Abstract:
A method is disclosed for treating systemic lupus erythematosus in a mammalian subject, comprising administering to said subject an effective dose of at least one laminin peptide, or an analog or a derivative thereof. In one exemplary embodiment, the laminin peptide is selected from the group consisting of R38, and claimed R38 analogs and derivatives thereof including 5200, 5104, 5105, 5106, 5107, 5108, 5109, and 5110. The laminin peptides of the present invention may be prepared by known chemical synthetic methods or by biotechnological methods. Assays useful for the diagnosis of and following pathological activity course of systemic lupus erythematosus in patients suffering therefrom.

Description:
This application is a continuation of PCT International Application No. PCT/IB98/00415, filed Mar. 20, 1998, designating the United States of America, which claims priority of Israeli Application No. 120503, filed Mar. 20, 1997, the contents of which are incorporated by reference into the present application. 
    
    
     FIELD OF THE INVENTION 
     This invention relates to the use of laminin peptides and laminin derivatives, including R38 peptide and related analogs for the treatment and detection of systemic lupus erythematosus. 
     BACKGROUND OF THE INVENTION 
     Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs. Through the involvement of the kidneys in the autoimmune inflammatory process lupus glomerulonephritis is a major cause of morbidity and mortality in this disease (Alarcon-Segovia D. In: Primer on the Rheumatic diseases. Ed. Schumascher H. R. Arthritis Foundation, Atlanta, Ga., (1988) pp. 96-100). 
     Serologically, the disease is characterized by the occurrence of a variety of autoantibodies in the serum, of which the most prominent are the anti-DNA auto antibodies (Naparstek Y et al Annu. Rev. Immunol. (1993) 11 79-104). Although low titers of anti-DNA antibodies may occur in various inflammatory and autoimmune diseases, high levels are found mainly in SLE, and the combination of high anti-DNA antibodies with low complement levels is virtually diagnostic of SLE (Wallace D. J. et al In: Dubois&#39; Lupus erythematosus. Lea and Febiger, Philadelphia, 1993). 
     The binding of immunoglobulins to the glomerular basement membrane (GBM) has been shown by the staining of kidneys derived from lupus patients or lupus strains of mice (Wallace D. J. et al supra). It has also been shown that anti-DNA antibodies eluted from the kidneys of a lupus patient as well as from MRL/1pr/1pr mice cross react with sulfated glycosaminoglycans whereas the serum anti-DNA antibodies do not show this cross reactivity (Naparstek Y et al Arthritis Rheum. (1990) 33, 1554-1559). These results have suggested that extracellular matrix (ECM) play a role in pathogenesis of lupus as the target for the nephritogenic autoantibodies. 
     Temmat R. M. et al J. Autoimmun. (1990) 3 531-545, discloses the cross reaction of components of the ECM, like laminin and heparin with murine monoclonal anti-DNA antibodies. 
     EP Patent Application EP 670,495 discloses the presence of anti-ECM antibodies in the urine of patients with active lupus. Furthermore this patent application discloses the cross reaction of these antibodies with a 200 kDa laminin component of the ECM, and an assay for SLE based on the detection of these anti ECM/laminin antibodies in urine. 
     R38 is a peptide sequence isolated from the C-terminal region of the mouse laminin α chain (residues 2890-2910 according to Skubitz et al., J. Cell Biol (1991)115 1137-1148, or residues 2851-2871 according to Sasaki M. et al., J. Biol. Chem. (1988) 263, 16,536-16,544). It is located at the junction of the globular domains of the fourth and fifth loops (peptide GD-2 in Skubitz et al. J Cell Biol (1991) 115 1137-1148) and is comprised of the following amino-acid sequence: 
     KEGYKVRLDLNITLEFRTTSK (SEQ ID NO. 1) 
     Current SLE therapy is limited to corticosteroids which suppress the over-reactive immune system. This therapy is not specific and its inevitable side effects may themselves be fatal. Furthermore, immunosuppressive therapy is complicated and its initiation is based on a combination of clinical symptoms, blood serological tests and kidney biopsy. There is therefore a need for a more specific therapy for SLE that will not be associated with the side effects of the immunosuppresive agents as well as a more specific and less invasive assay for the evaluation of disease activity. Indeed a recent review (The Lancet (1995) 310 1257-1261) stated that blood tests though useful in confirming diagnosis of SLE are “less useful in monitoring disease activity.” 
     None of the above mentioned references disclose the treatment of systemic lupus erythematosus by the administration of the R38 peptide or analogs thereof. Moreover none of the above mentioned references disclose the use of R38 peptide in a diagnostic test for the disease or in monitoring disease activity. The contents of all these patents and all literature references referred to above are hereby incorporated by reference in their entirety. 
     SUMMARY OF THE INVENTION 
     It is therefore an object of the present invention to provide a method for treating systemic lupus erythematosus comprising the administration of laminin peptides. 
     Another object of the present invention is to disclose R38′ and other novel analogs and derivatives of R38 peptide, the administration of which comprises a method for treating systemic lupus erythematosus. 
     A further object of the present invention is to provide a diagnostic test for the disease by using the R38 peptide, R38′ peptide and other structurally related analogs and derivatives thereof. 
     The invention also relates to pharmaceutical compositions comprising R38 peptide, R38′ peptide and other novel analogs and derivatives of R38 peptide, or pharmaceutically acceptable salts thereof for use in the treatment of SLE. 
     As used herein the term “R38 peptide” is used to include the R38 peptide itself, analogs, derivative and fragments thereof that retain the activity of the complex peptide. The term analogs is intended to include variants on the peptide molecule brought about by, for example, homologous substitution of individual or several amino acid residues. The term derivative is used to include minor chemical changes that may be made to R38 itself or analogs thereof that maintain the biological activity of R38 and similarly the term “fragments” is used to include shortened molecules of R38. 
    
