METHODS FOR DIFFERENTIAL DIAGNOSIS OF AUTOIMMUNE DISEASES

CROSS-REFERENCE

[0001] This patent application claims the benefit of U.S. Application Serial No. 62/352,525, filed June 20, 2016; and U.S. Application Serial No. 62/421,180, filed November 11, 2016; each of which is incorporated herein by reference in their entirety.

BACKGROUND OF THE INVENTION

[0002] Autoimmune disease patients can experience chronically active disease, fluctuating rounds of remission and flare, or long quiescence. Accurately detecting and determining the status of a patient is central to prescribing appropriate drug regimens, evaluating treatment outcomes, defining patient subgroups, and early detection of flare onsets or progression of disease in order to improve therapeutic outcomes of patients afflicted with an autoimmune disease.

SUMMARY OF THE INVENTION

[0003] Provided herein are methods, devices and assays for making a differential diagnosis of an autoimmune disease, said method comprising (a) contacting a sample from a subject to an array of peptides comprising at least 10,000 different peptides synthesized in situ; (b) detecting the binding of antibodies present in said sample to at least 25 peptides on said array to obtain a combination of binding signals; and (c) comparing said combination of binding signals to one or more groups of combinations of reference binding signals, wherein at least one of each of said group of combinations of reference binding signals are obtained from a plurality of reference subjects known to have a disease different from the autoimmune disease of the subject, thereby enabling the differential diagnosis of said subject for the autoimmune disease, wherein the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) between the autoimmune disease and each of the group of combinations of reference binding signals being greater than 0.6.

[0004] In some embodiments, the methods, devices and assays further comprises each of said combination of reference binding signals is obtained by detecting the binding of antibodies present in a sample from each of said plurality of subjects in said reference group to said at least 25 peptides on an array of peptides comprising at least 10,000 different peptides synthesized in situ. In some embodiments, the difference between said combination of binding signals and said combination of said reference binding signals to said at least 25 peptides determines said differential diagnosis. In an embodiment, said different disease is an autoimmune disease. In some embodiments, the methods, devices and assays further comprises (d) comparing said combination of binding signals to a reference binding signal obtained from a plurality of reference subjects known to have the autoimmune disease.

[0005] In another embodiment, said autoimmune-disease is dermatomyositis (DM), and said different autoimmune disease is scleroderma (SSc). In still other embodiments, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least 100% in one or more amino acids selected from serine, glycine, tyrosine, arginine, alanine, glutamine and valine when compared to the at least 10,000 peptides in said array. In another embodiment, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 13A when compared to the at least 10,000 peptides in said array.

[0006] In some embodiments, the method further comprises comparing the binding signal from said subject to a combination of reference binding signals obtained from healthy subjects. In some embodiments wherein the autoimmune disease is SSc, the at least 25 peptides that differentiate said combination of binding signals from said combination of said healthy reference binding signals are enriched by at least 100% in one or more amino acids selected from tyrosine, lys, arginine, phenylalanine, serine, tryptophan, glycine, and alanine. In other embodiments, wherein the autoimmune disease is SSc, the at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 5 A when compared to the at least 10,000 peptides in said array.

[0007] In some embodiments, wherein the autoimmune disease is DM, the at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals from healthy subjects are enriched by at least 100% in one or more amino acids selected from tyrosine, tryptophan, serine, glycine, aspartic acid, and phenylalanine. In other embodiments, wherein the autoimmune disease is DM, the at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 17A when compared to the at least 10,000 peptides in said array.

[0008] In some embodiments, said autoimmune disease is SSc, and said one group of reference binding signals comprises a combination of binding signals obtained from a plurality of subjects having other autoimmune diseases comprising Mixed Connective Tissue Disease (MCTD), Undifferentiated Connective Tissue Disease (UCTD), myositis, polymyositis, systemic lupus erythematosus, and morphea. In some embodiments, wherein said autoimmune disease is SSc, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least 100% in one or more amino acids selected aspartic acid, glutamic acid, proline, valine, glycine, and serine. In other embodiments, wherein said autoimmune disease is SSc, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 7A when compared to the at least 10,000 peptides in said array.

[0009] In some embodiments, said autoimmune disease is DM, and wherein said one group of reference binding signals comprises a combination of binding signals obtained from a plurality of subjects having other autoimmune diseases comprising MCTD, UCTD, myositis, polymyositis, systemic lupus erythematosus, and morphea. In some embodiments, wherein said autoimmune disease is DM, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least 100% in one or more amino acids selected lysine, histidine, serine, arginine, glutamic acid, alanine, and glycine. In other embodiments, wherein said autoimmune disease is DM, the at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 19A when compared to the at least 10,000 peptides in said array.

[0010] In still other embodiments, the methods, devices and assays disclosed herein further comprises comparing the binding signal from said subject to a binding signal obtained from at least one healthy subject. In some embodiments, the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) ranging from 0.60 to 0.70, 0.70 to 0.79, 0.80 to 0.89, or 0.90 to 1.00.

[0011] Also provided herein are methods, devices and assays for determining disease progression in a subject known to have an autoimmune disease, said method comprising (a) contacting a sample from a subject to an array of peptides comprising at least 10,000 different peptides synthesized in situ; (b) detecting the binding of antibodies present in said sample to at least 25 peptides on said array to obtain a first combination of binding signals; and (c) comparing said first combination of binding signals to at least a second combination of reference binding signals, wherein said second combination of reference binding signals comprises a combination of binding signals obtained from a reference group comprising a plurality of subjects having a clinical manifestation indicative of progression of said autoimmune disease, thereby making said differential diagnosis, wherein the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.6. In some embodiments, the methods, devices and assays further comprises (d) comparing said combination of binding signals to a reference binding signal obtained from a plurality of reference subjects known to have the autoimmune disease.

[0012] In some embodiments, each of said combination of reference binding signals is obtained by detecting the binding of antibodies present in a sample from each of said plurality of subjects in said reference group to said at least 25 peptides on a array of peptides comprising at least 10,000 different peptides synthesized in situ. In one embodiment, the difference between said combination of binding signals and said combination of said reference binding signals to said at least 25 peptides determines said disease progression. In another embodiment, said disease progression is determined in scleroderma (SSc). In yet other embodiments, said disease progression is determined in SSc, and said clinical manifestation is selected from renal crisis, interstitial lung disease (ILD), and gastric antral vascular ectasia (GAVE).

[0013] In one embodiment, said disease progression is determined in subjects having SSc, and said clinical manifestation is renal crisis. In some embodiments, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least 100% in one or more amino acids selected from proline, aspartic acid and glutamic acid when compared to the at least 10,000 peptides in said array. In other embodiments, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least in one or more motifs listed in Figure 9A when compared to the at least 10,000 peptides in said array.

[0014] In another embodiment, wherein said disease progression is determined in SSc, and said clinical manifestation is ILD. In some embodiments, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least in one or more amino acids selected from proline, arginine, lysine, histidine, and aspartic acid when compared to the at least 10,000 peptides in said array. In other embodiments, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 15A when compared to the at least 10,000 peptides in said array.

[0015] In another embodiment, said disease progression is determined in SSc, and said clinical manifestation is GAVE. In one embodiment, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least in one or more amino acids selected from arginine, tyrosine, serine, histidine, lysine, and phenylalanine when compared to the at least 10,000 peptides in said array. In another embodiment, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 11A when compared to the at least 10,000 peptides in said array.

[0016] In another embodiment, said disease progression is determined in subjects with dermatomyositis (DM), and said clinical manifestation is ILD. In one embodiment, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched by at least in one or more amino acids selected from proline, aspartic acid, glutamic acid, serine, glycine, and glutamine when compared to the at least 10,000 peptides in said array. In another embodiment, said at least 25 peptides that differentiate said combination of binding signals from said combination of said reference binding signals are enriched in one or more of the motifs listed in Figure 21A when compared to the at least 10,000 peptides in said array.

[0017] In still other embodiments, the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) ranging from 0.60 to 0.70, 0.70 to 0.79, 0.80 to 0.89, or 0.90 to 1.00.

[0018] In some embodiments, the subject is human. In other embodiments, the sample is a blood sample. In still other embodiments, the blood sample is selected from whole blood, plasma, or serum. In yet other embodiments, the sample is a serum sample. In one

embodiment, the sample is a plasma sample. In another embodiment, the sample is a dried blood sample. In still other embodiments, the at least 10,000 different peptides on the peptide array is at least 5 amino acids in length. In yet other embodiments, the at least 10,000 different peptides on the peptide array is between 5 and 15 amino acids in length. In some embodiments, the at least 10,000 different peptides are synthesized from less than 20 amino acids. In another embodiment, the at least 10,000 different peptides on the peptide array are synthesized by excluding one or more of cysteine, methionine, isoleucine and threonine.

[0019] In another aspect, a method is provided for identifying a candidate protein biomarker for an autoimmune disease, said method comprising: (a) identifying a set of discriminating peptides that differentiate said autoimmune disease from one or more different health condition; (b) aligning said set of (discriminating) peptides to proteins in a proteome to obtain an alignment score for said set of discriminating peptides to one or more proteins of said proteome; (d) ranking said identified proteins according to a statistical significance; and (e) identifying said protein as a candidate protein biomarker for treating said autoimmune disease. In some embodiments, the method further comprises identifying a set of discriminating peptides that differentiate said autoimmune disease from a healthy condition. In some embodiments, the candidate protein biomarker is selected from targets listed in Table 3. [0020] In some embodiments, the discriminating peptides are identified as having /^-values of less than 10 ^"5 , less than 10 ^'6 , less than 10 ^"7 , less than 10 ^'8 , less than 10 ^"9 , less than 10 ^'10 , less than 10 ^"11 , less than 10 ^"12 , less than 10 ^"13 , less than 10 ^'14 , or less than 10 ^"15 . In other embodiments, said candidate protein biomarker is ranked according to a p-value of less than less than 10 ^"3 , less than less than 10 ^"4 , less than less than 10 ^"5 , or less than less than 10 ^"6 .

INCORPORATION BY REFERENCE

[0021] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

[0022] The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

[0023] The novel features of the invention are set forth with particularity in the appended claims A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative

embodiments, in which the principles of the invention are utilized, and the accompanying drawings in the following.

[0024] FIG. 1A is a list of clinical manifestations and physiological symptoms of SSc.

[0025] FIG. IB shows a continuation of clinical manifestations and physiological symptoms of SSc.

[0026] FIG. 2 is an example of a list of clinical symptoms used to assess SSc diagnosis and assessment.

[0027] FIG. 3 shows a list of clinical manifestations and symptoms for polymyositis and dermatomyositis, and clinical differentiation criteria for both.

[0028] FIG. 4. is a pathway showing how a self protein/antigen can lead to up-regulation and down-regulation of an immunosignature in peptide microarrays.

[0029] FIG. 5 is a table depicting the top differentiating peptides when comparing patients with SSc and healthy subjects.

[0030] FIG. 5A depicts the top sub-motifs.

[0031] FIG. 5B depicts the enriched peptides in the top 1000 differentiating peptides.

[0032] FIG. 6 is a graphical representation of the results in FIG. 5.

[0033] FIG. 6A is Volcano Plot depicting the differentiation of subjects with Scleroderma (SSc) from healthy controls by peptide binding intensities. The ratio of mean intensity among samples from patients with Scleroderma to mean intensity in control patients is plotted vs. the p- value for the difference in means from a t-test.

[0034] FIG. 6B are ROC curves for an Immuno Signature model of Scleroderma for identifying patients with Scleroderma from healthy controls. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90% Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

FIG. 6C are ROC estimates as a function of input size - Five fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of Scleroderma vs. healthy controls. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0035] FIG. 7 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and other autoimmune disorders.

[0036] FIG 7A depicts the top sub-motifs.

[0037] FIG. 7B depicts the enriched peptides in the top 1000 differentiating peptides.

[0038] FIG. 8 is a graphical representation of the results seen in FIG. 7.

[0039] FIG. 8A is a Volcano Plot depicting the differentiation of subjects with Scleroderma (SSc) from other autoimmune mimic diseases ("Other AI") by peptide binding intensities. The ratio of mean intensity among samples from patients with Scleroderma to mean intensity in patients with other autoimmune disorders is plotted vs. the p-value for the difference in means from a t-test.

[0040] FIG. 8B are ROC curves for an ImmunoSignature model of Scleroderma for identifying patients with Scleroderma from other autoimmune diseases. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90% Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0041] FIG. 8C are ROC estimates as a function of input size - Four fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of Scleroderma vs. other autoimmune disorders. Feature selection and model construction were performed within the cross-validation loop to prevent bias. [0042] FIG. 9 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and patients in a renal crisis.

[0043] FIG 9A depicts the top sub-motifs.

[0044] FIG. 9B depicts the enriched peptides in the top 1000 differentiating peptides.

[0045] FIG. 10 is a graphical representation of the results seen in FIG. 9.

[0046] FIG. 10A is a Volcano Plot depicting the differentiation of subjects with Scleroderma (SSc) having renal crisis from subjects with SSc without renal crisis by peptide binding intensities. The ratio of mean intensity among samples from patients with Scleroderma having renal crisis to mean intensity in patients with SSc without renal crisis is plotted vs. the p-value for the difference in means from a t-test.

[0047] FIG. 10B are ROC curves for an ImmunoSignature model of Scleroderma for identifying patients with Scleroderma with renal crisis from subjects with SSc without renal crisis. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90% Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0048] FIG. IOC are ROC estimates as a function of input size - Four fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of Scleroderma with renal crisis vs. SSc without renal crisis. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0049] FIG. 11 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and gastric antral vascular ectasia (GAVE).

[0050] FIG 11A depicts the top sub-motifs.

[0051] FIG. 11B depicts the enriched peptides in the top 1000 differentiating peptides.

[0052] FIG. 12 is a graphical representation of the results seen in FIG. 11.

[0053] FIG. 12A is a Volcano Plot depicting the differentiation of subjects with Scleroderma (SSc) having Gastric Antral Vascular Ectasia (GAVE) from subjects with SSc without GAVE by peptide binding intensities. The ratio of mean intensity among samples from patients with Scleroderma having GAVE to mean intensity in patients with SSc without GAVE is plotted vs. the p-value for the difference in means from a t-test.

[0054] FIG. 12B are ROC curves for an ImmunoSignature model of Scleroderma for identifying patients with Scleroderma with GAVE from subjects with SSc without GAVE. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90%

Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0055] FIG. 12C are ROC estimates as a function of input size - Four fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of Scleroderma with GAVE vs. SSc without GAVE. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0056] FIG. 13 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and DM.

[0057] FIG 13A depicts the top sub-motifs.

[0058] FIG. 13B depicts the enriched peptides in the top 1000 differentiating peptides.

[0059] FIG. 14 is a graphical representation of the results seen in FIG. 13.

[0060] FIG. 14A is a Volcano Plot depicting the differentiation of subjects with Scleroderma (SSc) from subjects with Dermatomyositis (DM) by peptide binding intensities. The ratio of mean intensity among samples from patients with DM to mean intensity in patients with DM is plotted vs. the p-value for the difference in means from a t-test.

[0061] FIG. 14B are ROC curves for an ImmunoSignature model of Scleroderma for identifying patients with Scleroderma from DM. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90% Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0062] FIG. 14C are ROC estimates as a function of input size - Four fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of Scleroderma vs. DM. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0063] FIG. 15 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc with interstitial lung disease (ILD+) and SSc without interstitial lung disease (ILD-).

[0064] FIG 15A depicts the top sub-motifs.

[0065] FIG. 15B depicts the enriched peptides in the top 1000 differentiating peptides.

