CIRCULATING PHAGOCYTES

CROSS REFERENCE

[0001] This application is a continuation-ϊn-part of U.S. Patent Application Serial No.

12/325,035 filed November 28, 2009, the disclosure of which is incorporated in its entirety by reference herein.

BACKGROUND OF THE INVENTION

[0002] Multiple Sclerosis (MS) is predominantly a disease of women of northern European origin and afflicts up to three million people worldwide. In the United States it is estimated that 400,000 people are affected. It is thought to be an autoimmune disorder and typically strikes young adults, causing a wide variety of symptoms that are often mistaken for other diseases. These symptoms stem from disruption of the central nervous system (CNS) and may include blurred or double vision; weakness in the arms or legs; changes or difficulties in balance, coordination and gait; bladder and/or bowel dysfunction; and emotional disturbances. Each patient may present a little differently and there may have been episodes in the past which were barely noticed by the patient at the time. It is difficult to firmly diagnose MS, especially if there has been only one symptomatic episode. This leaves patients and their doctors waiting months or years for a relapse to confirm that the symptoms are due to MS.

[0003] MS is a demyelinating disease, where myelin, the insulating layer on nerve fibers, is destroyed in the CNS, which consists of the brain, optic nerves, and spinal column. There is an accompanying inflammatory response and the blood brain barrier (BBB) is breached. Axon damage can occur and the optic nerve is commonly affected. Myelin damage m akes it more difficult f or nerves to transmit impulses, leading to symptoms of MS. The diagnostic McDonald Criteria (1 ) were revised in 2005 to include magnetic resonance imaging (MRi) criteria of different types of lesions of the brain and spinal cord in the diagnosis of MS. Prognosis is difficult to determine, and many brain lesions do not necessarily correlate with severity of disease. There are medications available to alleviate some symptoms and a few others to modify and hopefully delay the onset or severity of relapses of MS.

[0004] The most common form of MS is relapsing-remitting multiple sclerosis (RRMS), which is characterized by symptomatic episodes separated in t ime, with partial or complete recovery of an apparently normal state between relapses. It often converts to secondary progressive MS after several years, where there is a steady worsening of symptoms. A minority of patients have Primary Progressive MS which presents as a continuous slow worsening of the disease state. An even smaller minority of patients is diagnosed with Progressive-Relapsing MS, w here in contrast to RRMS, there is a continuous worsening of their condition between acute episodes. A first episode is referred to as Clinically Isolated Syndrome (CIS) pending a more certain diagnosis of MS corresponding to clinical signs and/or brain lesions visualized by MRI ₁ or possibly a spinal tap to check for immunoglobulin oligoclonal bands (OCB) in the cerebral spinal fluid (CSF). None of these diagnostic methods is 100% specific. (2). Its drawbacks include the expense and the fact that a patient must wait one to three months between scans to determine if new lesions have formed during the intervening period. There is a clear need for identification of a biomarker or set of biomarkers that indicate presence and/or severity of disease for MS patients. A simple blood test would be ideal for diagnosing MS, however at this time, no commercial blood test exists.

[0005] Early diagnosis of MS is thought to be increasingly important, as much of the damage occurs early in the disease process. The earlier the diagnosis, the earlier disease-modifying treatment can begin and progression of the disease and associated disability can hopefully be slowed. [0006] The present invention features a method of detecting multiple sclerosis or a risk of multiple sclerosis. The present invention also features methods of determining the status of a disease or condition or monitoring disease activity and drug efficacy. The method comprises detecting a multiple sclerosis-associated biomarker, e.g., an antigen, wherein detecting an elevated level of such multiple sclerosis-associated biomarker indicates the presence of multiple sclerosis or a risk of multiple sclerosis.

SUiVlMARY OF THE INVENTION

[0007] The present invention features methods of defecting the status of a disease or condition (or monitoring disease activity). The method comprises (a) providing a first sample (e.g., fluid sample) from outside a brain tissue, the first sample comprises a circulating phagocyte; and (b) detecting a biomarker associated with the disease or condition (e.g., neurological disease) in the phagocyte. The method may further comprise comparing the level of the biomarker in the first sample with a level of the biomarker in a second sample. The second sample may be either a control sample or a sample that was collected prior to the first sample. The sample may be derived from a mammal (e.g., a patient).

[0008] Further, the present invention features a method of monitoring or detecting multiple sclerosis (or a risk of multiple sclerosis), the method comprises (a) providing a sample from outside of a brain tissue, the fluid sample contains a circulating phagocyte; and (b) detecting a multiple sclerosis-associated biomarker in the phagocyte. The sample may be derived from a mammal (e.g., a patient).

[0009J Still further, the present invention features a method of monitoring or detecting an inflammatory condition, said method comprising (a) providing a sample from outside of a brain tissue, the fluid sample contains a circulating phagocyte; and (b) detecting a biomarker in the phagocyte, wherein the biomarker is associated with the inflammatory condition. The sample may be derived from a mammal (e.g., a patient).

[0010] In some embodiments, the monitoring of one of the above conditions is achieved by detecting the level of the respective biomarkers through a time interval. !n some embodiments, a decrease in the level of a biomarker through time is an indication that the condition is improving (assuming that the level of biomarker directly correlates with the severity of the condition). In some embodiments, an increased in the level of a biomarker through time is an indication that the condition is improving (assuming that the level of biomarker inversely correlates with the severity of the condition).

[0011] in some embodiments, the detection of one of the above conditions is achieved by detecting a biomarker that is at a level that is higher than that of a control (assuming that an elevated level of the biomarker relative to that of a control is indicative of a condition— this correlation may be established by routine procedures by one of ordinary skill).

[0012] In some embodiments, the detection of one of the above conditions is achieved by detecting a biomarker that is at a ieve! that is ϊower than that of a control (assuming that a decreased level of the biomarker relative to that of a control is indicative of a condition — this correlation may be established by routine procedures by one of ordinary skill).