    
     BRIEF DESCRIPTION OF THE FIGURES 
     FIG. 1 shows the direct bonding of C72 murine anti-DNA antibody to laminin peptides; 
     FIG. 2 shows the inhibition by R38, 5200, DNA, DNase and heparin of the binding of C72 to the R38 analog 5200 (sometimes referred to herein as R38′); 
     FIGS. 3 and 4 show the binding of the human lupus monoclonal anti-DNA antibodies (DIL6 and B3) to laminin peptides and derivatives thereof; 
     FIGS.  5 , 6  and  7  show the correlation between lupus activity score and urinary anti-R38 level in three lupus patients; 
     FIG. 8 shows the effect of 5200 (R38′) treatment on prolongation of survival of lupus mice; 
     FIG. 9 shows the effect of R38 (also referred to herein as 5100) treatment on prolongation of survival of lupus mice; and 
     FIG. 10 shows the inhibition of C72 binding to R38 (5100) by DNA and by R38 analogs. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Accordingly the present invention relates to the use of laminin peptides for the treatment of systemic lupus erythematosus. 
     The present invention is based on the observation that R38 peptide, which is a peptide derived from the C-terminal region of the mouse laminin α chain, is recognized by pathogenic lupus antibodies and may therefore possess therapeutic potential in the treatment of systemic lupus erythematosus by competing with the binding to the lupus antibodies. 
     Furthermore the present invention relates to the use of a mixture of at least two or more different peptides derived from laminin for the treatment of systemic lupus erythematosus. In a preferred embodiment, at least one of the peptides is R38 or an analog thereof. 
     The invention also relates to a method of monitoring disease activity of patients suffering from SLE comprising detecting the ability of the antibodies in the urine to bind to the R38 component of the laminin. This binding can have a direct correlation to disease activity evaluated by a combination of various laboratory parameters. 
     An increase in the amount of antibodies binding to R38 may indicate an approaching active phase of the disease and a declining level of antibodies, an approaching remission. Therefore, this method provides an assay for detecting changes in the level of laminin-specific antibodies and many enable the initiation of therapy prior to the onset of an active phase of the disease. 
     This method also provides an easy assay that can be used by the patients themselves as it is performed using urine and does not require venipuncture. It may be used as a diagnostic assay, a routine assay for evaluation of disease activity, for early identification of disease exacerbation and for early therapeutic intervention in lupus nephritis. 
     The R38 peptide or analogs, fragment or derivatives thereof may be used in such an assay using the methods described in EP 670,495. Thus, the R38 peptide may be bound to a solid phase and incubated with the urine from a patient. If the patient is suspected of suffering from SLE, suffering from SLE or is approaching an active phase of the disease, the level of R38-binding antibodies in the urine will increase. 
     Detection of R38-binding antibodies may be undertaken by any method known by one skilled in the art. Examples of such methods of detection include ELISA and variations thereon, chemiluminescent techniques, etc. The actual method of detection is not crucial to the success of the assay. The level of R38-binding antibodies observed may then be compared to values observed in a control group. The control group may consist of healthy volunteers, or the patient may act as an internal control i.e. the observed value is compared to an earlier value from the same patient. In this manner a profile of the patient&#39;s disease state may be compiled and used as an indicator of further active phases or remission states of the disease. 
     Pharmaceutically acceptable salts of the R38 peptide include both salts of the carboxy groups and the acid addition salts of the amino groups of the peptide molecule. Salts of the carboxy groups may be formed by methods known in the art and include inorganic salts such as sodium, calcium, ammonium, ferric or zinc salts and the like and salts with organic bases such as those formed with amines such as triethanolamine, arginine or lysine, piperidine, procaine and the like. Acid addition salts include salts with mineral acids such as hydrochloric acid and sulphuric acid and salts of organic acids such as acetic acid or oxalic acid. 
     The pharmaceutical composition may contain laminin peptides such as the R38 peptide as unique peptides or in polymerized or conjugated forms attached to macromolecular carriers or polymers. The compositions may optionally contain pharmaceutically acceptable excipients. In an alternative embodiment the composition may contain the R38 peptide alone. 
     The route of administration may include oral, intra-venous, intra-peritoneal, intra-muscular, subcutaneous, intra-articular, intra-nasal, intra-thecal, intra-dermal, trans-dermal or by inhalation. 
     An effective dose of the R38 peptide for use in treating SLE may be from about 1 μg to 100 mg/kg body weight, per single administration, which may be easily determined by one skilled in the art. The dosage may depend upon the age, sex, health and weight of the recipient, kind of concurrent therapy, if any, and frequency of treatment. 
     EXAMPLES 
     GENERAL 
     The Peptides 
     Peptides R26, R28, R30, R31, R35, R37, and R38 (also referred hereinafter as “5100”) derived from the C-terminal of mouse laminin α chain, and the R18 peptide derived from the N-terminal of mouse laminin α chain were tested. The peptides are 17-22-mer synthetic peptides, and were prepared by the F-moc technique (Carpino L A &amp; Han G Y (1972) J Org Chem 37 3404). These peptides could also be produced by methods well known to one skilled in the art of biotechnology. For example, using a nucleic acid selected from the group including DNA, RNA, cDNA, genomic, synthetic DNA, mRNA, total RNA, hnRNA, synthetic RNA, the desired peptides may be produced in live cell cultures and harvested. 
     The sequence of the peptides is presented in the Table 1: 
     
