# Patent

## Title
Assay of isomerised and/or optically inverted proteins and protein fragments

## Abstract

In an in vitro diagnostic test for osteoarthritis or rheumatoid arthritis, the amount or presence in a sample of anisomerised or optically inverted protein fragment is measured which derives from perlecan, bigylcan, decorin, fibrillin-1 or protocadherin or which is a specific sequence from aggrecan, type II collagen, COMP or CILP.

## Background
The present application claims benefit to PCT/EP02/05612 (WO 02/095415) as filed on May 22, 2002 which application claims benefit to Great Britain Application No. 0112626.7 as filed on May 23, 2001. The disclosures of the PCT/EP02/05612 (WO 02/095415) and 0112626.7 are incorporated herein by reference.
BACKGROUND OF THE INVENTION
The present invention relates to immunoassays for non-collagen cartilage proteins and their fragments in biological samples such as body fluids. Such proteins and protein fragments may serve as an index of joint disease.
A number of diseases are associated with increased turnover of the extra cellular matrix of tissues or organs in the mammalian body. As examples of such diseases or pathological conditions, arthritic diseases involves increased turnover of tissues of the joint, osteoporosis is associated with increased turnover of bone tissue, psoriasis and scleroderma is associated with increased turnover of skin and various cancer types are also associated with increased tissue turnover of the disease affected tissue(s) or organ(s). Of special relevance in these conditions is a quantification of the catabolic processes associated with the disease as these often predominates and results in degradation of the affected tissues or organs. Such catabolic process can be difficult to quantify, and specific biochemical markers for monitoring such processes would be of great clinical utility for diagnosis, monitoring and assessing prognosis of the diseases. Furthermore, such markers could be used in pre-clinical and clinical research for identification and assessment of new therapeutic agents and for optimising treatment dose and treatment modality. However, even though a need for such markers clearly exists it has been difficult to identify and develop such biochemical markers and very few such markers exist today for routine use in clinical management of disease or research into disease mechanisms and development of new therapeutic agents.
The present invention provides a general method for identification of biochemical markers specific for catabolic processes in a mammalian tissue or organ. This method has been applied for identification of new markers of cartilage turnover; a process which is of relevance for all arthritic diseases, as described below.
Increased awareness of the early biochemical and structural changes in cartilage-related diseases in combination with the introduction of new disease suppressive agents has created the need to develop improved tools to assess disease severity and prognosis. Thus the need for sensitive simple and reliable markers for cartilage degradation is evident, and such markers will fulfill important clinical purpose for management of arthritic disease.
As of today, no tissue specific biochemical marker exists which is of general use for diagnosis and monitoring of cartilage degradation in Rheumatoid Arthritis (RA) and Osteoarthritis (OA) patients. Markers such as C-reactive protein (CRP), rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR) are frequently applied in RA. These markers provide information about the inflammatory reactions in the disease, but are not specific for joint diseases, and in spite of their wide-spread use, their clinical utility is still discussed. At present one of the best ways to obtain information about the status of the (individual) joints in arthritis patients is radiological examination.
Measurement of metabolites, such as hyaluronates and aggrecan fragments arising from destruction of the specific organ (the joints) affected by the arthritis has been reported, for review please see Wollheim (Wollheim, 1996). The two main arthritic diseases, RA and OA are briefly described below.
Osteoarthritis:
Osteoarthritis (OA) is a chronic disease characterized by degenerative changes of the joints and bone with destruction of the cartilage and reactive formation of bone in the periphery of the joint. OA is a common disease, with an increasing incidence with age. At the age of 50 approximately 20% have symptoms of OA and radiologically almost 90% exhibit OA-related changes.
One of the earliest events that can be detected histologically is the loss of proteoglycans (aggrecan) from the tissue (Flannerly et al 1992). The likely mechanism is the fragmentation of aggrecan by proteinases. The generation of aggrecan fragments is detrimental to the proper functioning of cartilage. In later stages of the disease also collagen fibrils are degraded (Eyre et al 1991) and the surface of the cartilage is eroded due to loss of tissue (Inerot & Heineg{dot over (a)}rd, 1982).
Rheumatoid Arthritis:
