FIELD OF THE INVENTION

Aspects of the present disclosure provide novel compositions and methods for identifying antibodies resulting from infection by Babesia species.

SEQUENCE LISTING

The instant application incorporates by reference the Sequence Listing in the ASCII text file filed April 22, 2022, entitled “0153-2018US02 - Sequence Listing - ST25.txt”, which was created in March 1, 2022 the size of which file is 81.819 bytes.

BACKGROUND

Apicomplexan protozoan parasites of the genus Babesia cause babesiosis in humans and animals. There were 2,161 cases of human babesiosis reported in the USA in 2018 to the US Centers for Disease Control and Prevention (CDC). Ixodes scapularis, I. ricinus, I. persulcatus and Dermacentor albipictus are some hard ticks that transmit babesiosis to humans after acquiring Babesia species from reservoir animals such as white-footed mice and mule deer. Human to human transmission of Babesia species can occur through blood transfusion, congenital transmission, and organ transplantation. Babesia microti, B. duncani, and B. divergens are mainly responsible for human babesiosis in the USA, with B. microti and B. duncani considered to be, respectively, more prevalent in the East and West coasts of North America. Babesia microti, B. divergens, B. venatorum and B. crassa are responsible for babesiosis in Eurasia. Babesiosis is also prevalent in Africa, Australia, and South America.

The two main approaches for diagnosing human babesiosis in a clinical laboratory are the detection of parasites in blood and assaying antibodies produced against the parasite. Parasites in peripheral blood are frequently detected by examining stained blood smears by microscopy. However this method cannot identify Babesia parasites at the species level. Alternatively, Babesia parasite nucleic acids are detected by qPCR on blood samples and the detection of ribosomal RNA within infected red blood cells (iRBCs) by fluorescence in situ hybridization (FISH). Several qPCR tests have been developed for B. microti and may be used for screening blood for transfusion. A qPCR test for B. duncani has been recently developed, but is not yet in common use. Babesia genus-specific FISH is used to detect B. duncani and 5. microti in blood and provides laboratory confirmation of babesiosis with lower resource and shorter time requirements than qPCR tests, a lower sensitivity of detection. However, Babesia parasite concentrations in peripheral blood can be low very early in an infection and during chronic low grade infections where parasites may be sequestered by binding to capillary endothelia in internal organs. Cytoadherence to the capillary endothelium has been reported in B. duncani, and cytoadherence and the variant antigens on the surface of infected red blood cells (iRBCs) that are responsible for it have been characterized in the bovine parasite Babesia bovis.

Serum antibodies are commonly detected by immunofluorescence assays (IF A) performed with B. microti fixed on microscope slides, but an equivalent IF A has not been widely used for detecting antibodies against B. duncani. An ELISA utilizing recombinant proteins as antigens that has been recently developed for B. microti is less sensitive than IF A and is not yet in common use for diagnosis. There is presently no report of an ELISA test for B. duncani. Immunochromatography-based lateral flow tests have been recently trialed for point-of-care diagnosis of bovine babesiosis, but similar tests are not yet available for human babesiosis. IgM is the first antibody class to be formed in a primary immune response. IgM antibodies are produced early, usually within days, during an infection before class switching later to higher affinity IgG and other immunoglobulin classes. Serum antibodies may therefore be below the threshold of detection in the very early stages of an infection. As the infection resolves, either as a result of the immune response or through drug treatment, antibody levels begin to diminish but can persist at detectable levels for several months. A total immunoglobulin or IgG IF A titer of > 1 :256 is recognized by the CDC as laboratory evidence that supports a diagnosis of babesiosis. IgM IF A titers of > 1:32 have been, however, reported to have high sensitivity and specificity for acute or early Babesia infections. Detection of anti-Babesia antibodies per se does not differentiate between an active or ongoing infection and a resolved past infection, although high IgG antibody titers indicate a probable active indication. A marked increase in IF A titers over time in a patient is a better indicator of an active infection, but the required temporal follow-up in serum collection and testing is often not easily possible. Therefore, a simple, quick, and reliable test for Babesia is a high priority. BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 presents a photomicrographic image showing Babesia ImmunoBlot strips tested with rabbit anti-sera with antibodies to the following pathogens: P - Positive Control (. Babesia ); (1) Borrelia burgdorferi B31 and (2) B. burgdorferi 297; Tick-Borne Relapsing Fever Borrelia species (3) B. hermsii , (4) B. turcica , (5) B. coriaceae, (6) B. miyamotoi; Bartonella species (7)

B. elizabethae , (8 ) B. henselae , (9) B. vinsonii, and (10) B. quintana ; and (1 1) E. coli. M, IgM; g,IgG

Figure 2 presents photomicrographic images showing Babesia-positive patient sera tested with Babesia ImmunoBlots (IBs). Patient 3 was positive for B, microti and Patient 2 was positive for B. duncani by immunofluorescence assay (IF A) and western blots. Babesia IB testing confirmed sera from both patients were positive for Babesia infection at the genus level. Serum from Patient 3 was positive for B. microti ; serum from Patient 2 was positive for B. duncani. Arrows indicate bands 8, 12, and 14-16 (SEQ ID NOs: 8, 12, and 14-16, respectively). M, IgM; g, IgG.

