating RDAA-positive disease can be provided, and the patient with the RDAA-positive disease has a negative ALK gene rearrangement test result and a plasma concentration of ⁇ 418ng/ml.
  • Rnase1 expression levels in or positive immunohistochemical staining results for Rnase1 and positive immunohistochemical staining results for ALK phosphorylation.
  • a device for diagnosing RDAA-positive diseases which includes:
  • Detection part including a reagent part that is respectively provided with a reagent capable of detecting the expression level of ALK gene rearrangement, a reagent that detects the ALK phosphorylation level, and a reagent that detects the RNase1 expression level, and a measurement part that performs detection;
  • Data collection department collects the results output by the detection department
  • Figure 1 shows the results of Western immunoblot hybridization experiments of five RNase1 monoclonal antibodies in Example 1.
  • Figure 2 shows the results of Western immunoblot hybridization experiments of nine ALK protein phosphorylated monoclonal antibodies in Example 2.
  • Figure 3 shows the experimental results of the killing effect of ALK inhibitors on RDAA-positive lung cancer cells.
  • Figure 4 shows the inhibitory effect of ALK inhibitor on tumor growth in RDAA-positive tumor-bearing mice.
  • Figure 5 shows the results of the survival effect of ALK inhibitors on RDAA-positive tumor-bearing mice.
  • Figure 6 shows the tumor growth inhibitory effect of ALK inhibitors on RDAA-positive patients.
  • Figure 7 shows the sensitivity of cells from RDAA-positive PDAC patients to ALK inhibitors.
  • ALK refers to anaplastic lymphoma kinase, as detailed at https://www.ncbi.nlm.nih.gov/gene/238(ALK ALK receptor tyrosine kinase[Homo sapiens( human)]Gene ID: 238), and its homologues.
  • ALK gene rearrangements includes, but is not limited to, those described in U.S. Patent No. 9,651,555 and Du et al. (Thoracic Cancer. 9:423-430, 2018), which are incorporated by reference in their entirety. Incorporated herein.
  • the ALK gene rearrangement may be a rearrangement of ALK with a gene selected from the group consisting of: EML4, KIF5B, KLC1, TFG, TPR, HIP1, STRN, DCTN1, SQSTM1, NPM1, BCL11A, BIRC6, RANBP2, ATIC, CLTC , TMP4, and MSN, leading to the formation of fusion oncogenes.
  • ALK gene rearrangement negative refers to the result of ALK gene rearrangement when detected by FISH (Fluorescence in situ hybridization) method, NGS (Next-generation sequencing) method, IHC (Immunohistochemistry) method, etc. row negative.
  • the Vysis ALK Break Apart FISH Probe Kit (Abbott Molecular, Inc.) was used to diagnose ALK rearrangement negative for the patient's surgical or puncture pathological tissue samples; the patient's surgical or puncture pathological tissue samples were diagnosed as negative for ALK rearrangement using the second-generation Qualcomm Quantitative genetic testing technology (Wuhan Angkeyi Technology Consulting Co., Ltd., Yishan Biotechnology Co., Ltd., Shenzhen BGI Co., Ltd., etc.) diagnosed no ALK gene-related mutations and was diagnosed as negative for ALK molecular rearrangement; the patient underwent surgery or puncture Pathological tissue samples were diagnosed as negative for ALK molecular rearrangement using anti-ALK(D5F3) Rabbit Monoclonal Antibody reagent (immunohistochemistry) (VENTANA anti-ALK(D5F3) Rabbit Monoclonal Primary Antibody).
  • Rnase1 refers to ribonuclease 1 (ribonuclease1), which belongs to the human secreted ribonuclease family.
  • ribonuclease1 ribonuclease 1
  • RNASE1 ribonuclease A family member 1, pancreatic [Homo sapiens (human)]
  • RDAA-positive disease refers to a disease associated with RNAse1-driven ALK activation.