       
         
               
             
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Laminin Derived Peptides. 
               
             
          
           
               
                 PEPTIDES 
                 RESIDUES (*) 
                 SEQUENCE 
               
               
                   
               
               
                 R18 
                 42-63 
                 RPVRHAQCRVCDGNSTNPRERH 
               
               
                   
                   
                 (SEQ ID NO. 2) 
               
               
                 R26 
                 2443-2463 
                 KNLEISRSTFDLLRNSYGVRK 
               
               
                   
                   
                 (SEQ ID NO. 3) 
               
               
                 R35 
                 2547-2565 
                 TSLRKALLHAPTGSYSDGQ 
               
               
                   
                   
                 (SEQ ID NO. 4) 
               
               
                 R37 
                 2615-2631 
                 KATPMLKMRTSFHGCIK 
               
               
                   
                   
                 (SEQ ID NO. 5) 
               
               
                 R28 
                 2779-2795 
                 DGKWHTVKTEYIKRKAF 
               
               
                   
                   
                 (SEQ ID NO. 6) 
               
               
                 R38 
                 2890-2910 
                 KEGYKVRLDLNITLEFRTTSK 
               
               
                   
                   
                 (SEQ ID NO. 7) 
               
               
                 R30 
                 3011-3032 
                 KONCLSSRASFRGCVRNLRLSR 
               
               
                   
                   
                 (SEQ ID NO. 8) 
               
               
                   
               
               
                 (*) Residue designations per Skubitz supra.  
               
             
          
         
       
     
     Other laminin peptides used for comparative purposes in the Examples include AS31 (comprising the residue YIGSR), AC15 and F9 (other laminin peptides) and R27 a peptide from the 4th loop of the globular region of the laminin α chain. 
     Additional peptides which are fragments of, or analogs closely derived from R38 have been constructed and are presented in Table 2 hereinbelow. Peptides 5200 and 5101-5111 disclosed in Table 2 were prepared in the same manner as the peptide of Table 1 hereinabove. The Table 2 peptides comprise R38 (5100), human R38 (5300), fragments of R38, a fragment 5111 derived from 5300 or analogs of R38 wherein one or more point substitutions were made according to techniques which are well known to one skilled in the art. These peptides were constructed to investigate, among other things, the effect on anti-DNA antibody binding activity caused by changing the net charge of the R38 peptide. 
     