[0066] FIG. 16 is a graphical representation of the results seen in FIG. 15. [0067] FIG. 16A is the differentiation of subjects with Scleroderma (SSc) having Interstitial Lung Disease (ILD) (ILD+) from subjects with SSC without ILD (ILD-) by peptide binding intensities. The ratio of mean intensity among samples from patients with Scleroderma-ILD+ to mean intensity in patients with SSC ILD- is plotted vs. the p-value for the difference in means from a t-test.

[0068] FIG. 16B are ROC curves for an ImmunoSignature model of Scleroderma for identifying patients with Scleroderma ILD+ from subjects with SSc ILD-. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90% Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0069] FIG. 16C are ROC estimates as a function of input size - Four fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of SSc ILD+ vs. SSc ILD-. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0070] FIG. 17 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with DM and healthy subjects.

[0071] FIG 17A depicts the top sub-motifs.

[0072] FIG. 17B depicts the enriched peptides in the top 1000 differentiating peptides.

[0073] FIG. 18 is a graphical representation of FIG. 17.

[0074] FIG. 18A is a Volcano Plot depicting the differentiation of subjects with

Dermatomyositis (DM) from healthy controls by peptide binding intensities. The ratio of mean intensity among samples from patients with DM to mean intensity in control patients is plotted vs. the p-value for the difference in means from a t-test.

[0075] FIG. 18B are ROC curves for an ImmunoSignature model of DM for identifying patients with DM from healthy controls. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90% Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0076] FIG. 18C are ROC estimates as a function of input size - Four fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of DM vs. healthy controls. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0077] FIG. 19 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with DM and other autoimmune disorders.

[0078] FIG 19A depicts the top sub-motifs.

[0079] FIG. 19B depicts the enriched peptides in the top 1000 differentiating peptides.

[0080] FIG. 20 is a graphical representation of FIG. 19.

[0081] FIG. 20A is a Volcano Plot depicting the differentiation of subjects with

Dermatomyositis (DM) from other autoimmune mimic diseases (Other AI) by peptide binding intensities. The ratio of mean intensity among samples from patients with Scleroderma to mean intensity in patients with other autoimmune disorders is plotted vs. the p-value for the difference in means from a t-test.

[0082] FIG. 20B are ROC curves for an ImmunoSignature model of DM for identifying Subjects with Dermatomyositis (DM) from other autoimmune mimic diseases (Other AI). The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90%

Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0083] FIG. 20C are ROC estimates as a function of input size - Four fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of DM vs. other autoimmune disorders. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0084] FIG. 21 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with DM and Interstitial lung disease (ILD+) and DM without interstitial lung disease (ILD-).

[0085] FIG 21A depicts the top sub-motifs.

[0086] FIG. 21B depicts the enriched peptides in the top 1000 differentiating peptides.

[0087] FIG. 22 is a graphical representation of FIG. 21.

[0088] FIG. 22A is a Volcano Plot depicting the differentiation of subjects with

Dermatomyositis (DM) having Interstitial Lung Disease (ILD) (ILD+) from subjects with DM without ILD (ILD-) by peptide binding intensities. The ratio of mean intensity among samples from patients with DM ILD+ to mean intensity in patients with DM ILD- is plotted vs. the p- value for the difference in means from a t-test. [0089] FIG. 22B are ROC curves for an ImmunoSignature model of DM for identifying patients with DMILD+ from subjects with DMILD-. The green line (top) indicates the upper 95% confidence interval of the classifier (middle) and the red line (bottom) the lower 95% confidence interval. Sensitivity estimates are provided for a test with 90% Specificity and Specificity estimates are provided for a test with 90% Sensitivity. Accuracy is estimated at a threshold that matches sensitivity and specificity.

[0090] FIG. 22C are ROC estimates as a function of input size - Five fold cross validated area under the ROC curve (+/- 95% CI) are provided for models of different input peptide sizes. Peptides were selected based on a t-test and the top k features were used in a support vector machine to build a classifier of DM ILD+ vs. DM ILD-. Feature selection and model construction were performed within the cross-validation loop to prevent bias.

[0091] FIG. 23A shows the peptide overlap difference scores, s, calculated for the alignments of IMS peptide-motifs plotted alongside the RNA Pol II subunit L aa positions.

[0092] FIG. 23B shows a histogram displaying the distribution of protein epitope scores, S, for each protein in the human proteome vs the SSc vs healthy classifying peptides.

[0093] FIG. 24 shows a histogram representing the frequency of alignments of IS

discriminating peptides distinguishing subjects with SSc having GAVE from subjects with SSc without GAVE along the protein sequence of CCL22.

DETAILED DESCRIPTION OF THE INVENTION

[0094] The disclosed embodiments concern methods, apparatus, and systems for obtaining and qualifying antibody binding profiles from biological samples to diagnose autoimmune diseases relative to healthy individuals, differentially diagnose autoimmune disease relative to other autoimmune, non-autoimmune mimic diseases, and other overlap diseases, and to determine progression of autoimmune diseases.

[0095] Unless defined otherwise herein, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Various scientific dictionaries that include the terms included herein are well known and available to those in the art. Although any methods and materials similar or equivalent to those described herein find use in the practice or testing of the present invention, some preferred methods and materials are described.

[0096] Numeric ranges are inclusive of the numbers defining the range. It is intended that every maximum numerical limitation given throughout this specification includes every lower numerical limitation, as if such lower numerical limitations were expressly written herein. Every minimum numerical limitation given throughout this specification will include every higher numerical limitation, as if such higher numerical limitations were expressly written herein. Every numerical range given throughout this specification will include every narrower numerical range that falls within such broader numerical range, as if such narrower numerical ranges were all expressly written herein.

[0097] The headings provided herein are not limitations of the various aspects or embodiments of the invention which can be had by reference to the specification as a whole.

[0098] The terms defined immediately below are more fully described by reference to the Specification as a whole. It is to be understood that this invention is not limited to the particular methodology, protocols, and reagents described, as these may vary, depending upon the context they are used by those of skill in the art.

Definitions

[0099] The terms "condition" and "health condition" are used herein interchangeably to encompass all illnesses including diseases and disorders, but can include injuries and normal health situations, such as pregnancy, that might affect a person's health, benefit from medical assistance, or have implications for medical treatments.

[00100] The term "immunosignature" herein refers to a combination of binding signals produced by the differential binding of antibodies in a sample from a subject to an array of peptides relative to the binding of antibodies in reference sample(s) to the array of peptides.

[00101] The term "subject" herein refers to a human subject as well as a non-human subject such as a non-human mammal. Thus, various veterinary applications are contemplated in which case the subject may be a non-human mammal (e.g., a feline, a porcine, an equine, a bovine, and the like). The concepts described herein are also applicable to plants.

[00102] The term "patient sample" and "subject sample" are used interchangeably herein to refer to a sample e.g. a biological fluid sample, obtained from a patient i.e. a recipient of medical attention, care or treatment. The subject sample can be any of the samples described herein. In certain embodiments, the subject sample is obtained by non-invasive procedures e.g. peripheral blood sample.

[00103] As used herein the term "microarray system" refers to a system usually comprised of array peptides formatted on a solid planar surface like glass, plastic or silicon chip and any one or more of instruments needed to handle samples (automated robotics), instruments to read the reporter molecules (scanners), and analyze the data (bioinformatic tools).

[00104] The term "array peptide" herein refers to a peptide immobilized on a microarray.

[00105] The term "discriminating" and "differentiating" are used herein interchangeably in reference to peptides in an antibody binding profile/pattern that differentially bind antibodies in a sample from a test subject relative to a reference subject or subjects to determine the health condition of the test subject.

[00106] The term "accuracy" herein refers to the proportion of correct outcomes classified by the method.

[00107] The term "sensitivity" herein refers to the proportion of samples to be correctly identified as being positive for the condition being tested.

[00108] The term "specificity" herein refers to the proportion of samples to be correctly identified as being negative for the condition being tested.

[00109] The term "amino acid" herein refers to naturally occurring carboxy-amino acids comprising alanine (three letter code: ala, one letter code: A), arginine (arg, R), asparagine (asn, N), aspartic acid (asp, D), cysteine (cys, C), glutamine (gin, Q), glutamic acid (glu, E), glycine (gly, G), histidine (his, H), isoleucine (ile, I), leucine (leu, L), lysine (lys, K), methionine (met, M), phenylalanine (phe, F), proline (pro, P), serine (ser, S), threonine (thr, T), tryptophan (tip, W), tyrosine (tyr, Y), and valine (val, V).

[00110] Detecting and diagnosing immune-mediated disorders, such as autoimmune disorders, is challenging, with patients having a difficult time receiving an accurate or correct diagnosis. In many instances, patients are often misdiagnosed with other autoimmune conditions because of the closely related nature of these diseases. There are currently no reliable bio-markers available for the detection and assessment of automimmune diseases or disorders.

[00111] For example, Systemic Sclerosis or Scleroderma (SSc) is a multisystem autoimmune disease in which there is increased fibroblast activity resulting in abnormal growth of connective tissue. SSc is difficult to diagnose or obtain a prognosis of the disease condition because of its close relationship to other similar diseases. SSc causes vascular damage and fibrosis in the skin, the gastrointestinal (GI) tract and other internal organs, and is suspected in patients with skin thickening, puffy or swollen fingers, hand stiffness, and painful distal finger ulcers. Symptoms of Raynaud's phenomenon (RP; disorder which affects blood vessels, mostly in the extremities (fingers and toes); cause blood vessels to narrow in cold and stress, resulting in numb feeling in the affected extremities) and gastroesophageal reflux are often present. Figures 1A and IB depict a list of clinical manifestations of systemic sclerosis, which are heterogenous and vary as a result of the type of disease (limited or diffuse) and organ involvement.

[00112] The diagnosis of systemic scleroderma may be made on the basis of characteristic findings of cutaneous skin thickening, which may be in association with Raynaud's phenomenon and varying degrees of internal organ involvement. In early stages of the disease, Raynaud's phenomenon may be the only clinical manifestation of the disease. Nailfold capillarscopy may be helpful in these cases for determining whether Raynaud's phenomenon is primary or secondary to SSc. Diagnostic criteria for SSc as proposed by the American College of

Rheumatology are listed in FIG. 2, however experts differ regarding the usefulness of these criteria, and disease manifestations are often advanced by the time patients fulfill these criteria. Additionally, the heterogeneity of clinical presentation, range of internal organ involvement, and differences in rates of disease progression make counseling and management of each individual patient' s disease challenging.

[00113] Scleroderma may occur alone or in overlap syndromes with other diseases of connective tissue (such as systemic lupus erythematosus, dermatomyositis, and rheumatoid arthritis). Depending on which other diseases it is associated with, the disease state may be referred to as an "overlap syndrome". Overlap diseases associated with scleroderma may also be a mimic disease, i.e. , different diseases that present with, for example, scleroderma, but cannot be readily distinguished from scleroderma symptoms.

[00114] Dermatomyositis is an idiopathic inflammatory myopathy, that characteristically presents with skin manifestations. Although this condition is rare (one to 10 cases per million in adults), early diagnosis and treatment is important because of systemic complications that can increase morbidity of the disease. Polymyositis includes the inflammatory myopathy seen in these patients minus the cutaneous findings of the disease. Classification of the disease, which was first described in 1975, is seen in FIG. 3. The difficulty of diagnosing the disease from other cutaneous and connective tissue disorders such as scleroderma, makes differential diagnostic guidelines and assays important in making a correct diagnosis of the disease. Differential diagnosis of dermatomyositis includes the evaluation of whether a patient has, for example, an HIV infection, Lichen planus, polymorphous light eruption, seborrheic dermatitis, systemic lupus erythematosus, psoriasis, contact dermatitis, atopic dermatitis, trichinosis, drug effects, including penicillamine, nonsteroidal anti-inflammatory agents, hydroxylurea, pravastatin, clofibrate and ipecac, as well as the general effects of alcohol.

[00115] Accordingly, it would be useful and desirable to develop methods, assays and devices for the differential diagnosis of closely related autoimmune disorders, including

dermatomyositis, SSc, myositis, systemic lupus erythematosus and other autoimmune diseases. This is especially needed because early recognition of the correct underlying disease or disorder can assist in reducing or slowing the progression of the disease. For example, interstitial lung disease develops in 20-40% of dermatomyositis patients; early recognition would contribute to improved patient care and facilitate therapeutic efforts.

[00116] Disclosed herein are methods, assays and devices that identify differential patterns of peripheral-blood antibody binding to a peptide array. Differential binding of patient samples to the array results in specific binding patterns or signatures indicative of the disease state of the patient. These binding signatures can accurately differentiate a disease activity from closely related disease activities, including but not limited to different classifications of autoimmune diseases or disorders. For example, the methods, devices and assays disclosed herein can differentiate between dermatomyositis (DM), and systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), among other autoimmune diseases, including but not limited to mixed connective tissue disease (MCTD), undifferentiated connective tissue disease (UCTD), systemic lupus erythematosus (SLE), polymyositis, and localized scleroderma (morphea) and other autoimmune disorders. Additionally, the methods, devices and systems disclosed herein can distinguish signatures of patients with or without specific internal organ complications, such as interstitial lung disease (ILD), and gastric antral vascular ectasia (GAVE), which are indicative of disease progression, for example, in systemic scleroderma and dermatomyositis.

[00117] The method is predicated on the binding of the complex mixture of antibodies in a sample e.g. blood sample, to an array of peptides. The technology disclosed herein uses arrays of at least thousands of unique peptides designed from chemical sequence space to enable broad surveys of an individual's antibody binding repertoire from a small sample. Different samples comprise different mixtures of antibodies that bind different sets or combinations of array peptides. This differential binding results in specific binding patterns, herein referred to as immunosignatures (IS), that are indicative of the condition of the subject from which the sample was obtained. Typically, an immunosignature characteristic of a condition is determined relative to one or more reference immunosignatures, which are obtained from one or more different sets of reference samples obtained from one or more groups of reference subj ects, each group having a different condition. For example, an immunosignature obtained from a test subject identifies the condition of the test subject when compared to immunosignatures of reference subjects with different conditions that can be induced, for example, by the occurrence of disease, drug treatment, environmental effects, and the like. Accordingly, comparison of immunosignatures from a test subject with those of reference subjects can determine the condition of the test subject. A reference group can be a group of healthy subjects, and the condition is referred to herein as a healthy condition. Healthy subjects are typically those who do not have the condition that is being tested.

[00118] In some embodiments, the method provides a differential diagnosis. Differential diagnosis is a process for removing diagnoses based on the common factors. For example, differential diagnoses distinguish mimic diseases, which are different diseases that present with symptoms that are common to other diseases that the diseases cannot be readily distinguished. These diseases are often called overlap diseases. Consequently, a correct diagnosis for such a disease can take several months or even years to determine. It typically requires a combination of medical history review, multiple physical examinations, numerous lab tests, and often scans. Typically, biomarkers for such diseases are not available, and diagnosis relies on serologic tests whose information can be attributable to other diseases. Differential diagnosis of some autoimmune diseases is particularly difficult to achieve. Examples of mimic diseases that are difficult to diagnose include without limitation autoimmune diseases, e.g. systemic lupus erythematosus, that has overlapping symptoms with rheumatoid arthritis, mixed connective tissue disease, Sjogren's syndrome, Reynaud's syndrome, scleroderma and systemic sclerosis. For example, Systemic Sceroderma (SSc) and dermatomyositis, can present with skin manifestations. The difficulty in diagnosing one of these diseases from other cutaneous and connective tissue disorders makes differential diagnostic guidelines and assays important for making the correct diagnosis.