  • a “patient with RDAA-positive disease” means that the patient has a negative ALK gene rearrangement test result, an ALK phosphorylation level that is higher than that of the reference population, and an RNase1 expression that is higher than that of the reference population. level of RNase1 expression; specifically, the patient had a negative ALK gene rearrangement test result, a plasma RNase1 expression level ⁇ 418 ng/ml or a positive immunohistochemical stain for RNase1, and a positive ALK phospho immunohistochemical staining results.
  • reference population refers to healthy individuals or patients with RDAA-negative disease.
  • ALK inhibitors have good application prospects in the preparation of drugs for the treatment of RDAA-positive diseases.
  • a method for diagnosing and/or treating a disease may be provided, which at least includes the following steps:
  • ALK lymphoma kinase
  • the subject may be a healthy person, a patient suspected of a disease (eg, cancer), or a patient suffering from a disease (eg, cancer).
  • the subject may be a cancer suspect or a cancer patient.
  • the cancer may be lung cancer or pancreatic cancer.
  • the cancer may be non-small cell lung cancer or pancreatic ductal adenocarcinoma.
  • the detection is performed on a sample from the subject to be tested.
  • the sample to be tested may be from tissues, cells and/or body fluids of a subject.
  • the sample to be tested may be from tissue sections and/or blood of the subject.
  • the sample to be tested may be from a subject's tumor tissue section and/or blood.
  • the sample to be tested may be from lung or pancreatic cancer tissue sections and/or blood of the subject.
  • the sample to be tested may be from a non-small cell lung cancer or pancreatic ductal adenocarcinoma tissue section and/or blood of the subject.
  • the reference population has ALK phosphorylation levels that are negative for immunohistochemical staining for ALK phosphorylation. In some embodiments, the reference population has an ALK phosphorylation level with an immunohistochemical staining score for ALK phosphorylation of ⁇ 4 points.
  • the RNase1 expression level in the reference population is an Rnasel expression level in plasma ⁇ 418 ng/ml or a negative immunohistochemical staining result for Rnasel. In some embodiments, the RNase1 expression level in the reference population is an Rnasel expression level in plasma of ⁇ 418 ng/ml or an immunohistochemical staining score for Rnasel of ⁇ 4 points.
  • the set threshold for ALK phosphorylation level is a positive immunohistochemical stain for ALK phosphorylation. In some embodiments, the set threshold for ALK phosphorylation level is an immunohistochemical staining score for ALK phosphorylation ⁇ 4 points.
  • the set threshold for RNase1 expression level is an Rnasel expression level in plasma ⁇ 418 ng/ml or a positive immunohistochemical staining result for Rnasel. In some embodiments, the set threshold for RNase1 expression level is an Rnasel expression level in plasma ⁇ 418 ng/ml or an immunohistochemical staining score for RNase1 ⁇ 4 points.
  • immunohistochemical staining is performed using diseased tissue. In some embodiments, immunohistochemical staining is performed using tumor tissue. In some embodiments, immunohistochemical staining is performed using lung or pancreatic cancer tissue. In some embodiments, immunohistochemical staining is performed using non-small cell lung cancer or pancreatic ductal adenocarcinoma tissue.
  • ALK gene rearrangement expression level, ALK phosphorylation level and RNase1 expression level can be accomplished by any method known in the art, such as using commercial kits, sequencing, etc.
  • the detection of ALK gene rearrangement expression level, ALK phosphorylation level and RNase1 expression level are independently selected from one or more of Western blotting, immunohistochemistry, and enzyme-linked immunosorbent assay.
  • detection of ALK gene rearrangement expression levels, ALK phosphorylation levels, and/or RNase1 expression levels is performed using antibodies.
  • the ALK inhibitor includes an antibody or antigen-binding portion thereof capable of inhibiting ALK phosphorylation.
  • the ALK inhibitor includes any one of crizotinib, ceritinib, lorlatinib, alectinib, brigatinib, ensartinib, or a combination thereof.
  • a method for diagnosing and/or treating diseases can be provided, which at least includes the following steps:
  • the subject may be a healthy person, a patient suspected of a disease (eg, cancer), or a patient suffering from a disease (eg, cancer).