       
         
               
             
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 Synthetic Peptides Analogous To Mouse R38 Peptide 
               
             
          
           
               
                 Peptide 
                   
                   
                 Net 
               
               
                 # 
                 AMINO ACID SEQUENCE 
                 DESCRIPTION 
                 Charge 
               
               
                   
               
             
          
           
               
                 5100 
                 KEGYKVRLDLNITLEFRTTSK (SEQ 
                 Mouse R38 
                 +2 
               
               
                   
                 ID NO. 9) 
               
               
                 5200 
                 KEGYKVRLDLNTTLEFRTTSK (SEQ 
                 Mouse R38 analog 
                 +2 
               
               
                   
                 ID NO. 10) 
               
               
                 5300 
                 KEGYKVQSDVNITLEFRTSSQ (SEQ 
                 Human R38 
                 0 
               
               
                   
                 ID NO. 11) 
               
               
                 5101 
                 KEGYKVRLDLNITLEF (SEQ ID NO. 
                 Res. 1-16 of 5100 
                 0 
               
               
                   
                 12) 
               
               
                 5102 
                 VRLDLNITLEFR (SEQ ID NO. 13) 
                 Res. 6-17 of 5100 
                 0 
               
               
                 5103 
                 LDLNITEFRTTSK (SEQ ID NO. 14) 
                 Res. 8-21 of 5100 
                 0 
               
               
                 5104 
                 AEGYAVALDLNITLEFATTSA (SEQ ID 
                 Ala subst. of 5100 at all positive 
                 −3 
               
               
                   
                 NO. 15) 
                 a.a 
               
               
                 5105 
                 KEGYKVELDLNITLEFETTSK (SEQ 
                 charge subst. to neg. at 5100 a.a. 7 
                 −2 
               
               
                   
                 ID NO. 16) 
                 and 17 
               
               
                 5106 
                 KEGYKVELDLNITLEFRTTSK (SEQ 
                 charge subst. to neg. at 5100 a.a. 7 
                 0 
               
               
                   
                 ID NO. 17) 
               
               
                 5107 
                 KEGYKVRLDLNITLEFETTSK (SEQ 
                 charge subst. to neg. at 5100 a.a. 
                 0 
               
               
                   
                 ID NO. 18) 
                 17 
               
               
                 5108 
                 KAGYKVRLALNITLAFRTTSK (SEQ 
                 Ala subst. of 5100 at all negative 
                 +5 
               
               
                   
                 ID NO. 19) 
                 a.a. 
               
               
                 5109 
                 KEGYKVRLALNITLEFRTTSK (SEQ 
                 Ala subst. of 5100 a.a. 9 
                 +3 
               
               
                   
                 ID NO. 20) 
               
               
                 5110 
                 KEGYKVRLDLNITLAFRTTSK (SEQ 
                 Ala subst. of 5100 a.a. 15 
                 +3 
               
               
                   
                 ID NO. 21) 
               
               
                 5111 
                 VQSDVNITLEFR (SEQ ID NO. 22) 
                 Res. 6-17 of 5300 
                 −1 
               
               
                   
               
               
                 a.a. Amino Acid  
               
             
          
         
       
     
     Monoclonal Antibodies 
     The C72 murine anti-DNA antibody has been derived from (NZBxNZW)F1 lupus mice by the hybridoma technique as described in Eilat D. et al J. Immunol. (1991) 147 361-368. The monoclonal anti-DNA antibodies DIL6 and B3 were derived from lupus patients by hybridoma technique as described in Ehrenstein M. R. et al J. Clin. Invest. (1994) 93 1787-1799 and Ehrenstein M. R. et al Kidney Inter. (1995) 48 705-711. 
     It should be understood that the following description contemplates use of antibodies specific to the laminins and to the peptides disclosed herein. Methods for producing peptides specific to the laminin peptides and to R38 and its analogs and derivatives are well known to one skilled in the art. In this regard, specific reference may be had to the test “Antibodies, A Laboratory Manual,” Ed Harlow and David Lane, Cold Spring Harbor Publishing, 1988, the contents of which are incorporated herein by reference. This reference discloses methods which may be used for obtaining monospecific antibodies, i.e., monoclonal antibodies and polyclonal antibodies directed against laminin peptides. 
     Anti-Peptide (Direct Binding) ELISA: 
     Wells were coated with 10 μg/ml of the peptides, blocked with 1% BSA (bovine serum albumin) in PBS (pH 7,4), reacted with appropriately diluted serum or urine samples or monoclonal antibodies, incubated with anti-human or anti-mouse immunoglobulin enzyme conjugated to alkaline phosphatase and detected by addition of substrate (Sigma 100 Phosphatase Substrate Tablets) and color development using an Organon Teknika Microwell System spectrometer at wavelength of 405 nm. 
     Competitive Inhibition Assays: 
     In competitive inhibition assays, the antibodies were incubated with various concentrations of the inhibitor (for example: peptide, DNA, heparin) or with DNase for 45 minutes at room temperature and the remaining binding was then evaluated by ELISA as described heretofore. 
     % inhibition was computed as 
     