[0013J Any feature or combination of features described herein are included within the scope of the present invention provided that the features included in any such combination are not mutually inconsistent as will be apparent from the context, this specification, and the knowledge of one of ordinary skill in the art. Additional advantages and aspects of the present invention are apparent in the following detailed description and claims. Various modifications of the invention, in addition to those described herein, will be apparent to those skilled in the art from the foregoing description. Such modifications are also intended to fall within the scope of the appended claims. Each reference cited in the present application is incorporated herein by reference in its entirety. DESCRIPTION OF PREFERRED EMBODIMENTS

INFLAMMATORY CONDITIONS

[0014] The present invention features a method of detecting an inflammatory condition. The method comprises providing a first sample (e.g., a fluid sample) that contains a peripheral (e.g., circulating) phagocyte, and detecting one or more biomarkers, e.g., an antigen, inside a phagocyte of said fluid sample, wherein the biomarker is associated with an inflammatory condition. The sample may be provided from a mammal (e.g., a patient, a mouse, a rat, etc.). The fluid obtained does not necessarily directly come into contact with the inflamed tissue being detected. For example, there may be a barrier between the fluid and the source of the biomarker. In other words, the fluid obtained may have once directly come into contact with the inflamed tissue, but at the time that it is being extracted in accordance with the present invention, it is being separated from the inflamed tissue by a barrier.

[0015] The method may further comprise comparing the level of the biomarker in the first sample with a level of the biomarker in a second sample (e.g., a fluid sample). The second sample may be a control sample. In some embodiments, the second sample is a fluid sample from outside of a brain tissue comprising a peripheral (e.g., circulating phagocyte), The second sample may be provided from a mammal (e.g., a patient, a mouse, a rat, etc.). The second sample may have been collected prior to the first fluid sample.

[0016] As used herein, the term "peripheral" refers to anything outside of brain tissue. For example, a peripheral phagocyte may be obtained from cerebrospinal fluid (CSF). Phagocytes may include monocytes, macrophages, and/or lymphocytes. Such circulating phagocytes may be found in tissues, cells, and/or fluids in the body, for example in blood, peripheral blood mononuclear cells (PBMCs), synovial fluid, cerebrospinal fluid (CSF), central nervous system tissues, synovial fluid, cystic fluid, lymph fluid, ascites, pleural effusion, interstitial fluid, ocular fluids, vitreal fluid, urine the like, or a combination thereof. In some embodiments, the biomarker is an intracellular component. For example, the biomarker may be obtained from within a macrophage. In some embodiments, the macrophage sample is permeabϋϊzed. In some embodiments, the macrophage is lysed via various means, e.g., hypertonic soiution treatment, detergent solution treatment, mechanical stress, etc.

[0017] In some embodiments, the sample is a plasma sample.

[0018] Also, as used herein, "a fluid that does not directly come into contact with the inflamed tissue" is a fluid that is separated from the inflamed tissue by at least one barrier, e.g., a tissue membrane, a layer of cells, etc.

[0019J In some embodiments, one or more biomarkers are detected in the collected fluid sample. For example, a pattern of biomarkers may be detected in the sample. Detecting the bio marker or biomarkers indicates the presence of the inflammatory condition or a risk of the inflammatory condition. In some embodiments, detecting an increased level of the biomarker or biomarkers as compared to the level of the biomarker or biomarkers of a control sample indicates the presence of the inflammatory condition or a risk thereof. A control sample is discussed below. In some embodiments, detecting a decreased level of the biomarker or biomarkers as compared to the level of the biomarker or biomarkers of a control sample indicates the presence of the inflammatory condition or a risk thereof,

[ΘQ20J In some embodiments, the inflammation condition that may be monitored or detected includes Rheumatoid Arthritis, Systemic Lupus Erythematosis, Shogren's Syndrome, and the like.

[0021] In some embodiments, the biomarker(s) is a neural-derived biomarker. However, the biomarker(s) is not limited to neural-derived biomarkers, In some embodiments, one or more biomarkers are detected in the sample, wherein the biomarkers are neural-derived, non-neural-derived biomarkers, or a combination thereof. [0022] The biαmarker(s) may be detected using a variety of methods. Methods may include an immunoassay, a histological assay, a flow cytometry assay, the like, or a combination thereof. For example, in some embodiments, the step of detecting the biomarker(s) in the sample may comprise introducing an antibody to the sample, wherein the antibody binds to the biomarker or is specific for the biomarker.

[0023] In some embodiments, this method of detecting an inflammatory condition is used in combination with one or more different methods for detecting the inflammatory disease. Sn some embodiments, this method is used to differentiate between one or more inflammatory conditions.

NEUROLOGICAL CONDITIONS

[0024] The present invention also features a method of detecting a neurological condition. The method comprises providing a first sample (e.g., a fluid sample) that comprises a peripheral (e.g., circulating) phagocyte. The first sample may be derived from outside of a brain tissue. The method further comprises detecting one or more biomarkers, e.g., an antigen, inside a phagocyte of said sample, wherein the biomarker is associated with a neurological condition (e.g., a neurological condition-associated protein). The sample may be provided from a mamma! (e.g., a patient, a mouse, a rat, etc.). Detecting the neurological condition-associated protein indicates the presence of the neurological condition or a risk of the neurological condition.

[0025] The sample (e.g., fluid) obtained does not necessarily directly come into contact with the inflamed tissue being detected. For example, in some embodiments, there may be a barrier between the fluid and the source of the biomarker. In other words, the fluid obtained may have once directly come into contact with the inflamed tissue, but at the time that it is being extracted in accordance with the present invention, it is being separated from the inflamed tissue by a barrier.

[0026] The method may further comprise comparing the leve! of the biomarker in the first sample with a levei of the biomarker in a second sample (e.g., a fluid sample). The second sample may be a control sample. In some embodiments, the second sample is a fluid sample from outside of a brain tissue comprising a peripheral (e.g., circulating phagocyte), The second sample may be provided from a mammal (e.g., a patient, a mouse, a rat, etc.). The second sample may have been collected prior to the first fluid sample.

[0027] In some embodiments, detecting an increased level of the neurological condition- associated protein as compared to the level of the neurological condition-associated protein of a control sample indicates the presence of the neurological condition or a risk thereof. In some embodiments, detecting a decreased level of the neurological condition-associated protein as compared to the level of the neurological condition- associated protein of a control sample indicates the presence of the neurological condition or a risk thereof. A control sample is discussed below.