  • the subject may be a cancer suspect or a cancer patient.
  • the cancer may be lung cancer or pancreatic cancer.
  • the cancer may be non-small cell lung cancer or pancreatic ductal adenocarcinoma.
  • the detection is performed on a sample from the subject to be tested.
  • the sample to be tested may be from tissues, cells and/or body fluids of a subject.
  • the sample to be tested may be from tissue sections and/or blood of the subject.
  • the sample to be tested may be from a subject Tumor tissue sections and/or blood of the subject.
  • the sample to be tested may be from lung or pancreatic cancer tissue sections and/or blood of the subject.
  • the sample to be tested may be from a non-small cell lung cancer or pancreatic ductal adenocarcinoma tissue section and/or blood of the subject.
  • the reference population has ALK phosphorylation levels that are negative for immunohistochemical staining for ALK phosphorylation. In some embodiments, the reference population has an ALK phosphorylation level with an immunohistochemical staining score for ALK phosphorylation of ⁇ 4 points.
  • the RNase1 expression level in the reference population is an Rnasel expression level in plasma ⁇ 418 ng/ml or a negative immunohistochemical staining result for Rnasel. In some embodiments, the RNase1 expression level in the reference population is an Rnasel expression level in plasma of ⁇ 418 ng/ml or an immunohistochemical staining score for Rnasel of ⁇ 4 points.
  • the set threshold for ALK phosphorylation level is a positive immunohistochemical stain for ALK phosphorylation. In some embodiments, the set threshold for ALK phosphorylation level is an immunohistochemical staining score for ALK phosphorylation ⁇ 4 points.
  • the set threshold for RNase1 expression level is an Rnasel expression level in plasma ⁇ 418 ng/ml or a positive immunohistochemical staining result for Rnasel. In some embodiments, the set threshold for RNase1 expression level is an Rnasel expression level in plasma ⁇ 418 ng/ml or an immunohistochemical staining score for RNase1 ⁇ 4 points.
  • immunohistochemical staining is performed using diseased tissue. In some embodiments, immunohistochemical staining is performed using tumor tissue. In some embodiments, immunohistochemical staining is performed using lung or pancreatic cancer tissue. In some embodiments, immunohistochemical staining is performed using non-small cell lung cancer or pancreatic ductal adenocarcinoma tissue.
  • ALK gene rearrangement expression level, ALK phosphorylation level and RNase1 expression level can be accomplished by any method known in the art, such as using commercial kits, sequencing, etc.
  • the detection of ALK gene rearrangement expression level, ALK phosphorylation level and RNase1 expression level are independently selected from one or more of Western blotting, immunohistochemistry, and enzyme-linked immunosorbent assay.
  • detection of ALK gene rearrangement expression levels, ALK phosphorylation levels, and/or RNase1 expression levels is performed using antibodies.
  • the ALK inhibitor includes an antibody or antigen-binding portion thereof capable of inhibiting ALK phosphorylation.
  • the ALK inhibitor includes any one of crizotinib, ceritinib, lorlatinib, alectinib, brigatinib, ensartinib, or a combination thereof.
  • an ALK inhibitor in the preparation of a medicament for the treatment of non-small cell lung cancer and/or pancreatic ductal adenocarcinoma.
  • an anti-RNase1 antibody or an antigen-binding portion thereof comprising:
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 1 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 2, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 3 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO: 4, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 5, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 6 chain CDR3;
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 9 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 10
  • light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 11
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 17 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 18, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 19 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO: 20, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 21, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 22 chain CDR3;
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 25 light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 26, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 27 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO: 28, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 29, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 30 chain CDR3; or
  • the anti-RNase1 antibody or antigen-binding portion thereof comprises:
  • an anti-ALK phosphorylated antibody or an antigen-binding portion thereof comprising:
  • Light chain CDR1 having the amino acid sequence shown in SEQ ID NO: 105 Light chain CDR2 having the amino acid sequence shown in SEQ ID NO: 106, light chain CDR3 having the amino acid sequence shown in SEQ ID NO: 107 , a heavy chain CDR1 having an amino acid sequence as shown in SEQ ID NO: 108, a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 109, and a heavy chain CDR2 having an amino acid sequence as shown in SEQ ID NO: 110 Chain CDR3.
