# Patent

## Title
Human papilloma virus probes for the diagnosis of cancer

## Abstract

In one embodiment, the invention relates to a method of detecting cervical cancer, and other types of cancer, using a combination of at least three genomic clones, or fragments thereof, of high risk Human Papilloma Virus. For example, the invention relates to a composition comprising at least three full length genomic clones, or fragments thereof, of high risk Human Papilloma Viruses.

## Background
This application is a divisional of U.S. patent application Ser. No. 10/959,175, filed Oct. 7, 2004, now U.S. Pat. No. 8,221,970 B2, which claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 60/509,205, filed on Oct. 7, 2003, and U.S. Provisional Application No. 60/543,925, filed on Feb. 13, 2004, all of which are hereby incorporated by reference. This application also claims the benefit of priority under 35 U.S.C. §119 to Danish Patent Application No. DK PA 2003 01474.


SEQUENCE LISTING
The instant application contains a Sequence Listing which has been submitted in ASCII format via EFS-Web and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Jun. 19, 2012, is named 9138—14—01_SeqList.txt and is 94,208 bytes in size.
In one embodiment, the invention relates generally to methods of diagnosing cancer or the risk of developing cancer. For example, the invention relates to compositions useful in the diagnosis of cancer or the risk of developing cancer. In one embodiment, the invention relates to methods of diagnosing cervical cancer or the risk of developing cervical cancer.
Cervical cancer is the third most common cancer among women worldwide, preceded only by breast and colorectal cancer. Approximately 371,200 new cases of cervical cancer occur every year, accounting for 10% of all cases of cancer in women (Parkin et al., 1999, Int. J. Cancer 80(6):827).
Cytological assays, such as the Papanicolaou (PAP) smear, have traditionally been used in the diagnosis of cervical cancer. A standard PAP smear involves sampling the uterine cervix with a spatula or cytobrush and smearing the cells directly on a slide for staining and light microscopy. The microscopic examination is a tedious process, and requires a cytotechnologist to visually scrutinize all the fields within a slide to detect often few aberrant cells in a specimen. Detection, based on altered cell morphology is subjective and positive samples are often missed.
More recently, testing for cervical cancer has been done using ThinPrep® (Cytyc, Boxborough, Mass.) or SurePath® (Tripath, Burlington, N.C.). These techniques involve placing cell samples directly into a preservative solution. The solution is then used to prepare monolayer slides for staining. The monolayer slides are easier to read. The sensitivity of these assays is still low, with an accurate detection rate in the range of 50-80% of all positive specimens. Thus, a need exists to develop more accurate screening methods for diagnosing subjects having cervical cancer, as well as those at risk for developing cervical cancer. Papilloma viruses have been implicated in the etiology of cervical cancer, thus detection of the presence of a papilloma virus can provide a more objective way to diagnose cervical cancer.
Papilloma viruses are a group of small DNA viruses that in some cases induce warts in higher vertebrates, including humans. Human papilloma virus (HPV) is sexually transmitted, infecting over a million people per year in the United States (WO/0024760). HPV infection can result in genital warts. Persistent high risk HPV infection can result in cancer, such as cervical cancer (Knipe et al., 2001, Fundamental Virology Fourth Edition, Lippincott Williams and Wilkins, Philadelphia, Pa.). Papilloma viruses have also been associated with other types of cancer, e.g., epidemodysplasia verruciforms, colon cancer, cancers of the head, neck and mouth (Baron, S. eds., Medical Microbiology, 1996, University of Texas Medical Branch, Galveston, Tex.).
There are more than 90 HPV types. HPV types are classified according to the risk associated with the development of cervical cancer. Fifteen types are classified as high-risk. They include HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82. Three types are classified as probable high risk. They are HPV types 26, 53, and 66. Those with little associated risk of developing cervical cancer include HPV types 6, 11, 41, 42, 43, 44, 54, 61, 70, 72 and 81. High risk HPV types are detected in more than 99% of all cervical cancers.
In one embodiment, the inventors have determined that a single cellular sample can be used to screen for more than one marker for cancer, e.g., cervical cancer. In one embodiment, the present invention provides for a sensitive and specific method for the early detection of any cancer that is characterized by the presence of an HR-HPV infection, e.g., cervical cancer, colon cancer, by providing a method of detecting cancer markers. The method uses probes, comprising full length genomic clones, or fragments thereof, of HPV. The probes may be combined with other means of detecting cancer, e.g., a pap smear, thus ensuring both specificity and sensitivity in the detection of cancer.
In one embodiment, the invention provides a new method of detecting cancer, or the risk of developing cancer, e.g., cervical cancer, comprising performing at least two assays to detect cancer on one sample on a single platform, e.g., a microscope slide. Thus, in one embodiment, cervical cells are placed on a microscope slide and HPV is detected in the sample and the sample is stained for a pap smear. As an example, HPV detection can be done by in situ hybridization using a cocktail of nucleic acid probes that are specific to at least 14 HR-HPV types. In another embodiment, the method can include an assay which detects at least one protein marker for cancer combined with at least one other assay for the detection of cancer, e.g., a PAP stain or in situ hybridization using nucleic acid probes which are specific to at least 14 HR-HPV types, or an additional protein marker. The invention contemplates any combination of assays and particularly where more than one detection method is used on a single sample.
In one embodiment, the invention provides a new method of detecting cancer, or the risk of developing cancer, e.g., cervical cancer, comprising contacting one sample on a single platform, e.g., a microscope slide, with a cocktail of nucleic acid probes which can hybridize to at least 14 HR-HPV types.
In other embodiments, the invention provides an automated method of analyzing a sample for markers that indicate the presence of cancer, or the risk of developing cancer, e.g., cervical cancer. The automated method comprises creating a digital image of a sample that has been contacted with at least two molecules capable of detecting markers for cancer, e.g., a cocktail of nucleic acid probes which hybridize to at least 14 HR-HPVs and a pap stain, saving the digital image to a digital media, such as a computer hard drive or CD, analyzing the digital image using an algorithm which detects and quantifies the molecules used to detect the markers which indicate the presence of cancer, and creating a report which contains information relating to the identification and quantification of markers for cancer.
In other embodiments, the invention provides an automated method of analyzing a sample for markers that indicate the presence of cancer, or the risk of developing cancer, e.g., cervical cancer. The automated method comprises creating a digital image of a sample that has been contacted with a cocktail of nucleic acid probes which hybridize to at least 14 HR-HPVs, saving the digital image to a digital media, such as a computer hard drive or CD, analyzing the digital image using an algorithm which detects and quantifies the molecules used to detect the markers which indicate the presence of cancer, and creating a report which contains information relating to the identification and quantification of markers for cancer.
In other embodiments, the invention provides a new composition useful for the detection of cancer, or the risk of developing cancer, e.g., cervical cancer, comprising a cocktail of nucleic acid probes which specifically hybridize to nucleic acid sequences encoded by HR-HPV genomic DNA. In some embodiments, the nucleic acid probe can hybridize to at least 14 HR-HPV types.
In one embodiment, the invention provides a method of detecting markers for cervical cancer in a subject comprising:

    
    
        a) obtaining a sample comprising cervical cells from the subject;
        b) contacting the sample with a probe comprising, a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 16 (FIG. 1) (SEQ ID NO: 1); and, a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 18 (FIG. 2) (SEQ ID NO: 2); and, a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 51 (FIG. 4) (SEQ ID NO: 4) under conditions such that the probe hybridizes to human papilloma virus nucleic acid contained in the sample; wherein hybridization of the probe to the sample indicates the presence of cervical cancer or the risk of developing cervical cancer. In some embodiments, the probe comprises SEQ ID NO: 1, or a fragment thereof, SEQ ID NO: 2, or a fragment thereof, and SEQ ID NO: 4, or a fragment thereof.
    
    


The invention provides a composition comprising a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 16 (FIG. 1) (SEQ ID NO: 1); and, a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 18 (FIG. 2) (SEQ ID NO: 2); and, a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 51 (FIG. 4) (SEQ ID NO: 4); and at least one of the following: a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 11 (FIG. 3) (SEQ ID NO: 3); a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 58 (FIG. 5) (SEQ ID NO: 5); a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 56 (FIG. 17) (SEQ ID NO: 6); a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 66 (FIG. 18) (SEQ ID NO: 7); a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 73 (FIG. 19) (SEQ ID NO: 8); a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 70 (FIG. 20) (SEQ ID NO: 9); a molecule that binds to a protein marker for cancer, e.g., c-Myc, Cox-2, HIF-1α, telomerase markers, such as hTERT, hTR, and other telomerase associated proteins; an extra-cellular matrix marker, such as, Laminin; a proliferation marker, such as, Ki-67 or Histone H3; a cell cycle marker, such as, Cyclin E or, P63, p16INK4a; or apoptosis markers, such as Bax, or Bcl-2.
In some embodiments, the invention provides for a composition comprising SEQ ID NO: 1, or a fragment thereof, SEQ ID NO: 2, or a fragment thereof, and SEQ ID NO: 4, or a fragment thereof and at least one of the following: SEQ ID NO: 3, or a fragment thereof; SEQ ID NO: 5, or a fragment thereof; SEQ ID NO: 6, or a fragment thereof; SEQ ID NO: 7, or a fragment thereof; SEQ ID NO: 8, or a fragment thereof; SEQ ID NO: 9, or a fragment thereof; a molecule that binds to a protein marker for cancer, e.g., c-Myc, Cox-2, HIF-1α, telomerase markers, such as hTERT, hTR, and other telomerase associated proteins; an extra-cellular matrix marker, such as, Laminin; a proliferation marker, such as, Ki-67 or Histone H3; a cell cycle marker, such as, Cyclin E, P63 or p16INK4a; or apoptosis markers, such as Bax, or Bcl-2.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 depicts the DNA sequence of the full length genomic clone of HR HPV 16 (SEQ ID NO: 1).
FIG. 2 depicts the DNA sequence of the full length genomic clone of HR HPV 18 (SEQ ID NO: 2).
FIG. 3 depicts the DNA sequence of the full length genomic clone of HPV 11 (SEQ ID NO: 3).
FIG. 4 depicts the DNA sequence of the full length genomic clone of HR HPV 51 (SEQ ID NO: 4).
FIG. 5 depicts the DNA sequence of the full length genomic clone of HR HPV 58 (SEQ ID NO: 5).
FIG. 6 depicts in situ hybridization (ISH) with an HPV probe cocktail on a cytology sample prepared by the Thin Prep® method (HPV positive sample). HPV positive dysplastic cells displayed brown nuclear staining (400× magnification).
FIG. 7 depicts ISH with an HPV probe cocktail on a cervical biopsy sample that was HPV 16 positive. The HPV probe hybridized to HPV 16 positive cells in the cervical epithelium as demonstrated by brown nuclear staining (200× magnification).
FIG. 8 depicts ISH with an HPV probe cocktail on a cervical biopsy sample that was HPV 18 positive. The HPV probe hybridized to HPV 18 positive cells in the cervical epithelium as demonstrated by brown nuclear staining (200× magnification).
FIG. 9 depicts ISH with an HPV probe cocktail on a cervical biopsy sample that was HPV 31 positive. The HPV probe hybridized to HPV 31 positive cells in the cervical epithelium as demonstrated by brown nuclear staining (200× magnification).
FIG. 10 depicts ISH with an HPV probe cocktail on a cervical biopsy sample that was HPV 33 positive. The HPV probe hybridized to HPV 33 positive cells in the cervical epithelium as demonstrated by brown nuclear staining (200× magnification).
FIG. 11 depicts ISH with an HPV probe cocktail on a cervical biopsy sample that was HPV 51 positive. The HPV probe hybridized to HPV 51 positive cells in the cervical epithelium as demonstrated by brown nuclear staining. (200× magnification).
FIG. 12 depicts ISH with an HPV probe cocktail on a cervical biopsy sample that was HPV 52 positive. The HPV probe hybridized to HPV 52 positive cells in the cervical epithelium as demonstrated by brown nuclear staining. (200× magnification).
FIGS. 13a and 13b depict ISH with an HPV probe cocktail a) without the addition of unlabeled HPV 11 DNA (Full-length clone) and b) with the addition of unlabeled HPV 11 DNA (Full-length clone) on cervical biopsy sample that was HPV 11 positive. Unlabeled HPV 11 DNA blocked the cross-hybridization to HPV 11 positive cells in the cervical epithelium as demonstrated by the reduction of brown nuclear staining in FIG. 13b (compare to 13a) (40× magnification).
FIG. 14 depicts ISH with an HPV probe cocktail on a cytology sample prepared by the Thin Prep® method followed by PAP staining (HPV positive sample). HPV positive dysplastic cells displayed brown nuclear staining. Cells were also PAP stained (400× magnification).
FIG. 15 is a flow chart depicting the parameters considered in an automated analysis of a sample for the presence of cervical cancer.
FIG. 16 is a flow chart depicting the steps performed in an automated analysis of sample for the detection of cervical cancer.
FIG. 17 depicts the DNA sequence of the full length genomic clone of HR HPV 56 (SEQ ID NO: 6).
FIG. 18 depicts the DNA sequence of the full length genomic clone of HPV 66 (SEQ ID NO: 7).
FIG. 19 depicts the DNA sequence of the full length genomic clone of HR HPV 73 (SEQ ID NO: 8).
FIG. 20 depicts the DNA sequence of the full length genomic clone of HPV 70 (SEQ ID NO: 9).
FIG. 21 depicts ISH with an HPV probe cocktail in hybridization buffer containing HMW dextran sulfate on a cervical biopsy sample that was HPV 31 positive. The HPV probe hybridized to HPV 31 positive cells in the cervical epithelium as demonstrated by brown nuclear staining, however, non-specific background brown staining was also apparent (200× magnification).
FIG. 22 depicts ISH with an HPV probe cocktail in hybridization buffer containing LMW dextran sulfate on a cervical biopsy sample that was HPV 31 positive. The HPV probe hybridized to HPV 31 positive cells in the cervical epithelium as demonstrated by brown nuclear staining, however, no non-specific background brown staining was apparent with the use of LMW dextran sulfate (200× magnification).
FIG. 23 depicts the image of a sample acquired using ScanScopeTM.
FIG. 24 was obtained after use of “median blur” on the image in FIG. 23.
FIG. 25 depicts the image of FIG. 23 transformed from RGB space into HIS space.
FIG. 26 depicts the image in FIG. 25 after a Roberts Cross edge detection operation.
FIG. 27 depicts a pair of 2×2 convolution kernels.
FIGS. 28 and 29 depict an example of median filtering of a single 3×3 window.
FIG. 30 depicts in situ hybridization with an HPV probe cocktail on a liquid based cytological sample of the cervix uteri in combination with immunostaining of p16INK4a expression. The HPV probe hybridized to HPV positive cells is demonstrated by brown nuclear staining. The p16INK4a antibody reacting with cells positive for expression of p16INK4a is demonstrated by red nuclear and cytoplasmic staining. (400× magnification).
FIG. 31 depicts in situ hybridization with an HPV probe cocktail on a liquid based cytological sample of the cervix uteri in combination with immunostaining of Laminin 5 expression. The HPV probe hybridized to HPV positive cells is demonstrated by brown nuclear staining. The Laminin 5 antibody reacting with cells positive for expression of Laminin 5 is demonstrated by red cytoplasmic staining. (400× magnification).
FIG. 32 depicts immunostaining of p16INK4a and Laminin 5 expression on a liquid based cytological sample of the cervix uteri. The p16INK4a antibody reacting with cells positive for expression of p16INK4a is demonstrated by brown nuclear and cytoplasmic staining. The Laminin 5 antibody reacting with cells positive for expression of Laminin 5 is demonstrated by red cytoplasmic staining. (200× magnification).
FIG. 33 depicts in situ hybridization with an HPV probe cocktail on a liquid based cytological sample of the cervix uteri in combination with immunostaining of p16INK4a expression, performed with automated immunocytochemical detection. The HPV probe hybridized to HPV positive cells is demonstrated by brown nuclear staining. The p16INK4a antibody reacting with cells positive for expression of p16INK4a is demonstrated by red nuclear and cytoplasmic staining. (400× magnification).
FIG. 34 depicts in situ hybridization with an HPV probe cocktail on a liquid based cytological sample of the cervix uteri in combination with immunostaining of p16INK4a and Laminin 5 expression. The HPV probe hybridized to HPV positive cells is demonstrated by brown nuclear staining. The p16INK4a and Laminin 5 antibodies reacting with cells positive for expression of p16INK4a and Laminin 5 are demonstrated by red nuclear and cytoplasmic staining. (400× magnification).
FIG. 35 depicts in situ hybridization with an HPV probe cocktail on a liquid based cytological sample of the cervix uteri in combination with immunostaining of Ki-67 overexpression. The HPV probe hybridized to HPV positive cells is demonstrated by brown nuclear staining. The Ki-67 antibody reacting with cells positive for expression of Ki-67 is demonstrated by red nuclear staining. (400× magnification).