Figure 3 presents photomicrographic images showing patient serum samples (1-11) tested with Babesia IgM (M) and IgG (G) ImmunoBlots. Bands 1-7, 9, 11, 13, 16-19 were Babesia genus-specific (SEQ ID NOs: 1-7, 9, 11, 13, and 16-19, respectively). Bands 8, 10, and 12 (SEQ ID NOs: 8, 10, and 12, respectively) were specific fori?, microti , indicated by arrows for samples 1-7. Bands 14 and 15 (SEQ ID NOs: 14 and 15, respectively) were specific for B. duncani , indicated by arrows for samples 8-11. Samples 1-7 were positive fori?, microti ; samples 8-11 were positive fori?, duncani.

Figure 4 presents a chart showing Babesia IB results for patient samples previously tested with FISH and IFA assays. Band intensity was recorded as 1+, 2+, 3+, or 4+, and intensities of 1+ and above were scored as positive. P, positive; N, negative.

SUMMARY

According to an aspect of the disclosure, a composition is provided, the composition including labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences include amino acid sequences SEQ ID NO: 1, SEQ ID NO: 2, SEQ ID NO: 3, SEQ ID NO: 4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7, SEQ ID NO: 8, SEQ ID NO: 9, SEQ ID NO: 10, SEQ ID NO: 11, SEQ ID NO: 12, SEQ ID NO: 13, SEQ ID NO: 14, SEQ ID NO: 15, SEQ ID NO: 16, SEQ ID NO: 17, SEQ ID NO: 18, and SEQ ID NO: 19, and variants thereof which retain the immunological binding profile of the corresponding non-variant. In some aspects, the bound amino acid sequences are bound to a substance (i.e. a solid support) selected from the group consisting of nitrocellulose, nylon, polyvinylidene difluoride (PVDF), plastic, metal, magnetic beads, and agarose.

According to another aspect of the disclosure, a method for detecting infection by one or more Babesia species, if present in a biological sample obtained from a subject suspected of having a Babesia infection, is provided, the method including: (a) providing a composition including labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences include amino acid sequences SEQ ID NO: 1, SEQ ID NO: 2, SEQ ID NO: 3, SEQ ID NO: 4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7, SEQ ID NO: 8, SEQ ID NO: 9, SEQ ID NO: 10, SEQ ID NO: 11, SEQ ID NO: 12, SEQ ID NO: 13, SEQ ID NO: 14, SEQ ID NO: 15, SEQ ID NO: 16, SEQ ID NO: 17, SEQ ID NO: 18, and SEQ ID NO: 19, and variants thereof which retain the immunological binding profile of the corresponding non-variant; (b) providing the biological sample obtained from the subject suspected of having a Babesia infection; (c) contacting the biological sample with the composition of step (a) under conditions appropriate for specific antibody binding to an epitope; and (d) detecting specific binding of IgM- and/or IgG-class antibodies, if present in the biological sample, with the amino acid sequences of step (a), wherein the sample is scored as positive for infection by one or more Babesia species when: (i) a positive immunobinding reaction with IgM-class antibodies is detected for at least two of the amino acid sequences of step (a), or (ii) a positive immunobinding reaction with IgG-class antibodies is detected for at least two of the amino acid sequences of step (a), and wherein a positive score for infection indicates infection by one or more Babesia species in the subject. In some aspects, the binding of IgM-class antibodies is detected through the use of an anti -human IgM antibody linked to a detectable moiety. In other aspects, the binding of IgG-class antibodies is detected through the use of an anti-human IgG antibody linked to a detectable moiety. In some aspects, the detectable moiety is selected from the group consisting of chromophores, radioactive moieties, and enzymes. In some aspects, the detectable moiety includes alkaline phosphatase. In other aspects, the detectable moiety includes biotin. In some aspects, the Babesia genus includes species selected from B. microti, B. duncani, B. MOl, B. divergens, B. venatorum, and B. crassa. According to yet another aspect of the disclosure, a method for detecting species-specific infection by B. microti and/or B. duncani , if present in a biological sample obtained from a subject suspected of having & Babesia infection, is provided, the method including: (a) providing a composition including labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences include amino acid sequences SEQ NO: 18, and SEQ ID NO: 19, and variants thereof which retain the immunological binding profile of the corresponding non-variant; (b) providing the biological sample obtained from the subject suspected of having a Babesia infection; (c) contacting the biological sample with the composition of step a) under conditions appropriate for specific antibody binding to an epitope; and (d) detecting specific binding of IgM- and/or IgG-class antibodies, if present in the biological sample, with the amino acid sequences of step (a), wherein: (i) the sample is scored as positive for infection by B. microti when a positive immunobinding reaction with IgM- or IgG- class antibodies is detected for at least one of SEQ ID NOs: 1-7, 9, 11, or 13 and at least one of SEQ ID NOs: 8, 10, or 12, or (ii) the sample is scored as positive for infection by B. duncani when a positive immunobinding reaction with IgM- or IgG-class antibodies is detected for at least one of SEQ ID NOs: 1-7, 9, 11, 13, or 16-19 and at least one of SEQ ID NOs: 14 or 15, and wherein a positive score indicates infection by B. microti and/or B. duncani. In some aspects, the binding of IgM-class antibodies is detected through the use of an anti-human IgM antibody linked to a detectable moiety. In other aspects, the binding of IgG-class antibodies is detected through the use of an anti-human IgG antibody linked to a detectable moiety. In some aspects, the detectable moiety is selected from the group consisting of chromophores, radioactive moieties, and enzymes. In some aspects, the detectable moiety includes alkaline phosphatase. In other aspects, the detectable moiety includes biotin.