  • the anti-ALK phosphorylated antibody or antigen-binding portion thereof comprises:
  • a kit comprising:
  • the reagent for detecting ALK phosphorylation level, the reagent for detecting RNase1 expression level, and the reagent for detecting ALK gene rearrangement expression level can be any reagent known in the art that can achieve this function.
  • a reagent for detecting ALK phosphorylation levels includes an anti-ALK phosphorylation antibody or an antigen-binding portion thereof as described in this disclosure.
  • reagents for detecting RNase1 expression levels include an anti-RNase1 antibody or an antigen-binding portion thereof as described in the present disclosure.
  • the kit further includes a reagent for detecting the expression level of ALK gene rearrangement.
  • a combination of a reagent for detecting ALK phosphorylation level and a reagent for detecting RNase1 expression level in preparing a kit for detecting RDAA-positive disease in patients with negative RDAA-positive disease can be provided.
  • a positive immunohistochemical staining result for Rnase1 refers to an immunohistochemical staining score for Rnase1 of ⁇ 4 points.
  • a positive immunohistochemical staining result for ALK phosphorylation refers to an immunohistochemical staining score for ALK phosphorylation ⁇ 4 points.
  • the use of a combination of a reagent for detecting the expression level of ALK gene rearrangement, a reagent for detecting ALK phosphorylation level, and a reagent for detecting the expression level of RNase1 in preparing a kit for detecting RDAA-positive diseases can be provided.
  • patients with the RDAA-positive disease have negative ALK gene rearrangement test results, Rnase1 expression levels in plasma of ⁇ 418ng/ml or positive immunohistochemical staining results for Rnase1, and positive immunohistochemical staining for ALK phosphorylation. Histochemical staining results.
  • a positive immunohistochemical staining result for Rnase1 refers to an immunohistochemical staining score for Rnase1 of ⁇ 4 points.
  • a positive immunohistochemical staining result for ALK phosphorylation refers to an immunohistochemical staining score for ALK phosphorylation ⁇ 4 points.
  • the use of an ALK inhibitor in preparing a medicament for treating RDAA-positive disease can be provided, and the patient with the RDAA-positive disease has a negative ALK gene rearrangement test result and a plasma concentration of ⁇ 418ng/ml.
  • Rnase1 expression levels in or positive immunohistochemical staining results for Rnase1 and positive immunohistochemical staining results for ALK phosphorylation.
  • a positive immunohistochemical staining result for Rnase1 refers to an immunohistochemical staining score for Rnase1 of ⁇ 4 points.
  • a positive immunohistochemical staining result for ALK phosphorylation refers to an immunohistochemical staining score for ALK phosphorylation ⁇ 4 points.
  • the ALK inhibitor can be any substance known in the art that can effectively inhibit the activity and/or expression of ALK.
  • ALK inhibitors include, but are not limited to, any one of crizotinib, ceritinib, lorlatinib, alectinib, brigatinib, ensartinib, or combinations thereof .
  • ALK inhibitors include antibodies or antigen-binding portions thereof capable of inhibiting ALK phosphorylation.
  • an ALK inhibitor includes an anti-ALK phosphorylated antibody of the present disclosure, or an antigen-binding portion thereof.
  • a device for diagnosing RDAA-positive diseases which includes:
  • Detection part including a reagent part that is respectively provided with a reagent capable of detecting ALK gene rearrangement, a reagent that detects ALK phosphorylation level, and a reagent that detects RNase1 expression level, and a measurement part that performs detection;
  • Data collection department collects the results output by the detection department
  • the subject may be a healthy person, a patient suspected of a disease (eg, cancer), or a patient suffering from a disease (eg, cancer).
  • the subject may be a cancer suspect or a cancer patient.