[00119] In one aspect, a method of the invention is a method of diagnosing or determining the presence or absence of an automimmune disorder in a subject, the method comprising: a.

contacting a peptide array with a first biological sample from an individual patient or subject; b. detecting binding of antibodies in the first biological sample with the peptide array to obtain a first immunosignature profile; c. contacting a peptide array with a control sample derived from one or more individuals with a known autoimmune disorder; d. detecting binding of antibody in the control sample with the peptide array to obtain a second immunosignature profile; e.

comparing the first immunosignature profile to the second immunosignature profile to determine if a patient or subject has an autoimmune disease or disorder.

[00120] In one embodiment, a method is provided for making a differential diagnosis of an autoimmune disease, said method comprising (a) contacting a sample from a subject to an array of peptides comprising at least 10,000 different peptides synthesized in situ; (b) detecting the binding of antibodies present in said sample to at least 25 peptides on said array to obtain a combination of binding signals; and (c) comparing said combination of binding signals to a one or more groups of combinations of reference binding signals, wherein each of said groups of combinations of reference binding signals comprises a combination of binding signals obtained from a plurality of subjects having a different disease, thereby making said differential diagnosis, wherein the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.6. In some embodiments, the different disease is an autoimmune disease. In some embodiments, the diagnosis can be made between scleroderma and dermatomyosistis. In other embodiments, the diagnosis differentiates between SSc and a combination of other autoimmune diseases. For example, the method can differentiate a subject having SSc from a group of reference subjects having different diseases including Mixed Connective Tissue Disease (MCTD), Undifferentiated Connective Tissue Disease (UCTD), myositis, polymyositis, systemic lupus erythematosus, and morphea.

[00121] In another aspect, a method is provided for determining the presence of an

autoimmune disease by comparing the immunosignature obtained from a subject having or suspected of having an autoimmune disease to a combination of reference binding signals obtained from a group of healthy individuals. In some embodiments, the method provided is used to diagnose a subject as having or not having an autoimmune disease, the method comprising: A method of making a diagnosis of an autoimmune disease, said method comprising: (a) contacting a sample from a subject to an array of peptides comprising at least 10,000 different peptides synthesized in situ; (b) detecting the binding of antibodies present in said sample to at least 25 peptides on said array to obtain a combination of binding signals; and (c) comparing said combination of binding signals to a one or more groups of combinations of reference binding signals, wherein each of said groups of combinations of reference binding signals comprises a combination of binding signals obtained from a plurality of healthy subjects, thereby determining the presence or absence of the autoimmune disease in the subject. In some embodiments, the autoimmune disease is SSc. In other embodiments, the autoimmune disease is DM. In some embodiments, the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.6.

[00122] The binding information that characterizes the health condition from a subject sample i.e. test sample, is obtained as a combination of detectable and subsequently quantifiable binding signals that are reflective of the binding of the mixture of antibodies in the sample to a combination of the array peptides. The combination of binding signals of the antibodies in a sample from a test subj ect is compared to one or more combinations of binding signals that are common to groups of reference individuals having known conditions to identify combinations of binding signals that discriminate different health conditions.

Binding Assay

[00123] The IS of a subject is identified as a pattern of binding of antibodies that are bound to the array peptides. The peptide array can be contacted with the sera under any suitable conditions to promote binding of antibodies in the sera to peptides immobilized on the array. Thus, the methods of the invention are not limited by any specific type of binding conditions employed. Such conditions will vary depending on the array being used, the type of substrate, the density of the peptides arrayed on the substrate, desired stringency of the binding interaction, and nature of the competing materials in the binding solution. In a preferred embodiment, the conditions comprise a step to remove unbound antibodies from the addressable array. Determining the need for such a step, and appropriate conditions for such a step, are well within the level of skill in the art.

[00124] Any suitable detection technique can be used in the methods of the invention detecting binding of antibodies in the sera to peptides on the array to generate a disease immune profile; In one embodiment, any type of detectable label can be used to label peptides on the array, including but not limited to radioisotope labels, fluorescent labels, luminescent labels, and electrochemical labels (i.e. : ligand labels with different electrode mid-point potential, where detection comprises detecting electric potential of the label). Alternatively, bound antibodies can be detected, for example, using a detectably labeled secondary antibody.

[00125] Detection of signal from detectable labels is well within the level of skill in the art. For example, fluorescent array readers are well known in the art, as are instruments to record electric potentials on a substrate (For electrochemical detection see, for example, J. Wang (2000) Analytical Electrochemistry, Vol., 2nd ed., Wiley— VCH, New York). Binding interactions can also be detected using other label-free methods such a s SPR and mass spectrometry. SPR can provide a measure if dissociation constants and dissociation rates. The A-100 Biocore/GE instrument, for example, is suitable for this type of analysis. FLEX chips can be used to up to 400 binding reactions on the same support.

[00126] Alternatively, binding interactions between antibodies in a sample and the peptides on an array can be detected in a competition format. A difference in the binding profile of an array to a sample in the presence versus absence of a competitive inhibitor of binding can be useful in characterizing the sample.

Classification Algorithms

[00127] Analyses of the antibody binding signal data i.e. immunosignaturing, and the diagnosis derived therefrom are typically performed using various computer algorithms and programs. The antibody binding pattern produced by the labeled secondary antibody is scanned using, for example, a laser scanner. The images of the binding signals acquired by the scanner can be imported and processed using software such as the GenePix Pro 8 software (Molecular Devices, Santa Clara, CA), to provide tabular information for each peptide, for example, in a continuous value ranging from 0-65,000. Tabular data can be imported and statistical analysis performed using, for example, into Agilent' s GeneSpring 7.3.1 (Agilent, Santa Clara, CA).

[00128] Peptides displaying differential signaling patterns between samples obtained from subjects with different health conditions can be identified using known statistical tests such as a Welch-corrected T -test or ANOVA. For example, patterns of antibody binding to array peptides can be obtained for a set of samples comprising samples from a group of test patients e.g. subjects having a disease, and samples form a group of reference subjects e.g. healthy patients. Binding signal information is compared, and the statistical analyses are applied to select the differentiating peptides that distinguish the two conditions i.e. the test and reference groups at predetermined stringency levels. A list of the most differentiating peptides can be obtained by ranking the peptides according to their p-value. Differentiating peptides can be

* * * 30 29 28 ranked and identified as having /^-values of at least 10 ^" , at least 10 ^" , at least 10 ^" , at least 10 ^{" 27} , at least 10 ^"26 , at least 10 ^"25 , at least 10 ^'24 , at least 10 ^"23 , at least 10 ^"22 , at least 10 ^'21 , at least 10 ^{' 20} , at least 10 ^"19 , at least 10 ^"18 , at least 10 ^'17 , at least 10 ^"16 , at least 10 ^"15 , at least 10 ^'14 , at least 10 ^{' 13} , at least 10 ^"12 , at least 10 ^"11 , at least 10 ^'10 , at least 10 ^"9 , at least 10 ^"8 , at least 10 ^"7 , at least 10 ^"6 , or at least 10 ^"5

[00129] Alternatively, binding signal information of the discriminating peptides selected following statistical analysis can be subsequently imported into a machine learning algorithm to obtain a model that classifies the antibody profile data with the desired accuracy, sensitivity and specificity, and determine presence or absence of disease, severity of disease, disease progression, and other applications described elsewhere herein. A basic classification algorithm, Linear Discriminant Analysis (LDA) is widely used in analyzing biomedical data in order to classify two or more disease classes. LDA can be, for example, a classification algorithm. A more complex classification method, Support Vector Machines (SVM), uses mathematical kernels to separate classes by a hyperplane, projecting the original predictors to higher- dimensional spaces. Some common kernels include linear, polynomial, sigmoid or radial basis functions. A comparative study of common classifiers described in the art is described in (Kukreja et al, BMC Bioinformatics. 2012; 13 : 139). Other algorithms for data analysis and predictive modeling based on data of antibody binding profiles include Bayes Net, Logistic Regression, Simple Logistic, Multilayer Perceptron, KNearest neighbor, K Star, Attribute Selected Classifier (ACS), Classification via clustering, Classification via Regression, Hyper Pipes, Voting Feature Interval Classifier, J48 (Java implementation of C4.5 algorithm), Random Trees, and Random Forest.

[00130] In some embodiments, antibody binding profiles are obtained from a training set of samples, which are used to identify the most discriminative combination of peptides by applying an elimination algorithm based on SVM analysis. The accuracy of the algorithm at various levels of significance can be determined by cross-validation. To generate and evaluate antibody binding profiles of a feasible number of discriminating peptides, multiple models can be built, using a plurality of discriminating peptides to identify the best performing model. In some embodiments, at least 25, at least 50, at least 75, at least 100, at least 200, at least 300, at least 400, at least 500, at least 750, at least 1000, at least 1500, at least 2000, at least 3000, at least 4000, at least 5000, at least 6000, at least 7000, at least 8000, at least 9000, at least 10,000, at least 1 1,000 at least 12,000 at least 13,000 at least 14,000 at least 15,000 at least 16,000 at least 17,000 at least 18,000 at least 1 ,000 at least 20,000 or more differentiating peptides are used to train a specific disease-classifying model. In some embodiments at least 0.00001%, at least .0001%, at least .0005%, at least .001%, at least .005%, at least .01%, at least .05%, at least 0.1%, at least 0.5%, at least 1.0%, at least 2%, at least 3%, at least 4%, at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, or at least 99% of the total number of peptides on the array are differentiating peptides, and the corresponding binding signal information is used to train a specific condition -classifying model. In some embodiments, the signal information obtained for all of the peptides on the array is used to train the condition-specific model.

[00131] Multiple models comprising different numbers of differentiating peptides can be generated, and the performance of each model can be evaluated by a cross-validation process. An SVM classifier can be trained and cross-validated by assigning each sample of a training set of samples to one of a plurality of cross-validation groups. For example, for a four-fold cross- validation, each sample is assigned to one of four cross-validation groups such that each group comprises test and control i.e. reference samples; one of the cross-validation groups e.g. group 1, is held-out, and an SVM classifier model is trained using the samples in groups 2-4. Peptides that discriminate test cases and reference samples in the training group are analyzed and ranked by p— value; the top k peptides are then used as predictors for the SVM model. To elucidate the relationship between the number of input predictors and model performance, and to guard against overfitting, the sub=loop is repeated for a range of k, e.g. 25, 50, 100, 250, 1000, 200, 3000 top peptides or more. Predictions i.e. classification of samples in group 1 are made suing the model generated using groups 2-4. Models for each of the four groups are generated, and the performance (AUC, sensitivity and/or specificity) is calculated using all the predictions from the 4 models using signal binding data from true disease samples. The cross-validation steps are repeated at least 100 times, and the average performance is calculated relative to a confidence interval e.g. 95%. Diagnostic visualization can be generated using e.g. volcano plots, ROC (receiver operating characteristic) curves, and model performance relative to the number of input peptides.

[00132] An optimal model based on antibody binding information to a set of discriminating input peptides (list of the most discriminating peptides, k) is selected and used to predict the disease status of a test set. The performance of different classifiers is determined using a validation set, and using a test set of samples, performance characteristics such as accuracy, sensitivity, specificity, and F-measure are obtained from the model having the greatest performance. Different sets of discriminating peptides are identified to distinguish different conditions. Accordingly, an optimal model based on a set of the most discriminating input peptides is established for each of the health conditions to be determined in patients.

[00133] In some embodiments, the resulting classification performance can be provided as a Radio Operator Characteristic curve (ROC). Specificity, sensitivity, and accuracy metrics of the classification can be determined by the area under the ROC (AUC). In some embodiments, the method determines/classifies the health condition of a subject with a method performance or accuracy characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.60. In other embodiments, the method performance characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater 0.70, greater than 0.80, greater than 0.90, greater than 0.95, method performance characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.97, method performance characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.99. In other embodiments, the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) ranging from 0.60 to 0.70, 0.70 to 0.79, 0.80 to 0.89, or 0.90 to 1.0. In yet other embodiments, method performance is expressed in terms of sensitivity, specificity, predictive values or likelihood ratios (LRs).

[00134] In some embodiments, the method has a sensitivity of at least 60%, for example 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% sensitivity.

[00135] In other embodiments, the method has a specificity of at least 60%, for example 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% specificity.

[00136] Having established an optimal classifier model for a particular health condition or disease, the method is applied to determine the health condition of a subject. A sample is obtained from a subject for whom a diagnosis is desired. The sample is contacted to the array of peptides, and the binding signals resulting from the binding of the antibodies in the subject sample to a plurality of peptides on the array are detected e.g. using a scanner, and are imported into software to compare the binding signal resulting from the binding antibodies in the subject sample to the discriminating peptides previously identified for the optimal classifying model. An overall score that accounts for differences in signals between the discriminating peptides of the model and the binding signals of the corresponding peptides obtained from the sample is provided, and an output indicating presence or absence of disease is given.

[00137] In some embodiments, the condition of a subject is determined relative to that of one or more reference groups with a method performance characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater 0.70, greater than 0.80, greater than 0.90, greater than 0.95, method performance characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.97, method performance characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.99. In other embodiments, the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) ranging from 0.60 to 0.70, 0.70 to 0.79, 0.80 to 0.89, or 0.90 to 1.0. In yet other embodiments, method performance is expressed in terms of sensitivity, specificity, predictive values or likelihood ratios (LRs).

[00138] In some embodiments, the method has a sensitivity of at least 60%, for example 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% sensitivity.

[00139] In other embodiments, the method has a specificity of at least 60%, for example 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% specificity.

[00140] Discriminating peptides can be characterized by enrichment of one or more particular amino acids, and/or by enrichment of one or more sequence motifs. Enrichment of amino acid and motif content is relative to the corresponding total amino acid and motif content of all the peptides in the array library. Enriched motifs were identified from the list of significant peptides unless that list was less than 100 peptides long, in which case the top 500 peptides based on the p-value associated with a Welch's t-test were used. The different n-mers in this list of peptides was compared to the same sized n-mers in the total library to determine if any were enriched. Fold enrichment is calculated by determining the number of times a motif (e.g. ABCD) occurs in the list divided by the number of times the motif (ABCD) occurs in the library. This value is further divided by the relative number of times the motif type (e.g., tetramers) appears in the library (i.e., total number of all tetramers in the list divided by the total number of tetramers in the library). This Fold Enrichment (E) calculation can be represented by:

E=(m/M)/(t/T)

where m is the number of times the motif occurs as part of the discriminating peptide list; M is the total number of times the motif occurs in the library; t is the number of times the motif type appears in the list; and T is the number of times the motif occurs in the library. Fold enrichment can also be reported as Percent enrichment, i.e. , "Enrichment value" multiplied by 100.

[00141] In some embodiments, the discriminating peptides of the immunosignature binding patterns that distinguish a subject with an autoimmune disease from reference healthy subjects in diagnosing or detecting an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different amino acids.

Enrichment of the amino acids can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one amino acid for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, the autoimmune disease is SSc or DM. In some embodiments, discriminating peptides that distinguish SSc from healthy reference subjects are enriched in one or more of tyrosine, lysine, arginine, phenylalanine, serine, tryptophan, glycine, and alanine. In some embodiments, discriminating peptides that distinguish DM from healthy reference subj ects are enriched in one or more of tyrosine, tryptophan, serine, glycine, aspartic acid, and phenylalanine.

[00142] In some embodiments, the discriminating peptides of the immunosignature binding patterns for diagnosing or detecting an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different sequence motifs. Enrichment of the sequence motifs can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one motif for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, the autoimmune disease is SSc or DM. In some embodiments, discriminating peptides that distinguish SSc from healthy reference subjects are enriched in one or more of motifs provided in Figure 5A. In some embodiments, discriminating peptides that distinguish DM from healthy reference subjects are enriched in one or more of motifs provided in Figure 17A.