DESCRIPTION OF THE SEQUENCES SEQ ID NO: 1 - B. microti Bm8630

DETAILED DESCRIPTION

The present disclosure provides novel compositions and methods for diagnosing, and treating babesiosis resulting from infection by diverse Babesia species. To assess the impact of testing limitations and to identify exposure to Babesia species, a recently developed modified Western Blot procedure was employed. The procedure, termed the line immunoblot (also referred to herein as “immunoblot” or “IB”), uses recombinant antigens from multiple Babesia species for the serological diagnosis of Babesia infection. As discussed in greater detail elsewhere herein, testing was conducted on patients with suspected babesiosis. Positive immunoblots were further characterized at the species level for B. microti and B. duncani.

Aspects of the instant disclosure provide compositions and methods for quickly, easily, and accurately detecting Babesia antibodies in a biological sample from a subject suspected of having babesiosis, thereby satisfying the need for such a test. Because multiple Babesia species have pathogenic potential for babesiosis, tests for Babesia species should be inclusive — that is, a test should be able to detect antibodies to multiple species from the Babesia genus concurrently. The present disclosure provides for antigenic amino acid sequences specific for various Babesia species. The amino acid sequences of the present disclosure encode antigenic peptides that have high specificity and/or sensitivity for the indicated species. The inclusion of antigenic peptides that exhibit cross-reactivity across Babesia species boundaries is also important with respect to the development of inclusive serological, or other immunologically-based assays, wherein the goal is to detect infection, not necessarily to identify a particular species responsible for infection. For example, the disclosure includes immunoassays wherein, in the context of a single test screen, multiple Babesia species are detectable.

Aspects of the present disclosure provide novel compositions and methods for diagnosing infection by one or more species of the Babesia genus. In some aspects, the instant disclosure provides compositions and methods for quickly, easily, and accurately distinguishing between infection by B. microti and B. duncani. The disclosure is based, in part, on the discovery of species-specific amino acid sequences encoding antigenic peptides (which may also be referred to in the art as peptide antigens or antigens), as described herein. Aspects of the present disclosure provide antigen-specific amino acid sequences for Babesia species, including B. microti and B. duncani. These novel amino acid sequences may be used in assays to identify infection by one or more species of the Babesia genus in samples from subjects suspected of having babesiosis, including but not limited to Babesia species comprising B. microti, B. duncani, B. MOl, B. divergens, B. venatorum, and B. crassa. With the amino acid sequences of the present disclosure, identification of Babesia infection in subject samples is performed with speed, sensitivity, and specificity at least equivalent to or greater than other current methods.

The amino acid sequences of the present disclosure may be used in diagnostic and scientific assays. Non-limiting examples of suitable assays include immunoblots, line immunoblots, ELISA (enzyme-linked immunosorbent assay), etc. The amino acid sequences of the present disclosure may be used for the detection of Babesia- specific T-cells, for example, with the IgXSPOT test (IGeneX, Milpitas, CA).

In one aspect, a composition of the present disclosure comprises labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences comprise amino acid sequences , and variants thereof which retain the immunological binding profile of the corresponding non-variant. In one aspect, a composition of the present disclosure comprises labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences comprise amino acid sequences having at least 90%, 95%, 98%, 99%, 99.5%, or 100% homology to SEQ NO: 18, and SEQ ID NO: 19, and variants thereof which retain the immunological binding profile of the corresponding non-variant. As used herein, a non-variant is an amino acid sequence with 100% sequence homology to Variants of amino acid sequences SEQ ID NOs: 1-19 which retain the immunological binding profile of the corresponding non-variant may have conservative amino acid substitutions in conserved or non- conserved regions. The expression “variants” encompasses any modification(s) of a specified amino acid sequence (e.g., SEQ ID NOs: 1-19) which retain(s) the immunological binding profile of the corresponding non-variant. Such modifications may include insertions and deletions (internal or from the N- or C- terminus, or both). One skilled in the art, using no more than routine experimentation, could design and produce antigenic peptides carrying conservative amino acid substitutions in non-conserved regions, or even at non-conserved amino acid positions as identified by alignment comparisons. The term “immunological binding profile” as used herein refers to the ability of a labelled and/or tagged and/or bound amino acid sequence to be bound by antibodies present in a biological sample. Non-limiting examples of immunological binding profiles include Figures 2-4.

Sequences with less than 100% homology may be modified with one or more substitutions, deletions, insertions, or other modifications with respect to the amino acid sequences provided herein. Exemplary modifications include, but are not limited to conservative amino acid substitutions, which will produce molecules having functional characteristics similar to those of the molecule from which such modifications are made. Conservative amino acid substitutions are substitutions that do not result in a significant change in the activity or tertiary structure of a selected polypeptide or protein. Such substitutions typically involve replacing a selected amino acid residue with a different residue having similar physico-chemical properties. For example, substitution of Glu for Asp is considered a conservative substitution because both are similarly-sized negatively-charged amino acids. Groupings of amino acids by physicochemical properties are known to those of skill in the art. The following groups each contain amino acids that are conservative substitutions for one another: 1) Alanine (A), Glycine (G); 2) Aspartic acid (D), Glutamic acid (E); 3) Asparagine (N), Glutamine (Q); 4) Arginine (R), Lysine (K); 5) Isoleucine (I), Leucine (L), Methionine (M), Valine (V); 6) Phenylalanine (F), Tyrosine (Y), Tryptophan (W); 7) Serine (S), Threonine (T); and 8) Cysteine (C), Methionine (M) (see, e.g., Creighton, Proteins (1984)). One of ordinary skill in the art can determine if sequences with less than 100% homology can bind naturally- or non-naturally-occurring Babesia- related antibodies, as well as the sensitivity and specificity of the antibody to the modified sequences. One of ordinary skill in the art will be able to identify sequences with significant homology to SEQ ID NOs: 1-19 of the present disclosure that give acceptable or equivalent responses in the methods of the present disclosure without undue experimentation, in view of the teachings of this specification.