[0028] In s ome em bodiments, t he neu rological c ondition t hat may be m onitored o r detected includes Alzheimer's Disease, Parkinson's Disease, Neuromyelitis Optica, transverse myelitis, Acute and chronic Stroke, and the like.

[0029] In some embodiments, the neurological condition-associated protein is derived from a brain source. In some embodiments, the neurological condition-associated protein is derived from a non-brain source. In some embodiments, one or more neurological condition-associated proteins is derived from a brain source, a non-brain source, or a combination thereof.

[0030] The neurological condition-associated protein may be present in a circulating phagocyte. Phagocytes may include monocytes, macrophages, and/or lymphocytes. Such circulating phagocytes may be found in tissues, cells, and/or fluids in the body, for example in blood, peripheral blood mononuclear cells (PBMCs), cerebrospinal fluid (CSF), central nervous system tissues, synovial fluid, cystic fluid, lymph fluid, ascites, pleural effusion, interstitial fluid, ocular fluids, vitreal fluid, urine, the like, or a combination thereof. In some embodiments, the neurologica! condition-associated protein is an intracellular component. For example, the neurological condition- associated protein may be obtained from within a macrophage. In some embodiments, the macrophage sample is permeabilized. In some embodiments, the macrophage is lysed via various means, e.g., hypertonic solution treatment, detergent solution treatment, mechanical stress, etc.

[0031] The neurological condition-associated protein may be detected using a variety of methods. Methods may include an immunoassay, a histological assay, a flow cytometry assay, the like, or a combination thereof. In some embodiments, the step of detecting the neurological condition-associated protein in the sample may comprise introducing an antibody to the sample, wherein the antibody binds to the protein or is specific for the protein.

[0032] In some embodiments, this method is used in combination with one or more different methods for detecting the neurological condition. In some embodiments, this method is used to differentiate between one or more neurological conditions.

MULTIPLE SCLEROSIS

[0033] The present invention also features methods of detecting multiple sclerosis or a risk of multiple sclerosis. In some embodiments, the methods of the present invention may allow for monitoring, detecting and/or predicting a relapse or a remission of multiple sclerosis. In some embodiments, the method of detecting multiple sclerosis is used in combination with one or more methods of detecting multiple sclerosis. For example, the present methods may be used in conjunction with other modalities to monitor, detect or predicting a relapse or a remission of multiple sclerosis.

[0034] The method of detecting multiple sclerosis comprises (1) providing a first sample (e.g., a fluid sample) that comprises a peripheral (e.g., circulating) phagocyte. The first sample may be derived from outside of a brain tissue, and (2) detecting a multiple sclerosis-associated biomarker in the phagocyte. The sample may be provided from a mammal (e.g., a patient, a mouse, a rat, etc.). In some embodiments, one or more multiple sclerosis-associated biomarkers is detected in the sample. The multiple sclerosis-associated biomarkers are associated with multiple sclerosis.

[0035] The method may further comprise comparing the level of the biomarker in the first sample with a level of the biomarker in a second sample (e.g., a fluid sample). The second sample may be a control sample. In some embodiments, the second sample is a fluid sample from outside of a brain tissue comprising a peripheral (e.g., circulating phagocyte), The second sample may be provided from a mammal (e.g., a patient, a mouse, a rat, etc.). The second sample may have been collected prior to the first fluid sample. Detecting the multiple sclerosis-associated biomarker may indicate the presence of multiple sclerosis or a risk of multiple sclerosis.

(0036] In some embodiments, detecting an increased level of the multiple sclerosis- associated biomarker as compared to the level of the multiple sclerosis-associated biomarker of a control sample indicates the presence of multiple sclerosis or a risk thereof. In some embodiments, detecting a decreased level of the multiple sclerosis- associated biomarker as compared to the level of the multiple sclerosis-associated biomarker of a control sample indicates the presence of multiple sclerosis or a risk thereof. In some embodiments, detecting an increased level of one class of multiple sclerosis-associated biomarker and a decreased of another class of multiple sclerosis- associated biomarker as compared to the respective level of the multiple sclerosis- associated biomarker of a control sample indicates the presence of multiple sclerosis or a risk thereof.

[0037] In some embodiments, the sample is obtained from the mammal immediately following a relapse (e.g., exacerbation of symptoms) before a drug (e.g., a steroid) treatment has begun. In some embodiments, the sample is obtained from the mammal before a relapse. In some embodiments, the sample is obtained during the course of the drug (e.g., steroid) treatment. [0038] The multiple sclerosis-associated biomarker may be present in a circulating phagocyte. Phagocytes may include monocytes, macrophages, and/or lymphocytes. For example, macrophages are a type of monocyte and are phagocytic cells important in both specific cell-mediated immunity and non-specific innate immunity. Circulating phagocytes may be found in tissues, cells, and/or fluids in the body, for example in blood, peripheral blood mononuclear cells (PBMCs), cerebrospinal fluid (CSF), central nervous system tissues, synovial fluid, cystic fluid, lymph fluid, ascites, pleural effusion, interstitial fluid, ocular fluids, vitreal fluid, urine, the like, or a combination thereof. In some embodiments, the neurological condition-associated protein is an intracellular component. For example, the neurological condition-associated protein may be obtained from within a macrophage. In some embodiments, the macrophage sample is permβabllized.

[00391 As used herein, a mammal includes a human, a mouse, a rat, a llama, a rabbit, a dog, a primate, a guinea pig, a cat, a hamster, a pig, a chicken, a goat, a horse, or a cow.

In some embodiments, the multiple sclerosis-associated biomarker is a Tau protein (or a fragment thereof) or a Tau protein (or fragment thereof) comprising a phosphorylated residue (e.g., a phosphorylated serine reside, a phosphorylated threonine reside). In some embodiments, the phosphorylated residue is serine 214, serine 235, serine 262, serine 356, serine 396, serine 404, serine 413, serine 46, serine 515, serine 516, serine 519, serine 531 , serine 552, serine 610, serine 622, serine 641 , serine 713, serine 721 , serine 726, serine 730, serine 739, threonine 181 , threonine 205, threonine 470, threonine 492, threonine 498, threonine 522, threonine 529, threonine 534, threonine 548, the like, or a combination thereof.