DESCRIPTION OF THE EMBODIMENTS
A. Definitions
Antibody, as used herein, means an immunoglobulin or a part thereof, and encompasses any polypeptide comprising an antigen-binding site regardless of the source, method of production, and other characteristics. The term includes for example, polyclonal, monoclonal, monospecific, polyspecific, humanized, single-chain, chimeric, synthetic, recombinant, hybrid, mutated, and CDR-grafted antibodies. A part of an antibody can include any fragment which can still bind antigen, for example, an Fab, F(ab′)2, Fv, scFv.
Biological information, as used herein, means the type of cell, the predicted cell size, etc.
Cell cycle markers, as used herein, refers to any protein that is involved in the regulation of the cell cycle, including cell cycle checkpoints (for surveillance of the cell cycle process) and cell cycle transition, e.g., entry from one phase of the cell cycle to the next. Examples include activating proteins such as cyclins, kinases, and cyclin dependent kinase inhibitors, e.g., p16INK4a.
Cervical cancer, as used herein, means any cancer or cancerous lesion associated with cervical tissue or cervical cells and includes precursors to cervical cancer, e.g., atypical squamous cell of undetermined significance (ASCUS), dysplasia also known as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (LSIL/HSIL).
As used herein HPV-related cancer relates to any cancer or cancerous lesion, including pre-stages thereof, associated with HPV-infection, e.g. cervical cancer, colon cancer, oral cancer, head and neck cancer, anal cancer, lung cancer, and gastric cancer.
As used herein, all cancer or cancerous lesions include pre-stages thereof.
Chromatic information, as used herein, means the color may be described in different color space, such as hue-saturation-illumination (HSI).
Detectable substance, as used herein, refers to any compound which when attached to a marker contained within a sample, permits recognition of the presence of this marker. The compound can comprise, for example, a radioactive molecule, a fluorescent molecule, a hapten, a carrier, an enzyme, an intervening molecule such as biotin, or a dye.
Digital media, as used herein, includes any material capable of storing a digital signal, e.g., a computer hard drive, a compact disc (CD).
Extra-cellular matrix marker, as used herein, refers to molecules associated with the extra-cellular matrix. The extra-cellular matrix is comprised of collagen fibers, proteoglycans, and multiadhesive matrix proteins. The extra-cellular matrix helps to organize cells into tissues and helps to coordinate cellular function. It provides a route for cellular migration and molecules within the matrix activate signal transduction pathways that induce cell proliferation. Example of extra-cellular matrix markers include laminins, fibronectins and collagens.
HPV-related cancer markers as used herein include markers associated with the cell cycle, e.g. cell cycle regulatory proteins.
As used herein, cancer markers used for e.g. cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, are cancer markers associated with cancer, cancerous lesions, and pre-stages thereof known in the art as well as disclosed herein. Examples are extra cellular matrix markers, proliferation markers, telomerase markers or telomerase associated markers, cell cycle associated markers, apoptosis markers, c-Myc, Cox-2, HIF-1α
Genomic clone, as used herein, refers to a nucleic acid sequence derived from the genome of a human papilloma virus. Also included within the definition of genomic clone are sequences that are substantially identical to the genome of a human papilloma virus. A full-length genomic clone means the complete nucleic acid sequence encoding a human papilloma virus, or sequences which are substantially identical to the complete nucleic acid sequence encoding a human papilloma virus. The sequence can be derived using any recombinant DNA technology, e.g., PCR, or can be isolated from cultured virus.
Geometric information, as used herein, means the size and shape of a cell.
High resolution, as used herein, means an image with at least 50,000 pixels.
HSI Color Space, as used herein, describes color pixels in terms of hue, saturation, and illumination.
Image resolution reduction, as used herein, means reducing the number of pixels in an image, e.g., from 50,000 pixels per inch to 25,000 pixels per inch to enhance processing time.
Label, as used herein, means an antibody or a probe.
Pre-determined object, as used herein, refers to a way to define expected object characteristics such as color, shape, and size.
Probe, as used herein, refers to at least one nucleic acid molecule or a nucleic acid analog which can hybridize, e.g., by complementary base pairing, under specified conditions, to another nucleic acid molecule, e.g., a portion of an HPV genome. A probe could be selected from the group of: DNA, RNA, LNA or PNA. As used herein this would also include mixtures thereof.
Proliferation marker, as used herein, refers to any protein that promotes cell division or the assembly of control mechanisms of the cell cycle. It can also refer to any protein that characterizes the proliferation status of a cell. A cell can be at an active, retarded or arrested state of proliferation. Examples include Ki-67, Histone H3 and cdc25.
Sample, as used herein, means a suitable quantity of cells or tissue, e.g., cervical cells, or cervical tissue, for testing for the presence of cancer, e.g., cervical cancer or any HPV-related cancer. The sample can take the form of a biopsy, a smear, or a swab containing cells.
Segmentation, as used herein, means the process of dividing an image into a number of individual objects or contiguous regions, differentiating them from each other and the image background.
Solid support, as used herein, means any three dimensional, non-liquid, surface upon which a sample is placed. The solid support can be comprised of any suitable material, e.g., glass, plastic. Examples of a solid support include a microscope slide, a chip, a micro-array, a bead, and a micro-titer plate.
Subject, as used herein, means a human, having, or suspected of having, cancer.
Substantially identical, as used herein, means that two or more nucleic acid sequences, are at least 50% identical, at least 60% identical, at least 70% identical, at least 80% identical, at least 90% identical, at least 95% identical, at least 99% identical, at least 99.9% identical, when compared and aligned for maximum correspondence as measured by either visual inspection or by using one of the algorithms described below. Substantially identical sequences are typically considered to be homologous. Substantial identity may exist over a region of the sequences that is at least 50 residues in length, at least 100 residues in length, at least 150 residues in length, or over the full length of the sequences to be compared. Two sequences can be substantially identical where at least one of the sequences has at least one nucleotide substitution, at least one nucleotide addition, or at least one nucleotide deletion. Percent identity between two nucleic acid sequences may be determined by standard alignment algorithms such as, for example, Basic Local Alignment Tool (BLAST) described in Altschul et al. 1990, J. Mol. Biol., 215:403-410 (hereby incorporated by reference); the algorithm of Needleman et al. 1970, J. Mol. Biol., 48:444-453; the algorithm of Meyers et al. 1988, Comput. Appl. Biosci., 4:11-17 (hereby incorporated by reference); or Tatusova et al. 1999, FEMS Microbiol. Lett., 174:247-250 (hereby incorporated by reference). Such algorithms are incorporated into the BLASTN, BLASTP and “BLAST 2 Sequences” programs (see www.ncbi.nlm.nih.gov/BLAST). When utilizing such programs, the default parameters can be used. For example, for nucleotide sequences the following settings can be used for “BLAST 2 Sequences”: program BLASTN, reward for match 2, penalty for mismatch −2, open gap and extension gap penalties 5 and 2 respectively, gap x_dropoff 50, expect 10, word size 11, filter ON. Percent identity between two nucleic acids may also be determined using commercially available software such as Vector NTI Suite (Invitrogen, Carlsbad, Calif.).
Topological information, as used herein, refers to how cells are organized and related to each other. For example, a membrane surrounds a nucleus or a group of cells clustered together, etc.
B. Human Papilloma Virus Probes
Persistent infection of cervical epithelia with high risk human papilloma virus (HR HPV) can lead to cancer, such as cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc. Detection of HR HPV can thus be used to screen for any cancer or risk for developing cancer, particularly any HR HPV related cancer such as cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc. The invention, in one embodiment, is based in part on the discovery that certain HR HPVs share significant sequence homology throughout their genome. Thus, probes derived from HR-HPV types will crossreact with other HR-HPV types. Accordingly, the invention, in one embodiment, provides for a cocktail of nucleic acid molecules, i.e., probes, comprised of HR HPV genomic clones, e.g., DNA, or fragments thereof, which have a high degree of homology to HR HPV types. HR HPV type 16, 18 and 51, share significant homology with 14 of the 15 known HR HPV types. These include HR HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, and 82. HR HPV 16 share more than 70% homology with HR HPV types 31, 33, 35, 52, and 58. HR HPV 18 share more than 70% homology with HR HPV types 39, 45, 59, and 68 and 60% homology with HPV type 56. Type 51 shares more than 70% homology with HR types 26 and 82 and 60% homology with HR HPV 56.
In some embodiments, the invention provides a composition comprising a full length genomic clone of HR HPV types 16, 18 and 51. In other embodiments, the invention provides a composition comprising a full length genomic clones of HR HPV types 16, 18 and 51, and at least one full length genomic clone, or fragment thereof, of HR HPV types 56 and 58. In some embodiments, the invention provides for a composition comprising a full length genomic clones of HR HPV types 16, 18 and 51 and at least one probe that is substantially identical to a full length genomic clone, or fragment thereof, of HR HPV types 56, 58, 66, and 73.
In some embodiments, the invention also provides for at least one probe, which hybridizes to at least one low risk HPV type, comprising at least one of the following: a nucleic acid molecule, comprising a full length genomic clone of HPV 11 (SEQ ID NO: 3), or fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 3, or a full length genomic clone of HPV 70 (SEQ ID NO: 9), or fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 9 (a low risk probe), or a mixture thereof.
In some embodiments, the low risk probe can be a blocking probe, i.e., a probe that prevents the HR-HPV specific probes contained in the nucleic acid cocktail from hybridizing with low risk HPV. Thus, in one embodiment, the blocking probe is not labeled with a detectable substance. In another embodiment, the low risk probe is labeled with a detectable substance that is different from the detectable substance used to label the HR-HPV nucleic acid probe so that low risk HPV and HR HPV can both be detected.
In some embodiments, the invention provides for a cocktail comprising genomic clone fragments of HR HPV. The genomic clone fragments can include fragments comprising nucleic acids from HR HPV types 16, 18 and 51 and optionally, at least one genomic clone fragment comprising nucleic acids from HR HPV types 56, 58, 66 and 73. In some embodiments, the fragment of HR HPV 56 comprises at least 10 nucleotides. In other embodiments, the fragments can be any length so long as they hybridize to at least 14 HR HPV types, e.g., HR HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 and 82, when combined in a nucleic acid cocktail comprising at least one other probe. The full length genomic clones, or fragments thereof, also include nucleic acid sequences which are substantially identical to the full length genomic clones or fragments thereof.
In some embodiments, fragments of the full length HR HPV genomic clones or LR HPV genomic clones may be any fragment of the full length genomic clone generated after enzymatic cleavage, such as DNase I cleavage, of the full length genomic clone is disclosed in the present invention. Such fragments are usually in a range of about 10-500 bp, such as about 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 200, 300, 400, or about 500 bp.
In some embodiments, fragments thereof is any fragment of the full length genomic HPV clone, such as 20, 30, 40, 50, 60, 70, 80, 90, 95, or even 99% of full length.
In some embodiments, the probe is comprised of DNA. In other embodiments, the probe is comprised of RNA. In yet other embodiments, the probe is comprised of a peptide nucleic acid (PNA). A peptide nucleic acid is a nucleic acid molecule in which the deoxyribose or ribose sugar backbone, usually present in DNA and RNA is replaced with a peptide backbone. Methods of making PNAs are known in the art (see e.g. Nielson, 2001, Current Opinion in Biotechnology 12:16) (hereby incorporated by reference). In other embodiments the probe is comprised of locked nucleic acids (LNA) (Sorenson et al. 2003, Chem. Commun. 7(17):2130).
In some embodiments, the HR HPV probes hybridize to a target sequence in a sample, e.g., a nucleic acid sequence encoding the HR HPV genome, under specific conditions of stringency. As used herein, the term “hybridization under stringent conditions,” is intended to describe conditions for hybridization and washes under which nucleotide sequences that are significantly identical or homologous to each other remain complementarily bound to each other. The conditions are such that sequences at least about 70%, more preferably at least about 80%, at least about 85-90% identical remain bound to each other. The percent identity is determined as described in Altschul et al. (1997) Nucleic Acids Res. 25:3389-3402 (hereby incorporated by reference).
Specified conditions of stringency are known in the art and can be found in Current Protocols in Molecular Biology, John Wiley & Sons, Inc. (Ausubel et al. 1995 eds.), sections 2, 4, and 6 (hereby incorporated by reference). Additionally, specified stringent conditions are described in Sambrook et al. (1989) Molecular Cloning: A Laboratory Manual, 2nd ed. Cold Spring Harbor Press, chapters 7, 9, and 11 (hereby incorporated by reference). In some embodiments, the hybridization conditions are high stringency conditions. An example of high stringency hybridization conditions is hybridization in 4× sodium chloride/sodium citrate (SSC) at about 65-70° C. or hybridization in 4×SSC plus 50% formamide at about 42-50° C., followed by one or more washes in 1×SSC, at about 65-70° C. It will be understood that additional reagents may be added to hybridization and/or wash buffers, e.g., blocking agents (BSA or salmon sperm DNA), detergents (SDS), chelating agents (EDTA), Ficoll, PVP, etc.
In some embodiments, the HR HPV probes hybridize to a target sequence in a sample, e.g., a nucleic acid sequence encoding the HR HPV genome, under moderately stringent conditions. Moderate stringency, as used herein, include conditions that can be readily determined by those having ordinary skill in the art based on, for example, the length of the DNA. Exemplified conditions are set forth by Sambrook et al. Molecular Cloning: A Laboratory Manual, 2d ed. Vol. 1, pp. 1.101-104, Cold Spring Harbor Laboratory Press (1989) (hereby incorporated by reference), and include use of a prewashing solution of 5×SSC, 0.5% SDS, 1.0 mM EDTA (pH 8.0), hybridization conditions of 50% formamide, 6×SSC at 42° C. (or other similar hybridization solution, such as Stark's solution, in 50% formamide at 42° C.), and washing conditions of 60° C., 0.5×SSC, 0.1% SDS.
In some embodiments, the HR HPV probes hybridize to a target sequence in a sample, e.g., a nucleic acid sequence encoding the HR HPV genome, under low stringent conditions. Low stringency conditions may include, as used herein, conditions that can be readily determined by those having ordinary skill in the art based on, for example, the length of the DNA. Low stringency may include, for example, pretreating the DNA for 6 hours at 40° C. in a solution containing 35% formamide, 5×SSC, 50 mM Tris-HCl (pH 7.5), 5 mM EDTA, 0.1% PVP, 0.1% Ficoll, 1% BSA, and 500 μg/ml denatured salmon sperm DNA. Hybridizations are carried out in the same solution with the following modifications: 0.02% PVP, 0.02% Ficoll, 0.2% BSA, 100 μg/ml salmon sperm DNA, 10% (wt/vol) dextran sulfate, and 5-20×106 CPM probe is used. Samples are incubated in hybridization mixture for 18-20 hours at 40° C., and then washed for 1.5 h at 55° C. in a solution containing 2×SSC, 25 mM Tris-HCl (pH 7.4), 5 mM EDTA, and 0.1% SDS. The wash solution is replaced with fresh solution and incubated an additional 1.5 h at 60° C.
The invention contemplates that the hybridization reaction can be automated. The slides will be automatically processed in a well controlled environment for the following steps: deparaffinization or conditioning, pre-treatment to provide probe access to the target, addition of the probe to the sample, denaturation of the probe and the target, hybridization of the probe to the target, stringency wash, and signal detection steps.
The invention contemplates that the antibody binding reaction, for detecting protein markers for cancer, can be automated. The slides will be automatically processed in a well controlled environment for the following steps: deparaffinization or conditioning, pre-treatment to provide antibody access to the target, addition of the antibody to the sample, and signal detection steps. Wash steps are included between each step.
C. HR HPV Probe Labels
The invention also provides for HR HPV probes which are labeled with a detectable substance. The detectable substance may be directly linked to the HR HPV probe, e.g., by a covalent or non-covalent bond. The detectable substance may be linked to the HP HPV probe indirectly, e.g., through an intervening molecule such as strepavidin or biotin. The detectable substance, for example, may be a fluorescent material, a dye, a chemiluminescent material, a bioluminescent material or a radioactive material, e.g., tritium, 32P. The detectable substance can take the form of any suitable molecule, e.g., an enzyme, a hapten, biotin.
Examples of fluorescent detectable substances include fluorescein isothiocyanate, rhodamine, phycoerythrin, phycocyanin, allophycocyanin, o-phthaldehyde and fluorescamine. When the fluorescently labeled substance is exposed to light of the proper wave length, its presence can then be detected due to fluorescence. Other fluorescent substances include fluorescence emitting metals such as 152Eu, or others of the lanthanide series. Fluorescent substances can be detected directly or indirectly using a hapten.
Examples of chemiluminescent substances include luminol, isoluminol, theromatic acridinium ester, imidazole, acridinium salt and oxalate ester. Examples of bioluminescent compounds for purposes of labeling include, luciferin, luciferase and aequorin.
In another embodiment, the detectable substance may be an enzyme. Catalysis of the enzyme substrate can result in a color change. The enzyme may be, for example, horseradish peroxidase, or alkaline phosphatase. Other additional detectable substances include, for example, digoxigenin, DNP and biotin.
Peroxidase, and phosphatase enzymes are naturally present in human tissues. These enzymes are called endogenous enzymes. When performing immuno-histo-chemistry (IHC) or in situ hybridization (ISH) it is important to distinguish between the endogenous enzymes and the enzymes added as part of the IHC or ISH label, otherwise the endogenous enzymes will react with the chromogenic substrate producing a color which cannot be distinguished from a true positive result. Generally, the endogenous enzymes are suppressed or blocked before performing the IHC or ISH stain. Reagents have been developed that can be applied to the tissues to block either endogenous peroxidase or endogenous alkaline phosphatase. Accordingly, the invention contemplates a method of performing IHC or ISH using either peroxidase or phosphatase which relies on a single reagent that can block both enzymes simultaneously. In one embodiment, the method for performing multi-staining in tissue or cell samples comprises simultaneously blocking endogenous expression of both peroxidase and alkaline phosphatase enzymes by applying a single blocking reagent. In certain specific embodiments the single blocking agent comprises the following: a chelating agent and hydrogen peroxide, where the reaction occurs at a pH <2.
D. Cellular Markers for Cancer
Combining detection of protein markers for cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc., with the HR HPV probes, and optionally the LR HPV probes, described above in methods of detecting cancer in a subject may increase both the specificity and the sensitivity of the method of detecting cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, e.t.c. Combining detection of more than one protein marker for cancer in methods of detecting cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc., may increase both the specificity and the sensitivity of the method of detecting cancer. Numerous markers for cancer, such as HPV-related cancer, e.g. cervical cancer, colon cancer, etc., have been described. Said markers for cancer may be detected by contacting a sample with a label that binds to the marker, e.g., an antibody or a probe. Examples of markers to detect cancer, such as any HPV-related cancer, e.g. cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc., are given below.
The p16INK4a protein is a cyclin-dependent kinase inhibitor that decelerates the cell cycle. Recent studies have indicated that p16INK4a expression is influenced by the status of Rb expression. p16INK4a overexpression has been demonstrated in cervical cancer because of the functional inactivation of the retinoblastoma protein by the HPV E7 protein (Sano et al. 1998, American Journal of Pathology, 153:1741). Accordingly, the invention provides for screening for p16INK4a expression as a means of detecting cervical cancer. In some embodiments, detection of p16INK4a is combined with detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV. The p16INK4a marker will sometimes detect a small fraction of metaplastic and columnar cells resulting in a false positive signal. This problem is alleviated by combining p16INK4a with a second marker which ensures the desired specificity and sensitivity.
Laminin 5 is an attachment protein for epithelial cells. Studies indicate that its expression is increased in the cytoplasm and basement membrane of cervical epithelium and expression correlates with the grade of dysplasia. (Kohlberger et al. 2003, Gynecology Oncology, 89:391). Accordingly, the invention provides for screening for Laminin 5 expression as a means of detecting cervical cancer. In some embodiments, detection of Laminin 5 is combined with detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV.
Cox-2 expression has been found to correlate with lymph node metastasis and parametrial invasion in cervical cancer (Kim et al. 2003, Gynecology Oncology, 90:83). Accordingly, the invention provides for screening for Cox-2 expression as a means of detecting cervical cancer. In some embodiments, detection of Cox-2 is combined with detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV.
Certain tumors, including squamous cell carcinoma of the uterine cervix, with low oxygen tension respond poorly to chemotherapy, radiotherapy or even surgery (Hockel, 1996, Cancer Res 56:4509). Several genes responsive to stresses of the microenvironment, such as low oxygen, have been identified (Denko, 2000, Clin Cancer Res 6:480). Tissue hypoxia is indicated by the expression of Hypoxia-inducible Factor 1a (HIF-1α). In cervical cancer the over expression has been found to be associated with diminished tumor response to radiotherapy (Bachtiary, 2003 Clin Cancer Res 9:2234). Furthermore, HIF-1α expression is increased in dysplasia compared to benign epithelia. Focal HIF-1α expression is seen near necrotic areas in invasive squamous cell carcinomas and correlates with the spatial distribution. (Acs, G 2003 Am J Pathol 162:1789). Thus, HIF-1α expression is a cellular marker for cervical cancer. Accordingly, the invention provides for screening for HIF-1α as a means of detecting cervical cancer. In some embodiments, detection of HIF-1α is combined with detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV.
Other markers for cervical cancer include hTERT (Ferber et al. 2003, Oncogene 22:3813), Ki-67 (Kruse et al. 2002, Am. J. Surg. Pathol., 26:1501), cyclin E (Yasmeen et al. 2003, Expert Rev. Mol. Diagn. 3(5):617) and histone H3 (Rakowicz-Szulczynska, et al. 1996, Cancer Biother. Radiopharm. 11:77). Accordingly, the invention provides for screening for hTERT expression as a means of detecting cervical cancer. In some embodiments, detection of hTERT is combined with detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV. The invention also provides for screening for Ki-67 expression as a means of detecting cancer, such as any HPV-related cancer, e.g. cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, e.t.c. In some embodiments, detection of Ki-67 is combined with detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV. The invention also provides for screening for histone H3 expression as a means of detecting cervical cancer. In some embodiments, detection of histone H3 is combined with the detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV.
PAP smears are commonly used to detect cervical cancer. A PAP smear involves applying cervical cells to a slide, staining the cells and examining the cells by light microscopy. Altered cell morphology indicates dysplasia or neoplasia. The invention thus provides for pap screening as a means of detecting cervical cancer. In some embodiments, a PAP smear is combined with detection of at least one other marker for cervical cancer, e.g., the presence of HR HPV.
E. Compositions for Detecting Cancer Markers
The invention discloses a probe composition for detection of cancer markers. The composition comprises a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 16 (SEQ ID NO: 1), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 1; and a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 18, (SEQ ID NO: 2), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 2; and a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 51 (SEQ ID NO: 4), or a fragment thereof or a nucleic acid molecule substantially identical to SEQ ID NO: 4.
In other embodiments, the composition further comprises at least one of:

    
    
        a) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 11 (SEQ ID NO: 3), or fragments thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 3;
        b) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 58 (SEQ ID NO: 5), or fragments thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 5;
        c) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 66 (SEQ ID NO: 7), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 7;
        d) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 73 (SEQ ID NO: 8), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 8;
        e) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 70 (SEQ ID NO: 9), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 9;
        f) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 56 (SEQ ID NO: 6), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 6.
    
    


Further embodiments of the invention include compositions wherein the nucleic acid is comprised of DNA, RNA, LNA or PNA. In these embodiments the sequence of the nitrogenous bases comprising the composition are the same as or substantially the same as the sequences recited infra.
In further embodiments, the composition further comprises at least one additional molecule that binds at least one protein marker for cancer or that binds at least one additional nucleic acid encoding a protein marker for cancer.
Further embodiments of the invention may include compositions wherein the at least one protein marker for cancer is chosen from p16INK4a P63, c-Myc, Cox-2, HIF-1α, a telomerase markers, a telomerase associated protein; an extra-cellular matrix marker; a proliferation marker; a cell cycle marker; or an apoptosis marker.
Still further embodiments of the invention may include compositions wherein the molecule that binds the at least one protein marker for cancer is an antibody.
Still further embodiments of the invention may include compositions wherein the molecule that binds the at least one further nucleic acid encoding a protein marker for cancer is a nucleic acid.
Still further embodiments of the invention may include compositions wherein the nucleic acid encodes a protein chosen from p16INK4a, P63, c-Myc, Cox-2, HIF-1α, a telomerase markers, a telomerase associated protein; an extra-cellular matrix marker; a proliferation marker; a cell cycle marker; or an apoptosis marker.
Still further embodiments of the invention may include compositions wherein the nucleic acid molecules are labeled with a detectable substance.
Still further embodiments of the invention may include compositions wherein the detectable substance is covalently linked to the nucleic acid molecule.
Still further embodiments of the invention may include compositions wherein the detectable substance is linked to an intervening molecule.
Still further embodiments of the invention may include compositions wherein the intervening molecule is biotin.
Still further embodiments of the invention may include compositions wherein the intervening molecule is streptavidin.
Still further embodiments of the invention may include compositions wherein the detectable substance is chosen from a fluorescent material, a chemiluminescent material, a bioluminescent material, an enzyme, and a radioactive material.
In yet other embodiments, the composition further comprises a molecule, which hybridizes to at least one low risk HPV type.
Other embodiments of the invention may include compositions wherein the molecule that hybridizes to said low risk HPV type is a nucleic acid molecule.
Still other embodiments of the invention may include compositions wherein the nucleic acid molecule is a nucleic acid substantially identical to a full length genomic clone of a low risk HPV type, or fragment thereof.
Still other embodiments of the invention may include compositions wherein the low risk HPV type is HPV 11 or HPV 70.
Still other embodiments of the invention may include compositions wherein the nucleic acid molecule is comprised of DNA, RNA, LNA or PNA.
Still other embodiments of the invention may include compositions wherein the nucleic acid that hybridizes to the low risk HPV types is not labeled with a detectable substance.
Still other embodiments of the invention may include compositions wherein the nucleic acid that hybridizes to the low risk HPV types is labeled with a detectable substance that is different from the detectable substance used to label the nucleic acid molecule which hybridizes to the HR-HPV.
Still other embodiments of the invention may include compositions wherein the detectable substance is chosen from a fluorescent material, a chemiluminescent material, a bioluminescent material, an enzyme and a radioactive material.
Still other embodiments of the invention may include compositions wherein the detectable substance is covalently linked to the nucleic acid which blocks probe hybridization to the low risk HPV types.
Still other embodiments of the invention may include compositions wherein the detectable substance is linked to an intervening molecule.
Still other embodiments of the invention may include compositions wherein the intervening molecule is biotin.
Still other embodiments of the invention may include compositions wherein the intervening molecule is streptavidin.
Still other embodiments of the invention may include compositions wherein the cancer markers detected are cervical cancer markers.
Still other embodiments of the invention may include compositions wherein the cancer markers detected are colon cancer markers.
Still other embodiments of the invention may include compositions wherein the cancer markers detected are anal cancer markers.
Still other embodiments of the invention may include compositions wherein the cancer markers detected are markers for HPV-related cancers.
In yet other embodiments, the composition further comprises a low molecular weight dextran sulfate.
Still other embodiments of the invention may include compositions wherein the dextran sulfate has a molecular weight range of about 25,000-75,000.
Still other embodiments of the invention may include compositions wherein the dextran sulfate has a molecular weight of about 35,000-50,000.
Still other embodiments of the invention may include compositions wherein the low molecular weight dextran sulfate is in a range of about 5-15 wt./vol. %.
Still other embodiments of the invention may include compositions wherein the low molecular weight dextran sulfate is in about 10 wt./vol. %.
Also contemplated is a kit for detecting at least one marker associated with cancer comprising the following reagent: a) a probe composition according to the present invention.
In other embodiments, the kit further comprises at least one of the following;

    
    
        b) reagents for performing a PAP stain
        c) reagents, e.g., an antibody or nucleic acid probe, for the detection of at least one of the following protein markers: c-Myc, Cox-2, HIF-1α, Histone H3, a telomerase marker, a telomerase associated protein; an extra-cellular matrix marker; a proliferation marker; a cell cycle marker; or an apoptosis marker.
        d) reagents for the detection of other cellular markers associated with the progression of cancer or risk of progression of cancer.
        e) reagent for the detection of antibodies or probes,
        f) at least one sample for carrying out a positive control reaction for at least one of the above markers,
        g) at least one container, and
        h) instructions for performing an assay to detect cancer markers in a sample.
    