       
         O.D. binding without inhibitor−O.D. binding with inhibitor×100=% inhibition O.D. binding without inhibitor 
       
     
     EXAMPLE 1: BINDING OF LAMININ PEPTIDES TO SLE ANTIBODIES 
     A: Murine SLE antibodies bind to C terminal peptides of laminin α chain 
     The interaction of the C72 murine anti-DNA antibody with laminin peptides was analyzed by ELISA as described above. The C72 conditioned medium was diluted in PBS in various dilutions. The results are summarized in FIG. 1 which shows the binding of C72 murine anti-DNA antibody to the 5200, R37, and R30 peptides, but not to R28 or R18 peptides of the laminin α chain. Control murine antibody, the anti-HEL, Hy5 did not bind to the 5200 peptide (data not shown). 
     B: Inhibition of the binding of C72 to 5200 is inhibited by DNA and Heparin 
     The binding of C72 to 5200 was tested before and after incubation with 5200, R38, R18, Heparin, DNA and DNase. The results are summarized in FIG. 2 which shows the inhibition of the binding of C72 to 5200 by the R38 or 5200 peptides of the present invention, by DNA and by heparin, but not by a control peptide or treatment with DNase. The percent inhibition is the percent reduction of the O.D. after incubation with the inhibiting agent. 
     EXAMPLE 2: POLYCLONAL MURINE ANTIBODIES BIND TO THE 5200 PEPTIDE 
     Analysis of the interaction of MRL/1pr/1pr urine antibodies with the 5200 peptide by a direct binding ELISA revealed specific binding. Thus, pooled urine from at least 5 mice (either MRL/1pr/1pr or control mice, e.g. BALB/c) was added to wells coated with R38′ (5200), R18 or DNA as described above and bound 5200 assayed by ELISA. 
     Binding of Murine Urinary Immunoglobulins To 5200 
     Each group is comprised of pooled urine. 
     
       
         
               
               
               
             
               
               
               
               
               
             
           
               
                   
                   
               
               
                   
                 ANTIGEN 
                   
               
             
          
           
               
                   
                 MICE 
                 DNA 
                 5200 
                 R18 
               
               
                   
                   
               
               
                   
                 BALB/c 
                 U.D. 
                 U.D. 
                 U.D. 
               
               
                   
                 MRL/lpr/lpr 
                 U.D. 
                 0.26(*) 
                 U.D. 
               
               
                   
                   
               
               
                   
                 U.D.—Undetected  
               
               
                   
                 (*)O.D. at 405 nm.  
               
             
          
         
       
     
     U.D.—Undetected 
     (*) O.D. at 405 nm. 
     EXAMPLE 3: HUMAN MONOCLONAL LUPUS ANTIBODIES BIND THE 5200 PEPTIDE 
     The human monoclonal anti-DNA antibodies DIL 6 and B3 were derived from lupus patients by the hybridoma technique. As shown in FIGS. 3 and 4 these antibodies were found to bind to the 5200 peptide but not to other laminin peptides tested. In FIGS. 3 and 4, the peptides are referred to as denoted above or as follows; AS30 is R27, AS19 is R35, AS35 is R26, AS17 is R28 and AS6 is R18. 
     EXAMPLE 4: EFFECT OF R38 (5100) &amp; R38′ ON THE CLINICAL COURSE OF MURINE SLE 
     To test whether R38 peptides can affect the course of SLE we have tested their effect on MRL/1pr/1pr mice disease. 60 μg of 5200 (R38′ alone or in peptide combinations, 30 μg of each) in 0.1 ml PBS, was injected i.p. to 6 week old female MRL/1pr/1pr mice once a week for 16 weeks and the mice were evaluated for survival (FIG.  8 ), and for renal histology. 
     50 μg of 5100 (R38) or 5300 (human R38) in 0.1 ml PBS, was injected i.p. to 6 week old MRL/1pr/1pr mice three times a week and the mice were evaluated for survival (FIG.  9 ), and for renal histology. Control mice received 0.1 ml phosphate buffer solution. Each test and control group contained 12-15 mice. 
     The survival of MRL/1pr/1pr mice treated with 5100, 5200 or 5300 was compared to that of PBS treated mice. As shown in FIGS. 8 and 9, the survival of mice treated with 5100 or 5200 was significantly higher than that of control mice. In FIGS. 8 and 9 the time in days shown on the x axis relates to the age of the mice. Two mice in each group were sacrificed after 5 months and their kidneys evaluated by light microscopy. The kidneys from the control mice showed severe diffuse proliferative glomerulonephritis with crescents and sclerosis whereas the 5100 or 5200 treated mice showed mild proliferative changes with no crescents and no sclerosis. 
     EXAMPLE 5—ANALYSIS OF THE CORRELATION BETWEEN ANTI-R38 ANTIBODIES AND DISEASE ACTIVITY 
     Urine from lupus patients with and without renal disease in active and inactive state were collected repeatedly and tested for presence of anti-R38 antibodies by ELISA. Activity of the disease was evaluated also be accepted clinical and serological parameters (Lockshin M. D. et al Am. J. Med. (1984) 77 893-898) and their correlation with anti-R38 levels was compared. 
     103 urine samples of 37 SLE patients were tested for anti-R38 activity by ELISA as described above. 23 samples were from patients without renal disease and 80 samples from patients with renal disease. A further 12 samples from patients with renal disease not relates to SLE were also included 
     The following results were obtained: 
     
