KR20160048686A - Biomarker for detecting lupus nephritis and use thereof - Google Patents

Abstract

The present invention provides compositions, kits and methods for detecting lupus nephritis comprising prostaglandin D synthetase, vitamin D binding protein, complement factor H, and a reagent for detection of trazlectin and / or retinol binding protein 4. The composition, kit and method according to the present invention can detect lupus nephritis with high sensitivity and specificity only by a small amount of urine specimen of the patient alone or in combination of two or more, and it is possible to overcome the inaccuracy of the conventional lupus nephritis diagnosis method The hassle and risk of kidney biopsy can be greatly reduced.

Description

Biomarkers for detecting active lupus nephritis and uses thereof -

The present invention relates to biomarkers that can be used for the detection, diagnosis, and measurement of progression of active lupus nephritis.

Lupus nephritis is the most serious form of kidney involvement in systemic lupus erythematosus and is associated with increased mortality. Although the treatment of systemic lupus erythematosus has developed over the past 20 years, the prognosis for lupus nephritis is still unsatisfactory.

As important as the development of more effective and less side-effects in the treatment of lupus nephritis, early detection and treatment of kidney involvement can reduce the use of potent immunosuppressants and reduce kidney damage when starting treatment early .

In order to diagnose and measure the progression of lupus nephritis, existing clinical indicators such as creatinine clearance, proteinuria, urine sediment, anti-dsDNA, and complement concentration have been used to detect kidney disease activity or renal flares early Specificity and sensitivity.

Korean Patent Laid-Open Publication No. 2014-0110692 relates to a diagnostic method and a diagnostic kit for a kidney disease, and relates to a diagnostic kit and a kit for diagnosing kidney disease, which comprises acetylated α-tubulin, EVC2, INPP5E, INVERSIN, NPHP3, Broad-Minded (bromi), FAM49B, GTL3 Protein markers such as TSGA14, WDR60, WDR11, polycystin-1, polycystin-2, NME7, EPT2, SEPT7, SEPT9, small GTPase Ran, importin, IFT57, IFT74, IFT80, IFT88, IFT122 and IFT172. And the like.

United States Patent Application Publication No. 2010-0323911 relates to a method for detecting aggravation of renal disease in a patient suffering from systemic lupus erythematosus, which comprises transferrin (TF), ceruloplasmin (Cp) , Alpha- 1-acid glycoprotein (AGP1), and UNGAL (Urinary neutrophil gelatinase associated lipocalin).

Therefore, it is urgent to develop a new biomarker that can improve the accuracy and sensitivity of diagnosis of kidney disease in systemic lupus erythematosus, determine prognosis, monitor therapeutic response, and detect the deterioration of kidney disease early.

The present invention provides a biomarker capable of detecting lupus nephritis with high sensitivity and specificity in the urine.

In one embodiment, the invention provides a pharmaceutical composition comprising at least one of prostaglandin D synthease, lipocalin type, vitamin D binding protein, transthyretin, and complement factor H The present invention provides a composition for diagnosing active lupus nephritis comprising a marker detecting reagent. One or more, e. G., Two, or a combination of three, or four markers may be used according to the present invention.

In one embodiment, the marker according to the present disclosure may further comprise Retinol Binding Protein 4 and may be used with any combination of the markers.

The detection reagent of the marker according to the present invention is a reagent capable of detecting the marker at the protein or nucleic acid level. The protein level detection reagent can be, for example, Western blot, ELISA, radioimmunoassay, immunodiffusion, immunoelectrophoresis, For example, immunoassay analysis, complement fixation assay, FACS, mass spectrometry, or protein microarray. The reagent for detecting the nucleic acid level of the marker may be, for example, polymerase chain reaction, reverse transcription polymerase chain reaction, competitive polymerase chain reaction, Nuclease But are not limited to, reagents used in RNase, S1 nuclease assay, in situ hybridization, nucleic acid microarrays or Northern blots.

In one embodiment, the protein level detection reagent of the marker according to the present invention is an antibody, antibody fragment, aptamer, avidity multimer or peptidomimetic antibody that specifically recognizes the protein full length or fragment thereof. wherein the nucleic acid level detecting reagent is selected from the group consisting of a nucleic acid sequence of the marker, a nucleic acid sequence complementary to the nucleic acid sequence, a primer pair specifically recognizing the nucleic acid sequence and a fragment of the complementary sequence, Or primer pairs and probes, but are not limited thereto.

In another embodiment, the present disclosure also provides a method for the treatment and / or prophylaxis of one or more of prostaglandin D synthease, lipocalin type, vitamin D binding protein, transthyretin, and complement factor H A diagnostic reagent for abnormal lupus nephritis.

The detection reagent of a marker contained in the kit according to the present invention is a reagent capable of detecting one or more, for example, two, or a combination of three, or four marker combinations of the marker.