  • the cancer may be lung cancer or pancreatic cancer.
  • the cancer may be non-small cell lung cancer or pancreatic ductal adenocarcinoma.
  • the detection is performed on a sample from the subject to be tested.
  • the sample to be tested may be from tissues, cells and/or body fluids of a subject.
  • the sample to be tested may be from tissue sections and/or blood of the subject.
  • the sample to be tested may be from a subject's tumor tissue section and/or blood.
  • the sample to be tested may be from lung cancer or pancreatic cancer tissue sections and/or blood of the subject.
  • the sample to be tested may be from a non-small cell lung cancer or pancreatic ductal adenocarcinoma tissue section and/or blood of the subject.
  • the detection of ALK gene rearrangement, ALK phosphorylation level and RNase1 expression level are independently selected from one or more of Western blotting, immunohistochemistry, and enzyme-linked immunosorbent assay. In some embodiments, detection of ALK gene rearrangement expression levels, ALK phosphorylation levels, and/or RNase1 expression levels is performed using antibodies.
  • the data analysis section compares the collected data on ALK gene rearrangement expression levels, ALK phosphorylation levels and RNase1 expression levels with set thresholds.
  • the set threshold for ALK phosphorylation level is a positive immunohistochemical stain for ALK phosphorylation.
  • the set threshold for ALK phosphorylation level is an immunohistochemical staining score for ALK phosphorylation ⁇ 4 points.
  • the set threshold for RNase1 expression level is an Rnasel expression level in plasma ⁇ 418 ng/ml or a positive immunohistochemical staining result for Rnasel.
  • the set threshold for RNase1 expression level is an Rnasel expression level in plasma ⁇ 418 ng/ml or an immunohistochemical staining score for RNase1 ⁇ 4 points.
  • the immunohistochemical staining result for ALK phosphorylation is positive, and the Rnase1 expression level in the plasma is ⁇ 418ng/ml or the Rnase1 expression level is negative.
  • the immunohistochemical staining result is positive, it is determined to be RDAA-positive disease.
  • the immunohistochemical staining score for ALK phosphorylation is ⁇ 4 points
  • the Rnase1 expression level in the plasma is ⁇ 418ng/ml or for Rnase1
  • the immunohistochemical staining score is ⁇ 4 points, it is determined to be RDAA-positive disease.
  • the detection part, data acquisition part, data analysis part and result output part may be separated into separate equipment units or formed into an integrated equipment.
  • a method for treating diseases which at least includes the following steps:
  • anaplastic lymphoma kinase (ALK) inhibitors to patients with RDAA-positive disease, defined as disease resulting from RNase1-driven ALK activation,
  • samples from patients with RDAA-positive disease have negative ALK gene rearrangement test results, Rnase1 expression levels in plasma of ⁇ 418ng/ml or positive immunohistochemical staining results for Rnase1, and positive for Immunohistochemical staining results of ALK phosphorylation, and
  • RDAA-positive disease is RDAA-positive non-small cell lung cancer
  • the ALK inhibitor is ensartinib.
  • tissue sections and/or blood from the patient Preferably, tissue sections and/or blood from the patient;
  • tumor tissue sections and/or blood from the patient Preferably, tumor tissue sections and/or blood from the patient;
  • non-small cell lung cancer tissue sections and/or blood from the patient Preferably, non-small cell lung cancer tissue sections and/or blood from the patient.
  • tissue sections and/or blood from the patient Preferably, tissue sections and/or blood from the patient;
  • tumor tissue sections and/or blood from the patient Preferably, tumor tissue sections and/or blood from the patient;
  • non-small cell lung cancer tissue sections and/or blood from the patient Preferably, non-small cell lung cancer tissue sections and/or blood from the patient.
  • Prokaryotic cell purified RNase1 protein was used as antigen (5 mg in total) in combination with adjuvant.
  • adjuvants Commonly used adjuvants: Freund's complete adjuvant, Freund's incomplete adjuvant.