       
         
               
               
               
               
             
           
               
                   
               
             
             
               
                 SLE 
                 Present 
                 Present 
                 Absent 
               
               
                 Renal Disease 
                 Absent 
                 Present 
                 Present 
               
               
                 No. Samples 
                 23 
                 80 
                 12 
               
               
                 Urine anti-R38 
                 0.035 ± 0.003 
                 0.229 ± 0.03* 
                 0.07 ± 0.01 
               
               
                 O.D. (Mean + S.E.) 
               
               
                   
               
               
                 *p &lt; 0.001  
               
             
          
         
       
     
     Positivity of the samples in those patients with renal disease usually correlated with active disease according to an activity score that includes 19 clinical laboratory parameters (Lockshin M. D. et al supra). These parameters included assessment of the presence/absence/condition of the following clinical criteria alopecia, rash, fever, serositis, athralgia/arthritis, mucosal ulcers, neurological events, malaise, fundi changes, nodes, spleen and the following blood tests including ESR (erythrocyte sedimentation rate), anti DNA antibodies, complement (U/ml), creatinine, haemoglobin (g/dl), PLT platelets (/mm 2 ) or urinalysis. The assessment of these parameters is measured as described in Lockshin supra. The overall percentage given reflects only the assessed parameters. 
     In some patients urine samples were tested in more than one occasion and a good correlation between the clinical activity and the level of anti R38 binding were observed. Three representative examples from three different lupus patients are shown in FIGS.  5 , 6  and  7  where the x-axis shows the No. of the hospital visit and y-axis, the observed binding (OD at 405 nm) or percentage of the activity score described above. As can be seen from these Figures, the assay using the R38 peptide provides a reliable method of monitoring disease activity. 
     EXAMPLE 6—ANALYSIS OF THE CORRELATION BETWEEN ANTI-5200 (R38′) ANTIBODIES AND DISEASE ACTIVITY 
     In an additional experiment, 178 urine samples from lupus patients, 24 with and 22 without renal disease in active and inactive state were collected and tested for presence of anti-5200 antibodies by ELISA as described above. The following results were obtained: 
     
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Renal Disease 
                 Absent 
                 Present 
               
               
                   
                 No. Samples 
                 46 
                 132 
               
               
                   
                 Urine anti-5200 
                 0.05 ± 0.005 
                 0.335 ± 0.035* 
               
               
                   
                 O.D. (Mean + S.E.) 
               
               
                   
                   
               
               
                   
                 *p &lt; 0.001  
               
             
          
         
       
     
     EXAMPLE 7—ANALYSIS OF THE CORRELATION BETWEEN ANTI-5100 (R38) ANTIBODIES AND DISEASE ACTIVITY 
     45 urine samples from 21 lupus patients, some with and some without renal disease in active and inactive state were collected and tested for presence of anti-5100 antibodies by direct ELISA as described above. 
     The following results were obtained: 
     
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Renal Disease 
                 Absent 
                 Present 
               
               
                   
                 No. Samples 
                 6 
                 39 
               
               
                   
                 Urine anti-5100 
                 0.058 ± 0.006 
                 0.376 ± 0.05* 
               
               
                   
                 O.D. (Mean + S.E.) 
               
               
                   
                   
               
               
                   
                 *p &lt; 0.03  
               
             
          
         
       
     
     EXAMPLE 8—ANALYSIS OF THE CORRELATION BETWEEN ANTI-5200 (R38′) ANTIBODIES AND DISEASE ACTIVITY 
     52 urine samples from 21 lupus patients, with and without renal disease in active and inactive state were collected and tested for presence of anti-5200 antibodies by ELISA as described above. 
     The following results were obtained: 
     
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Renal Disease 
                 Absent 
                 Present 
               
               
                   
                 No. Samples 
                 6 
                 46 
               
               
                   
                 Urine anti-5200 
                 0.052 ± 0.03 
                 0.431 ± 0.09 
               
               
                   
                 O.D. (Mean + S.E.) 
               