The kit according to the present invention may further comprise a detection reagent for Retinol Binding Protein 4 and may be used together with any combination of the markers.

The kits according to the present invention can be used in a variety of ways, including for example as a detection reagent, and the kit can be used for ELISA analysis.

In another embodiment, the present invention also provides a method of diagnosing or prophylaxis of active lupus nephritis, comprising contacting a biological sample derived from a test subject with a prostaglandin D synthease, a lipocalin type, a vitamin D binding protein (vitamin Detecting the presence and / or concentration of a nucleic acid and / or protein of a marker of at least one of D binding protein, transthyretin and complement factor H; Comparing the detection result for the concentration or presence of the nucleic acid or protein to a corresponding result of a corresponding marker of a normal control sample; And comparing the nucleic acid or protein concentration of the sample derived from the subject with that of the normal control sample and determining whether the nucleic acid or protein has a change in the presence or absence of the nucleic acid or protein, A method for detecting a biomarker to provide information necessary for diagnosis or prognosis of the biomarker.

The marker used in the method according to the present invention may be one or more, for example, two, or a combination of three, or four markers. The marker used in the method according to the present invention may further comprise retinol binding protein 4 (Retinol Binding Protein 4) and may be used in various combinations with other markers according to the present application.

The method according to the present invention can be carried out using various methods known in urine samples, and in one embodiment an ELISA is used, but not limited thereto.

The biomarkers according to the present invention which can detect lupus nephritis with high sensitivity and specificity, that is, prostaglandin D synthetase, vitamin D binding protein, complement factor H, transistin and retinol binding protein 4, (0.01-0.05 ml) urine samples can be used to overcome the inaccuracies of conventional lupus nephritis diagnostic methods or to replace kidney biopsy, which can greatly reduce the hassle and danger, The accuracy and convenience of diagnosis of nephritis is maximized.

Figure 1 shows the results of a normal control, a healthy control; Patients with non-LN (non-lupus nephritis), without lupus nephritis (lupus patients without renal involvement); LN (lupus nephritis), PGDS (prostaglandin D synthase, lipocalin type), prostaglandin D synthase in urine in patients with lupus nephritis; Vitamin D binding protein (VDBP), vitamin D binding protein; CFH (complement factor H), complement factor H; TTR (transthyretin), TRENSTYRETIN; RBP4 (retinol binding protein 4), retinol binding protein 4; And Cr (creatinine), and creatinine protein concentrations.

This study compared the urine of patients with activated lupus nephritis and patients without lupus nephritis using a proteomic analysis method to detect biomarkers that help diagnose lupus nephritis in the urine (kidney involvement-free lupus patients) We evaluated the efficacy of these new protein substances in the cohort of patients with systemic lupus erythematosus. As a result, prostaglandin D synthase (lipocalin type), vitamin D binding protein, transthyretin, complement factor H and retinol binding protein 4 Retinol Binding Protein 4) can be used effectively as a marker for lupus nephritis.

Thus, in one aspect, the present invention relates to a composition for the detection of a lupus nephritis comprising a detection reagent for a marker of at least one of prostaglandin D synthetase lipocalin type, vitamin D binding protein, TRENSTYRETIN, complement factor H and retinol binding protein 4.

The markers according to the present invention can be used for urine specimens and can be used for non-invasive specimens. Since they are directly concentrated and excreted in the kidneys, they can directly and sensitively reflect the protein substances related to the damaged kidneys It has advantages.

Systemic lupus erythematosus is an autoimmune disease that occurs in adolescent girls and causes autoimmune diseases such as kidney, blood cells, central nervous system, Rash, hematologic abnormalities, arthritis, as well as inflammation of the heart, lungs, central nervous system, kidneys and inflammation will occur.

In 80% of patients with systemic lupus erythematosus, urinary test abnormalities, renal dysfunction, and proteinuria, hematuria and hypertension, such as lupus nephritis, and type 1 to 6 are distinguished.

The biomarker according to the present invention enables early detection, diagnosis and treatment monitoring thereof through detection of lupus nephritis due to systemic lupus erythematosus.

The term diagnosis herein refers to determining the susceptibility of a test subject to a disease for a particular disease or disorder, determining whether a particular disease or disorder is presently present, the prognosis of a particular disease or disorder determining the prognosis (e. g., determining the stage or progress of the disease or determining the responsiveness of the disease to treatment), or determining therametrics (e. g., monitoring the status of the object to provide information about the therapeutic efficacy) .

Herein, the term biomarker for diagnosis, marker or diagnostic marker refers to a sample derived from a subject suffering from a disease, for example, a substance capable of diagnosing urine differently from a sample of a subject who has received proper treatment for treatment of a disease or a disease, , Disease progression, and an indicator for objectively measuring and evaluating the response of a drug to a treatment method. The term refers to a protein or nucleic acid that shows an increase in the sample derived from a diseased subject compared to a normal sample.