[0041] In some embodimetns, phosphorylation of Tau can decrease its solubility. In some embodiments, the method of detecting multiple sclerosis comprises detecting a level of insoluble Tau protein in the sample. In some embodiments, an increased level of insoluble Tau protein as compared to a control level of insoluble Tau protein is indicative of multiple sclerosis or a risk thereof.

|0042] In some embodiments, the multiple sclerosis-associated biomarker is a protein or a fragment thereof selected from the group consisting of neuroglobin, valosin-containing protein, brain hexokinase, hippocalcin-1 , nestin, synaptotagmin, myelin associated glycoprotein, myelin basic protein, myelin oligodendrocyte glycoprotein, myelin proteolipid protein, transketolase, NS1 assocated protein 1 , major vault protein, synaptojanin, enolase, alpha synuclein, glial fibrillary acidic protein, S-100 proteinNeu- N, 26S proteasome s ubunit 9, annexin A2 _« annexin A3, annexin A5, annexϊn A6, annexin A11 , ubiquitin activating enzyme ZE1 , ubϊquitin B precursor, vimentin, glyceraldehyde-3-phosphate dehydrogenase, 13-3-3 protein.

[0043] The multiple sclerosis-associated biomarker (e.g., Tau protein or fragment thereof) may be of various lengths. For example, in some embodiments, the multiple sclerosis-associated biomarker consists of between about 5 to 20 amino acids. In some embodiments, the multiple sclerosis-associated biomarker consists of about 20 to 40 amino acids. In some embodiments, the multiple sclerosis-associated biomarker consists of about 40 to 80 amino acids. In some embodiments, the multiple sclerosis- associated biomarker consists of about 80 to 150 amino acids. In some embodiments, the multiple sclerosis-associated biomarker consists of about 150 to 200 amino acids. In some embodiments, the multiple sclerosis-associated biomarker consists of about 200 to 300 amino acids, in some embodiments, the multiple sclerosis-associated biomarker consists of about 300 to 400 amino acids. In some embodiments, the multiple sclerosis-associated biomarker consists of about 400 to 500 amino acids. In some embodiments, the multiple sclerosis-associated biomarker consists of about 500 to 600 amino acids.

[0044] The multiple sclerosis-associated biomarker (e.g., Tau protein or fragment thereof) may comprise various regions of the full-length protein. For example, in some embodiments, the multiple sclerosis-associated biomarker comprises the amino- terminus (e.g., N-terminus, NH2-terminus, N-terminal end, amϊnβ-tβrminus). The ammo-terminus refers to tne amino acid at the end of a protein or polypeptide that has a free amine group (-NH2). In some embodiments, the multiple-sclerosis associated biomarker consists of about the first 15 amino acids. In some embodiments, the multiple-sclerosis associated biomarker consists of about the first 25 amino acids. In some embodiments, the multiple-sclerosis associated biomarker consists of about the first 50 amino acids. In some embodiments, the multiple-sclerosis associated biomarker consists of about the first 75 amino acids. In some embodiments, the multiple-sclerosis associated biomarker consists of about the first 100 amino acids. In some embodiments, the multiple-sclerosis associated biomarker consists of about the first 125 amino acids,

[0045] In some embodiments, the multiple-sclerosis associated biomarker or fragment thereof comprises the carboxy-terminus (e.g., C-terminus _s COOH-terminus, C-terminal end, carboxyl-terminus). The carboxy-terminus refers to the amino acid at the end of a protein or polypeptide that has a free carboxylic acid group (-COOH). In some embodiments, the multiple-sclerosis associated biomarker consists of about the last 100 amino acids.

MONITORING DISEASE ACTIVITY AND DRUG EFFICACY

[0046] The p resent inv ention al so features methods o f determining t he s tatus of a disease or condition (e.g., a neurological condition, an inflammatory condition, multiple sclerosis, etc.) or determining the status of drug efficacy. The present invention may also feature methods of monitoring disease activity and drug efficacy. For example, biomarkers can be used to detect a disease or condition and the biomarkers may be used to determine severity of the disease or condition (e.g. relapse, remission, etc.).

[0047] In some embodiments, the method comprises providing a sample (e.g., a fluid, a brain tissue), the sample comprising a circulating phagocyte. The sample may be derived from a mammal (e.g., a patient, a mouse, a rat, etc.). A biomarker or level thereof associated with a disease or condition (e.g., a multiple sclerosis-associated biomarker) may be detected in the sample (e.g., in the phagocyte) and compared to the level or presence of the biomarker in control samples. In some embodiments, the biomarker detected may be compared to the level or presence of the biomarker in a second sample, the second sample having been collected prior to the first sample. By comparing the level or presence of the biomarker in the sample to either a control sample or a patient's previous sample, disease activity may be determined. A biomarker may include but is not limited to Tau or a fragment thereof.

[0048] In some embodiments, the monitoring of disease activity may be used to determine drug efficacy. In some embodiments, the monitoring of disease activity may be used to determine drug failure and/or breakthrough disease. In some embodiments, the monitoring of disease activity may be used to determine patient compliance with drug therapy. In some embodiments, the monitoring of disease activity may be used to determine therapeutic non-responders. In some embodiments, the monitoring of disease activity may be used to aid drug development.

[0049] In some embodiments, the present invention features a method of monitoring disease activity of a neurologica! condition, the method comprises obtaining from a mammal a first fluid sample from outside of a brain tissue of the mammal, the first fluid sample comprises a first circulating phagocyte; detecting a level of a biomarker associated with the neurological condition in the first sample; and comparing the level of the biomarker in the first sample with a level of the biomarker in a second sample, the second sample being either a control sample or a second fluid sample from outside of a brain tissue of the mammal, the second fluid sample comprising a second circulating phagocyte, the second fluid sample having been taken prior to the first fluid sample.

[0050] Table 1 shows the amino acid sequence of full-length human Tau protein.