Nucleic acid sequences, including polynucleotides and oligonucleotides, encoding the amino acid sequences of the present disclosure, and portions thereof, may be expressed in cultured cells to provide isolatable quantities of peptides displaying biological (e.g., immunological) properties of the antigenic peptide encoded by the amino acid sequences of the present disclosure. Because of redundancy of the genetic code, multiple nucleic acid sequences may be suitable for the production of the peptide sequences of the present disclosure. One of ordinary skill in the art will be able to determine one or more nucleic acid sequences for production of the amino acid sequences of the present disclosure. A nucleic acid sequence encoding an amino acid sequence of the present disclosure may be labeled by any suitable label known to one of ordinary skill in the art.

In this regard, nucleic acid sequences suitable for the production of the amino acid sequences of the present disclosure may be substantially homologous to naturally occurring sequences. Substantial homology of a nucleic acid sequence as used herein means that: (a) there is greater than 65%, 75%, 85%, 95%, 98%, or 99% homology with the naturally occurring sequence, or (b) the homologous nucleic acid sequence will hybridize to the compared sequence or its complementary strand under stringent conditions of the temperature and salt concentration. These stringent conditions will generally be a temperature greater than about 22°C, usually greater than about 30°C and more usually greater than about 45°C, and a salt concentration generally less than about 1 M, usually less than about 500 mM, and preferably less than about 200 mM. The combination of temperature and salt concentration is more important in defining stringency than either the temperature or the salt concentration alone. Other conditions which affect stringency include GC content of the compared sequence, extent of complementarity of the sequences, and length of the sequences involved in the hybridization, as well as the composition of buffer solution(s) used in the hybridization mixture. These and other factors affecting stringency are well described in the scientific and patent literature. One of ordinary skill in the art will be able to determine suitable conditions for determining the homology of the nucleic acid sequences encoding the antigenic peptides of the present disclosure.

Homologous nucleic acid sequences may be determined based on the nature of a nucleotide substitution in the nucleic acid sequence. For example, synonymous nucleotide substitutions, that is, nucleotide changes within a nucleic acid sequence that do not alter the encoded amino acid sequence, will be better tolerated and, therefore, may be more numerous in a particular nucleic acid sequence than non-synonymous nucleotide substitutions. One of ordinary skill in the art will be able to determine the suitable number and location of substitutions that may be allowed in a nucleic acid sequence that encodes an amino acid sequence of the present disclosure without adversely affecting the antigenicity of the encoded antigenic peptide, without undue experimentation.

In another aspect, a composition of the present disclosure comprises labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences consist of amino acid sequences and/or variants thereof which retain the immunological binding profile of the corresponding nonvariant. In some aspects, the composition comprises labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences consist of amino acid sequences As used herein, “consist of’ or “consisting of’, when used as a claim transition referring to an amino acid sequence, refers to amino acid sequences having 100% homology to the specified amino acid sequence (i.e., SEQ ID NOs: 1-19). With regard to the present disclosure, the phrase “wherein the labelled and/or tagged and/or bound amino acid sequences consist of’ encompasses a composition having the one or more of the recited sequences and, for example, buffers, labels, etc. In other words, the sequence is limited to the sequence or sequences given but the composition is not limited. The definition specifically excludes amino acids naturally contiguous with a recited sequence being used as a label or tag, such as an oligonucleotide mass tag (OMT) for detection with mass spectrophotometry, as an element of the “composition comprising.”

Labels and Tags

One or more amino acid sequences of the disclosure may be labelled and/or tagged and/or bound. In the context of the present disclosure, a “labelled” or “tagged” amino acid sequence is an amino acid sequence that is attached to a detectable moiety. As used herein, a “label” or “tag” is a detectable moiety that may be attached to an amino acid sequence of the disclosure. A label or tag may be covalently or non-covalently attached to an amino acid sequence of the disclosure. Non-limiting examples of such “tags” are natural and synthetic (i.e., non-naturally occurring) nucleic acid and amino acid sequences ( e.g ., poly-AAA tags), antibodies (covalently bound) and detectable moieties such as labels (discussed below). Thus, the definitions of the phrases “labelled” and “tagged” may have overlap in that a tag may also, in some instances, function as a label. Further, tags useful with the present disclosure may be linked to a label.

The amino acid sequences of the present disclosure, or any tags attached to an amino acid sequence of the present disclosure, may be labeled with any suitable label known to one of ordinary skill in the art. Such labels may include, but are not limited to, biotin/streptavidin (labeled), enzyme conjugates (e.g., horseradish peroxidase (HRP), alkaline phosphatase (AP), glucose oxidase and b-galactosidase), fluorescent moieties (e.g, FITC, fluorescein, rhodamine, etc.), biological fluorophores (e.g, green fluorescent protein, R-phycoerythrin) or other luminescent proteins, etc. Any suitable label known to one of ordinary skill in the art may be used with the present disclosure.