  • the second immunization dose is the same as above, plus Freund's incomplete adjuvant for intraperitoneal injection, the dose is 0.3ml;
  • the third immunization dose is the same as above, without adjuvant, and injected intraperitoneally;
  • Myeloma cells were cultured in DMEM medium.
  • the concentration of calf serum is 10% and the cell concentration is 1 ⁇ 10 5 /ml.
  • the cells are in the mid-phase of logarithmic growth, passage them at a ratio of 1:3. Passage every 3 days. (Regular treatment with 8-azaguanine makes surviving cells uniformly sensitive to HAT.)
  • Mouse peritoneal macrophages were used in this study, and the amount was 10 5 cells/well.
  • HAT selects hybridoma cells and culture fusion cells in HAT selection culture medium.
  • a large number of tumor cells will die within 1 to 2 days of culture. After 3 to 4 days, the tumor cells will disappear and the hybrid cells will form small colonies.
  • the HAT selection culture medium will be maintained for 7 to 10 days. After 3 days, switch to HT culture medium, maintain it for another 2 weeks, and then switch to normal culture medium.
  • the selection culture period when the hybridoma cells cover 1/10 of the bottom area of the well, specific antibodies can be detected and the required hybridoma cell lines can be screened out.
  • half of the culture medium is generally changed every 2 to 3 days.
  • Hybridoma cells were inoculated in vivo to prepare ascites.
  • Preparation of ascites Routinely intraperitoneally inject 0.5 ml of Pristane (phytane) or liquid paraffin into BALB/C mice. Two weeks later, 1 ⁇ 10 6 hybridoma cells are intraperitoneally injected. Ascites can be produced 10 days after the cells are inoculated. The mice were killed, and the ascites was sucked into the test tube with a dropper. Generally, 10 ml of ascites could be obtained from one mouse.
  • Pristane phytane
  • the monoclonal antibody content in ascites fluid can reach 5 mg/ml.
  • Protein lysis solution 2 ⁇ sample buffer 40ml system configuration add the following ingredients: 80% glycerol 10ml, sterilized water 1ml, 10% SDS 24ml, 1M Tris-HCL (pH6.8) 5ml, mix thoroughly and store at room temperature for later use. .
  • Preparation of protein loading buffer Mix ⁇ -mercaptoethanol and appropriate amount of bromophenol blue powder in a 1.5ml EP tube, and store it in a -20°C refrigerator for routine use.
  • the microplate reader uses a wavelength of 562nm to detect the absorbance, record the OD value, and draw a protein standard curve;
  • Sample protein treatment Take the 96-well plate and the prepared protein sample, add 18 ⁇ l PBS and 2 ⁇ l sample to each well, and add 200 ⁇ l BCA mixture, and react in a 37°C metal bath or incubator for 30 minutes;
  • Protein loading Take out the protein sample stored in the -20°C refrigerator and wait for it to thaw and return to room temperature. Load equal amounts of protein in sequence according to the calculated protein loading volume, and reserve 1-2 wells to add 5 ⁇ l of protein loading indicator (marker) according to experimental needs;
  • Electrophoresis After loading the sample, start electrophoresis at a constant voltage of 80V. When you see bead-like bubbles starting to appear at the bottom of the gel plate, it marks the start of electrophoresis. Then you can see that the bromophenol blue in the protein sample is compressed to form a straight line. According to the marker After judging that the protein has reached a clearly differentiated transparent separation gel interface, adjust the voltage to a constant voltage of 120V. When the bromophenol blue indicator drops to the bottom edge of the gel plate, stop electrophoresis and start transfer;
  • Membrane transfer Prepare the filter paper required for membrane transfer in advance, install the methanol box for activation, transfer clamp, PVDF membrane, etc., and pre-cool the transfer liquid at 4°C before transfer. Place a piece of filter paper in a horizontal container and pour an appropriate amount of transfer solution so that the height slightly exceeds the thickness of the filter paper. Methanol wets and activates the PVDF membrane, which is then placed on filter paper. Take out the gel plate after electrophoresis, peel off the protein gel from the gel plate, trim the borders appropriately and place it on the PVDF membrane, cover it with a layer of filter paper, and continuously remove the bubbles generated during the operation.