The markers according to the present invention can be detected by quantitative or qualitative analysis at the level of detection of the presence of nucleic acids, in particular mRNA and / or protein and / or their expression levels themselves, changes in expression levels, and differences in expression levels.

Detection of a biomarker according to the present invention may be based on functional and / or antigenic characteristics of the marker. The markers according to the present invention may be detected using the detection of the activity or function of the marker, or a nucleic acid encoding the protein, especially a substance that specifically interacts at the mRNA level and / or protein level.

In this regard, a detection reagent according to the present invention is a reagent capable of detecting a marker according to the present invention through quantitative or qualitative analysis in various ways at the protein or nucleic acid level. The five markers according to the present invention, namely prostaglandin D synthase, lipocalin type, vitamin D binding protein, transthyretin, complement factor H, And Retinol Binding Protein 4 are disclosed as GenBnak ID AAK07679, AAA61704, CAA42087, CAA30403 and AAH20633, respectively, and using these known sequences and characteristics, the protein sequences of the markers according to the present invention can be quantitatively and qualitatively The detection reagent or the detection substance necessary for the analysis can be easily selected.

For quantitative and qualitative analysis of markers according to the present invention, various methods for qualitatively or quantitatively detecting known nucleic acids and proteins can be used.

Qualitative or quantitative detection methods at the protein level include, for example, Western blotting, ELISA, radioimmunoassay, immunodiffusion, immunoelectrophoresis, tissue immuno staining, immunoprecipitation assays, complement fixation assays, antibodies labeled in solution / suspension Or a method using a protein array such as a mass spectrometer or an antibody can be used.

A nucleic acid transcription and amplification system, an eTag system, a system based on a labeled bead, an array system such as a nucleic acid array, or the like can be used as a method for qualitative or quantitative detection at the nucleic acid level.

Such methods are well known, for example, chip-based capillary electrophoresis: Colyer et al. 1997. J Chromatogr A. 781 (1-2): 271-6; mass spectroscopy: Petricoin et al. 2002. Lancet 359: 572-77; eTag systems: Chan-Hui et al. 2004. Clinical Immunology 111: 162-174; microparticle-enhanced nephelometric immunoassay: Montagne et al. 1992. Eur J Clin Chem Clin Biochem. 30: 217-22.

In one embodiment, a sandwich immunoassay such as ELISA (Enzyme Linked Immuno Sorbent Assay), RIA (Radio Immuno Assay) or the like may be used. This method can be applied to a first antibody conjugated to a bead, membrane, slide or microtiter plate made of a solid substrate such as glass, plastic (e.g. polystyrene), polysaccharide, nylon or nitrocellulose, And then labeled or labeled with a labeling substance capable of direct or indirect detection, for example, a radioactive substance such as ³ H or ¹²⁵ I, a fluorescent substance, a chemiluminescent substance, a hapten, a biotin, a digoxigenin, Protein can be detected qualitatively or quantitatively through the conjugation of an enzyme conjugated with an enzyme such as horseradish peroxidase, alkaline phosphatase, or malate dehydrogenase capable of coloring or luminescence.

In other embodiments, Immunoelectrophoresis such as Ouchterlony plates, Western blot, Crossed IE, Rocket IE, Fused Rocket IE, Affinity IE can be used which can simply detect the marker through antigen-antibody binding. Methods of immunoassay or immunostaining are described in Enzyme Immunoassay, E. T. Maggio, ed., CRC Press, Boca Raton, Florida, 1980; Gaastra, W., Enzyme-linked immunosorbent assay (ELISA), in Methods in Molecular Biology, Vol. 1, Walker, J.M. ed., Humana Press, NJ, 1984. By analyzing the intensity of the final signal by the above-described immunoassay process, that is, performing signal contrast with a normal sample, diagnosis of disease occurrence can be made.

Reagents or substances used in such methods are well known in the art and include, for example, antibodies, substrates, nucleic acid or peptide aptamers that specifically bind to the markers, or receptors or ligands or cofactors that specifically interact with the markers Etc. may be used. Reagents or substances that specifically interact or bind to the markers of the present invention may be used in conjunction with chip-based or nanoparticles.

The markers herein may also be quantitatively and / or qualitatively detected using a variety of methods known at the nucleic acid level, particularly at the mRNA level.