Further, in some aspects, the amino acid sequences of the present disclosure may be “bound.” A “bound” amino acid sequence is an amino acid sequence that has been immobilized in order to permit the use of the amino acid sequence in a biological test such as, for example, immunoassays. In the context of the present disclosure, a “bound” amino acid sequence is an amino acid sequence attached ( e.g ., covalently or non-covalently bound, etc.) directly or indirectly to a non-natural surface or substance (i.e., a solid support). Further still, the “bound” amino acid sequences of the present disclosure may be attached, directly or indirectly, to a natural surface or substance (i.e., a solid support), either of which is not naturally associated with the amino acid sequence. Non-limiting examples of substances to which the amino acid sequences of the present disclosure may be bound are nitrocellulose, nylon, polyvinylidene difluoride (PVDF), plastics, metals, magnetic beads and agarose (e.g., beads). Linking agents known to those of ordinary skill in the art may be used to aid or enhance binding of the amino acid sequences of the present disclosure to a surface or substance.

Production of amino acid sequences

In some aspects, amino acid sequences of the present disclosure may be natural occurring and isolated from a natural source. Further, in some aspects, amino acid sequences of the present disclosure may be non-natural, synthetic sequences, such as sequences produced by recombinant technology or sequences synthesized by protein synthesizing apparatuses. As such, amino acid sequences of the present disclosure may be isolated or may be produced by recombinant technology, as is described and enabled in the literature and in commonly referred to manuals such as, e.g, Short Protocols in Molecular Biology, Second Edition, F.M. Ausubel, Ed., all John Wiley & Sons, N. Y., edition as of 2008; and, Sambrook, et ak, Molecular Cloning: A Laboratory Manual, 3rd ed., Cold Spring Harbor Laboratory Press, Cold Spring Harbor, 2001, and as is well known to one of ordinary skill in the art. In one aspect, amino acid sequences of the present disclosure are made recombinantly in E. coli.

As used herein, the term “vector” refers to a nucleic acid molecule capable of transporting between different genetic environments another nucleic acid to which it has been operatively linked. In addition to including a nucleic acid sequence encoding an amino acid sequence of the disclosure (e.g., SEQ ID NOs: 1-19) or variants thereof which retain the immunological binding profile of the corresponding non-variants, vectors of the present disclosure also include a heterologous nucleic acid sequence. As used herein, heterologous refers to a nucleic acid sequence that does not naturally occur in the organism from which the Markush group sequences are derived. The term “vector” may also refer to a virus or organism that is capable of transporting the nucleic acid molecule. One type of vector is a plasmid, a small, circular, double-stranded, extrachromosomal DNA molecule that is physically separate from and can self-replicate independently from chromosomal DNA. Some useful vectors are those capable of autonomous replication and/or expression of nucleic acids to which they are linked. Vectors capable of directing the expression of nucleic acids to which they are operatively linked are referred to herein as “expression vectors.” Other useful vectors, include, but are not limited to bacterial plasmids and bacterial artificial chromosomes (BACs), cosmids, and viruses such as lentiviruses, retroviruses, adenoviruses, and phages.

Vectors useful in methods of the disclosure may include additional sequences including, but not limited to, one or more signal sequences and/or promoter sequences, or a combination thereof. Promoters that may be used in methods and vectors of the disclosure include, but are not limited to, cell-specific promoters or general promoters. Non-limiting examples of promoters that can be used in vectors of the disclosure are: ubiquitous promoters, such as, but not limited to: CMV, CAG, CBA, and EFla promoters. Methods to select and use suitable promoters are well known in the art.

Vectors useful in methods of the disclosure may be used to express a fusion protein comprising sequences of the disclosure in a cell. Expression vectors and methods of their preparation and use are well known in the art. In some aspects of the disclosure, a nucleic acid sequence of an expression vector encodes a fusion protein comprising an amino acid sequence of the disclosure. It is well known in the art how to prepare and utilize fusion proteins that comprise a polypeptide sequence. In some aspects, a fusion protein comprising an amino acid sequence of the disclosure may also include an epitope tag that may be used for purification of the fusion protein or in a method of the disclosure. Non-limiting examples of epitope tags are a FLAG tag, a fluorescent tag (including but not limited to green fluorescent protein (GFP)), a GST tag, a hemagglutinin (HA), a poly-histidine (poly-His) tag, a Myc tag, an MBP tag, or a V5 tag. In some aspects, a fusion protein comprising an amino acid sequence of the disclosure may also include a detectable label, as described elsewhere herein.

Assays and methods of detection

Amino acid sequences of the present disclosure bind specifically to antibodies produced following infection by Babesia species.. Specificity for said amino acid sequence, i.e., antibody specificity, is the property of antibodies which enables them to react preferentially with some antigenic determinants and not with others. Specificity is dependent on chemical composition, physical forces and molecular structure at the binding site. Sensitivity is how strongly the antibody binds to the antigenic determinant. One of ordinary skill in the art can easily determine specificity and sensitivity of an antibody for a particular amino acid sequence using standard affinity assays, such as immunoblotting, Ouchterlony assays, titer assays, etc.

In another aspect, the present disclosure provides methods of quickly and accurately detecting Babesia antibodies in a sample from a subject suspected of having babesiosis.