  • Incubate primary antibody Use primary antibody diluent, 5% milk or 5% BSA according to the proportion to configure the primary antibody.
  • the concentration of the primary antibody configuration in this experiment is 1:1000 (the sources of the antibodies in this experiment are self-made monoclonal mouse antibodies). Each antibody is configured with 4ml.
  • Prepare the antibody before incubation pour it into the corresponding compartment of the incubation box and place it on ice at low temperature to maintain antibody activity.
  • the color marker as a scale to form the membrane into a strip shape, and then place it into the grid corresponding to the antibody. After sealing, place it in a shaker at 4°C and shake slowly for 12 hours;
  • Recover the secondary antibody Recover the secondary antibody and rinse the PVDF membrane again with PBST 3 times, 5-10 minutes each time;
  • ECL development Pre-configure the ultra-sensitive ECL developer (UltraSignal ultra-sensitive ECL chemiluminescent substrate, Sizhengbai, product number: 4AW011-100). Mix equal volumes of ECL A solution and B solution in an EP tube and protect from light. Reserve at low temperature. Before development, place the PVDF film on the foam board, dry the remaining PBST slightly, and then drop the prepared ultra-sensitive ECL developer on it according to the size of the film until both sides are completely infiltrated. Exposed in Bio-rad imaging instrument.
  • the preparation process of this antibody is the same as that of the above-mentioned RNase1 antibody, except that the antigen is used.
  • the antigen used to prepare ALK phosphorylated antibodies is a synthetic ALK protein phosphorylated peptide, a total of 2 ALK protein phosphorylated peptides, 5 mg each.
  • Example 3 Killing effect of ALK inhibitor on RDAA-positive disease cells
  • the second-generation sequencing method was used to detect the expression level of ALK gene rearrangement in the tumor tissue section samples of 3 subjects: the patient's surgical or puncture pathological tissue samples used second-generation high-throughput gene detection technology (Shenzhen BGI Co., Ltd. )
  • the diagnosis is that there is no ALK gene rearrangement and related mutations, and the diagnosis is negative for ALK gene rearrangement.
  • Enzyme-linked immunosorbent (ELISA) method was used to detect the expression level of RNase1 in plasma samples from three ALK gene rearrangement-negative subjects.
  • the detection method is as follows:
  • Elisa detection reagents and procedures use RNase1 Elisa kit (product name and item number: ELISA Kit for Ribonuclease1, human; Product Number: SEA297Hu)
  • Immunohistochemistry was used to detect the expression level of RNase1 in tumor tissue samples from three ALK gene rearrangement-negative subjects. Immunohistochemistry experimental steps:
  • tissue specimen under a light microscope and score according to the percentage of positively stained cells: 0: negative expression; 1 point: the number of positive cells is ⁇ 15%; 2 points: 15-50% of positive cells; 3 points: positive cells ⁇ 50%; the staining intensity is scored according to the depth of color development: 0 points: no positive; 1 point: light yellow; 2 points: brown; 3 points: tan.
  • the immunohistochemical staining score 4 points was used as the cut-off point to distinguish high and low RNase1 expression levels.
  • ALK phosphorylated monoclonal antibodies (CDA04 among the 9 ALK phosphorylated monoclonal antibodies shown in the Antibody Preparation section) were used to detect ALK phosphorylation levels in tumor tissue samples from 3 subjects.
  • the immunohistochemical staining score 4 points was used as the cut-off point to distinguish high and low ALK phosphorylation levels.
  • RDAA-positive subjects are divided into RDAA-positive subjects and non-RDAA-positive (RDAA-negative) subjects:
  • RDAA-positive subjects The expression level of Rnase1 in plasma is ⁇ 418ng/ml or the immunohistochemical staining score for Rnase1 is ⁇ 4 points; and the immunohistochemical staining score for ALK phosphorylation is ⁇ 4 points;
  • Rnase1 expression level in plasma is ⁇ 418ng/ml or immunohistochemical staining score for Rnase1 is ⁇ 4 points; and immunohistochemical staining score for ALK phosphorylation is ⁇ 4 points.