    


F. Methods for Detecting Markers for Cancer
The invention discloses a method for detecting markers for cancer in a subject. The method comprises

    
    
        a) obtaining a sample comprising cells from the subject;
        b) contacting the sample with a composition as described above, comprising a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 16 (SEQ ID NO: 1), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 1; and a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 18, (SEQ ID NO: 2), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO: 2; and a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 51 (SEQ ID NO: 4), or a fragment thereof or a nucleic acid molecule substantially identical to SEQ ID NO: 4, under conditions such that the nucleic acid molecules hybridizes to a human papilloma virus (HPV) nucleic acid contained in the sample thereby forming at least one nucleic acid-HPV hybridization complex, and
        c) detecting said nucleic acid-HPV hybridization complex, wherein hybridization of the nucleic acid molecules to the sample indicates the presence of cancer or the risk of developing cancer.
    
    


In further embodiments, the method further comprises contacting the sample with a probe comprising a nucleic acid molecule, comprising at least one of:

    
    
        a) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 56 (SEQ ID NO: 6), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO:6;
        b) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 58 (SEQ ID NO: 5), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO:5;
        c) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 66 (SEQ ID NO: 7), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO:7;
        d) a nucleic acid molecule substantially identical to a full length genomic clone of human papilloma virus 73 (SEQ ID NO: 8), or a fragment thereof, or a nucleic acid molecule substantially identical to SEQ ID NO:8,

under conditions such that the probe hybridizes to a human papilloma virus nucleic acid contained in the sample; and wherein hybridization of the probe to the sample indicates the presence of cervical cancer or the risk of developing cervical cancer.

    
    


Other embodiments of the invention may include methods wherein the conditions permitting the nucleic acid probe to hybridize to the human papilloma virus nucleic acid contained in the sample are high stringency conditions.
Other embodiments of the invention may include methods wherein the conditions permitting the nucleic acid probe to hybridize to the human papilloma virus nucleic acid contained in the sample are moderate stringency conditions.
Other embodiments of the invention may include methods wherein the conditions permitting the probe to hybridize to the human papilloma virus nucleic acid contained in the sample are low stringency conditions.
Other embodiments of the invention may include methods wherein the conditions permitting the probe to hybridize to the human papilloma virus nucleic acid contained in the sample include a hybridization buffer comprising 50% formamide, 0.3 M NaCl, and at least one non-specific DNA molecule.
In other embodiments, the invention provides a method for detecting markers for cancer in a subject further comprising contacting the sample with at least one molecule that hybridizes to at least one low risk HPV type.
Other embodiments of the invention may include methods wherein the at least one molecule is a nucleic acid molecule.
Other embodiments of the invention may include methods wherein the nucleic acid molecule is a full length genomic clone of a low risk HPV type, or fragment thereof; or a molecule which is substantially identical to a full length genomic clone of a low risk HPV type, or fragment thereof.
Other embodiments of the invention may include methods wherein the low risk HPV type is HPV 11 or HPV 70.
Other embodiments of the invention may include methods wherein the nucleic acid molecule is comprised of DNA, RNA, LNA or PNA.
In other embodiments, the method further comprises contacting the sample with at least one other agent that can detect cancer.
Other embodiments of the invention may include methods wherein the cancer is cervical cancer.
Other embodiments of the invention may include methods wherein the cancer is colon cancer.
Other embodiments of the invention may include methods wherein the cancer is a HPV-related cancer.
Other embodiments of the invention may include methods wherein the at least one other agent is a stain used in a PAP smear.
Other embodiments of the invention may include methods wherein the stain is Papanicolaou stain.
Other embodiments of the invention may include methods wherein the at least one other agent is an agent which binds to a protein marker for cancer or a nucleic acid encoding a protein marker for cancer.
Other embodiments of the invention may include methods wherein the agent that binds a protein marker is an antibody.
Other embodiments of the invention may include methods wherein the agent is an agent that binds to a protein marker for cervical cancer or a nucleic acid encoding a protein marker for cervical cancer.
Other embodiments of the invention may include methods wherein the agent is an agent that binds to a protein marker for HPV-related cancer or a nucleic acid encoding a protein marker for HPV-related cancer.
Other embodiments of the invention may include methods wherein the protein marker for cancer is chosen from p16INK4a P63, c-Myc, Cox-2, HIF-1α, a telomerase markers, a telomerase associated protein; an extra-cellular matrix marker; a proliferation marker; a cell cycle marker; or an apoptosis marker.
Other embodiments of the invention may include methods wherein the sample is a cytology sample comprising cells.
Other embodiments of the invention may include methods wherein the sample is a histology sample comprising cells.
Other embodiments of the invention may include methods wherein the sample is provided on a solid support.
Other embodiments of the invention may include methods wherein the solid support is chosen from a microscope slide, a bead, a micro-array and a chip.
Other embodiments of the invention may include methods wherein the sample is placed in solution and the cells comprised in the sample are lysed before the sample is applied to the solid support.
Other embodiments of the invention may include methods wherein the sample is screened for cancer by flow cytometry.
The invention also discloses a method of detecting markers for cancer in a subject comprising

    
    
        a) obtaining a sample comprising cells from the subject,
        b) placing the sample on a solid support,
        c) detecting HR-HPV in the sample from step b) by using the probe composition as described above,
        d) performing a PAP stain on the same sample from step b)

wherein the presence of HR-HPV and an abnormal PAP smear indicates the presence of cervical cancer or the risk of developing cancer.

    
    


Other embodiments of the invention may include methods wherein the sample is a cervical cancer sample and the cells comprised in the sample cervical cells.
Other embodiments of the invention may include methods wherein the sample is a colon cancer sample and the cells comprised in the sample colon cells.
Other embodiments of the invention may include methods wherein the sample is a HPV-related cancer sample, and the cells comprised in the sample HPV-infected cells.
Other embodiments of the invention may include methods wherein the detecting the HR-HPV in the sample is done by in situ hybridization of a nucleic acid probe specific to HR-HPV.
Other embodiments of the invention may include methods wherein the nucleic acid probe specific to HR-HPV detects at least 14 HR-HPV types.
The methods described above may be automated methods. Automated methods are further described in detail below.
G. A Composition Binding at Least Two Protein Markers
The invention also provides a composition comprising at least one molecule that binds at least two protein markers for cancer, or at least two nucleic acids encoding protein markers for cancer, or a combination of at least one protein marker and at least one nucleic acid encoding a protein marker for cancer.
Other embodiments of the invention include compositions wherein the at least two protein markers for cancer are chosen from: c-Myc, Cox-2, HIF-1α, Histone H3, a telomerase marker, a telomerase associated protein; an extra-cellular matrix marker; a proliferation marker; a cell cycle marker; an apoptosis marker, and HR HPV.
Other embodiments of the invention include compositions wherein the markers for cancer are markers for HPV-related cancer.
Other embodiments of the invention include compositions wherein the markers for cancer are markers for cervical cancer.
H. A Method for Detection and Quantitation of at Least Two Markers for Cancer
The invention further provides a method for detection and quantitation of at least two markers for cancer comprising: a) preparing a cytology sample on a solid support, b) staining the sample of a) with at least two markers for cancer using the composition described above, c) detecting the at least two markers for cancer, d) quantifying the at least two markers for cancer.
Other embodiments of the invention include methods wherein the cancer is HPV-related cancer.
Other embodiments of the invention include methods wherein the cancer is cervical cancer.
Other embodiments of the invention include methods wherein the cancer is colon cancer.
Other embodiments of the invention include methods wherein the markers for cancer are detected using at least one reagent chosen from an antibody, a nucleic acid molecule, and a PAP stain.
Other embodiments of the invention include methods wherein at least two markers for cancer are stained where the markers are chosen from a PAP stain, c-Myc, Cox-2, HIF-1α, Histone H3, a telomerase marker, a telomerase associated protein; an extra-cellular matrix marker; a proliferation marker; a cell cycle marker; or an apoptosis marker, and HR-HPV.
In other embodiments, the method may be automated.
I. A Method for Detecting Markers for Cancer
The present invention also discloses a method for detecting markers for cancer in a subject comprising

    
    
        a) obtaining a sample comprising cells from the subject;
        b) contacting the sample with a composition binding at least two markers, comprising at least two molecules that bind to at least two protein markers for cancer under conditions such that the at least two molecules bind to the at least two protein markers for cancer in the sample; wherein binding of the two molecules to the sample indicates the presence of cancer or the risk of developing cancer.
    
    


Other embodiments of the invention include methods wherein the cancer is HPV-related cancer.
Other embodiments of the invention include methods wherein the cancer is cervical cancer.
Other embodiments of the invention include methods wherein the protein markers for cancer are chosen from c-Myc, Cox-2, HIF-1α, Histone H3, a telomerase marker, a telomerase associated protein; an extra-cellular matrix marker; a proliferation marker; a cell cycle marker; HR HPV, or an apoptosis marker.
Other embodiments of the invention include methods wherein the sample is contained on a single solid support.
Other embodiments of the invention include methods where the single solid support is a microscope slide.
In other embodiments method further comprises contacting the sample with PAP stain, wherein an abnormal PAP stain and binding of the at least two molecules to the sample indicates the presence of cancer or the risk of developing cancer.
J. Platforms for Detecting Cancer
Any platform known in the art can be used to screen samples in the methods of the invention for the detection of cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc. In some embodiments, the method involves placing a sample on a solid support. In some embodiments, a label is placed on a solid support, e.g., an antibody, a probe. Examples of solid supports include a microscope slide, a chip, a bead, a micro titer plate, or a micro array. In these embodiments, the samples can be examined and analyzed manually, e.g., using a light microscope or the samples can be analyzed by a computer using a computer program which detects parameters associated with cervical cancer, as described infra in section F. In other embodiments, the method of the invention involves analyzing a sample in solution. The sample can be analyzed using flow cytometry. Flow cytometry can also be used to analyze a sample when the sample is provided on a bead.
K. Computer Analysis for Detecting Cancer in a Sample
In some embodiments the invention provides for an automated method of analyzing a sample for markers which indicate the presence of cancer, or the risk of developing cancer. Thus any of the methods described infra may further comprise

    
    
        a) creating a digital image of a sample
        b) saving the digital image to a digital media,
        c) analyzing the digital image using an algorithm which detects and quantifies molecules used to detect markers which indicate the presence of cancer or the risk of developing cancer, and
        d) creating a report which contains information relating to the identification and quantification of markers for cancer.
    
    


In one embodiment the saved digital image is a high resolution image, and step c) analyzing the digital image comprises

    
    
        a) reducing the image resolution by sub sampling the high resolution digital image to create a second low resolution digital image;
        b) analyzing the low resolution digital image to locate potential objects of interest within the low resolution image;
        c) mapping potential objects of interest back onto the high resolution image;
        d) analyzing each mapped object within the high resolution image to compile a list of descriptive statistics that describe each object; and
        e) comparing the descriptive statistics for each object to an object definition to determine the likelihood that the described object is a nuclei.
    
    


The method may further comprise analyzing the low resolution digital image comprises segmenting the low resolution digital image in HSI color space based on staining and counter staining colors; and detecting the edge of the cells to separate cells from background.
The method may also include smoothing the image.
Analyzing each mapped object within the high resolution image may comprise
classifying the objects (cells) based on chromatic, geometric, topological and biological information; and
collecting statistics by using the original image to gather chromatic, geometric and topological information.
When some objects are cells the method further comprises filtering the cells based on chromatic, geometric, topological and biological information by comparing the object descriptive statistics to a pre-determined object definition to determine the probability that the cell fits the acceptance criteria and that the cell is captured by the filter; storing the results for additional analysis.
The method may be executed using a computer controlled software algorithm.
The computer controlled software algorithm for performing image analysis of high resolution microscopic digital images of cells containing nuclei comprises the following steps:

    
    
        a) analyzing a saved high resolution digital image, said digital image saved as multiple gigabytes;
        b) sub sampling the high resolution digital image to create a second low resolution digital image;
        c) analyzing the low resolution digital image to locate potential objects of interest within the low resolution image;
        d) mapping potential objects of interest back onto the high resolution image;
        e) analyzing each mapped object within the high resolution image to generate a list of descriptive statistics that describe each object; and
        f) comparing the descriptive statistics for each object to an object definition to determine the likelihood that the described object is a nuclei.
    
    


The image analysis algorithm step c) comprises the analysis of the low resolution digital image to locate potential objects of interest in the low resolution image may comprise the following steps:

    
    
        a) reducing image resolution;
        b) smoothing the image;
        c) segmenting the image in HSI color space;
        d) detecting the edges of objects.
    
    


The image analysis algorithm step e), comprises analyzing each mapped object, comprising

    
    
        classifying the object based on chromatic, geometric, topological and biological information;
        collecting statistics by using the original image to gather chromatic, geometric and topological information.
    
    


The collected statistics for a mapped object within the high resolution image may include:
a) contour length; b) size; c) symmetry; d) compactness; e) topology; f) color; g) saturation; and h) intensity
The collected statistics for the whole image or the regions of interest within the high resolution image include:
a) total number of objects in each categories; b) average and mean intensity; c) average size; and d) topology.
In one embodiment, the invention provides a computer program, which can analyze a sample on a solid support, e.g., a microscope slide, for the presence of cancer, e.g., cervical cancer. (FIG. 15). For example, the program may analyze stained cells digitally for the detection of cervical cancer and can be run on a personal computer with a Pentium processor. The program considers the nuclear cytoplasm ratio by analyzing the shape of the nucleus, the chromatin structure and the density of the nucleus. The cytoplasm is analyzed for size and shape. The staining pattern is analyzed for the number of positively stained cells, the intensity of the stain and the location of the stain. A preferred embodiment of a system for using a program according to the invention is defined below:
System Architecture of a Preferred Embodiment
The above mentioned computer program is preferably carried out using a system as described herein. The design of the system is based on a multi-tiered architecture. The image FIG. 23 used as an example is acquired using a ScanScopeTM (a line scanner for scanning microscope slides) (Aperio Technologies, Vista, Calif.). The ScanScopeTM may be connected to another computer, which serves as an image repository through a 1 Gb network connection. The object lens may be a Nikon Plan Apo 20× with a numerical aperture value of 0.75 and the CCD camera model is L301 KC line scan camera from Basler. The computer used to store and serve image may have the following specifications:
















Motherboard
Intel



CPU
Pentium 4 2.6 GHz



RAM
 2 GB



Hard Drive
250 GB










Program Steps

In one embodiment, the steps of the program are described in FIG. 16. In this embodiment, the steps include
reducing the image resolution to enhance efficiency of the analysis (161); smoothing (162) the image to permit segmentation and edge detection; segmenting (163) the image in HSI color space based on staining and counter staining colors;
detecting (164) the edge of cells to separate cells from background; [through detection of high rate of change in HSA]
mapping (165) the cells back into the high resolution image; classifying (166) the cells based on chromatic, geometric, topological and biological information;
collecting (167) statistics by using the original image to gather chromatic, geometric and topological information;
filtering (168) the cells based on chromatic, geometric, topological and biological information by comparing the object descriptive statistics to a pre-determined object definition to determine the probability that the object fits the acceptance criteria and that the cell is captured by the filter;

storing (169) the results, e.g., chromatic, geometric and topological information is stored for additional analysis.