I)TABLE 1

[This is [This is the MHQDQEGDTD AGLKESPLQT PTEDGSEEPG the length MW of the SETSDAKSTP TAEDVTAPLV DEGAPGKQAA of the unprocessed AQPHTEIPEG TTAEEAGIGD TPSLEDEAAG

VVQEGFLREP GPPGLSHQLM unprocessed precursor] HVTQEPESGK

SGMPGAPLLP EGPREATRQP SGTGPEDTEG precursor] GRHAPELLKH QLLGDLHQEG PPLKGAGGKE

RPGSKEEVDE DRDVDESSPQ DSPPSKASPA

QDGRPPQTAA REATSIPGFP AEGAIPLPVD

FLSKVSTEIP ASEPDGPSVG RAKGQDΆPLE

FTFHVEITPN VQKEQAHSEE HLGRAAFPGA

PGEGPEARGP SLGEDTKEAD LPEPSEKQPA

AAPRGKPVSR VPQLKARMVS KSKDGTGSDD

KKAKTSTRSS AKTLKNRPCL SPKLPTPGSS

DPLIQPSSPA VCPEPPSSPK HVSSVTSRTG

SSGAKEMKLK GADGKTKIAT PRGAΆPPGQK

GQANATRIPA KTPPAPKTPP SSGEPPKSGD

RSGYSSPGSP GTPGSRSRTP SLPTPPTREP

KKVAVVRTPP KSPSSAKSRL QTAPVPMPDL

KNVKSKIGST ENLKHQPGGG KVQIINKKLD

LSNVQSKCGS KDNIKHVPGG GSVQIVYKPV

DLSKVTSKCG SLGNIHHKPG GGQVEVKSEK

LDFKDRVQSK IGSLDNITHV PGGGNKKIET

HKLTFRENAK AKTDHGAEIV YKSPVVSGDT

SPRHLSNVSS TGSIDMVDSP QLATLADEVS

ASLAKQGL

[0051] Table 2 shows examples of some of the possible multiple sclerosis-associated biomarkers (e.g., Tau protein or a fragment thereof).

I)TABLE 2

[0052] In some embodiments, the step of detecting the multiple sclerosis-associated biomarker in the sample may comprise introducing an antibody to the sample, wherein the antibody binds to the multiple sclerosis-associated biomarker.

[0053] In some embodiments, the step of detecting the multiple sclerosis-associated biomarker in the sample comprises subjecting the sample to a western blot, an enzyme- linked immunosorbent assay (ELISA), a lateral flow assay, a radioimmunoassay, an immunohistochemistry assay, a bioluminescent assay, a chemiiuminescent assay, a mass spectrometry assay, a flow cytometry assay (e.g., florescence-activated ceϋ sorting (FACS)), or a combination thereof and the like. Such assays are well known in the art,

f0054] In some embodiments, the step of detecting the multiple sclerosis-associated biomarker further comprises contacting the sample with an antibody that binds to the multiple sclerosis-associated biomarker and detecting an antibody-biomarker complex. The step of detecting an antibody-biomarker complex may comprise subjecting the sample to a micro array, western blot, an enzyme-linked immunosorbent assay (ELISA), a lateral flow assay, a radioimmunoassay, an immunohistochemistry assay, a bioluminescent assay, a chemiiuminescent assay, a flow cytometry assay (e.g., florescence-activated cell sorting (FACS)), or a combination thereof and the like. In some embodiments, detecting the antibody-biomarker complex indicates the presence of multiple sclerosis or a risk of multiple sclerosis.

[0055] As described above, in some embodiments, the step of detecting the multiple sclerosis-associated biomarker may comprise subjecting the sample florescence- activated cell sorting (FACS). Fluorescence-activated cell sorting (FACS) is a type of flow cytometry that sorts a mixture of biological cells, one at a time, into separate containers based upon the specific light scattering and fluorescent characteristics of each cell. St provides quantitative recording of fluorescent signals from individual cells as well as physical separation of cells of particular interest. Generally, a current of a rapidly flowing stream of liquid carries a suspension of cells through a nozzle. The flow is selected such that there is a large separation between cells relative to their diameter. Vibrations at the tip of the nozzle cause the stream of cells to break into individual droplets, and the system is adjusted so that there is a low probability of more than one cell being in a droplet. A monochromatic laser beam illuminates the droplets, which are electronically monitored by fluorescent detectors. The droplets that emit the proper fluorescent wavelengths are electrically charged between deflection plates in order to be sorted into collection tubes.

[00561 As described above, in some embodiments, the step of defecting the multiple sclerosis-associated biomarker may comprise subjecting the sample to an enzyme- linked immunosorbent assay (ELISA). ELISA is an assay used to detect the presence of an antibody or a biomarker in a sample. Generally, in ELlSA, a sample containing an unknown amount of biomarker, e.g., an antigen, is affixed/immobilized to a surface (e.g., a polystyrene microtiter plate). Then, an antibody that binds to the antigen of interest is washed over the surface so that it can bind the antigen and form an antibody/antigen complex. In some cases, this antibody is covalently linked to an enzyme. In some cases, the antibody is not covalently linked to an enzyme but can be detected by a secondary antibody that is linked to an enzyme, in the final step, a substance (e.g., substrate) that the enzyme is capable of converting to a detectable visible signal (e.g., color signal) is added to the reaction. Thus, if the antibody/antigen complex is present, the substrate will be converted to the detectable visible signal, and then amount of antigen in the sample can be measured.

[0057] As mentioned above, in some embodiments, an antibody is used to detect the presence of the multiple sclerosis-associated biomarker. The multiple sclerosis- associated biomarker may be detected with a variety of antibodies. In some embodiments, the antibody is a monoclonal or a polyclonal antibody. In some embodiments, the antibody is a humanized antibody. In some embodiments, the antibody is a chimera. In some embodiments, the antibody is derived from a human, a mouse, a rat, a llama, a rabbit, a dog, a primate, a guinea pig, a cat, a hamster, a pig, a chicken, a goat, a horse, or a cow. In some embodiments, the antibody is synthetic. In some embodiments, the antibody is a recombinant antibody.