  • the experimental results are shown in Figure 3.
  • the abscissa axis is the medication time in (days), and the ordinate axis is the relative cell number.
  • the results showed that placebo could not inhibit the growth of RDAA-positive lung cancer cells, but various ALK inhibitors effectively killed RDAA-positive lung cancer cells (P ⁇ 0.01), but had no significant effect on RDAA-negative lung cancer cells.
  • Example 4 Therapeutic effect of ALK inhibitor on RDAA-positive lung cancer mice
  • RDAA-positive tumor-bearing mice were constructed.
  • mice bearing RDAA-positive tumors were randomly divided into seven groups (5 mice in each group), and placebo (PBS buffer), crizotinib, ceritinib, lorlatinib, and aletinib were orally administered.
  • the dose of ALK inhibitor, brigatinib, or ensartinib (ALK inhibitor) was 25 mg per kilogram of body weight per day, and the dose of placebo was 2 ⁇ l per mouse per day, starting 2 weeks after tumor inoculation. , stop administration from the fourth week).
  • Example 5 Therapeutic effect of ALK inhibitor on RDAA positive patients
  • RDAA-positive patients The expression level of Rnase1 in plasma is ⁇ 418ng/ml or the immunohistochemical staining score for Rnase1 is ⁇ 4 points; and the immunohistochemical staining score for ALK phosphorylation is ⁇ 4 points;
  • RDAA-negative patients The expression level of Rnase1 in plasma is ⁇ 418ng/ml or the immunohistochemical staining score for Rnase1 is ⁇ 4 points; and the immunohistochemical staining score for ALK phosphorylation is ⁇ 4 points.
  • Example 6 Therapeutic effect of ALK inhibitor on patients with RDAA-positive PDAC
  • NGS second-generation high-throughput gene sequencing
  • the patient's tumor cells were cultured and treated with placebo control (PBS buffer), Crizotinib, Ceritininb, Loratinib, Alectinib ( Cells were treated with six ALK inhibitors (Alectinib), Brigatinib and Ensartinib (the final concentration of the above drugs was 1 ⁇ g per ml of culture medium, and the cell density was 50,000 cells per ml. base), observe cell survival, count the number of surviving cells every day, and draw a growth curve.
  • PBS buffer placebo control
  • Crizotinib Crizotinib
  • Ceritininb Ceritininb
  • Loratinib Loratinib
  • Alectinib Cells were treated with six ALK inhibitors (Alectinib),
  • Brigatinib and Ensartinib the final concentration of the above drugs was 1 ⁇ g per ml of culture medium, and the cell density was 50,000 cells per ml. base
  • the experimental results are shown in Figure 7.
  • the abscissa axis is the medication time in (days), and the ordinate axis is the relative cell number.
  • the results showed that placebo could not inhibit the growth of RDAA-positive PDAC cells, but various ALK inhibitors effectively killed RDAA-positive PDAC cells (P ⁇ 0.01).

Abstract

La présente invention concerne un procédé de traitement d'une maladie, comprenant au moins les étapes suivantes : l'administration d'un inhibiteur de kinase de lymphome anaplasique (ALK) à un patient souffrant d'une maladie positive pour RDAA, la maladie positive pour RDAA étant définie comme étant une maladie causée par l'activation d'ALK induite par RNase1, un échantillon provenant du patient souffrant de la maladie positive pour RDAA ayant un résultat négatif de test de réarrangement du gène ALK, un taux d'expression de RNase1 de 418 ng/ml ou plus dans le plasma sanguin ou un résultat positif de coloration immunohistochimique contre RNase1, et un résultat positif de coloration immunohistochimique contre la phosphorylation d'ALK, la maladie positive pour RDAA étant un cancer du poumon non à petites cellules positif pour RDAA, et l'inhibiteur d'ALK étant l'ensartinib.
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