Methods of the present disclosure for detecting Babesia antibodies in a sample from a subject suspected of having babesiosis, may comprise, for example, providing a biological sample (including but not limited to blood, saliva) obtained from a subject suspected of having babesiosis, mixing the biological sample with one or more of the labeled and/or bound amino acid sequences of the present disclosure and detecting a positive immunobinding reaction which indicates the presence of antibodies to one or more Babesia species in the sample. The antibodies may be detected by, for example, immunoblotting, Elispot, ELISA, Western blotting, lateral flow assay, or any other appropriate immunoassay known to one of ordinary skill in the art. These techniques are known to one of ordinary skill in the art and procedures can be found in common technical references. While similar, each of these techniques has its advantages and disadvantages. Other suitable techniques may be known to those of skill in the art and are incorporated herein.

To assess the impact of testing limitations and to determine levels of exposure to Babesia species, a modified Western blot procedure, the line immunoblot, was developed and employed in aspects of the disclosure described herein. A line immunoblot uses recombinant antigens from multiple Babesia species for serological identification and diagnosis of Babesia infection in serum from patients with suspected babesiosis. Infection with more than one Babesia species is possible and may occasionally be observed.

Western blotting can involve separating proteins by electrophoresis and then transferring to nitrocellulose or other solid media ( e.g ., polyvinylidene fluoride or PVDF-membrane and nylon membrane), and is described in more detail below. Immunoblotting can also involve applying proteins to a solid media manually or by machine. Preferably, the proteins or polypeptides are applied in straight lines or spots and dried, binding them to the solid support medium, e.g., nitrocellulose. The proteins used in an immunoblot can be isolated from biological samples or produced by recombinant technology, as is well known by those of ordinary skill in the art. The bound proteins are then exposed to a sample or samples suspected of having antibodies specific for the target proteins. With this procedure, a known antibody can be used to determine if a protein is present in a sample, such as when the proteins of lysed cells are separated by electrophoresis and transferred to the solid medium. Western blotting allows for the identification of proteins by size as well as by specificity for a specific antibody.

Similarly, with a procedure called immunoblotting, known proteins can be bound to the solid medium and samples, such as samples from subjects suspected of having an infection, can be tested for the presence of specific antibodies in the sample by contacting the bound protein with the sample. An antibody that binds the target protein is usually referred to as the primary antibody. A secondary antibody, specific for conserved regions of the primary antibody (for example, a rabbit-anti-human IgG antibody may be used to detect primary human antibodies) is used to detect any bound primary antibodies. The secondary antibody is usually labeled with a detectable moiety for visualization. Non-limiting examples of suitable labels include, for example, chromophores such as biotin, radioactive moieties and enzymes such as alkaline phosphatase, etc. The use of these and other materials for the visualization of antibodies are well known to one of ordinary skill in the art.

The Enzyme-Linked ImmunoSpot (ELISPOT) method can detect human T cells that respond to Babesia- specific antigens in vitro. In an ELISPOT assay, the surfaces of PVDF membrane in a 96-well microtiter plate are coated with capture antibody that binds, for example, anti-interferon gamma (IFNy) or other cytokine-specific antibody. During the cell incubation and stimulation step, the T cells isolated from patient whole blood are seeded into the wells of the plate along with aforementioned sequence(s), and form substantially a monolayer on the membrane surface of the well. Upon stimulation of any antigen-specific cells with one or more of the sequences of the present disclosure they are activated and they release the IFNy, which is captured directly on the membrane surface by the immobilized antibody. The IFNy is thus “captured” in the area directly surrounding the secreting cell, before it has a chance to diffuse into the culture media, or to be degraded by proteases and bound by receptors on bystander cells. Subsequent detection steps visualize the immobilized IFNy as an ImmunoSpot; essentially the secretory footprint of the activated cell.

For a specific example of an ELISPOT test, each well of the plate is coated with a purified cytokine-specific antibody specific for the test or cell being detected. Subject’s (i.e., a subject suspected of having babesiosis) T cells are isolated and cultured in each well and stimulated with recombinant antigens of one or more sequences of the present disclosure. Babesia- positive patient cells secrete cytokine in response to stimuli, which is captured by the antibody coated in the well and further detected by ELISA.

ELISA assays are also used to detect antigens. The ELISA assay can permit the quantification of a specific protein in a mix of proteins (for example, a lysate) or determine if a peptide is present in a sample. Likewise, ELISA assays can be used to determine if a specific antibody is present by using a specific antigen as a target. As used with the present disclosure, target amino acid sequence(s) are attached to a surface. Then, if present in the sample being tested, the reactive antibody can bind to the antigen. A secondary antibody linked to an enzyme is added, and, in the final step, a substance containing the enzyme's substrate is added. The subsequent reaction produces a detectable signal, most commonly a color change in the substrate.

Lateral flow assays, also referred to by a variety of other names that include but are not limited to lateral flow tests, lateral flow devices, lateral flow immunoassays, lateral flow immunochromatographic assays, and rapid tests, are simple, versatile, paper-based platforms for detecting and/or quantifying the presence of one or more analytes, such as an antigen, in a mixture, such as a liquid sample. Lateral flow assays may be qualitative or quantitative. In a lateral flow assay, a sample containing one or more analytes of interest is applied to an adsorbent sample pad and is drawn via capillary action through various zones of polymeric test strips to which are attached molecules that can interact with the analyte(s). The sample migrates to the conjugate release pad, which contains molecules that specifically bind to the analyte(s) of interest and are conjugated to fluorescent, colored, or otherwise detectable particles. Finally, the sample, including the bound analyte(s) migrates into the detection zone. Within the porous membrane of the detection zone are biological components such as antibodies or antigens, that are immobilized in lines and that will react with the detectable particles. Lateral flow assays typically have a control line for confirming sample flow through the strip and one or more test lines for detecting the presence of the analyte(s) of interest. The results may be read by eye or with a machine capable of reading and interpreting the results. A lateral flow assay may be designed as a direct or “sandwich” assay, in which the presence of a colored line at the test line position indicates a positive test, or as a competitive assay, in which the absence of a colored line indicates a positive test. Direct and competitive assays may be multiplexed.