[0058] Frequently, antibodies are labelled either covalently or non-covalentiy by combining the antibody with a second substance that provides for detectable signal. A wide variety of labels and conjugation techniques are known in the art and are reported extensively in both the scientific and patent literature. Examples of labels include but are not limited to radioisotopes, enzymes, substrates, cofactors, inhibitors, fluorescers, chemiluminescers, magnetic particles, and the like. In some embodiments of the present invention, the antibody comprises a label.

[00591 in some embodiments, the present invention is used to detect the presence of multiple sclerosis. For example, a patient may present with symptoms of a demyelinating disease. A sample (e.g., derived from the paitent) may be tested for an elevated level of a multiple sclerosis-associated biomarker. Sf, according to the present invention, the level of a multiple sclerosis-associated biomarker is elevated and the patient presents symptoms of a demyelinating disease, then the patient is diagnosed as having multiple sclerosis.

[0060] In some embodiments, the present invention is used to detect a risk of multiple sclerosis. For example, a patient may present with no symptoms of a demyelinating disease, but he or she wishes to be tested for a risk of multiple sclerosis. If, according to the present invention, the level of a multiple sclerosis-associated biomarker is elevated and the patient does not present symptoms of a demyelinating disease, then the patient is diagnosed as having a risk of multiple sclerosis.

[0061] As used herein, the term "elevated level" refers to a level that is higher than the normal level of the multiple sclerosis-associated biomarker (e.g., the level that would be detected in a person who does not have muitiple sclerosis). To identify the level of the multiple sclerosis-associated biomarker that is the normal level, samples are pooled from about, for example, 500 patients (or an appropriate number of patients that would be statistically meaningful) who do not experience any symptoms of multiple sclerosis (or other demyelinating diseases) and who do not test positive for multiple sclerosis as detected by MRI. From those pooled samples, the average level of the multiple sclerosis-associated biomarker can be quantified and then defined as being the normal level of the multiple sclerosis-associated biomarker. If the normal level of the multiple sclerosis-associated biomarker is about zero, then an elevated level refers to any level that is greater than zero, for example, about 5 units, about 25 units, about 50 units, about 100 units, about 500 units, about 1000 units, about 10,000 units, about 100,000 units, about 1 ,000,000 units. In some embodiments, a unit may be an absorbance unit (e.g., from an ELISA), a percent positive (e.g., from a flow cytometry or FACS assay), or a fluorescence unit,

[0062] If the normal level of the multiple sclerosis-associated biomarker is some positive value (e.g., 5 units, 10 units, 50 units, 100 units, 500 units), then an elevated level refers to any level that is higher than the normal level. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 10-20% higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 20-30% higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 30-40% higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 40-50% higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 50-60% higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 60-70% higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 70-80% higher than the normal level of the multiple sclerosis-associated biomarker. in some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 80-90% higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 90-100% higher than the norma! level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 1-2 fold higher than the normal level of the multiple sclerosis- associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 2-3 fold higher than the norma! level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 3-4 fold higher than the normal level of the multiple sclerosis-associated biomarker, In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 4-5 fold higher than the normal level of the multiple sclerosis-associated biomarker. in some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 5-10 fold higher than the normal level of the multiple sclerosis-associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 10-20 fold higher than the normal level of the multiple sclerosis- associated biomarker. In some embodiments, an elevated level of the multiple sclerosis-associated biomarker may be a level that is about 20-50 fold higher than the normal level of the multiple sclerosis-associated biomarker.

[0063] The present invention also provides a method of monitoring the progression of multiple sclerosis and/or monitoring the treatment of multiple sclerosis. For example, in some embodiments, the present invention may be used to measure the level of the multiple sclerosis-associated biomarker in order to detect a change in the level (e.g., an increase in the level, a decrease in the level, a maintaining of the level). Without wishing to limit the present invention to any theory or mechanism, a change in the level of the multiple sclerosis-associated biomarker may correlate with a change in the patient's status (e.g., remission, progression, worsening). For example, a decrease in the level of the multiple sclerosis-associated biomarker may indicate the patient has entered or will enter a remission period. In some embodiments, the present invention may be used to monitor the level of the multiple sclerosis-associated biomarker in a patient while the patient is on a treatment regimen (e.g., a drug). Without wishing to limit the present invention to any theory or mechanism, a treatment regimen (e.g., a drug) that is effective at inhibiting the progression of multiple sclerosis and/or reducing the symptoms of multiple sclerosis may decrease the level of the multiple sclerosis- associated biomarker in the patient.

[0064] As mentioned above, in some embodiments, the method of the present invention for detecting multiple sclerosis is used in combination with one or more different methods for detecting multiple sclerosis. For example, in some cases, a combination of family history, a physical exam, and magnetic resonance imaging (MRI) findings are used to diagnose multiple sclerosis. Currently, MRi is the most sensitive radiographic technique for the imaging of multiple sclerosis. Multiple sclerosis plaques are commonly seen as round or void discrete lesions in the periventricular white matter. Other common locations for multiple sclerosis plaques include the corpus callosum, corona radiate, internal capsule, and centrum semiovale. In some embodiments, the present invention is used to measure a multiple sclerosis-associated biomarker, and the level of the multiple sclerosis-associated biomarker is correlated with a magnetic resonance imaging (MRI) measurement. Without wishing to limit the present invention to any theory or mechanism, it is believed that elevated levels of the multiple sclerosis- associated biomarker correlate with a MRI scan showing the presence of multiple sclerosis plaques in the brain.

[0065] The method of the present invention for detecting multiple sclerosis may be used in combination with one or more methods for detecting a different condition. For example, the method of the present invention may also he!p to distinguish multiple sclerosis from other diseases with similar clinical manifestations. For example, neuromyelitis optica (NSVIO), also known as Devic's syndrome, is a neurological disorder regarded as a severe variant of multiple sclerosis. The characteristic inflammatory demyelinating lesions of NMO selectively and repeatedly affect the optic nerves and the spinal cord, causing blindness and paralysis. A marker (e.g., aquaporin-4 antibodies) has been identified in serum and cerebrospinal fluid of patients with NMO, and the presence of a NMO marker (e.g., aquaporin-4 antibodies) may be used to distinguish NMO from multiple sclerosis. In some embodiments, the method of detecting the presence of multiple sclerosis or a risk of multiple sclerosis comprises detecting the presence or absence of at least two biomarkers (e.g., proteins, antigens, or the like) wherein at least one biomarker is detected in order to distinguish multiple sclerosis from a disease with similar clinical manifestations.