Qualitative or quantitative detection methods at the nucleic acid level include, for example, detection at the mRNA level, reverse transcription-polymerase chain reaction (RT-PCR) / polymerase chain reaction, competitive RT-PCR, Methods using real-time RT-PCR, Nuclease protection assay (NPA) such as RNase, S1 nuclease analysis, in situ hybridization, DNA microarray or chip or Northern blot can be used, May be performed using commercially available kits, and those skilled in the art will be able to select appropriate ones for the practice of the present application. For example, Northern blot can detect the size of a transcript present in a cell, and it has an advantage that various probes can be used. NPA is useful for multi-marker analysis, and in situ hybridization Or tissue, and the reverse transcription polymerase chain reaction is useful for detecting a small amount of a sample. Also, an array comprising a binding agent or a binding agent that specifically binds to a nucleic acid such as mRNA or cRNA derived from a gene encoding the biomarker protein according to the present invention may be used.

The reagent or substance used in the method for detecting the biomarker at the nucleic acid level is well known. For example, in the method for measuring the presence and amount of mRNA by RT-PCR, the detection reagent includes, for example, a polymerase , A probe and / or a primer pair specific to the mRNA of the marker of the present invention. &Quot; Primer " or " probe " refers to a nucleic acid sequence having a free 3 'hydroxyl group capable of complementarily binding with a template and allowing the reverse transcriptase or DNA polymerase to initiate replication of the template do. The detection reagent used herein may be labeled as a chromogenic, luminescent or fluorescent material as described above for signal detection. In one embodiment, Northern blot or reverse transcription (PCR) (polymerase chain reaction) is used for mRNA detection. In the latter case, it is possible to detect a specific gene in a specimen by isolating RNA of the specimen, specifically mRNA, synthesizing cDNA therefrom, and then using a specific primer or a combination of a primer and a probe to detect the presence / Or the amount of expression can be determined. Such a method is described, for example, in Han, H. et al, 2002. Cancer Res. 62: 2890-6.

In one embodiment, this is done using antibody molecules that specifically bind to the lupus nephritis markers of the invention.

The antibody used in the present invention is a polyclonal or monoclonal antibody, preferably a monoclonal antibody. Antibodies can be produced using methods commonly practiced in the art, such as the fusion method (Kohler and Milstein, European Journal of Immunology, 6: 511-519 (1976)), the recombinant DNA method (US Patent No. 4,816,56) Or phage antibody library methods (Clackson et al., Nature, 352: 624-628 (1991) and Marks et al., J. Mol. Biol., 222: 58, 1-597 (1991)). General procedures for antibody preparation are described in Harlow, E. and Lane, D., Using Antibodies: A Laboratory Manual, Cold Spring Harbor Press, New York, 1999; Zola, H., Monoclonal Antibodies: A Manual of Techniques, CRC Press, Inc., Boca Raton, Florida, 1984; And Coligan, CURRENT PROTOCOLS IN IMMUNOLOGY, Wiley / Greene, NY, 1991, the disclosures of which are incorporated herein by reference. For example, the preparation of hybridoma cells producing monoclonal antibodies is accomplished by fusing an immortal cell line with an antibody-producing lymphocyte, and the techniques required for this process are well known and readily practicable by those skilled in the art. Polyclonal antibodies can be obtained by injecting a protein antigen into a suitable animal, collecting the antiserum from the animal, and then separating the antibody from the antiserum using a known affinity technique.

Such immunoassays can be performed according to various quantitative or qualitative immunoassay protocols developed in the past. The immunoassay format may include, but is not limited to, radioimmunoassays, radioimmunoprecipitation, immunoprecipitation, immunohistochemical staining, enzyme-linked immunosorbant assay, capture-ELISA, inhibition or competitive assay, sandwich assay, flow cytometry, But are not limited to, fluorescent staining and immunoaffinity purification. Methods of immunoassay or immunostaining are described in Enzyme Immunoassay, E. T. Maggio, ed., CRC Press, Boca Raton, Florida, 1980; Gaastra, W., Enzyme-linked immunosorbent assay (ELISA), in Methods in Molecular Biology, Vol. 1, Walker, J.M. ed., Humana Press, NJ, 1984, which is incorporated herein by reference. By analyzing the intensity of the final signal by the above-described immunoassay, that is, performing signal analysis of a normal sample or inactive lupus nephritis sample, lupus nephritis can be diagnosed.

Reverse transcription PCR (polymerase chain reaction) is a method for detecting a specific gene in a specimen by separating RNA of a sample, specifically mRNA, synthesizing cDNA therefrom, and then using a specific primer or a combination of primers and probes , The presence / absence or expression level of a specific gene can be determined. Such a method is described in, for example, Han, H., Bearss, DJ; Browne, LW; Calaluce, R .; Nagle, RB; Von Hoff, DD. Identification of differentially expressed genes in pancreatic cancer cells using cDNA microarray. Cancer Res 2002 , 62, (10), 2890-6. / Kwang Hyuck Lee, Quatification of DNA as a tumor marker in patients with pancreatic cancer, Korean Journal of Gastroenterology 2005, 46, 226-32.