               
                   
                   
               
             
          
         
       
     
     EXAMPLE 9—ANALYSIS OF THE CORRELATION BETWEEN ANTI-5108, 5101, 5109 AND 5110—ANTIBODIES AND DISEASE ACTIVITY 
     24 urine samples from some of the lupus patients of Examples 7 and 8, 2 with and 22 without renal disease in active and inactive state were collected and tested for binding to 5108 peptides by ELISA as described above. 
     The following results were obtained: 
     
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Renal Disease 
                 Absent 
                 Present 
               
               
                   
                 No. Samples 
                 2 
                 22 
               
               
                   
                 Urine anti-5108 
                 0.064 ± 0.05 
                 0.672 ± 0.1 
               
               
                   
                 O.D. (Mean + S.E.) 
               
               
                   
                   
               
             
          
         
       
     
     Similar results were observed for binding of peptides 5101, 5109 and 5110. 
     EXAMPLE 10—DIRECT BINDING OF C72 and B3 to R38 AND ANALOG PEPTIDES 
     The peptides of the present invention were tested for their ability to bind directly with C72 murine anti-DNA antibodies and B3 human anti-DNA antibodies according to the methods described hereinabove. The results of the direct binding study are reported in Table 3: 
     
       
         
               
             
               
               
               
             
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Direct Binding Of C72 And B3 To R38 And Analog Peptides 
               
             
          
           
               
                 Peptide # 
                 C72 Binding †   
                 B3 Binding ‡   
               
               
                   
               
             
          
           
               
                 5100 
                 2.57 
                 0.9 
               
               
                 5200 
                 1.6 
                 0.25 
               
               
                 5300 
                 0.03 
                 0.03 
               
               
                 5101 
                 1.11 
                 0.1 
               
               
                 5102 
                 0.1 
                 0.02 
               
               
                 5103 
                 0.03 
                 0.02 
               
               
                 5104 
                 0.06 
                 0.02 
               
               
                 5105 
                 0.07 
                 0.02 
               
               
                 5106 
                 1.9 
                 0.16 
               
               
                 5107 
                 0.05 
                 0.01 
               
               
                 5108 
                 2.75 
                 1.93 
               
               
                 5109 
                 2.72 
                 1.94 
               
               
                 5110 
                 2.8 
                 1.83 
               
               
                 5111 
                 0.01 
                 0.01 
               
               
                 R18 
                 0.01 
                 NT* 
               
               
                 R28 
                 0.01 
                 NT 
               
               
                 R30 
                 0.75 
                 NT 
               
               
                 R37 
                 1.8 
                 NT 
               
               
                   
               
               
                 *NT—Not Tested  
               
               
                   † - O.D. in a direct binding ELISA test after one (1) hour.  
               
               
                   ‡ - O.D. in a direct binding ELISA test after two (2) hours.  
               
             
          
         
       
     
     EXAMPLE 11: COMPETITIVE INHIBITION OF C72 BINDING TO R38 WITH ANALOG PEPTIDES 
     A competitive inhibition study compared how each of the peptides competes with R38 (5100) for binding to the C72 anti-DNA antibody. Conducted according to the methods described hereinabove, the results of the study are disclosed in Table 4 below and are further elucidated by reference to FIG.  10 . 
     
       
         
               
             
               
               
               
             
               
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 Inhibition of C72 Binding to R38 
               
             
          
           
               
                   
                   
                 50% inhibition of 
               
               
                   
                   
                 C72 binding to 
               
               
                   
                   
                 mouse R38 (5100) 
               
               
                   
                 Peptide # 
                 in μg/ml 
               
               
                   
                   
               
             
          
           
               
                   
                 5100 
                 10 
               
               
                   
                 5200 
                 10 
               
               
                   
                 5300 
                 85 
               
               
                   
                 5101 
                 5 
               
               
                   
                 5102 
                 30 
               
               
                   
                 5103 
                 NI** 
               
               
                   
                 5104 
                 NI 
               
               
                   
                 5105 
                 NI 
               
               
                   
                 5106 
                 2.5 
               
               
                   
                 5107 
                 85 
               
               
                   
                 5108 
                 2 
               
               
                   
                 5109 
                 0.7 
               
               
                   
                 5110 
                 0.7 
               
               
                   
                 5111 
                 NI 
               
               
                   
                   
               
               
                   
                 *Concentration of competitive inhibitor which resulted in 50% inhibition of the binding of C72 anti-DNA antibody to peptide 5100 (R38) in an ELISA test.  
               
               
                   
                 **NI—No Inhibition  
               
             
          
         
       
     
     It should be understood that the foregoing description and examples are merely illustrative and that many modifications and variations may be made thereto by one skilled in art without departing from the scope and spirit of the invention as claimed hereinbelow. 
     
       
         
           
             22 
           
           
             1 
             21 
             PRT 
             mouse 
           
            1
Lys Glu Gly Tyr Lys Val Arg Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             2 
             22 
             PRT 
             mouse 
           
            2
Arg Pro Val Arg His Ala Gln Cys Arg Val Cys Asp Gly Asn Ser Thr
  1               5                  10                  15
Asn Pro Arg Glu Arg His
             20 
           
             3 
             21 
             PRT 
             mouse 
           
            3
Lys Asn Leu Glu Ile Ser Arg Ser Thr Phe Asp Leu Leu Arg Asn Ser
  1               5                  10                  15
Tyr Gly Val Arg Lys
             20 
           
             4 
             19 
             PRT 
             mouse 
           
            4
Thr Ser Leu Arg Lys Ala Leu Leu His Ala Pro Thr Gly Ser Tyr Ser
  1               5                  10                  15
Asp Gly Gln 
           
             5 
             17 
             PRT 
             mouse 
           
            5
Lys Ala Thr Pro Met Leu Lys Met Arg Thr Ser Phe His Gly Cys Ile
  1               5                  10                  15
Lys 
           
             6 
             17 
             PRT 
             mouse 
           
            6
Asp Gly Lys Trp His Thr Val Lys Thr Glu Tyr Ile Lys Arg Lys Ala
  1               5                  10                  15
Phe 
           
             7 
             21 
             PRT 
             mouse 
           
            7
Lys Glu Gly Tyr Lys Val Arg Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             8 
             22 
             PRT 
             mouse 
           
            8
Lys Gln Asn Cys Leu Ser Ser Arg Ala Ser Phe Arg Gly Cys Val Arg
  1               5                  10                  15
Asn Leu Arg Leu Ser Arg
             20 
           
             9 
             21 
             PRT 
             mouse 
           
            9
Lys Glu Gly Tyr Lys Val Arg Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             10 
             21 
             PRT 
             mouse 
           
            10
Lys Glu Gly Tyr Lys Val Arg Leu Asp Leu Asn Thr Thr Leu Glu Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             11 
             21 
             PRT 
             Homo sapiens 
           
            11
Lys Glu Gly Tyr Lys Val Gln Ser Asp Val Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Arg Thr Ser Ser Gln
             20 
           
             12 
             16 
             PRT 
             mouse 
           
            12
Lys Glu Gly Tyr Lys Val Arg Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15 
           
             13 
             12 
             PRT 
             mouse 
           
            13
Val Arg Leu Asp Leu Asn Ile Thr Leu Glu Phe Arg
  1               5                  10 
           
             14 
             14 
             PRT 
             mouse 
           
            14
Leu Asp Leu Asn Ile Thr Leu Glu Phe Arg Thr Thr Ser Lys
  1               5                  10 
           
             15 
             21 
             PRT 
             mouse 
           
            15
Ala Glu Gly Tyr Ala Val Ala Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Ala Thr Thr Ser Ala
             20 
           
             16 
             21 
             PRT 
             mouse 
           
            16
Lys Glu Gly Tyr Lys Val Glu Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Glu Thr Thr Ser Lys
             20 
           
             17 
             21 
             PRT 
             mouse 
           
            17
Lys Glu Gly Tyr Lys Val Glu Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             18 
             21 
             PRT 
             mouse 
           
            18
Lys Glu Gly Tyr Lys Val Arg Leu Asp Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Glu Thr Thr Ser Lys
             20 
           
             19 
             21 
             PRT 
             mouse 
           
            19
Lys Ala Gly Tyr Lys Val Arg Leu Ala Leu Asn Ile Thr Leu Ala Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             20 
             21 
             PRT 
             mouse 
           
            20
Lys Glu Gly Tyr Lys Val Arg Leu Ala Leu Asn Ile Thr Leu Glu Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             21 
             21 
             PRT 
             mouse 
           
            21
Lys Glu Gly Tyr Lys Val Arg Leu Asp Leu Asn Ile Thr Leu Ala Phe
  1               5                  10                  15
Arg Thr Thr Ser Lys
             20 
           
             22 
             12 
             PRT 
             Homo sapiens 
           
            22
Val Gln Ser Asp Val Asn Ile Thr Leu Glu Phe Arg
  1               5                  10