In one embodiment the digital image may be created using a high resolution, e.g. 0.46 micron per pixel. If the type of cells, which are the target of the actual analysis, generally are expected to have a size of 8 micron then the image of the target would cover about 16 pixels per line. The algorithm according to the present invention, in general, does not require this full resolution for object detection and thus the image may be reduced to a lower resolution, such as e.g. a resolution of about 4 micron per pixel. Consequently, the memory requirement is greatly reduced. FIG. 23 is an example of such an image. The actual reduction chosen for a specific sample will depend on the biologic information available for this sample, i.e. the type and size of cells to be looked for. If those cells are big a great reduction may be applied; otherwise in case of small cells no reduction or only a small reduction may apply.
The smoothing is carried out in order to remove or blur irrelevant items. The smoothing is recommended in view of the fact that images obtained through scanning slides, especially with high resolution, may contain small pixels due to dust, optical aberration, stain background, and compression that are not normally perceived by the human eye. These artifacts may interfere the algorithm in the later stages. A smoothing operation maybe used to remove these minor artifacts. As an example, a “median blur” may be used on the preceding image to obtain the image shown in FIG. 24. Other filters such as Mean of Least Variance (MLV)[3] and Mean of Coefficient of Variation (MCV)[4] may also be used.
Median filter is a type of spatial filter that uses a sliding-window. It replaces the center value in the window with the median of all pixel value in the window. An example of median filtering of a single 3×3 window of values is shown in FIGS. 28, 29 where the center pixel of value 97 is under consideration.
When sorted in order, the numbers appear in the following sequence: 0, 2, 3, 3, 4, 6, 10, 15, 97, where 4 is selected to replace 97 as the pixel value.
This illustrates one of the celebrated features of the median filter: its ability to remove ‘impulse’ noise. The median filter is also recognized to be edge-preserving based on the fact it will preserve step edges without blurring.
Segmenting:
Segmentation is the process of dividing an image into meaningful regions. In the context of histological image processing, it means separating the object of interest from the image background. Segmentation is carried out by converting the image from RGB color space to HSI color space. This process is well known, see, e.g., Rafael Gonzalez, Richard Woods, Digital Image Processing, 2nd Edition. [1][2]: The segmented image is shown in FIG. 25.
To cleanly detect the edges in order to extract objects from the image, color segmentation may be used to separate out background and desired biological objects. The human eye, viewing the slides, does not perceive red-green-blue components, but hue, saturation, and brightness. (This is explained in details in Rafael Gonzalez, Richard Woods, Digital Image Processing, 2nd Edition.). Since the original images are acquired and represented in RGB color space, the image may be transformed into HSI color space. As an example, shown in FIG. 25, the image was transformed from RGB space into HSI space and then partitioned into regions. Such transformation may be carried out by use of the following algorithm:













Kender's Algorithm for



Faster Computation of HUE:
Saturation:


if ((R > B) and ((G > B)  



  hue
  =
  
    
      π
      3
    
    +
    
      arctan
      ⁡
      
        (
        
          
            
              3
            
            ×
            
              (
              
                R
                -
                G
              
              )
            
          
          
            R
            -
            B
            +
            G
            -
            B
          
        
        )
      
    
  








  
    
      
        
          saturation
          =
        
      
    
    
      
        
          
            
          
          ⁢
          
            1
            -
            
              
                3
                ×
                
                  min
                  ⁡
                  
                    (
                    
                      R
                      ,
                      G
                      ,
                      B
                    
                    )
                  
                
              
              
                R
                +
                G
                +
                B
              
            
          
        
      
    
  
   







Intensity:


else if (G > R)  



  hue
  =
  
    π
    +
    
      arctan
      ⁡
      
        (
        
          
            
              3
            
            ×
            
              (
              
                B
                -
                G
              
              )
            
          
          
            B
            -
            R
            +
            G
            -
            R
          
        
        )
      
    
  








  intensity
  =
  
    
      R
      +
      G
      +
      B
    
    3
  






 


else if (B > G)  



  hue
  =
  
    
      
        5
        ×
        π
      
      3
    
    +
    
      arctan
      ⁡
      
        (
        
          
            
              3
            
            ×
            
              (
              
                R
                -
                B
              
              )
            
          
          
            R
            -
            G
            +
            B
            -
            G
          
        
        )
      
    
  







 


else if (R > B)



 hue = 0



else



  ‘achromatic’









An example of such implementation in Java is given infra.
Detect Edge of Objects to Separate Objects from Background
The object may first be described in terms of its edge Then we may use it to derive other information such as chromatic information or topological information. As an example, the image in FIG. 26 is obtained by passing the preceding image shown in FIG. 25 through the Roberts Cross edge detection operation. Edge detection attempts to determine whether an edge passes through or near to a given pixel. This can be done by examining the rate of change of intensity near the pixel. A sharp change of intensity or hue is an indication of an edge. Works by Roberts (1965), Sobel, (Davis, 1975) and Prewitt (1970) are typical of approach. The example given above, uses the Robert Cross operator which performs a quick 2-dimensional spatial gradient measurement on an image. One way to implement this is to use a pair of 2×2 convolution kernels as show in FIG. 27: The kennel can be applied separately to the source image and produce two gradient measurement corresponding to two orientations. The absolute magnitude of the gradient at each point is defined as:

|G|=√{square root over (Gx2+Gy2)}

Or as an approximation:

|G|=|Gx|+|Gy|

Map Object Back onto High-Resolution Image
The edge of the objects identified in previous step is in a lower resolution image space compared to the original image. At this stage, a simple linear translation between the coordinate system in the low resolution image of FIG. 26 and the coordinate system in the stored high resolution image is used for mapping the cells back into the high resolution image.
In the following steps the cells are classified based on chromatic, geometric, topological and biological information; and statistics are collected by using the original image to gather chromatic, geometric and topological information; Further the cells are filtered based on chromatic, geometric, topological and biological information by comparing the object descriptive statistics to a pre-determined object definition to determine the probability that the object fits the acceptance criteria and that the cell is captured by the filter. Finally the results, e.g., chromatic, geometric and topological information a restored for additional analysis.
Each of the image processes mentioned above are well-known and described in the literature, see, e.g.,

    [1] Rafael Gonzalez, Richard Woods, Digital Image Processing, 2nd Edition.
    [2] A. Th. Schwarzbacher, P. A. Comiskey, and J. B. Foley, A Low-Power CMSO Design for RBG to HSI Conversion. Dublin Institute of Technology, Dublin, Ireland, Trinity College, Dublin, Ireland, Dun Logahire Institute of Technology, Dublin, Ireland. Biomedical Image Processing with Morphology-Based Nonlinear Filters 
    [3] Mark Allen Schulze, University of Texas at Austin, 1994
    [4] Mark A. Schulze and Qing X. Wu, Noise Reduction in Synthetic Aperture Radar Imagery Using a Morphology-Based Nonlinear Filter, Landcare Research New Zealand Wellington, New Zealand, 1995.


The invention provides, In certain embodiments, combinations of the various processes as described infra.
The algorithm is specifically developed, for example, for use in the automated method of analyzing a sample for markers which indicate the presence of cancer, or the risk of developing cancer, for executing a method of the invention.
Converting RGB to HIS in a Java Method












public static int RGBtoHSI(int rgb)


{


 double h = 0, s = 0, l = 0; // initialize HSI value


 // extract RGB values


 int r = (rgb & 0x00FF0000) >> 16;


 int g = (rgb & 0x0000FF00) >> 8;


 int b = (rgb & 0X000000FF);


 // Calculate maximum, and minimum of the RGB component values


 int max, min;


 if (r>g && r>b) {


  max = r;


  min = Math.min(g,b);


 } else {


  if (g>b) {


   max = g;


   min = Math.min(r,b);


  } else {


   max = b;


   min = Math.min(r,g);


  }


 }


 // Compute intensity Value, normalized between 0-255


 i =Math.round(((float)max/255)*100);


 if (i==0) return (int)(((int)h << 16) + ((int)s << 8) + (int)i);


 // No intensity - Colour is black


 // Compute Saturation Value, normalized between 0-255


 if (max==min) return (int)(((int)h << 16) + ((int)s << 8) + (int)i);


 // No saturation - Colour is grey


 s = Math.round((((float)max/255) −


 ((flost)min/255))/((flost)max/255)*100);


 // Compute Hue Value, normalized between 0-255


 double d_hue = Math.acos((0.5*((r−g)+(r−b)))/


 (Math.sqrt(Math.pow((r−g),2)+(r−b)*(g−b))));


 if (b>g) d_hue = (2*Math.PI)− d_hue;


 d_hue = Math.toDegrees(d_hue);


 h = Math.round(Math.round(d_hue));


 return (int)(((int)h << 16) + ((int)s << 8) + (int)i);