Herein, the markers can also be detected using mass spectrometry and can be analyzed, for example, in the manner described in the examples herein after separating proteins from the sample, and also for example (Kim, SJ J, IJ; Kim, Y., Verification of biomarkers for diabetic retinopathy by multiple reaction monitoring. J Proteome Res 2010, 9, (2), 689-99 / Anderson , Hunter, CL, Quantitative mass spectrometric multiple reaction monitoring assays for major plasma proteins. Mol Cell Proteomics 2006, 5, (4), 573-88.

In another aspect, the disclosure also relates to a kit for the diagnosis of lupus nephritis of a specimen comprising a detection reagent of a marker according to the present invention.

The detection reagent included in the kit according to the present invention may refer to the foregoing, and the kit may further include a use guide.

In another aspect, the present invention relates to a method for quantitatively and / or qualitatively detecting a biomarker according to the present invention at a nucleic acid and / or protein level in a biological sample derived from an object in Invitro for diagnosis or prognosis of lupus nephritis .

One embodiment of the present invention is a method for detecting one or more biomarkers according to the present disclosure in order to provide information necessary for the diagnosis or prognosis of lupus nephritis, said method comprising detecting the presence or absence of a nucleic acid of one or more biomarkers according to the present invention And / or detecting the presence and / or concentration of the protein; Comparing the detection result of the concentration or presence of the nucleic acid or protein with a corresponding result of a corresponding marker of a normal control or inactive lupus nephritis sample; And determining the presence of a change in the nucleic acid or protein concentration of the subject-derived sample or a change in the presence or absence of the nucleic acid or protein as compared with the normal control sample or inactive lupus nephritis, .

Detection of the presence / absence or expression level of the marker in the method of the present invention can be determined at the protein and / or nucleic acid level, as described above.

The biological sample used in the method according to the present invention is as mentioned above.

The detection of the marker according to the method of the present invention includes both qualitative and quantitative detection and can be an index for the onset and progression of the disease and can be used for diagnosis of the disease, Can be used.

In addition to the marker analysis results, the method of the present invention can additionally use non-protein clinical information of the patient, i.e., clinical information other than the marker, in order to provide information on the diagnosis or prognosis of lupus nephritis. Such non-protein clinical information includes, but is not limited to, age, sex, weight, diet, body mass, underlying disease, or information derived from existing diagnostic methods, for example.

The method includes the step of associating a detection result of the marker with a diagnosis or prognosis of lupus nephritis, wherein the step of correlating comprises determining the amount or presence of the protein of the determined marker, or the amount or presence of the nucleic acid, And the diagnosis is based on this comparison. Herein, the biomarker is differentially expressed in a sample of a patient with or suspected to have lupus nephritis, for example, a urine sample as compared with a control sample, for example, a patient with inactive lupus nephritis, In the case of a significant increase can provide information for diagnosing that the disease has occurred in the subject. According to an embodiment of the present invention, the associating step may include comparing a sample of a normal control group with a sample, setting a threshold value for diagnosing the onset of the marker, and comparing the detection result of the target body with the threshold value Can be compared.

The markers herein may be used in combination of a plurality of markers, and two, three, four or five markers may be used. If multiple markers are used, they can be analyzed using algorithms to improve the accuracy of diagnosis and prediction. In this regard, the subject matter also includes a computer embedded with reagents, apparatus, and algorithms for detecting one or more markers herein, wherein the algorithm associates the detection of the marker with a diagnosis or prognosis of lupus nephritis. To a lupus nephritis diagnostic kit. Wherein the associating step compares the expression level values of the one or more markers of the subject for lupus nephritis test, normal control, inactive lupus nephritis, or a patient with a particular type of lupus nephritis to derive a pattern of differences in the expression levels ≪ / RTI >

In one embodiment of the present invention, the algorithm training deriving the pattern comprises constructing an algorithm for mapping the marker expression amount given as an input value to a diagnostic or prognostic result given as a calculated value; Mapping the marker emission amount to diagnosis or absence of lupus nephritis by executing the constructed algorithm; And performing the algorithm while varying the input value of the constructed algorithm and the calculated value thereof to realize an optimal algorithm mapping architecture, wherein the optimal algorithm mapping is performed using the normal control or inactive lupus nephritis The present inventors identified a significant difference between the markers expression level of a patient or a patient having a specific lupus nephritis by using the marker expression level of the lupus nephritis test subject and used it for diagnosing or not having lupus nephritis.

Known algorithms may be used herein, including, but not limited to, linear or non-linear regression algorithms; Pre- or non-linear classification algorithms; ANOVA; Neural network algorithm; Genetic Algorithm; Support vector machine algorithm; Hierarchical analysis or clustering algorithm; A hierarchical algorithm using a decision tree, or a kernel principal components analysis algorithm; Markov Blanket algorithm; recursive feature elimination or entropy - basic recursive feature elimination algorithms; Multiple algorithms arranged in committee network; And a forward floating search or a back floating search algorithm.

Example

The range of the reference standard concentration for the quantitative analysis was also set.

We measured levels of prostaglandin D synthase, vitamin D binding protein, complement factor H, and transretinal and retinol binding protein 4 in urine samples from patients with lupus (including patients with lupus nephritis and lupus nephritis) and healthy controls RESULTS: The levels of prostaglandin D synthase, vitamin D binding protein, complement factor H, and transretinal and retinol binding protein 4 were correlated with clinical indicators of patients with lupus.

Specifically, 1) Q-Exact mass spectrometer was used to compare the urinary protein of patients with active lupus nephritis and patients with inactive lupus nephritis.

Example  One. Systemic lupus erythematosus  patient Urine protein Proteomics  analysis

Five urine specimens were collected from patients with active lupus nephritis or inactive lupus nephritis.

Specifically, 10 ml of urine from each of 5 patients with active lupus nephritis and inactive lupus nephritis were collected and mixed. The urine protein was separated from the mixed urine by methanol precipitation method. Albumin was removed from the separated urine protein using Agilent finite spin cartridge. The albumin-depleted urine protein was then loaded onto Invitrogen's 4-12% SDS-PAGE gel. Each lane of the ear gel was cut into 8 pieces and treated with trypsin. Proteins were then measured using a thermospray LTQ-Velos hybrid mass spectrometer from Thermo Fisher. The data was then processed using SorcererTM-SEQUEST. The SEQUEST searching algorithm is set up to retrieve IPI HUMAN V 3.83 DECOY FASTA (186578 entries) with a condition of fragment ion mass tolerance of 1.0 Da and a parent ion tolerance of 2.0 Da. The retrieved data was imported into Scaffold software (Proteome Software) for compilation, and the datasets were imported into R and created with the Power Law Global Error Model (PLGEM, www.bioconductor.org) values (FDR <1%).

Urine samples from patients with systemic lupus erythematosus were analyzed by mass spectrometry and 487 proteins and 3550 peptides were detected. We analyzed the high secreted proteins in the lupus nephritis patients compared to the non-lupus nephritis patients and then selected the following five biomarker candidates based on their high confidence: prostaglandin D synthase, vitamin D binding protein, complement factor H, transistin and retinol binding protein 4.

Patient global assessment, physician global assessment and SLE disease activity index 2K at the time of collection of urine samples were also measured as previously described ( Gladman DD, Ibanez D, Urowitz MB, Systemic Lupus Erythematosus Disease Activity Index 2000. J Rheumatol 2002; 29: 288-91).

Example  2. Biomarker Candidate Verification

The biomarker candidates obtained through the proteomic analysis of Example 1 were measured by ELISA in 24 patients (20 patients with lupus nephritis, 104 patients without lupus nephritis) and 21 healthy control urine samples The detailed method is as follows.

Specifically, each urine sample was centrifuged at 3000g and 4 ° C for 20 minutes to remove cell debris. ELISA kits from R & D Systems were used to measure RBP4 in the urine. The concentrations of CFH, VDBP and TTR in the urine were measured by sandwich ELISA method. Tracheal epithelial cells were stained with anti-TCR antibody (abcam) or monoclonal antibody (abcam), and monoclonal anti-TCR antibody (abcam) was added to each well of 96 well plate (NUNC Maxi-sorp, Thermo Fisher Scientific) Were coated in a bicarbonate buffer at 4 ° C overnight. After coating, the cells were blocked with 1% BSA at 37 ° C for 1 hour and the standards of each biomarker candidate (recombinant soluble human CFH (Sigma), VDBP (abcam), and TTR (abcam)) And diluted urine samples were also added. After incubation at 37 ° C for 2 hours, each detection antibody (mouse monoclonal anti-CFH antibody (abcam), biotinylated mouse monoclonal anti-VDBP antibody (abcam), and biotinylated mouse monoclonal anti-TTR antibody well and reacted at 37 ° C for 1 hour. After incubation, anti-mouse IgG-horseradish peroxidase (HRP) or avidin-HRP was added. One hour after the reaction, the developer containing TMB (KPL) was added to stop the reaction using a 2N sulfuric acid solution. After stopping the reaction, the absorbance of each well was measured at 450 nm using an ELISA plate reader. The indirect ELISA method was used for urine concentration measurement of PGDS. The detailed method is as follows. The PGDS standard (recombinant soluble human PGDS (Prospec-Tany Technogene Ltd.)) and urine specimens were diluted in bicarbonate buffer in each well of a 96 well plate (NUNC Maxi-sorp, Thermo Fisher Scientific) Respectively. After coating, the cells were blocked with 1% BSA at 37 ° C for 1 hour, and a capture antibody (rat monoclonal anti-PGDS antibody (Cayman chemical)) solution was added and reacted at 37 ° C for 1 hour. After the reaction, anti-rat IgG-HRP (Sigma) was added and reacted at 37 ° C for 1 hour. Then, a developer containing TMB (KPL) was added to perform a color reaction. The color reaction was stopped with 2N sulfuric acid solution and the absorbance of each well was measured at 450 nm using a LISA plate reader. Concentrations of CFH, VDBP, TTR and PGDS were taken as mean values of duplicated assays and the measured ELISA values normalized to the amount of urine creatinine.

A biomarker with a p value <0.05 was verified by comparing the values of the biomarker candidates of the patients without acute lupus nephritis with the values of the biomarkers of the lupus nephritis patients. p value was obtained by nonparametric t test and Mann-Whitney U test.

As a result, prostaglandin D synthase, vitamin D binding protein, complement factor H, transistin and retinol binding protein 4 were verified as biomarkers for active lupus nephritis.

Example  3. On the biomarker  Establishment of a quantitative ELISA system

Several kinds of antibodies against prostaglandin D synthase, vitamin D binding protein, complement factor H, and transretinal and retinol binding protein 4 were tested to select antibodies suitable for quantitative ELISA and the quantitative range was determined. ELISA kit was used.

As a standard substance, recombinant soluble human PGDS (Prospec-Tany Technogene Ltd.) and detection antibody; rat monoclonal anti-PGDS antibody (Cayman chemical). Then, quantification range of prostaglandin D synthase (lipocalin type) standard substance to be used for quantification was set by ELISA using the above antibody. As a result, the quantitative range of the PGDS ELISA was 500 ng / ml-7.8125 ng / ml.

The accuracy of the quantitative ELISA for prostaglandin D synthase, vitamin D binding protein, complement factor H, and transretinal and retinol binding protein 4 was evaluated by repeated experiments. The range of quantification of each marker is as follows: Quantitative range of vitamin D binding protein ELISA; 20 ng / ml-0.3125 ng / ml, range of quantification of complement factor H ELISA; 20 ng / ml-0.3125 ng / ml, the range of quantification of the transistin ELISA; 6 ng / ml-0.0938 ng / ml, quantitative range of retinol binding protein 4 ELISA; 1.5ng / ml-0.0234ng / ml.

Five candidates for lupus nephritis biomarkers were identified by enzyme immunoassay in 124 patients with systemic lupus erythematosus (including 20 patients with lupus nephritis and 104 without lupus nephritis) and 21 healthy control urine samples at each biomarker level Were measured. The level of each biomarker measured was corrected by urine creatinine concentration of each individual (FIG. 1). As a result, it was confirmed that prostaglandin D synthase, vitamin D binding protein, transistiren, complement factor H and retinol binding protein 4 were highly secreted in urine specimens of patients with lupus nephritis compared with healthy controls or patients without lupus nephritis P = 0.0001, p = 0.0001, p = 0.0001, p = 0.0003, p <0.0001, p = 0.0043, p = 0.2252, p = 0.0003, respectively) 0.0110, p < 0.0001, respectively).

In addition, we examined the relationship between the level of each biomarker and the clinical indices of systemic lupus erythematosus in patients with systemic lupus erythematosus. Results showed that prostaglandin D synthase, vitamin D binding protein, transistiren and complement factor H and retinol binding protein 4 And 4 other biomarkers other than retinol-binding protein 4 were also significantly associated with the evaluation of lupus disease activity (Table 1). In patients with lupus nephritis and those without lupus nephritis, the prostaglandin D synthase, vitamin D binding protein, and Transthyretin plus complement factor H were significantly associated with the overall evaluation of physicians in patients with lupus nephritis, Prostaglandin D synthase and transistiren were not associated with the physician's comorbidity and lupus nephritis in patients without lupus nephritis. In addition, the two markers, prostaglandin D synthetase and TRS, were highly correlated with lupus nephritis activity (Table 2).

Table 1 shows the association of systemic lupus erythematosus with biomarkers in urine samples of systemic lupus erythematosus (including both lupus nephritis and non-renal involvement). The association was analyzed using the nonparametic correlation test, spearmann.