In aspects of methods of the present disclosure, a positive result for infection by one or more Babesia species, if present in a biological sample obtained from a subject suspected of having a Babesia infection, is indicated when a biological sample obtained from a subject suspected of having a Babesia infection is provided and contacted with a composition of the disclosure comprising labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences comprise amino acid sequences SEQ and variants thereof which retain the immunological binding profile of the corresponding non-variant under conditions appropriate for specific antibody binding to an epitope, and specific binding of IgM- and/or IgG-class antibodies, if present in the biological sample, with amino acid sequences included in the composition is detected, wherein the sample is scored as positive for infection by one or more Babesia species when (i) a positive immunobinding reaction with IgM-class antibodies is detected for at least two of SEQ ID NOs: 1-19, or (ii) a positive immunobinding reaction with IgG-class antibodies is detected for at least two of SEQ ID NOs: 1-19, and wherein a positive score for infection indicates infection by one or more Babesia species in the subject.

In methods of the present disclosure, any primary antibody bound to a peptide encoded by an amino acid sequence of the present disclosure may be detected with anti-human antibodies, such as IgG or IgM, used as the secondary antibody conjugated to a detectable moiety. As discussed elsewhere herein, the detectable moiety may be selected from the group consisting of chromophores, radioactivity moieties and enzymes or other detectable moiety known to one of ordinary skill in the art. In one aspect, the detectable moiety comprises alkaline phosphatase. In another aspect the detectable moiety comprises biotin. In one aspect, the Babesia genus comprises species selected from B. microti, B. duncani, B. MOl, B. divergens, B. venatorum, and B. crassa.

In another aspect of the present disclosure, methods are provided for detecting and distinguishing infection by B. microti and/or B. duncani in a biological sample. The sample may be from a subject suspected of having babesiosis. In one aspect of methods of the disclosure, a positive result for infection by B. microti or B. duncani is indicated when a biological sample obtained from a subject suspect of having a Babesia infection is provided and contacted with a composition of the disclosure under conditions appropriate for specific antibody binding to an epitope, wherein the composition comprises labelled and/or tagged and/or bound amino acid sequences, wherein the labelled and/or tagged and/or bound amino acid sequences comprise amino acid sequences and SEQ ID NO: 19, and variants thereof which retain the immunological binding profile of the corresponding non-variant, and detecting specific binding of IgM- and/or IgG-class antibodies, if present in the biological sample, with the amino acid sequences of the composition. In one aspect of methods of the disclosure, a sample is scored as positive for infection by B. microti when a positive immunobinding reaction with IgM- or IgG- class antibodies is detected for at least one of SEQ ID NOs: 1-7, 9, 11, or 13 and at least one of SEQ ID NOs: 8, 10, or 12, and wherein a positive score indicates infection by B. microti. In another aspect of methods of the disclosure, a sample is scored as positive for infection by B. duncani when a positive immunobinding reaction with IgM- or IgG-class antibodies is detected for at least one of SEQ ID NOs: 1-7, 9, 11, 13, or 16-19 and at least one of SEQ ID NOs: 14 or 15, and wherein a positive score indicates infection by B. duncani. Amino acids may be labeled to confirm their presence if positive results are not obtained in the assay. Subjects and cells

As used herein, a subject may be an animal, such as a mammal or a non-mammal. Nonlimiting examples of mammalian subjects include primates (including but not limited to humans), rodents (including but not limited to mice, rats, squirrels, chipmunks, prairie dogs), lagomorphs, deer, canids (including but not limited to dogs, foxes, coyotes, and wolves), felids (including but not limited to domestic cats, bobcats, cougars, and other wild cats), bears, horses, cows, sheep, goats, and pigs. Non-limiting examples of non-mammalian subjects include birds, amphibians, lizards, insects, and arthropods. As used herein, a cell may be a bacterial cell, including but not limited to E. coli , or an animal cell, either mammalian or non-mammalian.

EXEMPLIFICATION

Example 1. Detection of Babesia infection in patient samples Methods

Patient serum samples and rabbit antisera

Patient sera used were leftover decoded patient sera received for tick-borne testing at IGeneX (IGeneX, Milpitas, CA) that would otherwise have been discarded. Rabbit antiserum to B. microti and B. duncani recombinant proteins was raised using B. microti recombinant proteins and B. duncani recombinant proteins, according to standard methods known in the art.