}









L. Kits
In one embodiment, the invention provides for a kit comprising one or more nucleic acid probes which may hybridize to at least 14 HR HPV types, e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, and 82. The probes may include genomic clones, or fragments thereof, of HR HPV 16, 18 and 51. Optionally, the kit may further comprise at least one of the following: a nucleic acid probe comprising HPV 11, or fragment thereof; HR HPV 56, or fragment thereof; or HR HPV 58, or fragment thereof; or HR HPV 66, or fragment thereof; or HR HPV 70, or fragment thereof; or HR HPV 73, or fragment thereof. Of course nucleic acid probes comprised of nucleic acid sequences substantially identical to genomic clones of any of the HR-HPV or low risk HPV types described above can also be included in the kit. The probe hybridization conditions may include any of the conditions described herein. Optionally, the kit may further comprise a pap stain for performing a pap smear or a reagent to detect a marker for cancer, such as any HPV-related cancer, e.g., c-Myc, Cox-2, HIF-1α, telomerase markers, such as hTERT, hTR, and other telomerase associated proteins; an extra-cellular matrix marker, such as, Laminin 5; a proliferation marker, such as, Ki-67 or Histone H3; a cell cycle marker, such as, Cyclin E, P63 or p16INK4a; or apoptosis markers, such as Bax, or Bcl-2. The molecule can be a protein, e.g. an antibody, or a nucleic acid. In another embodiment, the kit comprises at least 2 molecules that may detect a marker for cancer e.g., c-Myc, Cox-2, HIF-1α, telomerase markers, such as hTERT, hTR, or other telomerase associated proteins; an extra-cellular matrix marker, such as, Laminin 5; a proliferation marker, such as, Ki-67 or Histone H3; a cell cycle marker, such as, Cyclin E, p63 or p16INK4a; or apoptosis markers, such as Bax, or Bcl-2. In yet another embodiment, the kit can comprises at least one molecules which can detect a marker for cancer, such as HPV-related cancer marker, e.g., c-Myc, Cox-2, HIF-1α, telomerase markers, such as hTERT, hTR, and other telomerase associated proteins; an extra-cellular matrix marker, such as, Laminin 5; a proliferation marker, such as, Ki-67 or Histone H3; a cell cycle marker, such as, Cyclin E, p63 or p16INK4a; or apoptosis markers, such as Bax, or Bcl-2 and a pap stain.
Optionally, the kit may further comprise instructions for using the probes or the molecules used to detect the protein markers for cancer. The kit may further comprise at least one container for each of the components.
M. Dextran Sulfates
For in situ hybridization (ISH), the rate of hybridization is dependent on many factors, including probe concentration and hybridization buffer used. The use of dextran sulfate in ISH has been described (see, e.g., U.S. Pat. Nos. 4,886,741, 5,750,340; WO 02/061139; U.S. application Ser. No. 09/772,123). Dextran sulfate is strongly hydrated in solution so it will exclude other macromolecules (e.g., a DNA probe) from the water and in effect “concentrate” the probe. This apparent increase in the concentration of the probe may accelerate the hybridization rate. Typically, high molecular weight (e.g. 500,000 dalton) dextran sulfate is used in the hybridization buffer at a concentration of 5-20% (weight to volume ratio) to achieve the desired acceleration rate for hybridization.
One problem associated with the “effective” increase in probe concentration due to the presence of high molecular weight dextran sulfate is an increase in nonspecific background staining. To address this problem, dextran sulfate of high molecular weight (450,000-550,000) and low molecular weight (35,000 to 50,000) were compared in ISH buffers. It was found that high molecular weight dextran sulfate generates higher nonspecific background on certain tissues than low molecular weight dextran sulfate. No decrease in signal intensity (inferring a similar accelerated hybridization rate) was observed, thus demonstrating that the volume exclusion effect of high and low molecular weight dextran sulfate is very similar.
The invention thus relates to a method of using low molecular weight dextran sulfate in ISH. The use of low molecular weight dextran sulfate in the hybridization buffer may decrease the non-specific background staining in an ISH sample, compared to an ISH sample in which high molecular weight dextran sulfate is used in the hybridization buffer (e.g. 500,000-550,000 daltons). In some embodiments of the invention the low molecular weight of dextran sulfate is in the range of 16,000-500,000 daltons. In other embodiments of the invention it is in the range of 25,000-75,000, or even in the range of 35,000-50,000 daltons.
Examples of hybridization buffers are disclosed herein, as well as in Current Protocols in Molecular Biology, Volume 3, Unit 14.7 “In situ hybridization and detection using nonisotopic probes”. (Ausubel F M. et al. 1995, John Wiley & Sons, USA, incorporated herein by reference), and in Nonradioactive In Situ Hybridization Application Manual. Chapter V, (Published by Boehringer Mannheim, Germany, 1992, incorporated herein by reference).
The concentration of low molecular weight dextran sulfate may be 5-15%, such as 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15% weight per volume. In one embodiment, 10% of low molecular weight dextran sulfate is used.
In certain embodiments the invention relates to a method of detecting cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc., by ISH using a hybridization buffer comprised of low molecular weight dextran sulfate. The cancer may be any cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, e.t.c and the ISH may be performed using a nucleic acid probe cocktail which specifically hybridizes to nucleic acid sequences encoded by HR-HPV genomic DNA and optionally detecting at least one other marker for cancer, e.g., cervical cancer (e.g. a pap smear or a protein associated with cancer such as p16INK4a).
The invention also relates to a composition useful for detecting cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc. comprising a nucleic acid probe cocktail which specifically hybridizes to nucleic acid sequences encoded by HR-HPV genomic DNA and a hybridization buffer comprised of low molecular weight dextran sulfate. The composition may further comprise at least one other agent for detecting cancer, such as any HPV-related cancer, e.g., cervical cancer, colon cancer, anal cancer, gastric cancer, oral cancer, neck and head cancer, lung cancer, etc., such as a PAP stain.
The invention also relates to an automated method of detecting cancer by ISH using a hybridization buffer comprised of low molecular weight dextran sulfate. The low molecular weight dextran may provide for lower viscosity which may allow easier probe dispensation thus enhancing the efficiency of the automated detection. The cancer may be cervical cancer and the ISH may be performed using a nucleic acid probe cocktail which specifically hybridizes to nucleic acid sequences encoded by HR-HPV genomic DNA and optionally detecting at least one other marker for cancer, e.g., cervical cancer (e.g. a PAP smear or a protein associated with cancer, e.g. p16INK4a).
The invention thus provides for a nucleic acid hybridization buffer for in situ hybridization comprising a low molecular weight dextran sulfate.
Further embodiments of the invention include a hybridization buffer wherein dextran sulfate has a molecular weight range of about 25,000-75,000.
Further embodiments of the invention include a hybridization buffer wherein the dextran sulfate has a molecular weight of about 35,000-50,000.
Further embodiments of the invention include a hybridization buffer wherein the low molecular weight dextran sulfate is in a range of about 5-15 wt./vol. %.
EXAMPLES
Example 1
Labeling of HPV Clones
Three full length HPV clones were selected based upon homology with other high risk HPV types. Full-length HPV 16 (7.9 kb) (SEQ ID NO: 1) was cloned into pGEM3Z vector (Promega). Full length HPV 18 (7.9 kb) (SEQ ID NO: 2) was cloned into pBR322 vector. Full length HPV 51 (7.8 kb) (SEQ ID NO: 4) was cloned into pUC13 vector (J. Virology 62:1452, GenBank accession number M62877). Full length HPV 58 (7.8 kb) (SEQ ID NO: 5) was cloned into pCRBluntII vector (Invitrogen, Carlsbad, Calif.)
Full-length HPV 16, 18, and 51 clones were mixed together in equal proportions. The pooled clones were treated with DNAase I in the same reaction tube to obtain fragments ranging from 50 to 500 bp in length.
The DNAase reaction was carried out in a buffer containing 50 mM Tris, pH 7.2, 10 mM MgSO4, 0.1 mM DTT, and 50 ug/mL acetylated BSA. DNA was added to the buffer at a final concentration of 0.5 μg/μl and equilibrated at 37° C. for 15 minutes. DNAase I was added at a final concentration of 0.05 mU/μL (diluted from a 2 mU/μL stock in a 50% glycerol, 20 mM Tris-HCl, pH 7.5, and 1 mM MgCl buffer) and the reaction was incubated at 37° C. for 20-40 minutes. The reaction was stopped by heating at 75° C. for 15 minutes.
1.5 μL of the DNAase reaction was then loaded in a 6% TBE/Urea denaturing gel and electrophoresed together with a low molecular weight marker to assess the extent of DNAasing. The gel was then stained with Ethidium Bromide (0.1 ug/mL) and visualized under UV. Optimal incubation time with DNAase I was one that gave a DNA smear from 50-500 bp.
The DNAase I digested DNA was then purified by ethanol precipitation using ammonium acetate according to the method of Sambrook et al. 1989, Molecular Cloning: A Laboratory Manual, 2 ed., Cold Spring Harbor Laboratory Press: Cold Spring Harbor, N.Y.). The precipitated DNA was resuspended in 10 mM Tris, pH 8.0 and 1 mM EDTA (TE) at a final concentration of 0.1 mg/mL and stored at −20° C. for long-term storage.
After treatment with DNAase I the plasmids were labeled with psoralen-biotin (Schleicher and Schuell, Keene, N.H.). The labeling reaction was carried out in a 96 well microtiter plate in an optimal volume of 100 μL per well. Psoralen-biotin intercalates into DNA and forms covalent bonds with the DNA upon UV irradiation.
A U-bottom 96 well microtiter plate was placed on ice. Fifty micrograms of plasmid treated with DNAase I was added to a sterile screw-capped microfuge tube at a concentration of 0.1 ug/uL (in 500 μL) and boiled for 10 minutes to denature the DNA. The microfuge tube was quickly put into an ice slurry after boiling and was kept on ice for 10 minutes to prevent reannealing of the denatured DNA. 52.6 μL of Psoralen-biotin (at a concentration of 0.25 μg/μL) was added to the denatured DNA in the microfuge tube. The labeling mixture was vortexed and then quickly spun down. The mixture was then aliquoted into the wells of the microtiter plate at a volume of 100 μL per well. A long-wave UV lamp (365 nM) was placed directly on top of the wells containing the labeling mixture and turned on for an hour. After UV irradiation, the labeling mixture was then pipetted and pooled into a polypropylene tube for N-butanol extraction. The wells of the microtiter plate were rinsed with 50 μL TE per well and the TE was added to the polypropylene tube.
Unincorporated psoralen-biotin was removed by several rounds of n-butanol extraction. Two volumes of water-saturated n-butanol were added to the labeling mixture and vortexed. The tube was then centrifuged at 1000 rpm for 5 minutes in a Beckman table-top centrifuge (Beckman, Fullerton, Calif.). The extracted labeling mixture (bottom phase) was transferred to a new tube. This procedure was repeated once. The residual n-butanol was removed by the addition of two volumes of ether. The tube was vortexed and spun down as described above. The final labeling mixture was transferred to a new tube and stored at −20° C.
The concentration of the labeled HPV probe cocktail was measured by spectrophometry at 260 nM using a Beckman model number DU640 (Beckman, Fullerton, Calif.). Labeling efficiency of DNA varies. The optimal DNA concentration to be used is determined by in situ hybridization (ISH) on histology samples.
Example 2
In Situ Hybridization (ISH) Using Cytology Samples
Monolayer cervical cytology samples prepared using either ThinPrep® (Cytyc, Boxborough, Mass.) or SurePath® (Tripath, Burlington, N.C.) were stored in 95% ethanol before use. To prepare the slides for in situ hybridization the slides were soaked in 50% ethanol for 30 minutes and then mildly fixed in 10% neutral buffered formalin for 20 minutes. The slides were rinsed in reagent water several times to remove residual neutral buffered formalin and then pre-treated with a ready-to-use proteolytic enzyme (DakoCytomation, Carpinteria, Calif.) for 7 minutes at room temperature. After rinsing in reagent water several times, the slides were incubated in 0.3% H2O2/methanol for 5 minutes to remove endogenous peroxidase activity.
The slides were then rinsed in reagent water several times and excess water was removed from the sample leaving behind a very thin film of moisture. The HPV probe cocktail labeled with biotin (described in Example 1) was added to the slides at a concentration of 1.8-4 ng/μl in hybridization buffer (DakoCytomation Carpinteria, Calif.) In some cases, HPV 11 DNA treated with DNAase I, but not labeled with biotin, was added at a concentration of 0.02-0.5 ng/μl) to prevent the probes from recognizing HPV11, if present. A glass coverslip was applied to each slide. The probe and the sample DNA were then denatured at 90-95° C. for 5 minutes and the slides were then incubated at 37° C. overnight (12-18 hours) in a moist chamber.
After hybridization, the coverslips were removed by soaking the slides in TBST buffer (50 mM Tris, pH 7.6, 0.3 M NaCl, 0.01% Tween). The slides were then incubated in a 0.1×SSC stringent wash buffer at 48-52° C. for 30 minutes. Signal amplification and detection were performed at room temperature using the DAKO GenPointTM detection system following manufacturer's instructions (DakoCytomation, Carpinteria, Calif.). Briefly, the slides were incubated with the primary streptavidin horse radish peroxidase (SA-HRP) for 30 minutes followed by a 15 minute incubation with biotinyl tyramide (signal amplification.) (DakoCytomation, Carpinteria, Calif.) The slides were incubated with a secondary SA-HRP for 15 minutes, followed by a 5 minute incubation with 3,3′-diaminobenzidine (DAB) substrate. Between each reagent step the slides were soaked in TBST for 3 minutes and this was repeated 3 times. The slides were counterstained with Hematoxylin (1 minute) (DakoCytomation, CA). A coverslip was applied and mounted in an aqueous mounting medium. Cells infected with high risk HPV types stained brown (DAB precipitate) in the nuclei. The stain pattern took the form of a punctate pattern (HPV integration into the human genome) or a diffuse signal within the entire nuclei (episomal copies of HPV) (FIG. 6).
Example 3
In Situ Hybridization Using Histology Samples
Formalin fixed paraffin embedded (FFPE) cervical biopsies were deparaffinized and rehydrated before use. For deparaffinization, the slides were soaked in Xylene or Histoclear (National Diagnostics, Atlanta, Ga.) for 5 minutes. This step was repeated twice. The sample was re-hydrated by placing it in 2 changes of 99% ethanol and 3 changes of 95% ethanol, 1 minute each. The slides were rinsed in reagent water several times before pre-treatment. For pre-treatment, the slides were incubated in 0.8% pepsin in 0.2N HCl at 37° C. for 10-15 minutes or with a ready-to-use proteinase K for 15-30 minutes at room temperature. After rinsing in reagent water several times, the slides were then incubated in 0.3% H2O2/methanol for 20 minutes to remove endogenous peroxidase activity.
Denaturation, hybridization, signal amplification and detection were as described above in Example 2.
Example 4
In Situ Hybridization Using Cytology Samples Followed by PAP Staining
In situ hybridization was as described above in Example 2.
After the DAB step of ISH, the slides were processed for PAP staining. The slides were soaked in 70% reagent alcohol, 50% reagent alcohol, and distilled water for 1 minute each. They were then stained with Hematoxylin (Richard-Allan Scientific, Kalamazoo, Mich.) for 45 seconds. After 2 rinses for 15 seconds each in distilled water, the slides were soaked in 0.025% glacial acetic acid (clarifier) for 30 seconds. The slides were then rinsed in distilled water for 30 seconds and soaked in bluing agent (10 mg LiCarb/L) (Richard-Allan Scientific, SC) for 30 seconds. The slides were then dehydrated by placing them in 50% reagent alcohol and 95% reagent alcohol for 30 seconds each. The slides were soaked in Richard-Allan cytology stain for 1 minute (Richard-Allan, Kalamazoo, Mich.). The slides were further dehydrated by placing them in 2 changes of 95% reagent alcohol and 3 changes of 100% reagent alcohol, for 30 seconds each. The slides were mounted in permanent mounting medium after 3 changes of xylene for 1, 1, and 3 minutes, respectively.
Example 5
In Situ Hybridization Using Another HPV Probe Mix
Full length HPV clone 66 (7.8 kb) (SEQ ID NO: 7) and/or HPV clone 73 (7.7 kb) (SEQ ID NO: 8) are added to the probe mixture containing full length HPV clones 16, 18, 51, and 58. The probe mixture is DNAased and labeled as described in Example 1. In some cases, HPV 11 DNA (SEQ ID NO: 3) and/or HPV 70 DNA (SEQ ID NO: 9) treated with DNAase I, but not labeled with biotin, is added at a concentration of 0.02-0.5 ng/μl to prevent the probes from recognizing HPV 11 and 70, respectively, if present.
In situ hybridization of the above probe mix is performed using cytology samples as described in Example 2, using histology samples as described in Example 3, and using cytology samples followed by PAP staining as described in Example 4.
The probe cocktail containing full length HPV types 16, 18, and 51 was labeled with biotin and tested by in situ hybridization described above on histology samples (FIGS. 7-14) and cytology samples (FIG. 6). The probe was able to cross-hybridize to high risk types 16, 18, 31, 33, 51, and 52 (FIGS. 7-12). In situ hybridization was also performed with the addition of unlabeled HPV 11 clone in the probe cocktail to block cross-hybridization to low risk HPV (FIGS. 13a and 13b). A cytology sample was counterstained with PAP stain after ISH with the HPV probe cocktail (FIG. 14).
Example 6
Immunocytochemical Detection of High Risk HPV and the Over Expression of p16INK4a in Samples of the Uterine Cervix for Identification of Pre-Neoplastic/Neoplastic Cells
Merckofix® (Merck, Whitehouse Station, N.J.) cytological smears of the cervix uteri are prepared using ThinPrep® (Cytyc, Boxborough, Mass.) (liquid based cytology samples). The smears are immunochemically stained using high risk HPV (HR HPV) DNA probes as described in Example 2 and an antibody specific for p16INK4a.
To rehydrate and remove the PEG film produced by the fixation, liquid based cytological samples are incubated in ethanol (50%) for 10 minutes and then transferred to distilled water. The smears are incubated in 4% neutral buffered formalin for 5 minutes and rinsed in distilled water and then transferred to washing buffer (50 mM Tris-HCl, 150 mM NaCl, 0.05% Tween 20, pH 7.6) for a minimum of 30 seconds. Antigen retrieval is carried out in 10 mM citrate buffer (pH 6.0). The cytological preparations are heated in a water bath for 40 minutes at 95-98° C. and then allowed to cool to room temperature for 20 minutes in the washing buffer.
After antigen retrieval the smears are rinsed twice in wash buffer (2 times, 5 minutes). To avoid endogenous peroxidase activity the smears are incubated in 3 hydrogen peroxide for 5 minutes followed by three washings in wash buffer for 5 minutes. To avoid endogenous biotin the smears are incubated in 0.1% avidin (X0590, DakoCytomation, Carpinteria, Calif.) for 10 min., followed by three washings in wash buffer for 1 min each. The smears are then incubated in 0.01% Biotin (X0590, DakoCytomation, Carpinteria, Calif.) for 10 min, followed by one washing in wash buffer and three washings in distilled water for 1 min each. Fifteen microliters of the hybridization probe is applied to each smear and a cover slip is applied to the smear. The probes and the HPV target DNA are denaturated by placing the smear with the cover slip in a Hybridizer (DakoCytomation) at 92° C. for five minutes. The smears are kept in the hybridizer for hybridization at 37° C. and incubated over night. After hybridization, the cover slips are removed from the smear by immersing the smears in wash buffer at room temperature and rinsing three times. Samples are thoroughly washed for 30 minutes at 48° C., under stringent conditions, using DakoCytomation code no. K0620. The smears are rinsed in wash buffer 3 times for 1 min. The smears are incubated with primary antibody for 30 min at room temperature. The primary antibody is mouse anti human p16INK4a antibody at a concentration of 3.48 μg/mL (clone E6H4) in 250 μl. The smears are rinsed with wash buffer and washed 2 times for 5 minutes. Excess buffer is tapped off and the smears are incubated for 30 minutes at room temperature with goat anto mouse/AP (code no D0486, DakoCytomation, Glostrup, DK) diluted 1:50. The smears are washed 3 times for 5 minutes in wash buffer. The smears are incubated for 30 minutes in primary streptavidin-HRP (DakoCytomation, Carpinteria, Calif.) diluted 1:3 in primary Streptavidin-HRP diluent (DakoCytomation, Carpinteria, Calif.). The smears are washed 3 times for 5 minutes in wash buffer. Biotinyl tyramide amplification reagent (DakoCytomation, Carpinteria, Calif.) is applied to the smears and incubated at room temperature for 15 minutes. The smears are washed in 3 times for 5 minutes in wash buffer. The smears are incubated with secondary streptavidin-HRP (DakoCytomation, Carpinteria, Calif.) for 15 minutes and then washed 3 times for 5 minutes in wash buffer. The chromogenic reaction is performed with di-amino-benzidine (DAB) where DAB chromogen concentrate is diluted 1:50 in DAB chromogen dilution buffer (DakoCytomation, Carpinteria, Calif.) and incubated 5 minutes at room temperature. The DAB reaction is stopped by washing the smears several times in distilled water and then placing the smears in wash buffer. Thereafter, the smears are incubated with Permanent Red Substrate Chromogen (code No K0640, DakoCytomation, Carpinteria, Calif.) for 10 minutes at room temperature. The smears are washed several times for a minimum of 10 minutes in distilled water before counterstaining with hematoxylin and mounted.
The microscopic examination of the cytological smears reveals, that cells positive for expression of p16INK4a and HR HPV only may be found in samples that may microscopically be identified as containing pre-neoplastic/neoplastic cells.
Cells that are stained by the p16INK4a specific reaction, but which are not stained by the HR HPV probe reaction are either metaplastic, of endometrial origin or contain an HR HPV type not detected by the probe cocktail.
Samples containing cells that react only with a specific HR HPV probe and not with the p16INK4a antibody are classified as samples having a risk for being malignant. Double stained cells that are reactive with both the HR HPV probe and p16INK4a antibody are pre-neoplastic/neoplastic cells.
The results show that this method allows for the specific identification of samples that contain pre-neoplastic/neoplastic cells having persistent HR HPV infection and samples that contain other cells infected with HR HPV virus having a risk for malignancy. Furthermore, double staining of the cells with reagents specific for HR HPV and p16INK4a permits discrimination of pre-neoplastic/neoplastic cells from metaplastic cells. It also permits identification of cells infected with HR HPV which are at risk for being malignant. The results are shown in FIG. 30.
Example 7
Immunocytochemical Detection of HR HPV and of Laminin 5 in Samples of the Uterine Cervix for Identification of Pre-Neoplastic/Neoplastic Cells with Invasive Capacity
The procedure described above in Example 6, for staining and fixing the cells is followed in this example as well, except that the smears are incubated with a different primary antibody. A mouse anti human Laminin 5 antibody is used at a concentration of 13.3 μg/mL (clone 4G1). Incubation is for 30 minutes at room temperature.
Examination of the stained smears by light microscopy reveals that cells positive for expression of Laminin 5 and HR HPV are pre-neoplastic/neoplastic cells with invasive capacity.
Cells that only react with specific HR HPV probes and not with Laminin 5 antibody are classified as at risk for malignancy or malignant.
The assay provides a method for the discrimination of pre-neoplastic/neoplastic cells from normal cervical cells and identify cells with invasive capacity. The results are shown in FIG. 31.
Example 8
Immunocytochemical Detection of Laminin 5 and the Over Expression of p16INK4a in Samples of the Uterine Cervix for Identification of Pre-Neoplastic/Neoplastic Cells with Invasive Capacity
Merckofix® (Merck, Whitehouse Station, N.J.) cytological smears (liquid based smears) of the cervix uteri are immunochemically stained using an antibody specific for Laminin 5 and an antibody specific for p16INK4a.
The following protocol is used to stain the cells. To rehydrate and remove the PEG film produced by the fixation, liquid based cytological samples are incubated in ethanol (50%) for 10 minutes and then rinsed in distilled water and then transferred to washing buffer (50 mM Tris-HCl, 150 mM NaCl, 0.05% Tween 20, pH 7.6) for a minimum of 30 seconds. Antigen retrieval is carried out in 10 mM citrate buffer (pH 6.0) where the smears are heated in a water bath for 40 minutes at 95-98° C. and afterwards are allowed to cool to room temperature for 20 minutes in the antigen retrieval buffer. The smears are incubated with a mixture of primary antibodies. The primary antibodies are mouse anti human p16INK4a, at a concentration of 3.48 μg/mL (clone E6H4) and rabbit anti human Laminin 5, at a concentration of 14.5 μg/mL in a volume of 250 μl for 30 minutes at room temperature. Smears are then rinsed with washing buffer and placed in a fresh wash buffer for 5 minutes.
Excess buffer is tapped off and each slide is incubated with 250 μl of visualization reagent comprising Goat anti mouse EnVision/HRP (vial 3 from code no. K5338, DakoCytomation, Glostrup, DK) and Goat anti Rabbit/AP diluted 1:50 (code no. D0487, DakoCytomation, Carpinteria, Calif.) and then incubated for 30 minutes at room temperature. Samples are washed 3 times for 5 minutes in wash buffer. The samples are then incubated for 5 minutes with the chromogenic substrate DAB (DakoCytomation, Carpinteria, Calif.). The DAB reaction is stopped by washing the smears several times in distilled water and then placed in wash buffer. The smears are then incubated with Permanent Red Substrate Chromogen (code no. K0640, DakoCytomation, Carpinteria, Calif.) for 10 minutes at room temperature and then washed several times in distilled water. The samples are then counterstained with hematoxylin and mounted.
The microscopic examination of the stained smears reveals that cells positive for expression of Laminin 5 and p16INK4a may only be found in samples that can be microscopically identified as containing pre-neoplastic/neoplastic cells. The results show that this method identifies pre-neoplastic/neoplastic cells with invasive capacity. The results are shown in FIG. 32.
Example 9
Immunocytochemical Detection of HR HPV and Laminin 5 in Sections of Formalin Fixed, Paraffin Embedded Tissue Samples with Diagnosed Colon Cancer
This procedure provides a method to diagnose colon cancer.
Sections of formalin fixed paraffin embedded tissue samples from a patient diagnosed with colon cancer are immunochemically stained using the DNA HR HPV probes, as described in Example 2, and an antibody specific for Laminin 5.
Tissue sections are rehydrated by incubating in xylene and graded ethanol, rinsed in distilled water and then transferred to washing buffer (50 mM Tris-HCl, 150 mM NaCl, 0.05% Tween 20, pH 7.6) for a minimum of 30 seconds. Antigen retrieval is carried out in 10 mM citrate buffer (pH 6.0). The slides are heated in a water bath for 40 minutes at 95-98° C. and then allowed to cool to room temperature for 20 minutes in washing buffer.
The sections are then incubated with Proteinase K (DakoCytomation, Carpinteria, Calif.) diluted 1:50 or 1:100 in TBS buffer and incubated for 4-5 minutes at room temperature. After incubation the slides are rinsed twice in wash buffer for 5 minutes per rinse. To avoid endogenous peroxidase activity the sections are incubated in 3% hydrogen peroxide for 5 minutes. The samples are then washed twice for 5 minutes per wash in wash buffer. To avoid endogenous biotin the sections are incubated in 0.1% avidin (X0590, DakoCytomation, Carpinteria, Calif.) for 10 minutes, followed by three washings in wash buffer for 1 min each. The sections are then incubated in 0.01% biotin (X0590, DakoCytomation, Carpinteria, Calif.) for 10 min, followed by three washings in wash buffer for 1 min each. Fifteen microliters of the hybridization probe is applied to each section and a cover slip is applied to the section. The probe and the HPV target DNA are denaturated by placing the section in a Hybridizer (DakoCytomation) at 92° C. for five minutes. The sections are kept in the Hybridizer for hybridization at 37° C. over night. After hybridization the cover slips are removed from the slide by immersing the slides in wash buffer at room temperature and rinsing three times for 1 minute each. Sections are washed under stringent conditions for 30 minutes at 48-52° C. using a prepared wash buffer (DakoCytomation, Carpinteria, Calif.). Then the sections are rinsed in 3× wash buffer for 1 min each.
The sections are incubated with the primary antibody, mouse anti human Laminin 5, at a concentration of 13.3 μg/mL (clone 4G1), for 30 minutes at room temperature. The method for staining and washing the samples described in Example 7 is followed.
Examination of the slides by light microscopy reveals that cells which are positive for expression of Laminin 5 and HR HPV are found only in samples with pre-neoplastic/neoplastic lesions. The results show that this method allows for the specific identification of samples having persistent HR HPV infection containing pre-neoplastic/neoplastic cells with invasive capacity.
Example 10
Automated Immunocytochemical Detection of HR HPV and the Over Expression of p16INK4a in Samples of the Uterine Cervix for Identification of Pre-Neoplastic/Neoplastic Cells
The method for staining and washing the samples described in Example 7 is followed.
The remaining steps are automated and performed under the control of a computer program. An Autostainer instrument (DakoCytomation, Carpinteria, Calif.) is used and a program for “HPV and p16INK4a” on cytological smears is run. Staining reagents vials are placed in the Autostainer rack according to the computer generated reagent layout map showed on the screen. The smears are loaded onto the instrument according to the computer generated slides layout map. An algorithm comprising the following steps is run:
“Rinse—300 mL primary antibody, mouse anti human p16INK4a antibody 3.48 μg/mL (clone E6H4), 30 minutes—rinse—8 minutes washing buffer (50 mM Tris-HCL, 150 mM NaCl, 0.05% Tween 20, pH 7.6)—300 mL visualization reagent goat anti mouse (DakoCytomation, Carpinteria, Calif.), 30 minutes—rinse—8 minutes TBST—rinse—primary streptavidin-HRP (DakoCytomation, Carpinteria, Calif.) diluted 1:3 in primary Streptavidin-HRP diluent (DakoCytomation, Carpinteria, Calif.), 30 minutes—rinse 8 minutes TBST—rinse 8 minutes TBST—rinse—biotinyl tyramide amplification reagent (DakoCytomation, Carpinteria, Calif.) 15 minutes—rinse 8 minutes TBST—rinse 8 minutes TBST—secondary streptavidin-HRP (DakoCytomation, Carpinteria, Calif.), 15 minutes—rinse 8 minutes TBST—rinse 8 minutes TBST—rinse 5 minutes—300 μL DAB chromogen concentrate is diluted 1:50 in DAB chromogen dilution (DakoCytomation, Carpinteria, Calif.), 5 minutes—rinse.
The smears are placed manually in Permanent Red Substrate Chromogen (DakoCytomation, Carpinteria, Calif.) for 10 minutes followed by several washings in distilled water. Finally, the smears are counterstained with hematoxylin and mounted.
Samples containing cells that react only with a specific HR HPV probe and not with the p16INK4a antibody are classified as samples having a risk for being malignant. Double stained cells that are reactive with both the HR HPV probe and p16INK4a antibody are pre-neoplastic/neoplastic.
The results show that this method allows for the specific identification of samples that contain pre-neoplastic/neoplastic cells having persistent HR HPV infection and samples that contain other cells infected with HR HPV virus having a risk for malignancy. Furthermore, double staining of the cells with reagents specific for HR HPV and p16INK4a permits discrimination of pre-neoplastic/neoplastic cells from metaplastic cells. It also permits identification of cells infected with HR HPV which are at risk for being malignant. The results are shown in FIG. 33.
Example 11
Immunocytochemical Detection of HR HPV and Laminin 5 and of the Over-Expression of p16INK4a in Samples of the Uterine Cervix for Identification of Pre-Neoplastic/Neoplastic Cells
In this experiment, cells are stained for HR HPV and both p16INK4a and Laminin 5. It is not necessary to distinguish between cells staining positive for Laminin 5 or p16INK4a. A positive result for either in combination with a positive HR HPV will be indicative of pre-neoplastic/neoplastic cells.
Merckofix® (Merck, Whitehouse Station, N.J.) cytological smears of the cervix uteri are prepared using ThinPrep® (Cytyc, Boxborough, Mass.) (liquid based cytology samples). The samples are immunochemically stained using DNA HR HPV probes, as described in Example 2, an antibody specific for p16INK4a and antibody specific for Laminin 5.
The method for staining and washing the samples described in Example 7 is followed with an antibody to p16INK4a and an antibody to Laminin 5.
The samples are incubated with a mixture of primary antibodies, including mouse anti human p16INK4a, at a concentration of 3.48 μg/mL (clone E6H4) and mouse anti human Laminin 5, at a concentration of 13.3 μg/mL (clone 4G1) for 30 minutes at room temperature.
The microscopic examination of the cytological smears reveals, that cells positive for expression of Laminin 5 or p16INK4a and HR HPV are found only in samples that may microscopically be identified as being pre-neoplastic or neoplastic.
Samples that contain cells reacting with only a specific HR HPV probe and not with the Laminin 5 or p16INK4a antibodies are classified as samples having a risk of being malignant. Triple stained cells that are reactive with both the HR HPV probe and Laminin 5/p16INK4a antibody are pre-neoplastic/neoplastic cells.
Triple staining of cells with reagents specific for HR HPV and Laminin 5/p16INK4a allows for discrimination of pre-neoplastic/neoplastic cells from metaplastic cells as well as cells infected with HR HPV having a risk for being malignant. The results are shown in FIG. 34.
Example 12
Detection of Pre-Neoplastic/Neoplastic Lesions Using a Ki-67 Antibody and HR-HPV Probes
The procedure described in Example 7, for fixing and staining of the cells is followed in this example as well, except that the smears are incubated with a different primary antibody. A mouse anti human Ki-67 (DakoCytomation, Carpinteria, Calif., clone MIB-1) at a concentration of 0.8 μg/ml is used. Samples are Incubated for 30 minutes at room temperature.
Examination of the stained slides by light microscopy reveals that cells that are positive for expression of Ki-67 and HR HPV are found in samples with pre-neoplastic/neoplastic lesions. The results are shown in FIG. 35.
Example 13
Detection of Pre-Neoplastic/Neoplastic Lesions Using a Cyclin E Antibody and HR-HPV Probes
The procedure described in Example 9, for pretreatment of tissue section and staining of the cells is followed in this example as well, except that the tissue samples from a patient diagnosed with cervical cancer is used and incubated with a different primary antibody. A mouse anti human cyclin E antibody (Novocastra Laboratories, Newcastle upon Tyne, clone 13A), diluted 1:25 is used. Samples are incubated for 30 minutes at room temperature.
Examination of the stained slides by light microscopy reveals that cells that are positive for expression of cyclin E and HR HPV are found in samples that with pre-neoplastic/neoplastic lesions.
Example 14
Detection of Pre-Neoplastic/Neoplastic Lesions Using a Cox-2 Antibody and HR-HPV Probes
The procedure described in Example 9, for pretreatment of tissue section and staining of the cells is followed in this example as well, except that the tissue samples from a patient diagnosed with colon cancer is used and incubated with a different primary antibody. A mouse anti human Cox-2 antibody (DakoCytomation, Carpinteria, Calif., clone CX-294) diluted to a concentration of 4.9 μg/mL is used. The samples are incubated for 30 minutes at room temperature.
Examination of the stained slides by light microscopy reveals that cells that are positive for expression of Cox-2 and HR HPV are found in samples that are diagnosed with colon cancer.
Example 15
In Situ Hybridization (ISH) Using a Probe Diluted in Hybridization Buffer Containing LMW Dextran Sulfate on Histology Samples
In Situ hybridization was performed as described above in Example 3. The only difference is that in some slides 10% LMW dextran sulfate (35,000 to 50,000) (USB Corporation, Cleveland, Ohio or MP Biochemicals, Aurora, Ohio) was used instead of 10% HMW dextran sulfate (450,000 to 550,000) (Sigma, St. Louis, Mo.) in the hybridization buffer described.
Slides stained with the probe in hybridization buffer containing HMW dextran sulfate showed non-specific background staining. In contrast, the non-specific background staining was removed when LMW dextran sulfate was used. (FIGS. 21 and 22).
Example 16
In Situ Hybridization (ISH) Using Probe Diluted in Hybridization Buffer Containing LMW Dextran Sulfate on Cytology Samples
In Situ hybridization was performed as described above in Example 2. The only difference is that in some slides 10% LMW dextran sulfate (35,000 to 50,000) (USB Corporation, Cleveland, Ohio or MP Biochemicals, Aurora, Ohio) was used instead of 10% HMW dextran sulfate (450,000 to 550,000) (Sigma, St. Louis, Mo.) in the hybridization buffer described.
Slides stained with the probe in hybridization buffer containing HMW dextran sulfate gave similar positive result as slides stained with the probe in hybridization buffer containing LMW dextran sulfate.
Example 17
Immunohistochemical Detection of Expression of Cox-2 and Laminin-5 in Cervical Samples
Formalin-fixed paraffin embedded (FFPE) cervical biopsies were deparaffinized and rehydrated before use. For deparaffinization, the slides were soaked in Histoclear (National Diagnostics, Atlanta, Calif.) for five minutes. This step was repeated once. The samples were rehydrated by placing in two changes of 99% ethanol, three minutes each, and 2 changes of 95% ethanol, three minutes each. The slides were then rinsed in reagent water before pre-treatment. For pre-treatment, Target Retrival Solution (TRS), pH 9, (DakoCytomation, code S 2367), was first diluted 1:10 in 180 mL of reagent water. The TRS was pre-warmed to 95° C. in a 97° C. water bath. The samples were incubated at 95° C. for 20 minutes in the TRS and then cooled at room temperature for 20 minutes. After rinsing the slides three times in reagent water the slides were put in 3% H2O2 for five minutes to remove endogenous peroxidase activity. After rinsing in reagent water, the slides were incubated in 0.05M Tris-HCl, pH 7.6, 0.15M NaCl (TBS) buffer for five minutes.
Primary antibody was applied after excess water was removed from the sample. Cox-2 (DakoCytomation, code M3617) diluted at 1:200 and Laminin-5 (DakoCytomation, code M7262) diluted at 1:25, were combined. Mouse IGg1 (DakoCytomation, code X0931) diluted at 1:50, was used as a negative control. Antibody dilutions were prepared using Antibody Diluent (DakoCytomation, code S0809). The slides were incubated at room temperature in a humid chamber for 30 minutes. The samples were then rinsed with TBS buffer and placed in fresh TBS for five minutes. Excess buffer was removed and Envision®+Labelled Polymer, HRP (DakoCytomation, code K4001) was applied. The slides were incubated at room temperature in a humid chamber for 30 minutes. The samples were then rinsed with TBS buffer and placed in fresh TBS for five minutes. The slides were next incubated for 10 minutes with chromogenic substrate DAB+ (DakoCytomation, Code K3468) in a humid chamber. After rinsing the slides three times in reagent water, they were counterstained with hematoxylin and mounted.
Examination of the stained samples by light microscopy revealed that the expression of Laminin 5 and Cox-2 is minimal in normal cervical samples but increases in high grade intra-epithelial lesions, squamous carcinoma, and adenocarcinoma.
Example 18
Detection of Human Telomerase and Histone H3 Expression by In Situ Hybridization Using Cervical Samples
Formalin-fixed paraffin embedded (FFPE) cervical tissues or cells (HeLa) were deparaffinized and rehydrated before use. For deparaffinization, the slides were soaked in Xylene or Histoclear (National Diagnostics, Atlanta, Ga.) for 5 minutes. This step was repeated once. The sample was re-hydrated by placing it in 2 changes of 99% ethanol and 3 changes of 95% ethanol, 1 minute each. The slides were rinsed in reagent water several times before pre-treatment. For pre-treatment, Target Retrival Solution (TRS) (DakoCytomation, code S1700) was pre-warmed to 95° C. in a 97° C. water bath. The samples were incubated at 95° C. for 40 minutes in the TRS and then cooled at room temperature for 20 minutes. For cervical tissues, an additional incubation of 20 minutes in 0.005% pepsin at room temperature was performed. After rinsing in reagent water several times, the slides were then incubated in 3% H2O2 for 5 minutes to remove endogenous peroxidase activity.
A cocktail probe targeting the RNA component of the human telomerase complex and mRNA of Histone H3 was used. Fifteen microliters of the probe was applied to each sample and a cover slip was applied. The samples were transferred to a humid chamber for hybridization at 37° C. and incubated for 2 hours. After hybridization, the cover slips were removed from the slides by immersing the slides in wash buffer at room temperature. Samples were thoroughly washed for 30 minutes at 52-55° C., under stringent conditions, using stringent wash buffer diluted 1:50 in water (DakoCytomation, code S3500). The samples were rinsed in wash buffer 3 times. The samples were incubated for 30 minutes in anti-FITC/HRP diluted 1:100 in anti-FITC/HRP diluent (DakoCytomation, code K0618) and then washed 3 times for 5 minutes in wash buffer. Fluoresyl tyramide amplification reagent (DakoCytomation, code K0618) was applied to the samples and incubated at room temperature for 15 minutes. The samples were washed 3 times for 5 minutes in wash buffer. The samples were incubated with anti-fluorescein/HRP (DakoCytomation, code no. K0618) for 15 minutes and then washed 3 times for 5 minutes in wash buffer. The chromogenic reaction was performed with di-amino-benzidine (DAB) where DAB chromogen concentrate was diluted 1:50 in DAB chromogen dilution buffer (DakoCytomation, code K0618) and incubated for 5 minutes at room temperature. After rinsing the slides three times in reagent water, they were counterstained with hematoxylin and mounted.
Examination of the stained samples by light microscopy revealed that the expression pattern of Histone H3 mRNA is cytoplasmic and the RNA component of telomerase is nuclear. The 2 markers gave strong staining in HeLa cells. In cervical tissues, both markers gave staining in proliferating cells.
Example 19
Detection of HR-HPV and the Overexpression of p16INK4a in Samples of the Uterine Cervix in Combination with Pap Staining for Identification of Pre-Neoplastic/Neoplastic Cells
The procedure described in example 6 for pretreatment and staining of cells is followed. After the DAB step, the slides are processed for PAP staining, as described in example 4.
The microscopic examination of the cytological smears reveals, that cells that are stained by the p16INK4a specific reaction and not stained by the HR HPV probe reaction, are either metaplastic, of endometrial origin, or contain an HR HPV type not detected by the probe cocktail, as can be morphologically identified by the Pap staining.
The results show that this method allows for the specific identification of samples that contain pre-neoplastic/neoplastic cells having persistent HR HPV infection and samples that contain other cells infected with HR HPV virus having a risk for malignancy. Furthermore, double staining of the cells with reagents specific for HR HPV and p16INK4a permits discrimination of pre-neoplastic/neoplastic cells from metaplastic cells. It also permits identification of cells infected with HR HPV which are at risk for being malignant.
Example 20
Immunocytochemical Detection of Ki-67 and Laminin 5, and the Overexpression of p16INK4a and Cyclin E in Samples of the Uterine Cervix for Identification of Pre-Neoplastic/Neoplastic Cells with Invasive Capacity
The procedure described in example 8 for pretreatment and staining of cells is followed, except that the smears are incubated with a antibody mixture containing antibody to p16INK4a, antibody to Cyclin E, and two additional antibodies. Mouse anti human p16INK4a antibody (isotype IgG2a) is used at a concentration of 3.48 μg/ml (clone E6H4), and Mouse anti human Cyclin E antibody (Novocastra Laboratories, Newcastle upon Tyne) (isotype IgG2a) diluted 1:25 is used. A mouse anti human Ki-67 antibody (clone MIB1) (isotype IgG1) is used at a concentration of 0.8 μg/mL and a rabbit anti human Laminin 5 antibody is used at a concentration of 14.5 μg/mL.
The smears are incubated with a mixture of all four primary antibodies and incubation time is for 30 min at room temperature.
Visualization of p16INK4a and Cyclin E is performed using goat anti mouse IgG2a/FITC (Jackson ImmunoResearch, PA). Visualization of Ki-67 is performed using goat anti mouse IgG1/Rhodamine (Jackson ImmunoResearch, PA). Visualization of Laminin 5 is performed using goat anti rabbit IgG/AMCA (Jackson ImmunoResearch, PA). The smears are incubated with a mixture of all three secondary antibodies and incubation time is for 30 min at room temperature.
The smears are counterstained with DAPI (1 μg/ml) in antifade solution (Vectashield, Vector Laboratories, CA).
The microscopic evaluation of the stained smears with a fluorescent microscope equipped with the corresponding filters reveals, that cells positive for expression of p16INK4a/Cyclin E, Ki-67 and Laminin 5 may only be found in samples that can be microscopically identified as pre-neoplastic/neoplastic cells with invasive capacity. The detection of both p16INK4a and Cyclin E increases the sensitivity for identification of pre-neoplastic/neoplastic cells. Cells only positive for Ki-67 can be identified as proliferating cells. Cells only positive for p16INK4a/Cyclin E and not for Ki-67 or Laminin 5 can be identified as metaplastic cells.
All numbers expressing quantities of ingredients, reaction conditions, and so forth used in the specification and claims are to be understood as being modified in all instances by the term “about.” Accordingly, unless indicated to the contrary, the numerical parameters set forth in the specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained by the present invention. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should be construed in light of the number of significant digits and ordinary rounding approaches.
Many modifications and variations of this invention can be made without departing from its spirit and scope, as will be apparent to those skilled in the art. The specific embodiments described herein are offered by way of example only and are not meant to be limiting in any way. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.

## Claims

1. A composition comprising a combination of nucleic acid probes consisting essentially of:
at least one first nucleic acid probe comprising a fragment of 10-500 consecutive bp from human papilloma virus 16 (SEQ ID NO: 1), which probe is capable of hybridizing to SEQ ID NO: 1 under low stringency conditions,
at least one second nucleic acid probe comprising a fragment of 10-500 consecutive bp from human papilloma virus 18 (SEQ ID NO: 2), which probe is capable of hybridizing to SEQ ID NO: 2 under low stringency conditions, and
at least one third nucleic acid probe comprising a fragment of 10-500 consecutive bp from human papilloma virus 51 (SEQ ID NO: 4), which probe is capable of hybridizing to SEQ ID NO: 4 under low stringency conditions;
wherein the combination of nucleic acid probes is capable of hybridizing to at least 14 high risk HPV types, and
wherein at least one nucleic acid probe chosen from the first, second or third nucleic acid probes is capable of hybridizing to a human papilloma virus (HPV) nucleic acid contained in a sample thereby forming at least one nucleic acid-HPV hybridization complex, and wherein hybridization of the at least one nucleic acid probe to the sample indicates the presence of cancer or the risk of developing cancer.

2. The composition of claim 1, wherein the nucleic acid probes comprise DNA, RNA, LNA or PNA.

3. The composition of claim 1, wherein the nucleic acid probes are labeled with a detectable substance.

4. The composition of claim 1, further comprising a hybridization buffer comprising a low molecular weight dextran sulfate.

5. The composition of claim 4, wherein the low molecular weight dextran sulfate is present in an amount ranging from 5-15 wt/vol %.

6. The composition of claim 1, wherein the fragments of 10-500 consecutive bp are 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 200, 300, 400, or 500 bp in length.

7. The composition of claim 1, wherein the at least one first, at least one second, and at least one third nucleic acid probes are present in equal proportions in the combination.

8. The composition of claim 1, wherein the composition further comprises materials for performing a PAP stain of a sample.

9. A composition comprising:
(a) a combination of nucleic acid probes consisting essentially of:
at least one first nucleic acid probe comprising a fragment of 10-500 consecutive bp from human papilloma virus 16 (SEQ ID NO: 1), which probe is capable of hybridizing to SEQ ID NO: 1 under low stringency conditions,
at least one second nucleic acid probe comprising a fragment of 10-500 consecutive bp from human papilloma virus 18 (SEQ ID NO: 2), which probe is capable of hybridizing to SEQ ID NO: 2 under low stringency conditions, and
at least one third nucleic acid probe comprising a fragment of 10-500 consecutive bp from human papilloma virus 51 (SEQ ID NO: 4), which probe is capable of hybridizing to SEQ ID NO: 4 under low stringency conditions;
wherein the combination of the first, second, and third nucleic acid probes is capable of hybridizing to at least 14 high risk HPV types, and
wherein at least one nucleic acid probe chosen from the first, second or third nucleic acid probes is capable of hybridizing to a human papilloma virus (HPV) nucleic acid contained in a sample thereby forming at least one nucleic acid-HPV hybridization complex, and wherein hybridization of the at least one nucleic acid probe to the sample indicates the presence of cancer or the risk of developing cancer; and further comprising

(b) at least one further nucleic acid probe that is capable of hybridizing to at least one low risk HPV type, and/or at least one molecule that is capable of hybridizing to at least one marker for cancer.

10. The composition of claim 9, comprising at least one further nucleic acid probe that is capable of hybridizing to at least one low risk HPV type, wherein the further nucleic acid probe is substantially identical to a full length genomic clone of a low risk HPV type, or fragment thereof.

11. The composition of claim 10, wherein the low risk HPV type is HPV 11 or HPV 70.

12. The composition of claim 9 wherein the nucleic acid probes comprise DNA, RNA, LNA or PNA.

13. The composition of claim 9, wherein the first, second, and third nucleic acid probes are labeled with a detectable substance.

14. The composition of claim 9, wherein the fragments of 10-500 consecutive bp are 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 200, 300, 400, or 500 bp in length.

15. The composition of claim 9, wherein the at least one first, at least one second, and at least one third nucleic acid probes are present in equal proportions in the combination.

16. The composition of claim 9, wherein the composition further comprises materials for performing a PAP stain of a sample.

17. The composition of claim 9, comprising at least one further nucleic acid probe that is capable of hybridizing to at least one low risk HPV type, wherein the further nucleic acid probe is not labeled with a detectable substance.

18. The composition of claim 13, comprising at least one further nucleic acid probe that is capable of hybridizing to at least one low risk HPV type, wherein the further nucleic acid probe is labeled with a detectable substance that is different from the detectable substance used to label the first, second, and third nucleic acid probes.

19. The composition of claim 9, comprising at least one molecule that is capable of hybridizing to at least one marker for cancer, wherein the molecule is capable of hybridizing to a cervical, colon, anal, or HPV-related cancer marker.

20. The composition of claim 9, comprising at least one molecule that is capable of hybridizing to at least one marker for cancer, wherein the molecule is an antibody.