[00143] In some embodiments, the discriminating peptides of the immunosignature binding patterns for providing a differential diagnosis of autoimmune disease in a subj ect with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different amino acids. Enrichment of the amino acids can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one amino acid for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, the differential diagnosis is made between S Sc and DM. In some embodiments, discriminating peptides that distinguish SSc from DM reference subj ects are enriched in one or more of serine, glycine, tyrosine, arginine, alanine, glutamine and valine.

[00144] In some embodiments, the discriminating peptides of the immunosignature binding patterns for providing a differential diagnosis of autoimmune disease in a subj ect with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different sequence motifs. Enrichment of the sequence motifs can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one motif for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, the autoimmune disease is SSc or DM. In some embodiments, discriminating peptides that distinguish SSc from DM subjects are enriched in one or more of motifs provided in Figure 13 A.

[00145] In some embodiments, differential diagnosis can be made for a subject relative to a group of reference subj ects having a plurality of different autoimmune diseases. In some embodiments, the differential diagnosis is made relative to a group of subjects having other autoimmune diseases comprising Mixed Connective Tissue Disease (MCTD), Undifferentiated Connective Tissue Disease (UCTD), myositis, polymyositis, systemic lupus erythomatosus, and morphea. The discriminating peptides of the immunosignature binding patterns for making a differential diagnosis of an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different amino acids.

Enrichment of the amino acids can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%), or at least 500% in at least one amino acid for the discriminating peptides that identify the autoimmune disease. In preferred embodiments, the autoimmune disease is SSc or DM. Discriminating peptides that distinguish a subject with SSc from reference subjects each having one of a plurality of different diseases are enriched I one or more of aspartic acid, glutamic acid, proline, valine, glycine, and serine.

[00146] Discriminating peptides that distinguish a subject with DM from reference subjects each having one of a plurality of different diseases are enriched I one or more of lysine, histidine, serine, arginine, glutamic acid, alanine, and glycine.

[00147] In some embodiments, the discriminating peptides of the immunosignature binding patterns for providing a differential diagnosis of autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different sequence motifs. Enrichment of the sequence motifs can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one motif for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, the autoimmune disease is SSc or DM. In some embodiments, discriminating peptides that distinguish SSc from the group of reference subjects each having one of a plurality of different autoimmune diseases are enriched in one or more of motifs provided in Figure 7A. In some embodiments, discriminating peptides that distinguish DM from the group of reference subjects each having one of a plurality of different autoimmune diseases are enriched in one or more of motifs provided in Figure 19A.

[00148] Comparison of the disease immune profile to a reference e.g. healthy immune profile and identifying differentially bound peptides can reveal that at least some discriminating peptides bind more antibody in the disease immune profile compared to the reference; and/or peptides that at least some discriminating peptides bind less antibody in the disease immune profile compared to the reference Accordingly, in some embodiments, a method of the invention is a method for diagnosing or detecting an autoimmune disorder, the method comprising: a) contacting a peptide array with a first biological sample from a patient or subject; b) detecting binding of antibodies in the first biological sample with the peptide array to obtain a first immunosignature profile; c) contacting a peptide array with a control sample derived from an individual with a known autoimmune disease or disorder; d) detecting binding of antibody in the control sample with the peptide array to obtain a second immunosignature profile; e) comparing the first immunosignature profile to the second immunosignature profile and identifying differentially bound peptides that either bind less or more antibody in the first immunosignature profile as compared to the second immunosignature profile; and f) determining if the patient or subject has an autoimmune disease or disorder.

[00149] The milder form of scleroderma is generally limited to areas of skin are thick; usually just the fingers and/or face. Every person with scleroderma can have a different pattern of symptoms including calcinosis, which is the deposit of calcium under the ski and tissues, Raynaud's phenomenon, esophageal dysmotility, sclerodactily, and telangiectasias. However, sceroderma can progress to a diffuse disease which involves more areas and thickening of the skin, and can include the skin of the arms, legs, and trunk. The tightened skin makes it difficult to bend fingers, hands, and other joints. There is sometimes inflammation of the joints, tendons and muscles. Tight skin on the face can reduce the size of a person's mouth and make good dental care very important. The skin can lose or gain pigment; making areas of light or dark skin. Some people lose hair on the limbs, sweat less, and develop dry skin because of skin damage. More importantly, diffuse scleroderma can have associated involvement of internal organs such as the gastrointestinal tract, heart, lungs, or kidneys. The degree of organ involvement is highly variable - some get none at all and other patients organs may be badly affected. Discriminating peptides can also distinguish different states reflective of the progression of a disease e.g. an autoimmune disease. For example, progression of SSc can manifest in interstitial lung disease (ILD). In some case, SSc can progress to manifest in gastric antral vascular ectasia (GAVE). In other cases, SSc can progress to involve the kidneys.

Complications relating to ILD and GAVE can also occur in other mimic autoimmune disease e.g. DM.

[00150] In another aspect, a method of the invention is a method of determining the disease state or progression of an automimmune disorder in a subject, the method comprising: a.

contacting a peptide array with a first biological sample from an individual patient or subject with a known autoimmune disorder; b. detecting binding of antibodies in the first biological sample with the peptide array to obtain a first immunosignature profile; c. contacting a peptide array with a control sample derived from one or more individuals with a known stage of an autoimmune disorder; d. detecting binding of antibody in the control sample with the peptide array to obtain a second immunosignature profile; e. comparing the first immunosignature profile to the second immunosignature profile to determine a disease stage or progression of a patient or subject with the autoimmune disease or disorder.

[00151] In some embodiments, the assays, methods and devices provided can determine disease progression in a subject known to have an autoimmune disease. The method comprising: (a) contacting a sample from a subject to an array of peptides comprising at least 10,000 different peptides synthesized in situ; (b) detecting the binding of antibodies present in the sample to at least 25 peptides on said array to obtain a first combination of binding signals; and (c) comparing the first combination of binding signals to at least a second combination of reference binding signals, wherein the second combination of reference binding signals comprises a combination of binding signals obtained from a reference group comprising a plurality of subjects having a clinical manifestation indicative of progression of said autoimmune disease, thereby making said differential diagnosis, wherein the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.6. In some embodiments, disease progression is determined in a subject having SSC accompanied by ILD. In other embodiments, progression is determined in a subject having SSC accompanied by ILD. In yet other embodiments, progression is determined in a subject having DM accompanied by ILD.

[00152] In some embodiments, the discriminating peptides of the immunosignature binding patterns for determining the progression of an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different amino acids. Enrichment of the amino acids can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one amino acid for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, determination of disease progression is made between in subjects with SSc, and the progression is determined in subjects with ILD and/or GAVE. In some embodiments, discriminating peptides that determine disease progression in subjects with SSc and ILD relative to subjects with SSC without ILD are enriched in one or more of proline, arginine, lysine, histidine, and aspartic acid. In other embodiments, discriminating peptides that determine disease progression in subjects with SSc and GAVE relative to subjects with SSC without GAVE are enriched in one or more of arginine, tyrosine, serine, histidine, lysine, and phenylalanine.

[00153] In some embodiments, the discriminating peptides of the immunosignature binding patterns for determining the progression of an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different sequence motifs. Enrichment of the sequence motifs can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one motif for the peptides comprising the immunosignature for the autoimmune disease. In preferred

embodiments, the autoimmune disease is SSc or DM. In preferred embodiments, determination of disease progression is made between in subjects with SSc, and the progression is determined in subjects with ILD and/or GAVE. In some embodiments, discriminating peptides that determine disease progression in subjects with SSc and ILD relative to subjects with SSC without ILD are enriched in one or more of motifs provided in Figure 15 A. In other embodiments, discriminating peptides that determine disease progression in subjects with SSc and GAVE relative to subjects with SSC without GAVE are enriched in one or more of motifs provided in Figure 11 A.

[00154] In some embodiments, the discriminating peptides of the immunosignature binding patterns for determining the progression of an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different amino acids. Enrichment of the amino acids can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one amino acid for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, determination of disease progression is made between in subjects with SSc without renal crisis, and the progression is determined in subjects with SSc having renal crisis. In some

embodiments, discriminating peptides that determine disease progression in subjects with SSc without renal crisis relative to subjects with SSC without renal crisis are enriched in one or more of proline, aspartic acid and glutamic acid.

[00155] In some embodiments, the discriminating peptides of the immunosignature binding patterns for determining the progression of an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different sequence motifs. Enrichment of the sequence motifs can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one motif for the peptides comprising the immunosignature for the autoimmune disease. In preferred

embodiments, determination of disease progression is made between in subjects with SSc without renal crisis, and the progression is determined in subjects with SSc having renal crisis. In some embodiments, discriminating peptides that determine disease progression in subjects with SSc and renal crisis relative to subjects with SSC without renal crisis are enriched in one or more of motifs provided in Figure 9A.

[00156] In some embodiments, the discriminating peptides of the immunosignature binding patterns for determining the progression of an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different amino acids. Enrichment of the amino acids can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one amino acid for the peptides comprising the immunosignature for the autoimmune disease. In preferred embodiments, determination of disease progression is made between in subjects with DM, and the progression is determined in subjects with ILD and/or GAVE. In some embodiments, discriminating peptides that determine disease progression in subjects with DM and ILD relative to subjects with DM without ILD are enriched in one or more of proline, aspartic acid, glutamic acid, serine, glycine, and glutamine.

[00157] In some embodiments, the discriminating peptides of the immunosignature binding patterns for determining the progression of an autoimmune disease in a subject with the methods and arrays disclosed herein are enriched in at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, or at least ten different sequence motifs. Enrichment of the sequence motifs can be by at least 100%, at least 125%, at least 150%, at least 175%, at least 200%, at least 225%, at least 250%, at least 275%, at least 300%, at least 350%, at least 400%, at least 450%, or at least 500% in at least one motif for the peptides comprising the immunosignature for the autoimmune disease. In preferred

embodiments, determination of disease progression is made between in subjects with DM, and the progression is determined in subjects with ILD and/or GAVE. In some embodiments, discriminating peptides that determine disease progression in subjects with DM and ILD relative to subjects with DM without ILD are enriched in one or more of motifs provided in Figure 21 A.

[00158] As described for the method of diagnosing and differentially diagnosing an

autoimmune disease, comparison of the disease immune profile to a reference that reflects a progression of the disease e.g. disease immune profile of a subject having organ involvement, and identifying differentially bound peptides can reveal that at least some discriminating peptides bind more antibody in the disease immune profile compared to the reference; and/or peptides that at least some discriminating peptides bind less antibody in the disease immune profile compared to the reference. In some embodiments, a method of the invention is a method for determining the disease state or progression of an autoimmune disorder, the method comprising: a) contacting a peptide array with a first biological sample from a patient or subject with an autoimmune disease or disorder; b) detecting binding of antibodies in the first biological sample with the peptide array to obtain a first immunosignature profile; c) contacting a peptide array with a control sample derived from an individual with a known stage or state of an autoimmune disease or disorder; d) detecting binding of antibody in the control sample with the peptide array to obtain a second immunosignature profile; e) comparing the first

immunosignature profile to the second immunosignature profile and identifying differentially bound peptides that either bind less or more antibody in the first immunosignature profile as compared to the second immunosignature profile; and f) determining the disease state or progression of the patient or subject with the autoimmune disease or disorder.

Autoimmune diseases

[00159] The assays, methods and devices provided can be utilized to diagnose any autoimmune disease, provide a differential diagnosis of an autoimmune disease relative to other autoimmune diseases, non-autoimmune mimic diseases, as well as other overlap diseases, determine the progression of the autoimmune disease, score the activity of the autoimmune disease, identify candidate targets for evaluation as therapeutics for the treatment of the autoimmune disease, and stratifying patients in clinical trials based on predicted responses to therapy. Non-limiting examples of autoimmune diseases or disorders that can be diagnosed, monitored, prevented, treated, or used for identifying target therapeutics according to the assays, methods and devices provided include: systemic lupus erythematosus (SLE) (e.g., systemic lupus erythematosus, discoid lupus, drug-induced lupus, neonatal lupus), rheumatoid arthritis, Sjogren' s disease, multiple sclerosis (MS), inflammatory bowel disease (IBD) e.g., Crohn's disease, ulcerative colitis, collagenous colitis, lymphocytic colitis, ischemic colitis, diversion colitis, Behcet's syndrome, infective colitis, indeterminate colitisinterstitial cystitis, psoriatic arthritis, scleroderma (SSc), type I diabetes, Addison' s disease, Agammaglobulinemia, Alopecia areata, Amyloidosis, Ankylosing spondylitis, Anti-GBM/Anti-TBM nephritis, Antiphospholipid syndrome (APS), Autoimmune hepatitis, Autoimmune inner ear disease (AIED), Axonal & neuronal neuropathy (AMAN), Behcet's disease, Bullous pemphigoid, Castleman disease (CD), Celiac disease, Chagas disease, Chronic inflammatory demyelinating polyneuropathy (CIDP), Chronic recurrent multifocal osteomyelitis (CRMO), chronic obstructive pulmonary disease (COPD), Churg-Strauss, Cicatricial pemphigoid/benign mucosal pemphigoid, Cogan's syndrome, Cold agglutinin disease, Congenital heart block, Coxsackie myocarditis, CREST syndrome, Crohn' s disease, Dermatitis herpetiformis, Dermatomyositis, Devic's disease (neuromyelitis optica), Discoid lupus, Dressler's syndrome, Endometriosis, Eosinophilic esophagitis (EoE), Eosinophilic fasciitis, Erythema nodosum, Essential mixed cryoglobulinemia, Evans syndrome, Fibromyalgia, Fibrosing alveolitis, Giant cell arteritis (temporal arteritis), Giant cell myocarditis, Glomerulonephritis, Goodpasture' s syndrome, Graft Versus Host Disease (GVHD) e.g. rejection of kidney, lung, liver or heart transplant, Granulomatosis with

Polyangiitis, Graves' disease, Guillain-Barre syndrome, Hashimoto's thyroiditis, Hemolytic anemia, Henoch-Schonlein purpura (HSP), Herpes gestationis or pemphigoid gestationis (PG), Hypogammaglobulinemia, IgA Nephropathy, IgG4-related sclerosing disease, Inclusion body myositis (IBM), Interstitial cystitis (IC), Juvenile arthritis, Juvenile myositis (JM), Kawasaki disease, Lambert-Eaton syndrome, Leukocytoclastic vasculitis, Lichen planus, Lichen sclerosus, Ligneous conjunctivitis, Linear IgA disease (LAD), Lyme disease chronic, Meniere' s disease, Microscopic polyangiitis (MP A), Mixed connective tissue disease (MCTD), Mooren' s ulcer, Mucha-Habermann disease, Myasthenia gravis, Myositis, Narcolepsy, Neuromyelitis optica, Neutropenia, Ocular cicatricial pemphigoid, Optic neuritis, Palindromic rheumatism (PR), PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus), Paraneoplastic cerebellar degeneration (PCD), Paroxysmal nocturnal hemoglobinuria (PNH), Parry Romberg syndrome, Pars planitis (peripheral uveitis), Parsonnage-Turner syndrome, Pemphigus, Peripheral neuropathy, Perivenous encephalomyelitis, Pernicious anemia (PA), POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes), Polyarteritis nodosa, Polymyalgia rheumatica, Polymyositis, Postmyocardial infarction syndrome, Postpericardiotomy syndrome, Primary biliary cirrhosis, Primary sclerosing cholangitis, Progesterone dermatitis, Psoriasis, Pure red cell aplasia (PRCA), Pyoderma angrenosum, Raynaud' s phenomenon, Reactive Arthritis, Reflex sympathetic dystrophy, Reiter' s syndrome, Relapsing polychondritis, Restless legs syndrome (RLS), Retroperitoneal fibrosis, Rheumatic fever, Rheumatoid arthritis (RA), Sarcoidosis, Schmidt syndrome, Scleritis, Sperm & testicular autoimmunity, Stiff person syndrome (SPS), Subacute bacterial endocarditis (SBE), Susac' s syndrome, Sympathetic ophthalmia (SO), Takayasu's arteritis, Temporal arteritis/Giant cell arteritis, Thrombocytopenic purpura (TTP), Tolosa-Hunt syndrome (THS), Transverse myelitis, Ulcerative colitis (UC), Undifferentiated connective tissue disease (UCTD), Uveitis, Vasculitis, Vitiligo, and/or Wegener's granulomatosis (now termed Granulomatosis with Polyangiitis (GPA).

Samples

[00160] The samples that are utilized according to the methods provided can be any biological samples. For example, the biological sample can be a biological liquid sample that comprises antibodies. Suitable biological liquid samples include, but are not limited to blood, plasma, serum, sweat, tears, sputum, urine, stool water, ear flow, lymph, saliva, cerebrospinal fluid, ravages, bone marrow suspension, vaginal flow, transcervical lavage, synovial fluid, aqueous humor, amniotic fluid, cerumen, breast milk, broncheoalveolar lavage fluid, brain fluid, cyst fluid, pleural and peritoneal fluid, pericardial fluid, ascites, milk, pancreatic juice, secretions of the respiratory, intestinal and genitourinary tracts, amniotic fluid, milk, and leukophoresis samples. A biological sample may also include the blastocyl cavity, umbilical cord blood, or maternal circulation which may be of fetal or maternal origin. In some embodiments, the sample is a sample that is easily obtainable by non-invasive procedures e.g. blood, plasma, serum, sweat, tears, sputum, urine, sputum, ear flow, or saliva. In certain embodiments the sample is a peripheral blood sample, or the plasma or serum fractions of a peripheral blood sample. As used herein, the terms "blood," "plasma" and "serum" expressly encompass fractions or processed portions thereof.

[00161] Because of its minimally invasive accessibility and its ready availability, blood is preferred, a human body fluid that is routinely measured and collected in clinical practice. Moreover, blood perfuses all body tissues and its composition is therefore relevant as an indicator of the over-all physiology of an individual. In some embodiments, the biological sample that is used to obtain an immunosignature/ antibody binding profile is a blood sample. In other embodiments, the biological sample is a plasma sample. In yet other embodiments, the biological sample is a serum sample. In yet other embodiments, the biological sample is a dried blood sample. The biological sample may be obtained through a third party, such as a party not performing the analysis of the antibody binding profiles, and/or the party performing the binding assay to the peptide array. For example, the sample may be obtained through a clinician, physician, or other health care manager of a subject from which the sample is derived.

Alternatively, the biological sample may be obtained by the party performing the binding assay of the sample to a peptide array, and/or the same party analyzing the antibody binding profile/IS. Biological samples that are to be assayed, can be archived (e.g., frozen) or otherwise stored in under preservative conditions.

[00162] The term "patient sample" and "subject sample" are used interchangeably herein to refer to a sample e.g. a biological fluid sample, obtained from a patient i.e. a recipient of medical attention, care or treatment. The subject sample can be any of the samples described herein. In certain embodiments, the subject sample is obtained by non-invasive procedures e.g. peripheral blood sample.

[00163] A antibody binding profile of circulating antibodies in a biofluid sample can be obtained according to the methods provided using limited quantities of sample. For example, peptides on the array can be contacted with a fraction of a milliliter of blood to obtain an antibody binding profile comprising a sufficient number of informative peptide-protein complexes to identify the health condition of the subject.

[00164] In some embodiments, the volume of biological sample that is needed to obtain an antibody binding profile is less than 10ml, less than 5ml, less than 3ml, less than 2ml, less than lml, less than 900ul, less than 800ul, less than 700ul, less than 600ul, less than 500ul, less than 400ul, less than 300ul, less than 200ul, less than lOOul, less than 50ul, less than 40ul, less than 30ul, less than 20ul, less than lOul, less than lul, less than 900nl, less than 800nl, less than 700nl, less than 600nl, less than 500nl, less than 400nl, less than 300nl, less than 200nl, less than lOOnl, less than 50nl, less than 40nl, less than 30nl, less than 20nl, less than lOnl, or less than lnl. In some embodiments, the biological fluid sample can be diluted several fold to obtain an antibody binding profile. For example, a biological sample obtained from a subject can be diluted at least by 2-fold, at least by 4-fold, at least by 8-fold, at least by 10-fold, at least by 15- fold, at least by 20-fold, at least by 30-fold, at least by 40-fold, at least by 50-fold, at least by 100-fold, at least by 200-fold, at least by 300-fold, at least by 400-fold, at least by 500-fold, at least by 600-fold, at least by 700-fold, at least by 800-fold, at least by 900-fold, at least by 1000- fold, at least by 5000-fold, or at least by 10,000-fold. Antibodies present in the diluted serum sample, and are considered significant to the health of the subject, because if antibodies remain present even in the diluted serum sample, they must reasonably have been present at relatively high amounts in the blood of the patient.

[00165] An example of detecting a disease in a subject according to the methods described herein is given in the Examples. The examples demonstrate that correct diagnosis of scleroderma was provided using a mere 100 microliters of serum or of plasma.

Identifying candidate target proteins

[00166] The immunosignature obtained can then be used for identifying candidate therapeutic targets and developing treatments for the individual against the identified autoimmune disorder according to the methods and devices disclosed herein. In another aspect, the differential binding of antibodies in samples from subjects having two or more different health conditions identifies discriminating peptides on the array can be analyzed, for example, by comparing the sequence of one or more discriminating peptides that distinguish between two or more health conditions in the array sequences in a protein database to identify a candidate target protein. In some embodiments, splaying the antibody repertoire out on an array of peptides

(immunosignaturing, IMS) and comparing samples from diseased subjects to samples from healthy reference subjects or subjects with other diseases or conditions, the discriminating peptides can be identified to reveal the proteins recognized i.e. bound by the antibodies. For example, the peptides can be identified with informatics methods.

[00167] In cases where the informatics cannot identify a putative match, such as in the case of discontinuous epitopes, the informative peptide can be used as an affinity reagent to purify reactive antibody. Purified antibody can then be used in standard immunological techniques to identify the target.

[00168] Having diagnosed a condition, the appropriate reference proteome can be queried to relate the sequences of the discriminating peptides bound by the antibodies in a sample.

Reference proteomes have been selected among all proteomes (manually and algorithmically, according to a number of criteria) to provide broad coverage of the tree of life. Reference proteomes constitute a representative cross-section of the taxonomic diversity to be found within UniProtKB at http://www.uniprot.org/proteomes/?query=reference:yes Reference proteomes include the proteomes of well-studied model organisms and other proteomes of interest for biomedical and biotechnological research. Species of particular importance may be represented by numerous reference proteomes for specific ecotypes or strains of interest. Examples of proteomes that can be queried include without limitation the human proteome, and proteomes from other mammals, non-mammal animals, viruses, bacteria and protozoan parasites.

Additionally, other compilations of proteins that can be queried include without limitation lists of disease-relevant proteins, lists of proteins containing known or unknown mutations (including single nucleotide polymorphisms, insertions, substitutions and deletions), lists of proteins consisting of known and unknown splice variants, or lists of peptides or proteins from a combinatorial library (including natural and unnatural amino acids). In some embodiments, the proteome that can be queried using discriminating peptides include without limitation the human proteome RefSeq release 84, corresponding to human genome build GrCh38

(https://www.ncbi.nlm.nih.gov/refseq/), compiled March 10, 2016, using the longest transcript variant for each unique gene ID.

[00169] Software for aligning single and multiple proteins to proteins in a proteome or protein list include without limitation BLAST, CS-BLAST, CUDAWS++, DIAMOND, FASTA, GGSEARCH (GG or GL), Genoogle, HMMER, H-suite, IDF, KLAST, MMseqs2, USEARCH, OSWALD, Parasail, PSI-BLAST, PSI Protein, Sequilab, SAM, S SEARCH, SWAPHI, SWIVIM, and SWIPE.

[00170] Alternatively, sequence motifs that are enriched in the discriminating peptides relative to the motifs found in the entire peptide library on the array can be aligned to a full-length protein or protein fragment in a proteome to identify target proteins that can be validated as possible therapeutic targets for the treatment of the condition. Discriminating peptides are aligned to the longest available transcript in the proteome database. Online databases and search tools for identifying protein domains, families and functional sites are available e.g. Prosite at ExPASy, Motif Scan (MyHits, SIB, Switzerland), Interpro 5, MOTIF (GenomeNet, Japan), and Pfam (EMBL-EBI).

[00171] In some embodiments, the alignment method can be any method for mapping amino acids of a query sequence onto a longer protein sequence, including BLAST (Altschul, S.F. & Gish, W. [1996] "Local alignment statistics." Meth. Enzymol. 266:460-480), the use of compositional substitution and scoring matrices, exact matching with and without gaps, epitope prediction, antigenicity prediction, hydrophobicity prediction, surface accessibility prediction. For each approach, a canonical or modified scoring system can be used, with the modified scoring system optimized to correct for biases in the peptide library composition. In some embodiments, a modified BLAST alignment is used, requiring a seed of 3 amino acids with a gap penalty of 4, with a scoring matrix of BLOSUM62 (Henikoff, J.G. Amino acid substitution matrices from protein blocks. Proc. Natl. Acad. Sci. USA 89, 10915-10919 [1992]) modified to reflect the amino composition of the array (States, D.J., Gish, W., Altschul, S.F. [1991] "Improved sensitivity of nucleic acid database searches using application-specific scoring matrices. " Methods 3 :66-70.) The number of seed amino acids and gap penalties are easily discerned by one of skill in the art. These modifications can include increasing the score of degenerate substitutions, remove penalties for amino acids absent from the array and score all exact matches equally.

[00172] The discriminating peptides that can be used to identify candidate biomarker proteins according to the method provided, are chosen according to their ability to distinguish between two or more different health conditions. Accordingly, discriminating peptides can be chosen at a predetermined statistical stringency, e.g. by p-value, for the probability of discriminating between two or more conditions; by differences in the relative binding signal intensity changes between two or more conditions; by their intensity rank in a single condition; by their coefficients in a machine learning model trained against two or more conditions e.g. the AUC, or by their correlation with one or more study parameters.

[00173] The method provided for identifying candidate protein biomarkers utilizes the homology between the discriminating peptides and proteins of a proteome or other protein list, while correcting for the potential oversampling from lists comprising larger peptides relative to lists.

[00174] The query peptides are the discriminating peptides capable of distinguishing two or more different health conditions to be aligned can be chosen based on their p-value for discrimination between two or more conditions, their relative intensity changes between two or more conditions, by their intensity rank in a single condition, by their coefficients in a machine learning model trained against two or more conditions, or by their correlation with one or more study parameters.

[00175] Having identified the set of discriminating peptides and the proteome or protein list to be queried, all the discriminating peptides are aligned with the longest available protein transcript in the proteome or protein list, and peptides having a positive BLAST score are identified. For each of the proteins to which discriminating peptides are aligned, the scores for the BLAST-positive peptides in the alignment are assembled into a matrix e.g. modified BLOSUM62. These modifications can include increasing the score of degenerate substitutions, remove penalties for amino acids absent from the array and score all exact matches equally.

[00176] Each row of the matrix corresponds to an aligned peptide and each column corresponds to one of the consecutive amino acids that comprise this protein, with gaps and deletions allowed within the peptide rows to allow for alignment to the protein.

[00177] Using the modified BLAST scoring matrix described above, each position in the matrix receives the score for paired amino acids of the peptide and protein in that column. Then, for each amino acid in the protein, the corresponding column is summed to create an "overlap score" that represents coverage of that amino acid by the ImmunoSignature discriminating peptides. [00178] The amino acid overlap score, s, is a corrected score of the representation of amino acids in the discriminating peptides that accounts for the composition of the library. For example, peptides on an array can exclude one or more of the 20 natural amino acids.

Therefore, the overlap score accounts for the amino acid content in the library. To correct this score for library composition, an overlap score is calculated by the same method for a list of all array peptides. This allows for the calculation of an overlap score, s, at each amino acid via the equation

s=a-(b/d)*c

where a is the overlap score from the ImmunoSignature peptides, b is the number of

ImmunoSignature peptides, c is the overlap score for the full array of peptide and d is the number of peptides on the full array.

[00179] Next, the amino acid overlap score obtained from the alignment of each of the discriminating peptides is converted to a protein score, S. To convert these scores at the amino acid level, s, to a full-protein statistic, S, the sum of scores for every possible tiling n-mer epitope within a protein is calculated, and the final score is the maximum along windows of, e.g., 20 mer..

[00180] Ranking of the identified candidate biomarkers is made relative to the ranking of randomly chosen non-discriminating peptides. Accordingly, an overlap score for nondiscriminating peptides (non-discriminating 's' score) that align to each of one or more proteins of a same proteome or protein list is obtained as described for the discriminating peptides. The non-discriminating 's' score is then converted to a non-discriminating protein ' S' score for each of a plurality of randomly chosen non-discriminating peptides. For example, non-discriminating protein ' S' scores can be obtained for at least 25, at least 50, at least 100, or more randomly- chosen non-discriminating peptides.

[00181] The protein biomarkers identified are then ranked relative to the proteins identified by alignment of non-discriminating peptides.

[00182] In some embodiments, a method is provided for identifying a candidate target protein for the treatment of an autoimmune disease in a human subject, the method comprising: (a) identifying a set of discriminating peptides that differentiate the autoimmune disease from one or more different autoimmune diseases; (b) aligning the set of peptides to proteins in a human proteome; (c) identifying regions of homology between each peptide in the set to a region of an immunogenic protein; and (d) identifying the protein as a candidate target protein for treating said autoimmune disease. The method can further comprise identifying a set of discriminating peptides that differentiate the autoimmune disease from a healthy condition. Example 3 illustrates a method for identifying candidate target proteins using differentiating peptides that distinguish samples form healthy subjects from samples from subjects having SSc. A list of candidate protein targets is provided in Table 3. Similarly, candidate protein targets can be identified using differentiating peptides that distinguish samples from subjects having other autoimmune diseases from samples from healthy subjects, samples from subjects having other autoimmune diseases, and samples from subjects having mimic or other overlap diseases, which may or may not be autoimmune.

[00183] In some embodiments, a method for identifying a candidate protein biomarker for an autoimmune disease in a human subject, the method comprising: (a) identifying a set of discriminating peptides that differentiate said autoimmune disease from one or more different health conditions; (b) aligning the set of discriminating peptides to proteins in a proteome to obtain an alignment score for said set of discriminating peptides to one or more proteins of said proteome; ranking the identified proteins according to a statistical significance; and identifying the protein as a candidate protein biomarker for said autoimmune disease. In some

embodiments, the method further comprises obtaining an overlap score, wherein the overlap score corrects for the peptide composition of the peptide library. In some embodiments, the discriminating peptides used in the method are identified as having /^-values of less than 10 ^"5 , less than 10 ^"6 , less than 10 ^'7 , less than 10 ^"8 , less than 10 ^'9 , less than 10 ^"10 , less than 10 ^"11 , less than 10 ^'12 , less than 10 ^"13 , less than 10 ^"14 , or less than 10 ^"15 .