Preparation of recombinant antigens and ImmunoBlots

Using recombinant antigens from several species of Babesia , simple and rapid immunoblot (IB) assays were developed for detection of Babesia- specific IgM and IgG antibodies in a patient’s serum in order to provide a laboratory diagnosis of Babesia. Briefly, several Babesia genus-specific and species-specific antigens were identified. Recombinant proteins for all 19 identified antigens (SEQ ID NOs: 1-19) were prepared by cloning portions of the selected genes into pET vectors, expressing the proteins in Escherichia coli , and purifying the proteins by metal affinity chromatography followed by gel filtration as previously described [Liu et al., Healthcare 6, 99 (2018)]. All proteins used for IB were > 90% pure by Coomassie blue staining after SDS PAGE. The Babesia antigens and control proteins were sprayed in straight lines to yield 7-19 ng of protein as a line in each 3 mm strip onto nitrocellulose membrane as previously described [Liu et al., Healthcare 6, 99 (2018)]. The two control proteins were Protein L (Sigma) for detecting the addition of human serum and a mixture of human IgM and IgG for detecting the addition of alkaline phosphatase conjugated anti-human antibodies as previously described [Liu et al, Healthcare 6, 99 (2018)]. The membranes were then blocked with 5% non-fat dry milk and sliced into 3 mm wide strips (IB strip). Table 1 lists IB bands and corresponding SEQ ID NOs.

Table 1. ImmunoBlot bands and corresponding SEQ ID NOs

ImmunoBlotting Prior to use, each strip was labeled and then soaked in 1 mL of diluent (100 mm Tris,

0.9% NaCl, 0.1% Tween-20 and 1% non-fat dry milk) for 5 min in a trough. A 10 pL aliquot of the test or control serum was added to a corresponding IB strip in a trough. The strips were then incubated at room temperature for one hour with serum, followed by three washes with wash buffer at ambient temperature. After aspirating the final wash solution, strips for detecting IgG and IgM were incubated with alkaline phosphatase-conjugated goat anti-human IgG at 1 : 10,000 dilution and IgM at 1 :3000 dilution, respectively, for one hour. After three washes, bands were visualized by reaction with 5-bromo-4-chloro-3-indolylphosphatenitro-blue tetrazolium or BCIP/NBT. The reactions were terminated by washing with distilled water when a calibration control used in parallel produced a visible band. Babesia IB strips were also reacted in parallel with a mixture of human sera from patients with confirmed Babesia infection as a positive control and sera from uninfected persons as a negative control.

Reading IB Strips and result interpretation

For a run to be considered acceptable for scoring, all bands were required to show up on the positive control strip and the negative control strip was required to show only the Cl and C2 control bands. All bands were recorded for each sample. A sample was considered positive for the Babesia genus if at least two of the 19 bands were present on the IB, as detected by either IgM or IgG. A sample was considered B. microti- positive if at least one of bands 1-7, 9, 11, and 13, and at least one of bands 8, 10, and 12 were present on the IB (either IgM or IgG). A sample was considered B. duncani- positive if at least one of bands 1-7, 9, 11, 13, 16-19, and at least one of bands 14 and 15 were present on the IB (either IgM or IgG). Results and Conclusion

Babesia IB strips were tested with serum samples from patients positive for Babesia by FISH and/or IF A, as well as other tick-borne diseases and E. coli antibodies. These results demonstrated that the Babesia IB could detect Babesia infection at the genus level and could speciate to B. microti and B. duncani in a single test. Babesia IB blots did not cross react with antibodies to other tick-borne infections (100% specificity to Babesia ) as shown in Figure 1 and Table 2.

Table 2. Lack of cross-reactivity with antibodies to non-Babesia tick-borne infections

As shown in Figures 2 and 3, the Babesia IB detected both B. microti and B. duncani. A set of 37 serum samples from patients suspected of babesiosis were tested. Twenty-eight samples were identified as positive for Babesia using the Babesia IB. Results are summarized in Table 3 and detailed results shown in Figure 4.

Table 3. Summary of Babesia IB performance in clinical samples Based on these data, Babesia IB sensitivity was 82.1%. Thus, the Babesia IB could be used to detect Babesia infection generally (genus-level detection), and to distinguish between infection by B. microti and B. duncani. It had 100% specificity as shown in Figure 1 and Table 2 Equivalents

Although several aspects of the present disclosure have been described and illustrated herein, those of ordinary skill in the art will readily envision a variety of other means and/or structures for performing the functions and/or obtaining the results and/or one or more of the advantages described herein, and each of such variations and/or modifications is deemed to be within the scope of the present disclosure. More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are meant to be exemplary and that the actual parameters, dimensions, materials, and/or configurations will depend upon the specific application or applications for which the teachings of the present disclosure is/are used. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific aspects of the disclosure described herein. It is, therefore, to be understood that the foregoing aspects are presented by way of example only and that, within the scope of the appended claims and equivalents thereto; the disclosure may be practiced otherwise than as specifically described and claimed. The present disclosure is directed to each individual feature, system, article, material, and/or method described herein. In addition, any combination of two or more such features, systems, articles, materials, and/or methods, if such features, systems, articles, materials, and/or methods are not mutually inconsistent, is included within the scope of the present disclosure.

All definitions, as defined and used herein, should be understood to control over dictionary definitions, definitions in documents incorporated by reference, and/or ordinary meanings of the defined terms.

The indefinite articles “a” and “an,” as used herein in the specification and in the claims, unless clearly indicated to the contrary, should be understood to mean “at least one.” The phrase “and/or,” as used herein in the specification and in the claims, should be understood to mean “either or both” of the elements so conjoined, i.e., elements that are conjunctively present in some cases and disjunctively present in other cases. Other elements may optionally be present other than the elements specifically identified by the “and/or” clause, whether related or unrelated to those elements specifically identified, unless clearly indicated to the contrary.

All references, patents and patent applications and publications that are cited or referred to in this application are incorporated by reference in their entirety herein.

What is claimed is: