# Patent

## Title
Method for diagnosing Streptococcus, Enterococcus and Peptostreptococcus genera infections

## Abstract

The invention concerns a method to determine if an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera comprising: (i) detection of antibodies directed against at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, in a biological sample of the individual, and (ii) deducing therefrom that the individual is infected by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera. The invention further concerns the kit for diagnosing of such an infection.

## Background
CROSS REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of U.S. Provisional Application No. 61/522,522, filed Aug. 11, 2011, and claims priority under 35 USC §119 to European patent application EP 11306037.0, filed Aug. 11, 2011, both of which are incorporated herein by reference in their entireties.
INCORPORATION OF SEQUENCE LISTING
A Sequence Listing containing the file named “12P1873_SEQLIST_ST25.txt” which is 83,782 bytes (as measure in MS-Windows®) and created on Aug. 9, 2012, is incorporated herein by reference in its entirety. The Sequence Listing contains SEQ ID NOs: 1-24.


FIELD OF THE INVENTION
The invention concerns a method for determining if an individual is infected by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera comprising: (i) detection of antibodies directed against at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, in a biological sample of the individual, and (ii) deducing therefrom that the individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera. The invention further concerns the kit for diagnosing of such an infection.
BACKGROUND OF THE INVENTION
Viridans streptococci and the β-hemolytic streptococci constitute a diverse group of organisms with varying environmental niches and pathogenicity. Although these organisms reside as commensals in the respiratory and intestinal tracts of humans, they may also invade sterile body sites, resulting in life-threatening diseases.
Viridans streptococci such as S. mitis group consisting of S. mitis, S. sanguis, S. gordonii, S. oralis are an important part of the normal microbial flora of humans. They are indigenous to the upper respiratory tract, the female genital tract, and all regions of the gastrointestinal tract, but are most prevalent in the oral cavity. They are responsible for bacteremia with 2.6% of positive blood cultures reported from clinical laboratories, for meningitis accounting for 0.3% to 5% of culture-proven cases, for pneumonia even if often isolated with non clinical significance, and miscellaneous infections such as pericarditis, peritonitis, acute bacterial sialadenitis, orofacial odontogenic infections, endophtalmitis, spondylodiscitis, and various upper respiratory tract infections (otitis, media, sinusitis).
Beta-hemolytic streptococci of large colony size (0.5 mm in diameter) can be grouped with Lancefield antisera using latex agglutination or coagglutination directed against the cell wall carbohydrate of groups A, B, C, or G. Infections caused by these groups are often severe: pneumonia, pharyngitis, arthritis with 11% to 28% of cases, osteomyelitis, endocarditis, respiratory tract infections, endocarditis, meningitis, puerperal infection, neonatal sepsis, bacteremia, skin and soft tissue infections (cellulitis, foot ulcers, abscess), infections of the female genital tract (group B streptococci) and other miscallenous infections such as pericarditis, pyomyositis, purpura, and spinal epidural abscess (Mandell, Douglas and Bennett's: Principles and practice of infectious Disesases, Sixth ed., volume 1).
Because enterococci are part of the normal gut flora of almost all humans, they are capable of causing infections both in and out of the hospital setting. Most enterococcal infections, however, occur in hospitalized patients or patients undergoing therapy such as peritoneal or hemodyalisis. Currently, enteroccocci infections rank second or third in frequency as causes of nosocomial infections in the United-States. Risk factors for acquiring nosocomial enterococcal infections include gastrointestinal colonization; serious underlying disease; a long hospital stay; prior surgery; renal insufficiency; neutropenia; transplantation (especially liver and bone marrow), the presence of urinary or vascular catheters; and residency in an intensive care unit. Clinical infections caused by enterococci are urinary tract infections, bacteremia, endocarditis, intra-abdominal and pelvic infections, wound and tissue infections, meningitis, respiratory tract infections and neonatal sepsis (Mandell, Douglas and Bennett's: Principles and practice of infectious Disesases, Sixth ed., volume 1).
Peptostreptococcus species are commensal organisms in humans, living predominantly in the mouth, skin, gastrointestinal, and urinary tracts, and compose a portion of the bacterial gut flora. Under immunosuppressed or traumatic conditions these organisms can become pathogenic, as well as septicemic, harming their host. Peptostreptococcus can cause brain, liver, breast, and lung abscesses, as well as generalized necrotizing soft tissue infections. They participate in mixed anaerobic infections, a term which is used to describe infections that are caused by multiple bacteria. These different bacterial species raise the problem of their detection in human pathological specimens and of their identification when isolated from such samples (Mandell, Douglas and Bennett's: Principles and practice of infectious Disesases, Sixth ed., volume 1).
Patients receiving total joint replacements number in the hundreds of thousands each year worldwide, and millions people have indwelling prosthetic articulations. Between 1 and 5% of indwelling prostheses become infected; this is a calamity for the patient, and it is associated with significant morbidity and occasionally with death. Prosthesis removal, which usually is necessary to treat these infections, produces large skeletal defects, shortening of the extremity, and severe functional impairment. The health cost of treating a single septic prosthetic joint has been conservatively at $50,000 to $60000, with an extrapolated expenditure of more than $200 million to $250 million per year in the United States alone. The patient faces protracted hospitalization, sizable financial expense, and potentially renewed disability (Mandell, Douglas and Bennett's: Principles and practice of infectious Disesases, Sixth ed., volume 2).
Prosthetic joints become infected by two different pathogenetic routes: locally introduced and hematogenous types of osteomyelitis. The locally introduced form of infection is the result of wound sepsis contiguous to the prosthesis or operative contamination. Any bacteremia can induce infection of a total joint replacement by the hematogenous route. Dentogingival infections and manipulations are known causes of Viridans streptococcal and anaerobic Peptostreptococcus infections in prosthesis. Pyogenic skins processes can cause staphylococcal and streptococcal (groups A, B, C and G streptococci) infections in joint replacements. Genitourinary and gastrointestinal tract procedures or infections are associated with gram-negative bacillary, Enterococci and anaeobic infections of prostheses. The frequency of the presence of the specific etiologic microorganisms in prosthetic joint sepsis varies among the published studies, but a general view of the spectrum of this bacteriology and the prominence of certain microbial groups is known. Staphylococci (coagulase-negative staphylococci and S. aureus) are the principal causative agents; aerobic streptococci and gram-negative bacilli are each responsible for 20% to 25%, and anaerobes represent 10% of these infections. The spectrum of microbial agents capable of causing prosthetic joint infection is unlimited and included organisms ordinarily considered “contaminants” of cultures, such as Bacillus spp. Although infections with fungi (particularly Candida) and mycobacteria are rare, these infections have been described (Mandell, Douglas and Bennett's: Principles and practice of infectious Diseases, Sixth ed., volume 2).
The gold standard for diagnosing prosthesis infection remains bacteriological analysis, which involved isolation and culture of the infecting bacteria at the site of infection, from relevant samples. Bacteriological analysis is generally considered as significant if at least 2 samples taken during the surgery are positive for streptococci, enterococci and Peptostreptococcus spp. Ultrasound-guided needle aspiration or image-guided core-needle biopsy can also be carried. Several drawbacks are however associated to bacteriological analysis. Conventional detection methods rely on the evidencing of Gram-positive bacteria on direct examination of the pathological specimen. However the microscopic detection of bacteria of the genus Streptococcus and related genera in clinical specimens has a limited sensitivity. It is therefore possible that a pathological specimen is not detected by direct microscopic examination of this pathological specimen. In addition, even though their structure is of Gram-positive bacteria type, they may give a false Gram-negative result after Gram staining of the pathological sample and give rise to erroneous or inconclusive identification. When a bacterium of one of the species of the genera under consideration is isolated in the laboratory, conventional phenotype identification methods are the most commonly used to identify bacteria of species belonging to genus Streptococcus and related genera, and several identification kits and automated analyzers have been developed to assist phenotype identification of bacteria of genus Streptococcus and related genera. In this respect, the extent of identification in routine practice is variable. In particular, one of the tests used for identifying streptococci and bacteria of related genera is the detection of a haemolytic reaction, i.e. the destruction by the bacterium of red blood cells contained in a blood agar. However, this haemolytic reaction can be inhibited by the presence of oxygen or by the presence of peroxide when streptococci bacteria are cultured in the presence of a high carbon dioxide concentration. Moreover, it is recognized that there exists a certain extent of subjectivity in assessing haemolysis by colonies of streptococci and hence inter-operator variability which is detrimental to the quality of identification of these.
There are currently no other methods for establishing the diagnosis of streptocococci, enterococci and Peptostreptotoccus spp. prosthesis infection. Thus the object of this invention proposes an alternative technique for the diagnosis of these infections. A serological approach based on the antibodies of anti-streptococci, anti-enterococci and anti-Peptostreptococcus spp. could overcome the drawbacks associated to bacteriological analysis.
SUMMARY OF THE INVENTION
The present invention arises from the unexpected identification, by the inventors, that the proteins 25D6, 25D3, 25H3, and 25C6 of S. agalactiae (represented respectively by SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 and SEQ ID NO: 8) provide for efficient detection of anti-streptococci, anti-enterococci and anti-Peptostreptococcus spp. antibodies in biological samples.
Thus, the present invention relates to a method, in particular an in vitro method, for determining if an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera, preferably, a Streptococcus bacterium selected from the group consisting of beta-hemolytic Streptococcus and Viridans Streptococcus, or an Enterococcus bacterium selected from the group consisting of Enterococcus faecalis and Enterococcus faecium, or a Peptostreptococcus bacterium selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros comprising:

    
    
        detection of antibodies directed against at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, in a biological sample of the individual, and
        deduction therefrom that the individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera, preferably a Streptococcus bacterium selected from the group consisting of beta-hemolytic Streptococcus and Viridans Streptococcus, or an Enterococcus bacterium selected from the group consisting of Enterococcus faecalis and Enterococcus faecium, or a Peptostreptococcus bacterium selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros. 
    
    


According to said method, when antibodies directed against at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 are detected in a biological sample of an individual, said individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera. Inversely, if no antibody directed against at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 is detected in a biological sample of an individual, said individual is not infected by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera.
Accordingly detection of antibodies directed against a protein of sequence SEQ ID NO: 2 may be sufficient to deduce that an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera. Similarly, detection of antibodies directed against a protein of sequence SEQ ID NO: 4, or a sequence SEQ ID NO: 6 or a sequence SEQ ID NO: 8 may be sufficient to deduce that an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera. Typically, detection of antibodies directed against a protein of sequence SEQ ID NO: 2 and antibodies directed against a protein of sequence SEQ ID NO: 4 or detection of antibodies directed against a protein of sequence SEQ ID NO: 2 and antibodies directed against a protein of sequence SEQ ID NO: 6 or detection of antibodies directed against a protein of sequence SEQ ID NO: 2 and antibodies directed against a protein of sequence SEQ ID NO: 8, or detection of antibodies directed against a protein of sequence SEQ ID NO: 4 and antibodies directed against a protein of sequence SEQ ID NO: 6 or detection of antibodies directed against a protein of sequence SEQ ID NO: 4 and antibodies directed against a protein of sequence SEQ ID NO: 8 or detection of antibodies directed against a protein of sequence SEQ ID NO: 6 and antibodies directed against a protein of sequence SEQ ID NO: 8 may be sufficient to deduce that an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera. Similarly, detection of antibodies directed against a protein of sequence SEQ ID NO: 2 and of antibodies directed against a protein of sequence SEQ ID NO: 4 and of antibodies directed against a protein of sequence SEQ ID NO: 6 or detection of antibodies directed against a protein of sequence SEQ ID NO: 4 and of antibodies directed against a protein of sequence SEQ ID NO: 6 and of antibodies directed against a protein of sequence SEQ ID NO: 8, or detection of antibodies directed against a protein of sequence SEQ ID NO: 2 and of antibodies directed against a protein of sequence SEQ ID NO: 6 and of antibodies directed against a protein of sequence SEQ ID NO: 8, or detection of antibodies directed against a protein of sequence SEQ ID NO: 2 and of antibodies directed against a protein of sequence SEQ ID NO: 4 and of antibodies directed against a protein of sequence SEQ ID NO: 8 may be sufficient to deduce that an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera. Analogously; detection of antibodies directed against a protein of sequence SEQ ID NO: 2 and of antibodies directed against a protein of sequence SEQ ID NO: 4 and of antibodies directed against a protein of sequence SEQ ID NO: 6 and of antibodies directed against a protein of sequence SEQ ID NO: 8 may be sufficient to deduce that an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera.
Preferably, said detection of antibodies directed against at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, in a biological sample of the individual comprises contacting the biological sample with:
(i) at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; and/or,
(ii) at least one homologous protein comprising or consisting of a sequence having at least 90% identity with a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; and/or,
(iii) at least one fragment of protein defined in (i) or homologous protein defined in (ii);
provided the homologous protein defined in (ii) or the fragment defined in (iii) can be bound by at least one antibody directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8.
Preferably said fragment defined in (iii) may comprise 4 to 200 contiguous amino acids of said proteins defined in (i) or of said homologous proteins defined in (ii).
As appropriate, a protein sequence comprising or consisting of a sequence SEQ ID NO: 2, or an homologous protein comprising or consisting of a sequence having at least 90% identity with a sequence SEQ ID NO: 2 or a fragment of said protein or said homologous protein may be used for detection of antibodies directed against protein of sequence SEQ ID NO: 2. Said method is applicable mutatis mutandis to SEQ ID NO: 4, SEQ ID NO: 6 and SEQ ID NO: 8.
Preferably, according to said method, the detection of antibodies directed against a protein of sequence SEQ ID NO: 2 is indicative of a patient having a bacterium from the Streptococcus genus or the Peptostreptococcus genus, more preferably, is indicative of a patient having a Peptostreptococcus bacterium selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros, or is indicative of a patient having a beta-hemolytic Streptococcus selected from the group consisting of Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus alactolyticus, Streptococcus equisimilis and Streptococcus dysgalactiae. 
Preferably, according to said method, the detection of antibodies directed against a protein of sequence SEQ ID NO: 8 is indicative of a patient having a bacterium from the Streptococcus genus or the Enterococcus genus, more preferably, is indicative of a patient having a Enterococcus faecalis bacterium or is indicative of a patient having a Streptococcus bacterium such as a beta-hemolytic Streptococcus selected from the group consisting of Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus equisimilis and Streptococcus dysgalactiae or is indicative of a patient having a Streptococcus bacterium such as a Viridans streptococcus bacterium selected from the group consisting of Streptococcus mitis, Streptococcus oralis, Streptococcus sanguis, Streptococcus parasanguis and Streptococcus gordonii. 
The present invention also relates to the use of:
(i) at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or
(ii) at least one homologous protein comprising or consisting of a sequence having at least 90% identity with a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or
(iii) at least one fragment of protein defined in (i) or homologous protein defined in (ii),
provided the homologous protein defined in (ii) or that the fragment defined in (iii) can be bound by at least one antibody directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8,
for in vitro diagnosis of infection with a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera.
Preferably said fragment defined in (iii) may comprise 4 to 200 contiguous amino acids of said proteins defined in (i) or of said homologous proteins defined in (ii).
The present invention also relates to a kit for diagnosing an infection by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera comprising antigens which can be bound by antibodies directed against at least two sequences selected from the group consisting of SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 and SEQ ID NO: 8,
wherein said antigens are:
(i) at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or,
(ii) at least one homologous protein comprising or consisting of a sequence having at least 90% identity with a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or,
(iii) at least one fragment of protein defined in (i) or homologous protein defined in (ii);
provided the homologous protein defined in (ii) or that the fragment defined in (iii) can be bound by at least one antibody directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 and SEQ ID NO: 8.
Preferably said fragment defined in (iii) may comprise 4 to 200 contiguous amino acids of said proteins defined in (i) or of said homologous proteins defined in (ii).
The present invention also related to an in vitro method, for determining if an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera, preferably, a Streptococcus bacterium selected from the group consisting of beta-hemolytic Streptococcus and Viridans Streptococcus, or an Enterococcus bacterium selected from the group consisting of Enterococcus faecalis and Enterococcus faecium, or a Peptostreptococcus bacterium selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros comprising:

    
    
        contacting capture ligands specific of at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, with a biological sample of the individual;
        determining if said protein is bound to the specific capture ligands;
        deducing therefrom that the individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera, preferably, a Streptococcus bacterium selected from the group consisting of beta-hemolytic Streptococcus and Viridans Streptococcus, or an Enterococcus bacterium selected from the group consisting of Enterococcus faecalis and Enterococcus faecium, or a Peptostreptococcus bacterium selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros. 
    
    


In an embodiment of the invention, the above-defined method comprises contacting specific capture ligands of at least two proteins of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8.
The present invention also relates to the use, in particular the in vitro use, of specific capture ligands, in particular an antibody, directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 for determining if an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera, preferably, a Streptococcus bacterium selected from the group consisting of beta-hemolytic Streptococcus and Viridans Streptococcus, or an Enterococcus bacterium selected from the group consisting of Enterococcus faecalis and Enterococcus faecium, or a Peptostreptococcus bacterium selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros. In other words, the present invention also relates to a method for the in vitro diagnosis of an infection by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera, preferably, a Streptococcus bacterium selected from the group consisting of beta-hemolytic Streptococcus and Viridans Streptococcus, or an Enterococcus bacterium selected from the group consisting of Enterococcus faecalis and Enterococcus faecium, or a Peptostreptococcus bacterium selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros. in an individual, in whom one detects the presence of at least an antigen of the aforesaid bacterium in a biological sample of the individual using a ligand of capture, in particular an antibody, directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8.
The present invention also relates to an antigenic kit for diagnosing an infection by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera, preferably, selected from the group consisting of beta-hemolytic Streptococcus, Viridans Streptococcus, Enterococcus and Peptostreptococcus spp., comprising a capture ligand, in particular an antibody, directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8.


DETAILED DESCRIPTION OF THE INVENTION
As intended herein, the expressions “Streptococcus”, “Streptococci”, or “Streptococcal” relates to a bacterium or to bacteria of the Streptococcus genus. The Streptococcus genus is composed of (i) the alpha-hemolytic group composed by the Viridans group and the pneumococci, (ii) the beta-hemolytic group composed of 18 antigenic groups classified between A to H and K to L (iii) the non hemolytic group also known as Enterococci. This last group has been re-classified en 1984 and defines currently the Enterococcus genus.
Preferably, the beta-hemolytic streptococci of the invention may be a Streptococcus pyogenes (also known as group A Streptococcus GAS), Streptococcus agalactiae (also known as group B Streptococcus GBS), Streptococcus alactolyticus (also known as group G Streptococcus GGS) and Streptococcus dysgalactiae (also known as group C Streptococcus GCS).
Preferably, the alpha-hemolytic streptococci of the invention may be a Viridans streptococcus more preferably said Viridans streptococcus bacterium may be selected from the group consisting of Streptococcus mitis, Streptococcus oralis, Streptococcus sanguis, Streptococcus parasanguis and Streptococcus gordonii. 
As intended herein, the expressions “Peptostreptococcus”, “Peptostreptococci”, or “Peptostreptococcal” relates to a bacterium or to bacteria of the Peptostreptococcus genus. Preferably, the Peptostreptococcus may be Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros. 
As intended herein, the expressions “enterococcus”, “enterocci”, or “enteroccal” relates to a bacterium or to bacteria of the enteroccus genus. The enterocci of the invention may be an Enterococcus faecalis, or an Enterococcus faecium. 
As intended herein, the expression ‘infected’ or ‘infection’ relates to individuals carrying bacteria selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera as defined above. Preferably, the infection is a surface associated infection or a biofilm-associated infection. Infections by Streptococcus, Enterococcus or Peptostreptococcus genera can occur by bacterial biofilms. Preferably, the infected individuals present one or more sites wherein multiplication of the bacteria is occurring. Infections by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera can occur as a consequence of the contact of internal tissues with a foreign material contaminated by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera, in particular in a hospital setting. Accordingly, as intended herein, the infection preferably arises from the implantation of a prosthetic material in the individual, such as prosthetic joint, notably selected from the group consisting of a knee joint, a shoulder joint and a hip joint. Thus, the infection may be a device-associated-infection. Said device may be a medical device implanted in an individual such as prosthesis. Indeed, the infection may be a prosthetic or a periprosthetic infection and notably a periprosthetic joint infection.
Accordingly, as intended herein, the method according to the invention is implemented in order to determine if an individual suffers from an infection by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera, the mentioned infection being selected among an infection on prosthesis (in particular articular) such as a periprosthetic joint infection, an osteo-articular infection, a post-operative infection (in particular during the installation of a foreign material such as a prosthesis), a dental infection, a parodontite, a conjunctivitis, a endophtalmy, a cerebral abscess, a empyeme under-dural, a lung infection, a peritonitis, an osteomyelitis, a septic arthritis, an endocarditis (in particular on prosthesis), a meningitis (in particular on shunts).
The individual can moreover be an individual diabetic, presenting an immunodepression, suffering of a cancer and/or carrying prosthetic material or catheter. Preferably the individual presenting a prosthetic joint selected from the group consisting of a knee joint, a shoulder joint and a hip joint. According to the invention, such a prosthetic joint may be infected by said a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera. As intended herein, the expression ‘biological sample’ includes both the sample as taken and the sample which has been subjected to various treatments, in particular to render it suitable for the use in the processes and methods according to the invention. The ‘biological sample’ according to the invention can be of any type liable to harbor antibodies, however, it is preferred that the biological sample is selected from the group consisting of a blood sample, a serum sample, a plasma sample, a mucosa-associated lymphoid tissue (MALT) sample, a cerebrospinal fluid sample, an articular liquid sample, a pleural liquid sample, a saliva sample, and an urine sample.
As intended herein, the expression ‘determining if an individual is infected by a bacterium selected from the group consisting Streptococcus, Enterococcus and Peptostreptococcus genera’ encompasses establishing a diagnosis or diagnosing an infection by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera in an individual. It also encompasses following-up of individuals having undergone a surgical operation for implanting, cleaning or replacing the prosthesis. It further encompasses following the evolution of infection by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera, in particular within the framework of a therapeutic treatment. Accordingly, it is preferred that the individual is under treatment by antibiotics.
Determining if antibodies directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO:6 and SEQ ID NO: 8, are present in a biological sample of the individual can be carried out by various methods well known to one of skill in the art. However, determining if antibodies directed against a protein comprising or consisting of a sequence selected from the group consisting of SEQ ID NO:2, 4, 6 or 8, are present in a biological sample of the individual comprises:

    
    
        contacting the biological sample with:
    
    


(i) a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or
(i) a homologous protein of sequence having at least 90% identity with a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or
(iii) at least one fragment of said protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 or of said homologous protein;
provided said homologous protein defined in (ii) or that the fragment defined in (iii) can be bound by at least one antibody directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8;

    
    
        detecting antibodies, preferably IgG, bound to said protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, to said homologous protein or to said at least one fragment.
    
    


Preferably said fragment defined in (iii) may comprise 4 to 200 contiguous amino acids of said proteins defined in (i) or of said homologous proteins defined in (ii).
The protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; the homologous protein thereto, or the fragments thereof, can present either as polypeptide chains resulting from the in vivo, ex vivo or in vitro polymerization of amino acids selected from the 20 natural amino acids, or as modified polypeptide chains. As intended herein, in vivo or ex vivo polymerization notably encompasses production by in vitro translation or by chemical synthesis. Where the polypeptide is modified, it can result from the use of non-natural amino acids during the in vivo, ex vivo or in vitro polymerization of the polypeptide chain and from post-polymerisation modifications. The polypeptide can be modified one or several times by identical or different modifications. The modifications can be anywhere in the polypeptide chain, and notably in the peptide backbone, in the amino acid lateral groups, or at the N-terminal or C-terminal extremities of the polypeptide chain. Modification notably encompass acylation, in particular acetylation, palmytoylation, glypiation, prenylation and myristoylation, ADP-ribosylation, amidation, covalant linkage of a lipid, such as phosphatidylinositol, flavin, an heme, or a nucleotide, covalent, or non-covalent cross-linking, cyclisation, disulfide bridge oxidation and reduction, methylation and demethylation, pyroglutamate formation, formylation, gamma-carboxylation, glycosylation, hydroxylation, iodation, phosphorylation, selenoylation, sulfatation, racemisation, addition of amino-acids, such as arginylation, or of polypeptides, such as ubiquitinylation (Proteins structure and molecular properties, 2nd ed., T. E. Creighton, W. H. Freeman and Company, New York (1993) and Wold, F., Posttranslational Protein Modifications: Prospects and Prospective customers, pgs 1-12 in Covalent posttranslational modification of proteins, B. C. Johnson, ED., Press Academy, New York (1983); Seifter et al. (1990) Meth. Enzymol. 182: 626-646 and Rattan et al. (1992) Protein Synthesis: Posttranslational Modifications and Aging, Ann. NR. Y. Acad. Sci. 663: 48-62).
Besides, where they are obtained by recombining means, the polypeptide chain or the protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, the homologous protein thereto, and the fragments thereof, may also comprise sequences useful for protein purification (so-called purification tags), such as polyhistidine tags, and optionally a sequence enabling the cleavage of these tags, such as protease cleavage sites.
Preferably, the protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 may comprise 350, 400, 500, or 1000 amino-acids at the most. More preferably the proteins of SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, respectively consist in SEQ ID NO: 2 or SEQ ID NO: 17, SEQ ID NO: 4 or SEQ ID NO: 18, SEQ ID NO: 6 or SEQ ID NO: 19, and SEQ ID NO: 8 or SEQ ID NO: 20. Preferably proteins of sequences SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6, and SEQ ID NO: 8 are respectively encoded by nucleic acids comprising or consisting of SEQ ID NO: 1, SEQ ID NO: 3, SEQ ID NO: 5, and SEQ ID NO: 7.
The percentage of identity according to the invention can be calculated by methods well-known to one of skill in the art. The percentage of identity may be calculated by performing a pairwise global alignment based on the Needleman-Wunsch alignment algorithm to find the optimum alignment (including gaps) of two sequences along their entire length, for instance using Needle, and using the BLOSUM62 matrix with a gap opening penalty of 10 and a gap extension penalty of 0.5.
The term “homologous protein” or “homologous polypeptide” means a protein having a percentage of identity with proteins of SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 according to the invention.
Preferably, the percentage of identity relates to the number of identical amino-acids obtained for an optimal paired alignment (i.e. the alignment maximizing the number of identical amino-acids) of the sequence of a protein homologous to SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, divided by the total number of amino-acids in SEQ ID NO: 2, 4, 6 or 8. Alignment can be performed manually or using computer programs such as the EMBOSS-Needle program (Needleman and Wunsch (1970) J. Mol. Biol. 48:443-453). Preferably, the percentage of identity according to the invention is at least 85%, more preferably from at least 90%, and even more preferably from at least 95%. Preferably, the fragment contains an epitope. The smaller fragment that may be recognized by an antibody may have 4 to 5 contiguous amino acids. Consequently, according to the invention a ‘fragment’ may be of 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 contiguous amino acids. Preferably, said fragment may comprise 22 to 200 contiguous amino acids, more preferably 25 to 150 contiguous amino acids, and more preferably 30 to 100 contiguous amino acids. Preferably also, the ‘fragment’ may comprise 35 to 80 contiguous amino acids, more preferably 40 to 75 contiguous amino acids at the most, and most preferably 45 to 70 contiguous amino acids at the most. Preferably also, the ‘fragment’ according to the invention consists of a portion of a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, or of a portion of sequences presenting at least 85%, more preferably at least 90%, and more preferably from at least 95% of a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 at the most.
As intended herein, the homologous protein as defined above and the at least one fragment as defined above can be bound by at least one antibody directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8. In other words, the homologous protein as defined above and the at least one fragment as defined above comprises at least one of the epitopes of a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8. Accordingly, the homologous protein as defined above and the at least one fragment as defined above comprise at least one of the epitopes of a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8. Accordingly, the homologous protein as defined above and the at least one fragment as defined above should preferably be such that they provide at least 70%, more preferably at least 80% and most preferably at least 90%, of the sensitivity provided by the protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, measured in the same conditions.
As intended herein, the term ‘sensitivity’ is defined as the percentage of individuals infected by a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera, which biological samples, such as serum samples, are determined to contain antibodies directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, detectable according to the invention. The determining of the sensitivity provided by an antigen can be carried out according to various methods well-known to one of skill in the art and notably as illustrated in the following Example 1. Preferably, the antibodies detected in the biological samples according to the invention are IgG.
In addition, as that will appear clearly to one of skill in the art, ‘an antibody directed against at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8’ means any antibody of the individual able to recognize a protein of a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, i.e. a specific antibody of this protein, but which can also recognize:

    
    
        a larger protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or a homologous protein comprising or consisting of a sequence having at least 90% identity with a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8;
        a fragment of homologous protein or a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8. Preferably said fragment defined in (iii) may comprise 4 to 200 contiguous amino acids of said proteins defined in (i) and/or of said homologous proteins defined in (ii).
    
    


Providing the detection of antibodies directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, in the biological samples, or the antigen detection of a bacterium selected from the group consisting of Streptococcus, Enterococcus and Peptostreptococcus genera, preferably selected from the group consisting of beta-hemolytic Streptococcus, Viridans Streptococcus, Enterococcus and Peptostreptococcus spp. using a ligand of capture, such as an antibody, directed, preferably specifically, against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, can be easily implemented by one of skill in the art.
Being the detection of antibody directed against a protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, in the biological samples, it can be carried out with the assistance (i) of at least one protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or (ii) of at least one homologous protein comprising or consisting of a sequence dividing at least 90% identity with a sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8; or (iii) of at least one fragment of protein defined in (i) or homologous protein defined in (ii), the fragment comprising 4 to 200 contiguous amino acids of said protein defined in (i) or homologous protein defined in (ii).
Preferably said fragments defined in (iii) may comprise 4 to 200 contiguous amino acids of said proteins defined in (i) or of said homologous proteins defined in (ii).
Preferably, in the above-defined method, detecting antibodies can be carried out with specific detecting ligands of the antibodies.
As intended herein, a “ligand” is a compound liable to specifically bind to a target, such as an antibody or an antigen. The ligand can be of any type but preferably, it is an antibody, an aptamer, or a peptide obtained by phage display. To determine whether antibodies or antigens are fixed by a ligand of capture one can use a ligand detection, which can be specific either antibodies or antigens fixed, or of the ligands of capture.
The methods calling upon ligands of capture and ligands of detection are well-known to one of skill of the art, and can be performed according to various well-known formats, solid or homogeneous phase, one or two stages, using a method sandwich or by competition. Preferably, the ligand of capture is immobilized on a solid phase, such as the walls of a well of a plate of microtitration or paramagnetic balls.
As intended herein, an “antigen” relates to any substance that triggers the production of an antibody by the immune system in an animal, including a human. Antigen refers also to a substance which is a ligand of an antibody to which it binds. The term “epitope” as used herein means the portion of the antigen which interacts with an antibody. When the antigen is a protein, said portion may be a specific amino acid sequence, a modified amino acid sequence, or a protein secondary or tertiary structure.
An “antibody” as intended herein relates to antibodies belonging to any species, such as human, mouse, rat, rabbit, goat, or camelidae species. The antibody can also be a chimeric antibody, i.e. an antibody which comprises parts originating from different species. Preferred chimeric antibodies are so-called “humanized” antibodies, wherein the constant parts (CH and CL) are of human origin and the variable parts (VH and VL) are of another species, such as mouse for instance. The antibody of the invention can be produced by any method known the man skilled in the art, such as by animal immunization, or by recombinant or synthetic methods for instance. Besides, an “antibody” according to the invention also encompasses antibody fragments which comprise at least one of the paratopes of said antibody, such as Fab, F(ab′)2, scFv fragments as well as camelidae single-chain antibodies. The antibody of the invention can be a polyclonal antibody, in particular a monospecific polyclonal antibody, or a monoclonal antibody.
“Aptamers” are well-known by the one skilled in the art. Aptamers are compounds of a nucleotide, in particular a ribonucleotide or desoxyribonucleotide, or a peptide nature able to bind specifically to a target, in particular a protein target. The aptamers of a nucleotide nature and the production thereof are described, in particular, by Ellington et al. (1990) Nature 346:818-822 and Bock et al. (1992) Nature 355:564-566. The aptamers of a peptide nature and the production thereof are described, in particular, by Hoppe-Seyler et al. (2000) J. Mol. Med. 78:426-430.
“Phage display” denotes a technique for selecting polypeptide ligands expressed on the capsid of a bacteriophage and encoded by a nucleic sequence inserted into the capsid encoding gene. This method is well known by the one skilled in the art and is described, in particular, by Scott and Smith (1990) Science 249:386-390, and Marks et al. (1991) J. Mol. Biol. 222:581-597. Preferably, the polypeptide obtainable by phage display is an scFv-type polypeptide (single-chain variable fragment). This technique is described, in particular, by Winter et al. (1994) Annu. Rev. Immunol. 12:433-455.
The term “specific”, when it refers to recognition of a ligand or binding of a ligand to a first target, such as an antigen or an antibody, means that the ligand interacts with the first target without interacting substantially with another target which does not structurally resemble the first target, for example, the ligand. Preferably the antibody directed against a polypeptide of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8 does not bind to a polypeptide having less than 85%, preferably 90%, sequence identity with SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, as appropriate.
As defined herein, the term “binds specifically” or similar terms, when used in the context of an antibody binding a target epitope, refers to the antibody having specificity for the target epitope (as opposed to other epitopes). The specificity need not be 100%. In one embodiment, the specificity is about 75% or greater (i.e., 75% specificity for the epitope). This means that about 75% of the antibodies that bind to an epitope will bind to the target epitope and about 25% of the antibodies will bind non-specifically. In another embodiment, the specificity is about 90% or greater.
In the above-defined method, determining if the capture ligands are respectively bound to an antigen can be carried out by using a detection ligand which is specific of said antigen but preferably binds to said antigen by recognition of an another binding site (i.e. epitope) than the recognition site of said capture ligand.
Preferably, the “detection ligand” according to the invention means marking or labeling molecules for detecting the ligand. The term ‘marking’ or “labeling” refers both to a direct labelling and to an indirect labelling (for example, by means of other ligands, themselves directly labelled, or using reagents of a labelled “affinity pair”, such as, but not exclusively, the labelled avidin-biotin pair, etc.). Preferably, the label is a radioisotope, an enzyme or a fluorophore.
As will be clear to one of skill in the art, in the above-defined method, the protein of sequence SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6 or SEQ ID NO: 8, the homologous protein or the fragment can be used as a capture antigen.
Methods using capture antigens or ligands and detection ligands are well known to one of skill in the art and can be carried out in accordance with various well-known formats, for example in solid or homogeneous phase, in one or two steps, by a sandwich method or by a competitive method.
Preferably, the capture antigen or ligand is immobilised on a solid phase. By way of non-limiting examples of solid phase, microplates could be used, in particular polystyrene microplates, solid optionally paramagnetic particles or beads, or even polystyrene or polypropylene test tubes, glass, plastic or silicon chips, etc.
Although having distinct significances, the terms comprising, ‘containing’, and ‘consisting of’ were used in an interchangeable way in the description of the invention, and can be replaced one by the other.
The invention will be further described in view of the following examples.
Summary of the sequences described herein:













Sequence description
SEQ ID NO:


















25D6 nucleotide sequence
1



25D6 protein sequence
2



25D3 nucleotide sequence
3



25D3 protein sequence
4



25H3 nucleotide sequence
5



25H3 protein sequence
6



25C6 nucleotide sequence
7



25C6 protein sequence
8



25E1 nucleotide sequence
9



25E1 protein sequence
10



26D3 nucleotide sequence
11



26D3 protein sequence
12



26E3 nucleotide sequence
13



26E3 protein sequence
14



25E3 nucleotide sequence
15



25E3 protein sequence
16



25D6 + His tag protein sequence
17



25D3 + His tag protein sequence
18



25H3 + His tag protein sequence
19



25C6 + His tag protein sequence
20



25E1 + His tag protein sequence
21



26D3 + His tag protein sequence
22



26E3 + His tag protein sequence
23



25E3 + His tag protein sequence
24









EXAMPLES
Example 1
Materials and Methods
Antigens 25D6 (SEQ ID NO: 17), 25D3 (SEQ ID NO: 18), 25H3 (SEQ ID NO: 19), 25C6 (SEQ ID NO: 20), 25E1 (SEQ ID NO: 21), 26D3 (SEQ ID NO: 22), 26E3 (SEQ ID NO: 23) and 25E3 (SEQ ID NO: 24) were recombinantly produced in Escherichia coli and purified according to usual methods, such as described in Lavallie (1995) “Production of recombinant proteins in Escherichia coli”. Unit 5.1. Current Protocols in Protein Science; Scopes (1995) “Strategies for protein purification” Unit 1.2. Current Protocols in Protein Science.
First screening was performed by high throughput ELISA. ELISA plates were coated overnight with 0,5 μg/mL of purified antigens (proteins 25D6, 25D3, 25H3, 25C6, 25E1, 26D3, 26E3, 25E3). The plates were further saturated 2 hours with PBS-TWEEN containing 4% serum albumin bovine (SAB). Hundred microliters of each serum sample of patients or controls were added at a 1/100 dilution for 30 minutes. Human peroxydase-labeled anti-IgG antibody was then added for 30 minutes before revelation with tetrabenzimidine (TMB) for approximately 15 minutes. Sulphuric acid (100 μL) were then added in each well to stop the reaction. The 450 nm absorbance of each well was then measured after 5 minutes. Are regarded as ‘positive’ in ELISA, the serums identified by their binding to polypeptides (antigens) such as defined according to the invention.
Pertinent antigens were then tested with sensitive technology LUMINEX®. Briefly, the antigens were covalently attached to surface carboxyl groups of MAGPLEX MICROSPHERES (LUMINEX®) using N-hydroxysulfosuccinimide (sulfo-NHS) and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) according the manufacturer's instructions. 50 μg were used for attachment to 5.000,000 microspheres. Detection of serum antibodies was carried out according to the manufacturer's instructions. Briefly, antigen-coupled microspheres were added to the wells of a multiwell plate and contacted with the various sera for a time sufficient to allow antibody-antigen complexes to be formed. After discarding the unreacted serum and washing the plate, a phycoerythrin-labeled anti-IgG antibody was added to the microspheres. Antibody-antigen complexes were further revealed by determining the mean fluorescence intensity (MFI) for each serum with a LUMINEX® analyzer.
The cut-off values for each serologic assay were determined by Receiver Operating Characteristics (ROC) curve analysis as described in the guideline GP10-A of December 1995 from the National Committee for Clinical Laboratory Standards (NCCLS) as the values yielding a maximum efficiency. The efficiency is defined as the ratio of the sum of the true positive samples and the true negative samples obtained with the serologic assays by the total number of samples assayed. True positive and negative samples are samples which are respectively determined as being positive and negative both using the serologic assay of the invention and bacteriological analysis. A sample was then considered positive if the antibody titer exceeded the defined cut-off value.
Example 2
Use of polypeptides of the invention for the detection of antibody in serum samples: first screening by high throughput ELISA.
The panel of samples tested is consisting of serum samples of 26 patients suffering from prosthetic joint infections wherein the infection with Viridans and beta hemolytic streptococci (A, B, C and G groups), Peptostreptococcus spp. was diagnosed positive with culture of 2 or more samplings on the infected prostheses. Control sera were collected from 64 healthy blood donors.







TABLE 1







Results (ELISA) obtained by testing of the antigens








Ratio of
Tested antigens















positive sera
25D6
25D3
25H3
25C6
25E1
26D3
26E3
25E3





Positive
44%
50%
31%
46%
7%
19%
11%
7%


patients (26)










Healthy blood
11%
11%
11%
11%
9%
12%
 9%
8%


donors (64)









Table 1 shows the results obtained according to the invention for polypeptides 25D6 (SEQ ID NO: 17), 25D3 (SEQ ID NO: 18), 25H3 (SEQ ID NO: 19), 25C6 (SEQ ID NO: 20), 25E1 (SEQ ID NO: 21), 26D3 (SEQ ID NO: 22), 26E3 (SEQ ID NO: 23), and 25E3 (SEQ ID NO: 24), with secondary antibodies recognizing the immunoglobulins G present in serum samples of patients or control healthy blood donors.
Results show that polypeptides of the invention 25D6 (SEQ ID NO: 17), 25D3 (SEQ ID NO: 18), 25H3 (SEQ ID NO: 19), and 25C6 (SEQ ID NO: 20) can be used for the diagnosis of infections of β hemolytic and Viridans streptococci, Peptostreptococcus spp. on articular prostheses. Other polypeptides also tested, such as 25E1 (SEQ ID NO: 21), 26D3 (SEQ ID NO: 22), 26E3 (SEQ ID NO: 23), and 25E3 (SEQ ID NO: 24) do not allow the diagnosis of such infections with no sufficient sensitivity.
Example 3
Use of polypeptides of the invention for the diagnosis of the beta hemolytic and Viridans streptococci, enterococci and Peptostreptococcus spp. prosthesis infections with panels of patient serum samples and control serum samples: evaluation by the LUMINEX® technology of the selected antigens.
The panel of samples tested is consisting of serum samples of 16 patients suffering from prosthetic joint infections wherein the infection with beta hemolytic streptococci (A, B, C, G groups) was diagnosed positive with culture of 2 or more samplings on the infected prostheses. Moreover, serums samples from 4 patients positive for a prosthesis infection to Viridans streptococci (3 S. mitis, 1 S. oralis), serum samples from 2 patients positive for a prosthesis infection to Peptostreptococcus spp., and serum samples from 3 patients positive for a prosthesis infection to Enterococcus faecalis, diagnosed positive with culture were tested. Control sera were collected from (i) 34 healthy prosthesis carriers with no clinical sign of infection since at least 2 years and (ii) 31 patients with prosthesis infections other than streptococci, enterococci, or Peptostreptococcus spp. infections; i.e. gram-positive coccus (n=1), Corynebacterium spp. (n=1), Enterobacter aerogenes (n=1), Enterobacter cloacae (n=2), Escherichia coli (n=1), Klebsiella oxytoca (n=1), Propionibacterium acnes (n=5), Pseudomonas aeruginosa (n=1), Propionibacterium granulosum (n=1), Pasteurella multocida (n=1), Propionibacterium avidum (n=1), Staphylococcus aureus (n=7), Staphylococcus capitis (n=4), coagulase negative staphylococci (n=2), Serratia marcescens (n=1), Staphylococcus warneri (n=1).







TABLE 2







Results (LUMINEX ® technology) obtained


by testing of the selected antigens.









Tested antigens











Ratio of positive sera
25D6
25D3
25H3
25C6





Beta hemolytic streptococci positive 
 73%
87%
80%
73%


patients (16)






Viridans streptococci positive patients (4)
 50%
50%
50%
50%


Peptostreptococcus spp. positive 
100%
50%
50%
 0%


patients (2)






Enterococcus faecalis positive patients (3)
 0%
33%
33%
33%


Healthy prosthesis carriers (22)
 14%
 5%
 9%
 0%


Infected prosthesis patients with other
 23%
19%
26%
16%


infections than streptococci, Enterococci, 






or Peptostreptococcus spp . . . (31)









The results show a significant antibody response (the probability associated with a test of X2 is lower than 0.05) against the polypeptides identified according to the invention during the infections to β hemolytic streptococci, Viridans streptococci, Peptostreptoccus spp. (25D6, 25D3, 25H3) and Enterococcus genus.
Example 4
Combination of the selected antigens (25D6, 25D3, 25H3 and 26C6) have been tested in the same conditions example 2 on the same panel of samples, in order to improve sensibility and/or specificity of the diagnosing method according to the invention.







TABLE 3







Results (LUMINEX ® technology) obtained by testing


combination of antigens for Viridans streptococci.













25D6-25H3-



Ratio of positive sera
25C6
25C6







Viridans streptococci positive patients (5)
50%
100%



Healthy prosthesis carriers (22)
 0%
 9%



Infected prosthesis patients with other 
16%
 32%



infections than streptococci, enterococci, 





or Peptostreptococcus spp. (31)

















TABLE 4







Results (LUMINEX ® technology) obtained by


testing combination of antigens for Peptostreptococcus.











25D6-


Ratio of positive sera
25D6
25D3





Peptostreptococcus positive patients (2)
100%
100%


Healthy prosthesis carriers (22)
 14%
 0%


Infected prosthesis patients with other infections 
 23%
 13%


than streptococci, enterococci, or Peptostreptococcus 




spp . . . (31)
















TABLE 5







Results (LUMINEX ® technology) obtained by testing


combination of antigens for Enterococcus faecalis.













25D6-25D3-



Ratio of positive sera
25C6
25H3-25C6






Enterococcus faecalis positive
33%
33%



patients (3)





Healthy prosthesis carriers (22)
 0%
 0%



Infected prosthesis patients with
16%
10%



other infections than streptococci,





enterococci, or





Peptostreptococcus spp . . . (31)
















TABLE 6







Results (LUMINEX ® technology) obtained by testing


combination of antigens for Beta hemolytic streptococci.













25D6-





25D3-25H3-



Ratio of positive sera
25D3
25C6






Beta hemolytic streptococci
87%
80%



positive patients (16)





Healthy prosthesis carriers (22)
 5%
 0%



Infected prosthesis patients with
19%
13%



other infections than streptococci,





enterococci, or





Peptostreptococcus spp . . . (31)









By comparing results obtained by using antigens combinations with best results obtained by testing one antigen, a clear improvement of the diagnosis method according to the invention is observed. Indeed, the combination of antigens (see tables 3 to 6) clearly provides an improvement in the sensibility and/or in the specificity of the test by increasing detection of positive tested patients (right positive) (see table 3) or reducing false positive detection (see table 4 to 6).

## Claims

1. An in vitro method of determining if an individual having an implanted prosthetic material is infected by a Streptococcus, Enterococcus, or Peptostreptococcus bacterium, the method comprising:
(a) detecting antibodies specific to the protein of at least one of SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6, and SEQ ID NO: 8 in a biological sample of the individual, wherein the biological sample is selected from the group consisting of blood, serum, plasma, saliva, urine, cerebrospinal fluid, pleural fluid, and articular fluid and
(b) deducing therefrom that the individual is infected by the Streptococcus, the Enterococcus, or the Peptostreptococcus bacterium when the antibodies specific to the protein of at least one of SEQ ID NO: 4 and SEQ ID NO: 6 are detected;
deducing therefrom that the individual is infected by the Streptococcus, or the Peptostreptococcus bacterium when the antibodies specific to the protein of SEQ ID NO: 2 are detected and
deducing therefrom that the individual is infected by the Streptococcus, or the Enterococcus bacterium when the antibodies specific to the protein of SEQ ID NO: 8 are detected.

2. The method of claim 1, wherein the Streptococcus bacterium is selected from the group consisting of beta-hemolytic Streptococcus and Viridans Streptococcus; the Enterococcus bacterium is selected from the group consisting of Enterococcus faecium and Enterococcus faecalis; or the Peptostreptococcus bacterium is selected from the group consisting of Peptostreptococcus magnus, Peptostreptococcus asaccharolyticus, Peptostreptococcus anaerobius, Peptostreptococcus prevotii, and Peptostreptococcus micros.

3. The method of claim 2, wherein the beta-hemolytic Streptococcus is selected from the group consisting of Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus alactolyticus and Streptococcus dysagalactiae.

4. The method of claim 2, wherein the Viridans Streptococcus is selected from the group consisting of Streptococcus mitis, Streptococcus oralis, Streptococcus sanguis, Streptococcus parasanguis, and Streptococcus gordonii.

5. The method of claim 1, wherein the detected antibodies are IgG.

6. The method of claim 1, wherein the implanted prosthetic material infected by the bacterium is a prosthetic joint implanted in the individual.

7. The method of claim 1, wherein the implanted prosthetic material in the individual infected is a knee joint, a shoulder joint, or a hip joint.

8. The method of claim 1, wherein the individual is under antibiotic treatment.

9. An in vitro method of determining if an individual having an implanted prosthetic material is infected by a Streptococcus, Enterococcus, or Peptostreptococcus bacterium, the method comprising:
(a) contacting capture ligands specific to the protein of at least one of SEQ ID NO: 2, SEQ ID NO: 4, SEQ ID NO: 6, and SEQ ID NO: 8 in a biological sample of the individual, wherein the biological sample is selected from the group consisting of blood, serum, plasma, saliva, urine, cerebrospinal fluid, pleural fluid, and articular fluid and
(b) determining if said protein is bound to the specific capture ligands and
(c) deducing therefrom that the individual is infected by the Streptococcus, the Enterococcus, or the Peptostreptococcus bacterium, when the capture ligands specific to the protein of at least one of SEQ ID NO: 4 and SEQ ID NO: 6 are detected;
deducing therefrom that the individual is infected by the Streptococcus, or the Peptostreptococcus bacterium when the capture ligands specific to the protein of SEQ ID NO: 2 are detected and
deducing therefrom that the individual is infected by the Streptococcus, or the Enterococcus bacterium when the capture ligands specific to the protein of SEQ ID NO: 8 are detected,
wherein the prosthetic material implanted in the individual is infected by said bacterium.