[0066] In some embodiments, the method of detecting the presence of multiple sclerosis or a risk of multiple sclerosis comprises detecting an elevated level of two or more multiple sclerosis-associated biomarkers. In some embodiments, the method of detecting the presence of multiple sclerosis or a risk of multiple sclerosis comprises detecting an elevated level of three or more multiple sclerosis-associated biomarkers.

[0067J The present invention also provides a method of diagnosing multiple sclerosis at an early stage of the disease before all clinical criteria are fulfilled, thus justifying early initiation of a multiple sclerosis-appropriate therapy.

[0068] The present invention also features a kit for detecting the status of a disease or condition (e.g., an inflammatory condition, a neurological condition, multiple sclerosis, etc). The kit may comprise an antibody specific for a biomarker (e.g., a multiple sclerosis-associated biomarker), wherein the biomarker is a protein selected from the group consisting of Tau or a fragment thereof, phosphorylated Tau or a fragment thereof, neurogiobin, valosin-containing protein, brain hexokinase, hippocalcin-1 , nestin, synaptotagmin, myelin associated glycoprotein, Myelin Basic Protein (MBP), Proteolipid Protein, Myelin Oligodendrocyte Glycoprotein, transketolase, NS1 assocated protein 1 , major vault protein, synaptojanin, enolase, alpha synuclein, glial fibrillary acidic protein, S-100 proteinNeu-N, 26S proteasome subunit 9, annexin A2, annexin A3, annexin A5, annexin A6, annexin A11 , ubiquitin activating enzyme ZE1 , ubiquitin B precursor, vimentϊn, gIyceraldehyde-3-phosphate dehydrogenase, 13-3-3 protein, or fragments thereof. In some embodiments, the kit further comprises a means for detecting the binding of the antibody to the multiple sclerosis-associated biomarker. In some embodiments, the antibody is a monoclonal or a polyclonal antibody.

[0069] In some embodiments, the detection of perforin is used in combination with detection of a marker (e.g., MBP) in phagocyites. For example, it has been surprisingly discovered that perforin levels can decline in CD16 cells as MBP levels increase.

A Kit for Detecting the Presence of Multiple Sclerosis

[0070] The present invention also features a kit for detecting the presence of multiple sclerosis or a risk of multiple sclerosis in a circulating phagocyte sample derived from a mammal. The kit comprises an antibody that binds to a multiple sclerosis-associated biomarker. In some embodiments, the kit further comprises a means for detecting the binding of the antibody to the multiple sclerosis-associated biomarker/antigen in the sample (e.g., an antibody-antigen complex). In some embodiments, the detecting of an elevated level of an antibody-antigen complex indicates presence of multiple sclerosis or a risk of multiple sclerosis.

[0071] In some embodiments, the kit comprises an antibody, wherein the antibody is a monoclonal or a polyclonal antibody. In some embodiments, the antibody is derived from a human, a mouse, a rat, a llama, a rabbit, a dog, a primate, a guinea pig, a cat, a hamster, a pig, a chicken, a goat, a horse, or a cow. In some embodiments, the antibody is humanized. In some embodiments, the antibody is a chimera. In some embodiments, the antibody is specific for the multiple sclerosis-associated biomarker.

EXAMPLE 1 Detecting Multiple Sclerosis in a Patient

[0072] The following example describes the detection of multiple sclerosis in a patient according to two methods disclosed in the present invention. A 24-year-old male patient presents to his primary care physician complaining of changes in vision, limb weakness, and extreme fatigue. He mentions his symptoms have been recurring over the last 3 months. The physician suspects the possibility of a tumor in the central nervous system (CNS) or a CNS disease, as well as multiple sclerosis. The physician obtains a blood sample to be sent to a diagnostic laboratory for multiple sclerosis testing, and also refers the patient to a neurologist.

[0073] The laboratory receives the patient's blood sample collected in a CPT tube. PBMCs are obtained from a BD Vacutainer™ CPT tube using a cell separation procedure. The cells are washed three times in 1X PBS and centrifuged in a horizontal rotor (swing-out head) for a minimum of 5 minutes at 1200 to 1500 RCF (Relative Centrifugal force). The supernatant is removed and the cells are resuspended in 1X PBS. After the final wash, extracts of the PBMCs are prepared by lysing with a hypotonic solution or other method. Then the lysate is subjected to assay involving an antibody that binds to Tau protein fragment comprising the phosphorylated serine residue Ser-404. The assay indicates that an elevated level of said Tau protein fragment is present in the PBMCs. The assay is the assay of example 2 or example 3. Thus, the results of the assay indicate that the patient has multiple sclerosis. The physician notifies the patient, who then begins treatment immediately.

[0074] The laboratory receives the patient's blood sample collected in a CPT tube. PBMCs are obtained from a BD Vacutainer™ CPT tube using a cell separation procedure. The cells are washed three times in 1X PBS and centrifuged in a horizontal rotor (swing-out head) for a minimum of 5 minutes at 1200 to 1500 RCF (Relative Centrifugal force). The supernatant is removed and the cells are resuspended in 1X PBS. The ceils are then subjected to assay involving an antibody that binds to Tau protein fragment comprising the phosphorylated serine residue Ser-404. The assay is the assay of example 4. EXAMPLE 2

Direct ELiSA Assay Protocol

[0075] The following example describes a direct ELISA assay used for detecting a multiple sclerosis-associated antigen in a sample. The protein concentration of the sample is determined using the BioRad™ (Bradford method) assay, MicroELISA plates are coated by addition of 100 μL of a 5- 20 μg/mL solution of the sample, which is then incubated for 1 hour at 21 ⁰ C. The weils are washed out with phosphate buffered solution (PBS) with 0.05% polysorbate (Tween 20™). The wells are then filled with 0.1 M glycine in PBS and incubated for 1 hour at 21 °C to block unoccupied binding sites. After rewashing the wells, 100 μL of an appropriate dilution of antibody in PBS-0.05% Tween™ 20 with 1% bovine serum albumin (BSA) is added and incubated for 1 hour at 21 ⁰ C. The unbound antibody is then washed out with three exchanges of PBS-0.05% Tween™ 20. One hundred μL of an appropriately diluted horse radish peroxidase conjugated antiimmunoglobulin G (IgG) in PBS-0.05% Tween™ 20-1 % BSA is then added to each well and incubated for 1 hour at 21 °C. The wells are then washed twice with PBS-Q,05% Tween™ 20 and finally with PBS. One hundred μL of soluble MTB substrate solution is added to each well and incubated for 30 minutes at 21 ^° C after which 100 μL of MTB stop reagent is added and the color intensity is measured at 450nm using an ELISA plate reader.