[00184] In some embodiments, the method further comprises identifying a set of discriminating peptides that differentiate the autoimmune disease from a healthy condition. In other embodiments, the method comprises identifying peptides that differentiate disease progression, In some embodiments, the differentiating peptides distinguish from subjects having SSc and organ involvement form subjects having SSc without organ involvement. Thus, the candidate biomarkers can serve to diagnose a disease, to identifying a stage of disease progression. The biomarkers can also be used in the monitoring of disease. Examples of candidate biomarkers identified for scleroderma are listed in Table 3. In some embodiments, the candidate biomarker proteins identified according to the method are ranked according to a /rvalue of less than less than 10 ^'3 , less than less than 10 ^'4 , less than less than 10 ^"5 , or less than less than 10 ^'6 .

[00185] Alternatively, discriminating peptides identified according to the methods provided, can identify candidate target proteins using sequence motifs that are enriched in the most discriminating peptides that distinguish two different conditions. In one embodiment, the method for identifying a candidate target for the treatment of an autoimmune disease in a human subject comprises (a) obtaining a set of discriminating peptides that differentiate the autoimmune disease from one or more different autoimmune diseases; (b) identifying a set of motifs for said discriminating peptides; (c) aligning the set of motifs to a human proteome; (d) identifying regions of homology between each motif in the set to a region of an immunogenic protein; and (e) identifying the protein as a candidate target for treating said autoimmune disease. The method can further comprise identifying a set of discriminating peptides that differentiate the autoimmune disease from a healthy condition. Motifs that are enriched in the most discriminating peptides that can be used to identify candidate target proteins for development and use in treating various autoimmune diseases, some at different stages of progression are provided in Figures 5, 7, 9, 1 1, 13, 15, 17, 19, and 21.

[00186] In some embodiments, the step of identifying the autoimmune disease in the sample from a subject comprises (i) contacting a sample from the subject to an array of peptides comprising at least 10,000 different peptides synthesized in situ; (ii) detecting the binding of antibodies present in the sample to at least 25 peptides on said array to obtain a combination of binding signals; and (iii) comparing the combination of binding signals to a one or more groups of combinations of reference binding signals, wherein each of said groups of combinations of reference binding signals comprises a combination of binding signals obtained from a plurality of subjects having a different autoimmune disease. In some embodiments, the combination of binding signals from the subject is compared to a combination of binding signals obtained from one or more healthy reference subjects.

[00187] The discriminating peptides can also serve as a basis for the design of drugs that inhibit or activate the target protein-protein interactions. In another aspect, therapeutic and diagnostic uses for the novel discriminating peptides identified by the methods of the invention are provided. Aspects and embodiments thus include formulations, medicaments and

pharmaceutical compositions comprising the peptides and derivatives thereof according to the invention. In some embodiments, a novel discriminating peptide or its derivative is provided for use in medicine. More specifically, for use in antagonising or agonising the function of a target ligand, such as a cell-surface receptor. The discriminating peptides of the invention may be used in the treatment of various diseases and conditions of the human or animal body, such as cancer, and degenerative diseases. Treatment may also include preventative as well as therapeutic treatments and alleviation of a disease or condition.

[00188] Accordingly, the methods, systems and array devices disclosed herein are capable of screening, identifying therapeutic targets, identifying vaccine targets, and/or treating a disease and/or condition at an early stage of the disease and/or condition. For example, the methods, systems and array devices disclosed herein are capable of detecting, diagnosing and monitoring a disease and/or condition days or weeks before traditional biomarker-based assays. Moreover, only one array, i.e., one immunosignature assay, is needed to detect, diagnose and monitor a wide spectra of diseases and conditions, including inflammatory conditions, autoimmune diseases, cancer and pathogenic infections.

[00189] Candidate therapeutic targets can be identified according to the method provided for any one of the autoimmune diseases recited elsewhere herein. In some embodiments, the candidate therapeutic targets can be identified for validation and subsequent treatment of SSc. Exemplary therapeutic candidates for the treatment of SSc are provided in Table 3.

Disease scoring systems

The differential binding activity or signatures, also referred to as "immunosignatures" (IS), obtained by the methods, devices and assays disclosed herein may also correlate with known disease scoring systems. For example the immunosignature binding patterns obtained with the methods and arrays disclosed have an area under the receiver operator characteristic (ROC) curve (AUC) of at least 0.6, at least 0.65, at least 0.7, at least 0.75, at least 0.8, at least 0.85, at least 0.9, at least 0.95, at least 0.97, at least 0.99 or at least 1.0 when compared to patients analyzed and diagnosed with an autoimmune disease or disorder when compared to a known immune-mediated disease scoring system, including clinical and laboratory scoring systems developed for SSc and DM. For example, binding signal data for discriminating peptides can be used to provide a score for the activity of an autoimmune disease. The score can correlate with an existing scoring system. For example, the score obtained for SSc according to the assay, method and devices provided can correlate with The Modified Rodnan Skin Score for scleroderma, the Medsger Severity Scale (Clin Exper Rheumatol 21 : S42-S46 [2003]), and CT scoring systems (Assayag et al, [2012] High Resolution Computed Tomography Scoring Systems for Evaluating Interstitial Lung Disease in Systemic Sclerosis Patients. Rheumatology S l :003. doi: 10.4172/2161-1 149.S 1-0030).

[00190] As disclosed herein, the AUC may be interpreted as the probability that a patient with active disease according to the known scoring system would have a higher value associated with the immunosignatures binding pattern than a patient with inactive or without disease according to the known scoring system.

Treatments and Conditions

[00191] The methods and arrays of the invention provide methods, assays and devices for the detection and diagnosis of an autoimmune disorder. Any one of the autoimmune disorders listed elsewhere herein can be detected and diagnosed. The methods and arrays of the embodiments disclosed herein can be used, for example, for screening of an immune disorder in a subject. A subject can be a human, a guinea pig, a dog, a cat, a horse, a mouse, a rabbit, and various other animals. A subject can be of any age, for example, a subject can be an infant, a toddler, a child, a pre-adolescent, an adolescent, an adult, or an elderly individual.

[00192] A condition of a subject can correspond to a disease or a healthy condition. In some embodiments, a condition of a subject is a healthy condition, and a method of the invention monitors the healthy condition. In some embodiments, a condition of a subject is a disease condition, and a method of the invention is used to diagnose/monitor a state and/or the progression of the condition. A method of the invention can also be used in the prevention of a condition. In some embodiments, a method of the invention is used in conjunction with a prophylactic treatment.

[00193] The arrays and methods of the invention can be used by a user. A plurality of users can use a method of the invention to identify and/or provide a treatment of a condition. A user can be, for example, a human who wishes to monitor one's own health. A user can be, for example, a health care provider. A health care provider can be, for example, a physician. In some embodiments, the user is a health care provider attending the subject. Non-limiting examples of physicians and health care providers that can be users of the invention can include, an anesthesiologist, a bariatric surgery specialist, a blood banking transfusion medicine specialist, a cardiac electrophysiologist, a cardiac surgeon, a cardiologist, a certified nursing assistant, a clinical cardiac electrophysiology specialist, a clinical neurophysiology specialist, a clinical nurse specialist, a colorectal surgeon, a critical care medicine specialist, a critical care surgery specialist, a dental hygienist, a dentist, a dermatologist, an emergency medical technician, an emergency medicine physician, a gastrointestinal surgeon, a hematologist, a hospice care and palliative medicine specialist, a homeopathic specialist, an infectious disease specialist, an internist, a maxillofacial surgeon, a medical assistant, a medical examiner, a medical geneticist, a medical oncologist, a midwife, a neonatal-perinatal specialist, a nephrologist, a neurologist, a neurosurgeon, a nuclear medicine specialist, a nurse, a nurse practioner, an obstetrician, an oncologist, an oral surgeon, an orthodontist, an orthopedic specialist, a pain management specialist, a pathologist, a pediatrician, a perfusionist, a periodontist, a plastic surgeon, a podiatrist, a proctologist, a prosthetic specialist, a psychiatrist, a pulmonologist, a radiologist, a surgeon, a thoracic specialist, a transplant specialist, a vascular specialist, a vascular surgeon, and a veterinarian. A diagnosis identified with an array and a method of the invention can be incorporated into a subject' s medical record.

Array platform

[00194] In some embodiments, disclosed herein are methods and process that provide for array platforms that allow for increased diversity and fidelity of chemical library synthesis. The array platforms comprises a plurality of individual features on the surface of the array. Each feature typically comprises a plurality of individual molecules synthesized in situ on the surface of the array, wherein the molecules are identical within a feature, but the sequence or identity of the molecules differ between features. The array molecules include, but are not limited to nucleic acids (including DNA, RNA, nucleosides, nucleotides, structure analogs or combinations thereof), peptides, peptide-mimetics, and combinations thereof and the like, wherein the array molecules may comprise natural or non-natural monomers within the molecules. Such array molecules include the synthesis of large synthetic peptide arrays. In some embodiments, a molecule in an array is a mimotope, a molecule that mimics the structure of an epitope and is able to bind an epitope-elicited antibody. In some embodiments, a molecule in the array is a paratope or a paratope mimetic, comprising a site in the variable region of an antibody (or T cell receptor) that binds to an epitope an antigen. In some embodiments, an array of the invention is a peptide array comprising random, pseudo-random or maximally diverse peptide sequences.

[00195] The peptide arrays can include control sequences that match epitopes of well characterized monoclonal antibodies (mAbs). Binding patterns to control sequences and to library peptides can be measured to qualify the arrays and the immunosignaturing assay process. mAbs with known epitopes e.g. 4C1, p53Abl, p53Ab8 and LnKB2, can be assayed at different doses. Additionally, inter wafer signal precision can be determined by testing sample replicates e.g. plasma samples, on arrays from different wafers and calculating the coefficients of variation (CV) for all library peptides. Precision of the measurements of binding signals can be determined as an aggregate of the inter-array, inter-slide, inter-wafer and inter-day variations made on arrays synthesized on wafers of the same batch (within wafer batches). Additionally, precision of measurements can be determined for arrays on wafers of different batches (between wafer batches). In some embodiments, measurements of binding signals can be made within and/or between wafer batches with a precision varying less than 5%, less than 10%, less than 15%, less than 20%, less than 25%, or less than 30%.

[00196] The technologies disclosed herein include a photolithographic array synthesis platform that merges semiconductor manufacturing processes and combinatorial chemical synthesis to produce array-based libraries on silicon wafers. By utilizing the tremendous advancements in photolithographic feature patterning, the array synthesis platform is highly-scalable and capable of producing combinatorial chemical libraries with 40 million features on an 8-inch wafer. Photolithographic array synthesis is performed using semiconductor wafer production equipment in a class 10,000 cleanroom to achieve high reproducibility. When the wafer is diced into standard microscope slide dimensions, each slide contains more than 3 million distinct chemical entities. [00197] In some embodiments, arrays with chemical libraries produced by photolithographic technologies disclosed herein are used for immune-based diagnostic assays, for example called immunosignature assays. Using a patient's antibody repertoire from a drop of blood bound to the arrays, a fluorescence binding profile image of the bound array provides sufficient information to classify disease vs. healthy.

[00198] In some embodiments, immunosignature assays are being developed for clinical application to diagnose/monitor autoimmune diseases and to assess response to autoimmune treatments. Exemplary embodiments of immunosignature assays is described in detail in US Pre- Grant Publication No. 2012/0190574, entitled "Compound Arrays for Sample Profiling" and US Pre-Grant Publication No. 2014/0087963, entitled "Immunosignaturing: A Path to Early Diagnosis and Health Monitoring", both of which are incorporated by reference herein for such disclosure. The arrays developed herein incorporate analytical measurement capability within each synthesized array using orthogonal analytical methods including ellipsometry, mass spectrometry and fluorescence. These measurements enable longitudinal qualitative and quantitative assessment of array synthesis performance.

[00199] In some embodiments, detection of antibody binding on a peptide array poses some challenges that can be addressed by the technologies disclosed herein. Accordingly, in some embodiments, the arrays and methods disclosed herein utilize specific coatings and functional group densities on the surface of the array that can tune the desired properties necessary for performing immunosignature assays. For example, non-specific antibody binding on a peptide array may be minimized by coating the silicon surface with a moderately hydrophilic monolayer polyethylene glycol (PEG), polyvinyl alcohol, carboxymethyl dextran, and combinations thereof. In some embodiments, the hydrophilic monolayer is homogeneous. Second, synthesized peptides are linked to the silicon surface using a spacer that moves the peptide away from the surface so that the peptide is presented to the antibody in an unhindered orientation.

Detector device

[0010] In some embodiments, the systems, platforms and methods disclosed herein include a detector device for detecting binding on the array formats disclosed herein, including antibody binding on the peptide arrays disclosed herein. In some embodiments, used in conjunction with optical detection methods (ccd, pmt, other optical detector, optical filters and other optical detection deivces), detection of antibody binding is reported via optical detection in real-time or on a timed interval. In certain instances, quantification of final binding activity is reported via optical detection converted to AFU (arbitrary fluorescence units) or translated to electrical signal via impedance measurement or other electrochemical sensing. In other instances, antibody binding is detected by an emission or absorption of light or electromagnetic energy, either in the visible range or otherwise from an optically-detectable label on a probe applied to the peptide device. Optically detectable labels include, without limitation, fluorescent, chemiluminescent, electrochemiluminescent, luminescent, phosphorescent, fluorescence polarization, and charge labels. In some instances, a fluorescently labeled probe is active only in the presence of a specific target or antibody so that a fluorescent response from a sample signifies the presence of the target or antibody.

[00200] In some instances, light delivery schemes are utilized to provide the optical excitation and/or emission and/or detection of antibody binding. In certain embodiments, this includes using the flow cell materials (thermal polymers like acrylic (PMMA) cyclic olefin polymer (COP), cyclic olefin co-polymer, (COC), etc.) as optical wave guides to remove the need to use external components. In addition, in some instances light sources - light emitting diodes - LEDs, vertical-cavity surface-emitting lasers - VCSELs, and other lighting schemes are integrated directly inside the cartridge or detection device or built directly onto the peptide array surface to have internally controlled and powered light sources. PMTs, CCDs, or CMOS detectors can also be built into the detection device or cartridge.

Digital processing device

[00201] In some embodiments, the systems, platforms, software, networks, and methods described herein include a digital processing device, or use of the same. In further embodiments, the digital processing device includes one or more hardware central processing units (CPUs), i.e., processors that carry out the device's functions. In still further embodiments, the digital processing device further comprises an operating system configured to perform executable instructions. In some embodiments, the digital processing device is optionally connected a computer network. In further embodiments, the digital processing device is optionally connected to the Internet such that it accesses the World Wide Web. In still further embodiments, the digital processing device is optionally connected to a cloud computing infrastructure. In other embodiments, the digital processing device is optionally connected to an intranet. In other embodiments, the digital processing device is optionally connected to a data storage device.

[00202] In accordance with the description herein, suitable digital processing devices include, by way of non-limiting examples, server computers, desktop computers, laptop computers, notebook computers, sub-notebook computers, netbook computers, netpad computers, set-top computers, handheld computers, Internet appliances, mobile smartphones, tablet computers, personal digital assistants, video game consoles, and vehicles. Those of skill in the art will recognize that many smartphones are suitable for use in the system described herein. Those of skill in the art will also recognize that select televisions, video players, and digital music players with optional computer network connectivity are suitable for use in the system described herein. Suitable tablet computers include those with booklet, slate, and convertible configurations, known to those of skill in the art.

[00203] In some embodiments, a digital processing device includes an operating system configured to perform executable instructions. The operating system is, for example, software, including programs and data, which manages the device' s hardware and provides services for execution of applications. Those of skill in the art will recognize that suitable server operating systems include, by way of non- limiting examples, FreeBSD, OpenBSD, NetBSD ^® , Linux, Apple ^® Mac OS X Server ^® , Oracle ^® Solaris ^® , Windows Server ^® , and Novell ^® NetWare ^® . Those of skill in the art will recognize that suitable personal computer operating systems include, by way of non-limiting examples, Microsoft ^® Windows ^® , Apple ^® Mac OS X ^® , UNIX ^® and UNIX- like operating systems such as GNU/Linux ^® . In some embodiments, the operating system is provided by cloud computing. Those of skill in the art will also recognize that suitable mobile smart phone operating systems include, by way of non-limiting examples, Nokia ^® Symbian ^® OS, Apple ^® iOS ^® , Research In Motion ^® BlackBerry OS ^® , Google ^® Android ^® , Microsoft ^® Windows Phone ^® OS, Microsoft ^® Windows Mobile ^® OS, Linux ^® , and Palm ^® WebOS ^® .

[00204] In some embodiments, a digital processing device includes a storage and/or memory device. The storage and/or memory device is one or more physical apparatuses used to store data or programs on a temporary or permanent basis. In some embodiments, the device is volatile memory and requires power to maintain stored information. In some embodiments, the device is non-volatile memory and retains stored information when the digital processing device is not powered. In further embodiments, the non-volatile memory comprises flash memory. In some embodiments, the non-volatile memory comprises dynamic random-access memory (DRAM). In some embodiments, the non-volatile memory comprises ferroelectric random access memory (FRAM). In some embodiments, the non-volatile memory comprises phase-change random access memory (PRAM). In other embodiments, the device is a storage device including, by way of non-limiting examples, CD-ROMs, DVDs, flash memory devices, magnetic disk drives, magnetic tapes drives, optical disk drives, and cloud computing based storage. In further embodiments, the storage and/or memory device is a combination of devices such as those disclosed herein.

[00205] In some embodiments, a digital processing device includes a display to send visual information to a user. In some embodiments, the display is a cathode ray tube (CRT). In some embodiments, the display is a liquid crystal display (LCD). In further embodiments, the display is a thin film transistor liquid crystal display (TFT-LCD). In some embodiments, the display is an organic light emitting diode (OLED) display. In various further embodiments, on OLED display is a passive-matrix OLED (PMOLED) or active-matrix OLED (AMOLED) display. In some embodiments, the display is a plasma display. In other embodiments, the display is a video projector. In still further embodiments, the display is a combination of devices such as those disclosed herein.

[00206] In some embodiments, a digital processing device includes an input device to receive information from a user. In some embodiments, the input device is a keyboard. In some embodiments, the input device is a pointing device including, by way of non-limiting examples, a mouse, trackball, track pad, joystick, game controller, or stylus. In some embodiments, the input device is a touch screen or a multi-touch screen. In other embodiments, the input device is a microphone to capture voice or other sound input. In other embodiments, the input device is a video camera to capture motion or visual input. In still further embodiments, the input device is a combination of devices such as those disclosed herein.

[00207] In some embodiments, a digital processing device includes a digital camera. In some embodiments, a digital camera captures digital images. In some embodiments, the digital camera is an autofocus camera. In some embodiments, a digital camera is a charge-coupled device (CCD) camera. In further embodiments, a digital camera is a CCD video camera. In other embodiments, a digital camera is a complementary metal-oxide-semiconductor (CMOS) camera. In some embodiments, a digital camera captures still images. In other embodiments, a digital camera captures video images. In various embodiments, suitable digital cameras include 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, and higher megapixel cameras, including increments therein. In some embodiments, a digital camera is a standard definition camera. In other embodiments, a digital camera is an HD video camera. In further embodiments, an HD video camera captures images with at least about 1280 x about 720 pixels or at least about 1920 x about 1080 pixels. In some embodiments, a digital camera captures color digital images. In other embodiments, a digital camera captures grayscale digital images. In various embodiments, digital images are stored in any suitable digital image format. Suitable digital image formats include, by way of non-limiting examples, Joint

Photographic Experts Group (JPEG), JPEG 2000, Exchangeable image file format (Exit), Tagged Image File Format (TIFF), RAW, Portable Network Graphics (PNG), Graphics

Interchange Format (GIF), Windows ^® bitmap (BMP), portable pixmap (PPM), portable graymap (PGM), portable bitmap file format (PBM), and WebP. In various embodiments, digital images are stored in any suitable digital video format. Suitable digital video formats include, by way of non-limiting examples, AVI, MPEG, Apple ^® QuickTime ^® , MP4, AVCHD ^® , Windows Media ^® , DivX™, Flash Video, Ogg Theora, WebM, and RealMedia. Non-transitory computer readable storage medium

[00208] In some embodiments, the systems, platforms, software, networks, and methods disclosed herein include one or more non-transitory computer readable storage media encoded with a program including instructions executable by the operating system of an optionally networked digital processing device. In further embodiments, a computer readable storage medium is a tangible component of a digital processing device. In still further embodiments, a computer readable storage medium is optionally removable from a digital processing device. In some embodiments, a computer readable storage medium includes, by way of non-limiting examples, CD-ROMs, DVDs, flash memory devices, solid state memory, magnetic disk drives, magnetic tape drives, optical disk drives, cloud computing systems and services, and the like. In some cases, the program and instructions are permanently, substantially permanently, semipermanently, or non-transitorily encoded on the media.

Computer program

[00209] In some embodiments, the systems, platforms, software, networks, and methods disclosed herein include at least one computer program. A computer program includes a sequence of instructions, executable in the digital processing device's CPU, written to perform a specified task. In light of the disclosure provided herein, those of skill in the art will recognize that a computer program may be written in various versions of various languages. In some embodiments, a computer program comprises one sequence of instructions. In some

embodiments, a computer program comprises a plurality of sequences of instructions. In some embodiments, a computer program is provided from one location. In other embodiments, a computer program is provided from a plurality of locations. In various embodiments, a computer program includes one or more software modules. In various embodiments, a computer program includes, in part or in whole, one or more web applications, one or more mobile applications, one or more standalone applications, one or more web browser plug-ins, extensions, add-ins, or add-ons, or combinations thereof.

Web application

[00210] In some embodiments, a computer program includes a web application. In light of the disclosure provided herein, those of skill in the art will recognize that a web application, in various embodiments, utilizes one or more software frameworks and one or more database systems. In some embodiments, a web application is created upon a software framework such as Microsoft ^® .NET or Ruby on Rails (RoR). In some embodiments, a web application utilizes one or more database systems including, by way of non-limiting examples, relational, non-relational, object oriented, associative, and XML database systems. In further embodiments, suitable relational database systems include, by way of non-limiting examples, Microsoft SQL Server, mySQL™, and Oracle ^® . Those of skill in the art will also recognize that a web application, in various embodiments, is written in one or more versions of one or more languages. A web application may be written in one or more markup languages, presentation definition languages, client-side scripting languages, server-side coding languages, database query languages, or combinations thereof. In some embodiments, a web application is written to some extent in a markup language such as Hypertext Markup Language (HTML), Extensible Hypertext Markup Language (XHTML), or extensible Markup Language (XML). In some embodiments, a web application is written to some extent in a presentation definition language such as Cascading Style Sheets (CSS). In some embodiments, a web application is written to some extent in a client-side scripting language such as Asynchronous Javascript and XML (AJAX), Flash ^® Actionscript, Javascript, or Silverlight ^® . In some embodiments, a web application is written to some extent in a server-side coding language such as Active Server Pages (ASP), ColdFusion ^® , Perl, Java™, JavaServer Pages (JSP), Hypertext Preprocessor (PHP), Python™, Ruby, Tel, Smalltalk, WebDNA ^® , or Groovy. In some embodiments, a web application is written to some extent in a database query language such as Structured Query Language (SQL). In some embodiments, a web application integrates enterprise server products such as IBM ^® Lotus Domino ^® . A web application for providing a career development network for artists that allows artists to upload information and media files, in some embodiments, includes a media player element. In various further embodiments, a media player element utilizes one or more of many suitable multimedia technologies including, by way of non-limiting examples, Adobe ^® Flash ^® , HTML 5, Apple ^® QuickTime ^® , Microsoft ^® Silverlight ^® , Java™, and Unity ^® .

Mobile application

[00211] In some embodiments, a computer program includes a mobile application provided to a mobile digital processing device. In some embodiments, the mobile application is provided to a mobile digital processing device at the time it is manufactured. In other embodiments, the mobile application is provided to a mobile digital processing device via the computer network described herein.

[00212] In view of the disclosure provided herein, a mobile application is created by techniques known to those of skill in the art using hardware, languages, and development environments known to the art. Those of skill in the art will recognize that mobile applications are written in several languages. Suitable programming languages include, by way of non-limiting examples, C, C++, C#, Objective-C, Java™, Javascript, Pascal, Object Pascal, Python™, Ruby, VB.NET, WML, and XHTML/HTML with or without CSS, or combinations thereof. [00213] Suitable mobile application development environments are available from several sources. Commercially available development environments include, by way of non-limiting examples, AirplaySDK, alcheMo, Appcelerator ^® , Celsius, Bedrock, Flash Lite, .NET Compact Framework, Rhomobile, and WorkLight Mobile Platform. Other development environments are available without cost including, by way of non-limiting examples, Lazarus, MobiFlex, MoSync, and Phonegap. Also, mobile device manufacturers distribute software developer kits including, by way of non-limiting examples, iPhone and iPad (iOS) SDK, Android™ SDK, BlackBerry® SDK, BREW SDK, Palm® OS SDK, Symbian SDK, webOS SDK, and

Windows® Mobile SDK.

[00214] Those of skill in the art will recognize that several commercial forums are available for distribution of mobile applications including, by way of non-limiting examples, Apple ^® App Store, Android™ Market, BlackBerry ^® App World, App Store for Palm devices, App Catalog for webOS, Windows ^® Marketplace for Mobile, Ovi Store for Nokia ^® devices, Samsung ^® Apps, and Nintendo ^® DSi Shop.

Standalone application

[00215] In some embodiments, a computer program includes a standalone application, which is a program that is run as an independent computer process, not an add-on to an existing process, e.g., not a plug-in. Those of skill in the art will recognize that standalone applications are often compiled. A compiler is a computer program(s) that transforms source code written in a programming language into binary object code such as assembly language or machine code. Suitable compiled programming languages include, by way of non-limiting examples, C, C++, Objective-C, COBOL, Delphi, Eiffel, Java™, Lisp, Python™, Visual Basic, and VB .NET, or combinations thereof. Compilation is often performed, at least in part, to create an executable program. In some embodiments, a computer program includes one or more executable complied applications.

Software modules

[00216] The systems, platforms, software, networks, and methods disclosed herein include, in various embodiments, software, server, and database modules. In view of the disclosure provided herein, software modules are created by techniques known to those of skill in the art using machines, software, and languages known to the art. The software modules disclosed herein are implemented in a multitude of ways. In various embodiments, a software module comprises a file, a section of code, a programming object, a programming structure, or combinations thereof. In further various embodiments, a software module comprises a plurality of files, a plurality of sections of code, a plurality of programming objects, a plurality of programming structures, or combinations thereof. In various embodiments, the one or more software modules comprise, by way of non-limiting examples, a web application, a mobile application, and a standalone application. In some embodiments, software modules are in one computer program or application. In other embodiments, software modules are in more than one computer program or application. In some embodiments, software modules are hosted on one machine. In other embodiments, software modules are hosted on more than one machine. In further embodiments, software modules are hosted on cloud computing platforms. In some embodiments, software modules are hosted on one or more machines in one location. In other embodiments, software modules are hosted on one or more machines in more than one location.

[00217] In some embodiments, a system is provided for making a differential diagnosis, the system comprising (a) an array of peptides comprising at least 10,000 different peptides synthesized in situ, wherein a sample from a subject is contacted to the array; (b) a detector for detecting the binding of antibodies present in said sample to at least 25 peptides on said array to obtain a combination of binding signals; and (c) a digital processing device for analyzing and comparing said combination of binding signals to one or more groups of combinations of reference binding signals, wherein each of said groups of combinations of reference binding signals comprises a combination of binding signals obtained from a plurality of subjects having a different disease, thereby making said differential diagnosis, wherein the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.6.

[00218] In other embodiments, a system is provided for determining disease progression in a subject known to have an autoimmune disease, said method comprising: (a) an array of peptides comprising at least 10,000 different peptides synthesized in situ; (b) a detector for detecting the binding of antibodies present in said sample to at least 25 peptides on said array to obtain a first combination of binding signals; and (c) a digital processing device for analyzing and comparing said first combination of binding signals to at least a second combination of reference binding signals, wherein said second combination of reference binding signals comprises a combination of binding signals obtained from a reference group comprising a plurality of subjects having a clinical manifestation indicative of progression of said autoimmune disease, thereby making said differential diagnosis, wherein the method performance is characterized by an area under the receiver operator characteristic (ROC) curve (AUC) being greater than 0.6.

[00219] The present invention is described in further detail in the following Examples which are not in any way intended to limit the scope of the invention as claimed. The attached Figures are meant to be considered as integral parts of the specification and description of the invention. The following examples are offered to illustrate, but not to limit the claimed invention. [00220] While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.

EXAMPLES

Example 1 - Assay Methods

[00221] Broadly, the "Immunosignature" assay protocol follows the principles of ELISA. The peptide array slides were washed and hydrated in water. The slides were then blocked with BSA (3% w/v BSA in PBS-T) for 60 minutes at RT with gentle shaking. One hundred microliters of serum or plasma samples obtained from diseased and healthy volunteers were diluted in a PBST based buffer. Ninety microliters of each sample were then incubated on a peptide array for one hour at 37C with an alternating shaking protocol. Following the sample (primary antibody) incubation the array was washed with a PBST wash buffer. Following the washing step, the array was incubated with 90ul of secondary antibody (goat anti-human IgG-conjugated to Alexa-555, Life-Technologies). The secondary reagent was incubated for one hour at 37C with an alternating shaking protocol. A secondary antibody-only control (negative control) was included on each slide along with normal serum control sample in triplicate to verify assay quality and reproducibility. After a one hour incubation, the array was washed again with a PBST wash buffer followed by water and isopropanol washes, then dried by centrifugation. The slide was then scanned on an Innopsys 910AL microarray scanner (InnoScan, Inc. Serial number 913p03). Fluorescent signal was measured by laser excitation at 532nm and emission quantification at 547nm.

[00222] Data acquisition was performed using the Innopsys Mapix software package (Innopsys Inc). The arrays ware analyzed for data outliers. After median normalization and logio- transformation, the median intensity of each feature across technical replicates was calculated and used for to classifier development work.

[00223] A Support Vector Machine (SVM) classifier was trained and cross-validated by assigning each sample to one of four cross-validated groups. Features that discriminate cases and controls in the training group were ranked by p-value. The top k features were used as input for the SVM model. Predictions for each group were made, and performance was calculated as Area Under the Curve (AUC) or sensitivity/specificity/accuracy) using all the predictions from the four models vs. the true disease classes. The average performance was and confidence intervals (CI) were calculated. Diagnostic visualizations were generated, including "volcano" plots (i.e. p-value vs. log fold-change), ROC (receiver operating characteristic) curves, and model performance vs. number of input peptides.

Example 2 - Diagnostic and Prognostic Assays for Scleroderma and Systemic Sclerosis

[00224] Background: Scleroderma and Systemic Sclerosis (SSc) is a disease of the connective tissue featuring skin thickening that can involve scarring, blood vessel problems, and varying degrees of inflammation not only of skin but also internal organs. Diagnosis of SSc is difficult due to the complexity of manifestations and overlap with other autoimmune diseases. It typically requires a combination of medical history review, physical examination, lab tests and X-Rays. No single biomarker is available but serologic testing has identified ANA and anticentromere antibodies (ACA) in 60%-80% of patients, and ScL 70 antibodies in 30%. However, these antibodies can also be found in some healthy individuals or patients with other autoimmune diseases e.g.dermatomyositis (DM). In addition to a better diagnostic, there is need for a better prognostic test. Raynaud's syndrome is the first manifestation of SSc in about 75% of patients, but does not serve as a prognostic. Patients with diffuse rather than limited skin involvement tend to develop more serious conditions such as ILD, PAH, GAVE, and renal complications. However, this observation is also not reliable enough to be prognostic.

[00225] Methods: A study population of 719 plasma samples was evaluated; it was comprised of SSC (n=301), DM (205), a group of other autoimmune diseases (95) including MCTD, UCTD, lupus, myositis & polymyositis, morphea, and healthy samples (118). A panel of 84 control samples were used to facilitate assay qualifications.

[00226] All patients met ACR classification criteria at diagnosis. An IS assay was used to detect plasma antibodies bound to a microarray of -126,000 unique peptides. Peptide sequences were designed (using 16 of the 20 amino acids) to broadly sample combinatorial space thus providing a library of diverse epitope mimetics for antibodies to selectively and competitively bind. Features most discriminating SSc contrasts were identified using a t-test. Support vector machines (SVM) classifiers were trained and assessed by 100 iterations of 5-fold cross validation analysis. Models ranging from 25 to 10,000 peptide inputs were evaluated.

[00227] Results: A classifier trained on 10,000 differentially bound peptides distinguished SSc patients from healthy donors with strong performance characteristics. Other algorithms with similar model sizes were built that differentiated SSc from other autoimmune diseases such as DM. Finally, SSc patients that ever progressed to one of several more severe conditions: ILD, renal crisis, and GAVE, could be distinguished from those SSc patients who never did. These cross-validated estimates of classification performance are provided in Table 1.

[00228] FIG. 5 is a table depicting the top differentiating peptides in an immunosignature when comparing patients with SSc and healthy subjects. FIG. 5A depicts the top sub-motifs. FIG. 5B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 6 is a graphical representation of the results in FIG. 5. The headings apply to the list of motifs in (A) and to the amino acids list in (B) of this and all tables of differentiating peptides provided herein, where "n" is the number of times the motif appeared in the sequences of the top discriminating peptides; "n. lib" is the number of times the motif appeared in the library; "enrich" is the enrichment factor of the motif in the discriminating peptides relative to all of the motifs found in all sequences in the library; "padj . holm" is the ^-adjusted value to control for multiple testing errors.

[00229] FIG. 7 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and other autoimmune disorders. "Other autoimmune disorders" include Atypical myositis, acne rosacea, anti-PL7 with ILD and myositis, atypical myositis, Behcet's, Crohn's with atypical, rash, cutaneous lupus, Discoid lupus, DM, DM rash but negative antibodies, DM versus lupus, DM vs UCTD, drug eruption, eosinophilic fasciitis, Graft Versus Host Disease (GVHD), Hodgkins disease, lichen planus, ISSc, lupus panniculitis, Mixed Connective Tissue Disease (MCTD), Morphea, myositis possibly drug induced, myositis with Jo-1 antibodies, nephrogenic systemic fibrosis, polymyalgia rheumatic, Polymyositis, possible DM— awaiting serotyping, possible drug eruption, Psoriasis, pulmonary fibrosis, pulmonary fibrosis with anti-JOl, Raynauds only, Rhabdomyolysis, Sle, SLE/mixed, SSc, SSc/DM overlap, SSc/SLE, Undifferentiated Connective Tissue Disease (UCTD), UCTD with rash, Unknown, unknown with features of urticarial, and weakness no diagnosis. FIG 7A depicts the top sub-motifs. FIG. 7B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 8 is a graphical representation of the results seen in FIG. 7.

[00230] FIG. 9 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and patients in a renal crisis. FIG 9A depicts the top sub-motifs. FIG. 9B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 10 is a graphical representation of the results seen in FIG. 9.

[00231] FIG. 11 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and gastric antral vascular ectasia (GAVE). FIG 1 1A depicts the top sub-motifs. FIG. 1 IB depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 12 is a graphical representation of the results seen in FIG. 11. [00232] FIG. 13 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc and DM. FIG 13A depicts the top sub-motifs. FIG. 13B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 14 is a graphical representation of the results seen in FIG. 13.

[00233] FIG. 15 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with SSc with interstitial lung disease (HJD+) and SSc without interstitial lung disease (ILD-). FIG 15A depicts the top sub-motifs. FIG. 15B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 16 is a graphical representation of the results seen in FIG. 15.

[00234] Conclusions: Reproducible binding patterns produced by peripheral-blood antibody repertoires on a mimetic-peptide microarray can differentiate SSc from healthy donors and from other autoimmune diseases. In addition, distinctive immunosignatures were established for SSc patients that ever progressed to more serious disease manifestations. This suggests that the IS technology might be instrumental in the development of both new diagnostic and prognostic tests for SSc.

[00235] Table 1. Classification Performance Estimates of IS for SSc Diagnosis and Prognosis

Example 3: Distinguishing Derniatomyositis and Systemic Sclerosis from Patients with Interstitial Lung Disease

[00236] Background: Dermatomyositis (DM) is an inflammatory autoimmune disease with heterogeneous manifestations affecting skin, muscles, and lungs. The complexities of presentation make clinical diagnosis and prognosis challenging. Histologic findings also vary, confounding their utility. Several DM-specific antigens have been identified suggesting serologic diagnosis may be possible. However, alternative antigens would be required since many DM patients do not possess antibodies to these antigens. Interstitial lung disease (ILD) develops in 20-40% of patients, displaying a spectrum from mild to rapidly progressive, and possibly fatal, lung disease. Some DM-serotypes are at higher risk than others for ILD progression, but serotyping alone is not sufficiently sensitive or specific to guide clinical care.

[00237] A simple test to differentiate DM from other inflammatory autoimmune disease and to predict those that will progress to ILD would improve patient care. In addition, a discovery method for new DM- antigens would facilitate diagnostic and therapeutic efforts. The immunosignature (IS) platform was investigated to determine if it could address both clinical and discovery goals.

[00238] Methods: A study population of 719 plasma samples was evaluated; it was comprised of SSC (n=301), DM (205), a group of other autoimmune diseases (95) including MCTD, UCTD, lupus, myositis & polymyositis, morphea, and healthy samples (118). A panel of 84 control samples were used to facilitate assay qualifications. All patients met ACR classification criteria at diagnosis. An IS assay was used to detect plasma antibodies bound to a microarray of -126,000 unique peptides. Peptide sequences were designed to broadly sample combinatorial space thus providing a library of diverse epitope mimetics for antibodies to selectively bind. Features most discriminating DM contrasts were identified using a t-test. Classification efficacy was determined in a support vector machine using 100 iterations of 5-fold cross validation.

[00239] Results: Cross-validated estimates of classification performance are provided in Table 2. Algorithms trained on differentially bound peptides distinguished DM from healthy donors and other AI, such as SSc. Both DM and SSc patients that ever progressed to ILD could be distinguished from those that never did. Up to 10,000 peptides whose antibody-binding characteristics differentiated disease groups were identified and used as inputs to these classifiers. Notably, the models for DM:ILD+/- and for SSc:ILD+/- were similarly predictive; however, the significantly distinguishing peptides used in these 2 classifiers showed no overlap. Table 2. Classification performance estimates of IS for DM contrasts

0.77 (0.74- 40% (33- 41% (33- 70% (67-

DM vs SSc 0.8) 48%) 48%) 73%)

0.69 (0.63- 22% (12- 30% (16- 65% (60-

DM: ILD+ vs ILD- 0.72) 33%) 45%) 70%)

0.68 (0.64- 23% (13- 31% (21- 63% (59-

SSc: ILD+ vs ILD- 0.72) 33%) 41%) 68%)

[00240] FIG. 17 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with DM and healthy subjects. FIG 17A depicts the top sub-motifs. FIG. 17B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 18 is a graphical representation of FIG. 17.

[00241] FIG. 19 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with DM and other autoimmune disorders. "Other autoimmune disorders" include Atypical myositis, acne rosacea, anti-PL7 with ILD and myositis, atypical myositis, Behcet's, Crohn's with atypical, rash, cutaneous lupus, Discoid lupus, DM, DM rash but negative antibodies, DM versus lupus, DM vs UCTD, drug eruption, eosinophilic fasciitis, Graft Versus Host Disease (GVHD), Hodgkins disease, lichen planus, ISSc, lupus panniculitis, Mixed Connective Tissue Disease (MCTD), Morphea, myositis possibly drug induced, myositis with Jo-1 antibodies, nephrogenic systemic fibrosis, polymyalgia rheumatic, Polymyositis, possible DM~awaiting serotyping, possible drug eruption, Psoriasis, pulmonary fibrosis, pulmonary fibrosis with anti-JOl, Raynauds only, Rhabdomyolysis, Sle, SLE/mixed, SSc, SSc DM overlap, SSc/SLE, Undifferentiated

Connective Tissue Disease (UCTD), UCTD with rash, Unknown, unknown with features of urticarial, and weakness no diagnosis. FIG 19A depicts the top sub-motifs. FIG. 19B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 20 is a graphical representation of FIG. 19.

[00242] FIG. 21 is a table depicting the top differentiating peptides in an immunosignature when comparing patients diagnosed with DM and Interstitial lung disease (ILD+) and DM without interstitial lung disease (ILD-). FIG 21 A depicts the top sub-motifs. FIG. 21B depicts the enriched peptides in the top 1000 differentiating peptides. FIG. 22 is a graphical representation of FIG. 21.

[00243] Mimotope binding patterns identified DM patients from non-DM patients.

Deciphering the antigens that these peptides mimic may reveal new DM-specific antigens. Classifiers for DM versus other AI, and for patients that progressed to ILD were also evaluated. The lack of any overlap between the ILD predicting peptides for DM vs. SSc patients supports a conclusion that these are unique diseases, despite common clinical manifestations and treatment regimens.

[00244] While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.

Example 4 - Identification of immunogenic autoantigen targets

[00245] Discriminating peptides that differentiate healthy subjects from subjects with SSc were analyzed relative to the human proteome to indicate the originally immunogenic autoantigen targets. The discriminating peptides were chosen for having a p-value of less than p<2.53E-06.

[00246] Proteome alignment: Array peptides were aligned to proteins in human proteome RefSeq release 84, corresponding to human genome build GrCh38

(https://www.ncbi.nlm.nih.gov/refseq/), compiled March 10, 2016, using the longest transcript variant for each unique gene ID. The alignment algorithm uses a modified BLAST strategy (Altschul, S.F. & Gish, W. (1996) "Local alignment statistics. " Meth. Enzymol. 266:460-480), requiring a seed of 3 amino acids with a gap penalty of 4, with a scoring matrix of BLOSUM62 (Henikoff, J.G. Amino acid substitution matrices from protein blocks. Proc. Natl. Acad. Sci. USA 89: 10915-10919 [1992]) modified to reflect the amino composition of the array (States, D.I., Gish, W., Altschul, S.F. (1991) "Improved sensitivity of nucleic acid database searches using application-specific scoring matrices." Methods 3 :66-70). These modifications increase the score of degenerate substitutions, remove penalties for amino acids absent from the array and score all exact matches equally.

[00247] To generate a p-value for alignment of a set of ImmunoSignature peptides to a protein, all peptides that yield a positive BLAST score to the protein were assembled into a matrix, with each row of the matrix corresponding to an aligned peptide and each column corresponding to one of the consecutive amino acids that comprise this protein, with gaps and deletions allowed within the peptide rows to allow for alignment to the protein. Each position within the matrix is the score, from the same scoring matrix as for the proteome alignments, of the paired peptide and protein amino acid in that position. Then, for each amino acid in the protein, the corresponding column is summed to create an "overlap score" that represents coverage of that amino acid by the ImmunoSignature peptides. To correct this score for library composition, an overlap score is calculated using an identical method for a list of all array peptides. Finally, a Fischer Exact Test is used to calculate a p-value for the ImmunoSignaure overlap score versus the full library overlap score. To convert these p-values at the amino acid level to a full-protein statistic, the sum of the negative log of the p-value for every possible 20-mer epitope within a protein is calculated, and the final score is the maximum along this rolling window of 20 for each protein.

[00248] Table 3 provides a list of the top scoring target proteins that were identified according to the method. One hundred and sixty nine candidate biomarkers were identified. The discriminating peptides were chosen for having a p-value of less than p<2.53E-06 by Welch's t- test.

Table 3. Candidate target proteins identified from alignments of discriminating peptides that distinguish samples from subjects having SSc from samples from healthy subjects

[00249] RNA Pol II subunit L is an example of the immunogenic autoantigens identified by the method by differentiating peptides that distinguish healthy subjects from subjects having SSc (Figures 23 A and B).

[00250] Figure 23 A shows the peptide overlap difference scores, s, calculated for the alignments of IMS peptide-motifs plotted alongside the RNA Pol II subunit L aa positions. Peptides from the SSc vs. healthy contrast showed significant alignment with RNA pol II subunit L, ranking it 35 out of 20,378 of the human proteins in the proteome. The ball and stick model to the right shows the structure of RNA pol II subunit L. The region displayed in balls corresponds to the aa positions marked with a red box within the graph. The highest scoring aa is aspartic acid, D, in the center of the RNA pol cluster; it is shown in the ball structure as orange. We note that a threonine (T) near the center of the cluster scored poorly; there is no T in the IMS array sequences. Figure 23 B shows a histogram displaying the distribution of protein epitope scores, S, for each protein in the human proteome vs the SSc vs healthy classifying peptides. POLR2L' s score is 583.

[00251] RNA pol II, is a known autoantigen that has been characterized in patients with scleroderma.

[00252] Figure 24 shows an exemplary autoantigen, CCL22, that was determined as a candidate protein biomarker that was identified by the discriminating peptides comparing subjects having SSc with organ involvement (GAVE +) with subjects having SSc without organ involvement (GAVE -).

[00253] These data show that discriminating peptides that distinguish different disease states can be used to identify candidate antigen or autoantigen target that can be investigated for use in developing therapeutics. Additionally, the presence of specific antigen or autoantigen targets can be used to determine the severity of a disease, and potentially predict disease progression.

Example 5 - Precision of measurements of binding signals

[00254] The binding precision of 200 array features (different peptides) used to distinguish subjects that tested sera-positive for Chagas disease from sera-negative subjects was estimated using a set of 8 serum samples. Four Chagas positive samples and 3 Chagas negative samples were selected from the full cohort of donors and assayed in triplicate on each slide from multiple wafers in two study designs. One in-house normal donor sample was also assayed in duplicate on each slide.

[00255] Within wafer lot: Three wafers from a single production lot were selected and qualified using a one-slide QC sample set. The remaining 12 slides from each wafer were evaluated using the precision study sample set. The slides were run across 3 cassettes per day over 3 days. Slides from each wafer were distributed evenly across the 3 days such that each cassette contained 2 slides from one of the three wafers and 1 slide each from the remaining two wafers.

[00256] Between wafer lot: One wafer from each of 4 production lots was selected and qualified using a one-slide QC sample set. The remaining 12 slides from each wafer were evaluated using the precision study sample set. The slides were run across 4 cassettes per day over 3 days. Slides from each wafer were distributed evenly across the 3 days such that each cassette contained 2 slides from two of the four wafers.

[00257] Data analysis: A mixed effect model was used to estimate the sources of experimental variance. Donor was treated as a fixed effect. Nested factors 'Wafer', 'slide', and 'array' were crossed with 'day', and were treated as random effects. Models were fit in r using the lme4 package.

Table 4. Precision of signal binding measurements

The data show that measurements of binding signals made on arrays within wafer batches can be made with precision varying less than 15%; and that measurements of binding signals made on arrays between wafer batches can be made with precision varying less than 25%".