[Table 1]

In Table 1, r is the rho value; p stands for p value, significance, and other abbreviations are: PGDS (prostaglandin D synthase, lipocalin type), prostaglandin D synthetase; Vitamin D binding protein (VDBP), vitamin D binding protein; CFH (complement factor H), complement factor H; TTR (transthyretin), TRENSTYRETIN; RBP4 (retinol binding protein 4), retinol binding protein 4; SLICC (Systemic Lupus International Collaborating Clinics); Patient global assessment (PGA), overall evaluation of the patient; PhyGA (physician global assessment), doctor's comprehensive evaluation; SLE disease activity index 2K (SLEDAI2K), Lupus disease activity. In the above table, the red numbers are the red numbers that indicate the probability of 95% or more based on p <0.05, that is, they are interpreted as statistically significant can do.

Table 2 shows the association of biomarkers in urine specimens with clinical manifestations of systemic lupus erythematosus patients with or without lupus nephritis.

[Table 2]

In Table 2, PGDS (prostaglandin D synthase, lipocalin type), prostaglandin D synthase; Vitamin D binding protein (VDBP), vitamin D binding protein; CFH (complement factor H), complement factor H; TTR (transthyretin), TRENSTYRETIN; RBP4 (retinol binding protein 4), retinol binding protein 4; Patient global assessment (PGA), overall evaluation of the patient; PhyGA (physician global assessment), doctor's comprehensive evaluation; SLEDAI2K (SLE disease activity index 2K), evaluation of lupus disease activity; Patients with non-LN (non-lupus nephritis), without lupus nephritis (lupus patients without renal involvement); LN (lupus nephritis), and lupus nephritis.

The results can be used to assess the physician's comprehensive evaluation of lupus erythematosus activity as a biologic marker of systemic lupus erythematosus, especially prostaglandin D synthetase, vitamin D binding protein, TR, and complement factor H, which are secreted into the urine. In addition, the specificity and sensitivity of detection for patients with lupus nephritis are high, and thus they can be usefully used for the accurate detection, diagnosis and treatment monitoring of lupus nephritis.

Claims (11)

A detection reagent for one or more of a prostaglandin D synthease, a lipocalin type, a vitamin D binding protein, a transthyretin, and a complement factor H, A composition for the diagnosis of active lupus nephritis.
The composition for diagnosing active lupus nephritis according to claim 1, wherein the marker further comprises a detection reagent for retinol binding protein 4 (4).
The method according to claim 1,
Wherein the detection reagent is a reagent capable of detecting the marker at a protein or nucleic acid level.
The method of claim 3,
The protein level detection reagent is a reagent for Western blotting, ELISA, radioimmunoassay, immunodiffusion, immunoelectrophoresis, tissue immuno staining, immunoprecipitation assay, complement fixation assay, FACS, mass spectrometry,
The reagent for detecting the nucleic acid level of the marker may be selected from the group consisting of a polymerase chain reaction, a reverse transcription polymerase chain reaction, a competitive polymerase chain reaction, an Nuclease protection assay (RNase, S1 nuclease assay), an in situ hybridization method, a nucleic acid microarray or a Northern blot &Lt; / RTI &gt; a composition for the diagnosis of active lupus nephritis.
5. The method of claim 4,
The protein level detecting reagent includes an antibody, an antibody fragment, an aptamer, an avidity multimer or peptidomimetics that specifically recognizes the protein full length of the marker or a fragment thereof,
The nucleic acid level detecting reagent includes a nucleic acid sequence of the marker, a nucleic acid sequence complementary to the nucleic acid sequence, a pair of primers or a probe or a pair of primers and a probe specifically recognizing the nucleic acid sequence and a fragment of the complementary sequence / RTI &gt; for the diagnosis of active lupus nephritis.
A detection reagent for at least one marker of prostaglandin D synthease, lipocalin type, vitamin D binding protein, transthyretin and complement factor H Includes active lupus nephritis diagnostic kit.
7. The kit for diagnosing active lupus nephritis according to claim 6, wherein the kit further comprises a detection reagent for retinol binding protein 4 (Retinol Binding Protein 4).
8. The diagnostic kit for active lupus nephritis according to claim 6 or 7, wherein the detection reagent comprises an antibody and the kit is for ELISA analysis.
In order to provide information necessary for the diagnosis or prognosis of active lupus nephritis,
(Prostaglandin D synthease, lipocalin type), vitamin D binding protein, transthyretin, and complement factor H from a biological sample derived from the test subject. Detecting the presence and / or concentration of nucleic acid and / or protein of the one or more markers;
Comparing the detection result for the concentration or presence of the nucleic acid or protein to a corresponding result of a corresponding marker of a normal control sample; And
Determining whether the nucleic acid or protein concentration of the sample derived from the subject is changed or the presence or absence of the nucleic acid or the protein to be present in comparison with the normal control sample as lupus nephritis A method for detecting a biomarker to provide information necessary for diagnosis or prognosis.
9. The method of claim 8,
Wherein the marker further comprises retinol binding protein 4 (Retinol Binding Protein 4).
10. The method according to claim 9 or 10, wherein the biological sample is urine.

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