[0076] Appropriate dilutions of the antigen and antibody are established by performing checkerboard titrations. Antigen concentrations in samples are interpolated from standard curves.

EXAMPLE 3

Indirect ELISA Assay Protocol

[0077] The following example describes an indirect ELISA assay used for detecting a multiple sclerosis-associated antigen in various samples. This assay is constructed using polyclonal and monoclonal antibodies. ELISA wells are coated with polyclonal antibody at an appropriate concentration and the wells are washed and blocked as described above. Various dilutions of antigen containing samples are added to the wells and incubated for 1 hour at 21 ⁰ C, after which the wells are washed 3 times with PBS-0.05% Tween™ 20. The monoclonal antibody is then added at an appropriate dilution in PBS-0.05% Tween™20 - 1 % BSA and incubated for 1 hour at 21 "C. The wells are then washed 3 times and an appropriately diluted horse radish peroxidase conjugated anti-mouse IgM in PBS-0.05% Tween™20-1 % BSA is then added to each well and incubated for 1 hour at 21 °C. The wells are then washed twice with PBS-0.05% Tween™20 and finally with PBS. One hundred μL of soluble MTB substrate solution is added to each well and incubated for 30 minutes at 21 °C after which 100 μL of MTB stop reagent is added and the color intensity is measured at 450nm using an ELISA plate reader.

[0078] Appropriate dilutions of antigen and antibody are established by performing checkerboard titrations. Antigen concentrations in samples are interpolated from standard curves.

EXAMPLE 4

Flow Cytometry Protocol

[0079] The following example describes a flow cytometry assay used for detecting a multiple sclerosis-associated antigen in various samples. PBMCs from multiple sclerosis (MS) subjects and control subjects are stained with fluorescent antibodies to the multiple sclerosis-associated antigen (e.g., Tau protein) and also with fluorescent labeled antibodies to cluster designation (CD) 3 T-lymphocyte marker or CD 19 B-

Lymphocytβ marker, CD68 intracellular monocyte marker and CDi 4 monocyte/ macrophage cell surface marker. The labeled cells are analyzed by flow cytometry for qualitative or quantitative differences.

[0080] PBMCs are obtained from a BD Vacutainer™ CPT tube using a cell separation procedure. The cells are washed three times in 1X PBS and centrifuged in a horizontal rotor (swing-out head) for a minimum of 5 minutes at 1200 to 1500 RCF (Relative Centrifugal force). The supernatant is removed and the cells are resuspended in 1X PBS. After the final wash, the cells are resuspended to approximately 4.0 mL in 1X PBS. Approximately 50 μL of the cell suspension to be analyzed is transferred into tubes for double staining with selected antibody pairs. Ten μL of 4Qmg/mL normal human SgG (Sigma-Aldrich) for a total of 400 μg is added to each tube to block FC binding. The appropriate cell surface monoclonal antibodies CD3 PE, CD19 PE or CD14 PE are added at this time and incubated for 20 minutes at room temperature.

[0081] One hundred μl of Dako Intrastain™ Reagent A (fixative) is added to each tube and then mixed gently with a vortex mixer to ensure that the cells are in suspension. Cells are incubated at room temperature for 15 minutes. Two mL of 1X PBS working solution is added to each test tube and mixed gentiy. The tubes are centrifuged at 300 X g for 5 minutes. Supernatant is aspirated leaving about 50 μl of fluid. The fluid is mixed thoroughly to ensure that the cells are in suspension.

[0082J One hundred μL of Dako Intrastain™ Reagent B (permeabilization) is added to each tube. The appropriate amount of the antibody specific for the multiple sclerosis- associated antigen is added to the appropriate tubes. The tubes are mixed gently to ensure that the cells are in suspension and incubated at room temperature for 15-60 minutes. Two mL of 1X PBS working solution is added to each test tube and mixed gently. The tubes are centrifuged at 300 X g for 5 minutes, and then the supernatant is aspirated, leaving approximately 50 μl of fluid. The fluid is mixed thoroughly to ensure that the cells are in suspension.

[0083] One hundred μL of Dako Intrastain™ Reagent B (permeabiϋzation) is added to each tube. The appropriate volume of the 2nd step antibody conjugated to FITC (specific to the multiple sclerosis-associated antigen) is added to the appropriate tubes. The tubes are mixed gently to ensure that the cells are in suspension and incubated at room temperature for 15-60 minutes. To each tube, 2.0 mLs of 1XPBS working solution is added. The tubes are mixed gently then centrifuged at 300 X g for 5 minutes. The supernatant is aspirated, leaving approximately 50 μl of fluid. The tubes are mixed thoroughly to ensure that the cells are in suspension. [0084] The pellet is resuspended in an appropriate volume of fluid for flow cytometry analysis. The sample is analyzed on a flow cytometer within 24 -48 hours. For analysis, the gate is on the monocyte population and the data is collected in list mode. Qualitative and or quantitative differences are determined between normal and MS patients using the analysis software. Optimization steps include varying incubation time with antibodies, fixation time and permeabilization time.

[0085] Although there has been shown and described the preferred embodiment of the present invention, it will be readily apparent to those skilled in the art that modifications may be made thereto which do not exceed the scope of the appended claims. Therefore, the scope of the invention is only to be limited by the following claims.