Rheumatoid arthritis (RA) is an autoimmune disease, where the patients own immune system attacks the joints, causing inflammation and subsequent degradation of the cartilage matrix. The disease affects approximately 1% of the population. At present the underlying causes responsible for initiation of the disease are unknown, however studies of its epidemiology show that genetic as well as environmental factors contribute to the pathogenesis.
RA is characterized by chronic inflammation associated with erosion of both cartilage and bone. In advanced late stages of the disease, radiographs show characteristic evidence of cartilage loss and bone erosion at the joint margin. However much damage may be done early in the disease, before radiographs change. Sensitive indices of the current cartilage and bone changes in RA would therefore be of potential value to clinicians.
The present invention describes methods for identifying such markers and also methods for developing and applying assays for such markers for management of arthritic disease as well as for developing new therapeutic or disease management methods for arthritic disease.
One aim of the present invention is to provide new methods and procedures for identifying potential markers of cartilage degradation based on identification of isomerised and/or optically inverted fragments of cartilage-derived proteins. Such markers will provide a significant advantage for the clinical management of OA, RA as well as other diseases affecting joint metabolism. Furthermore the use of such markers for management of arthritic disease and development of anti-arthritic therapeutic agents is described.
The Extracellular Matrix of Cartilage:
Cartilage matrix is synthesized, degraded, organized and maintained by a sparse population of chondrocytes (making up 0.5-2% of the total cartilage volume) (Poole et al 1994, Poole & Dieppe 1994). These cells are protected from the potentially damaging forces of mechanical function by the extra-cellular matrix (ECM) they produce.
The properties of cartilage are critically dependent upon the structure and integrity of the ECM. Thus, normal turnover is a conservative process in which the rate of matrix degradation does not exceed the rate at which it is replaced. There is a slow constant turnover of the ECM with chondrocytes both degrading and synthesizing matrix proteins. Healing of cartilage is dependent entirely on surviving chondrocytes near the margins of the injury. In adults these cells mediate essentially no repair.
A number of cartilage proteins have been identified and characterized. The main structural component of cartilage is made up of collagen fibers, predominantly composed of collagen type II with minor amounts (typically less than 10%) of collagen type IX and type XI. Interspaced between the collagen network are long chains of the negatively charged polysaccharide hyaluronic acids, to which several large proteoglycans are attached. The major proteoglycan is aggrecan. Aggrecan is a large protein with a molecular mass of 2600 kDa with a core protein of 220 kDa (Doege et al 1991). The protein is composed of 93% glycosaminoglycans (about 87% chondroitin sulphate and 6% keratan sulphate) and 7% protein. Aggrecan is a major component of cartilage where it accounts for about 10% of the dry weight of cartilage. The oligosaccharide moieties of aggrecan are highly negatively charged which draws water into the tissue as it creates a large osmotic swelling pressure. The water thus swells and expands the aggrecan-rich matrix. This places the collagen network under tension and an equilibrium is achieved when tension in the collagen network balances the swelling pressure (i.e., when no more water enters the tissue because the force is insufficient to stretch the collagen network any further). The aggrecan molecule is made up of 7 different domains. At the N-terminus there are two structurally related globular domains termed G1 and G2, separated by a short region known as the interglobular domain (IGD). Although the function of the G2 domain has not been determined the G1 domain is known to serve as a ‘linker’ to hyaluronan and is responsible for the formation of large aggrecan aggregates (Hardingham & Muir, 1972). The G1 domain is also in contact with cartilage link protein (see below). C-terminally to the G2 domain there is a long region consisting of two glycosaminoglycan-rich regions. The first is a domain rich in keratan sulphate (KS), whereas the other is composed of two domains rich in chondroitin sulphate (CS). At the C-terminus aggrecan possesses a third globular domain G3. The G3 domain seems to be lost soon after synthesis and secretion, the consequence of loss of the G3 domain is not yet understood (Hardingham & Fosang, 1992). Current evidence indicates that aggrecan fragments released during degradation of the cartilage matrix are heterogeneous products and may reflect various stages of disease progression depending on which fragments are monitored. In early or non-cartilage destructive diseases no or only small amounts of fragments related to the G1 domain are released (Saxne & Heineg{dot over (a)}rd 1992). Increased release of G1 related fragments, only accompanies the more profound and presumably irreversible cartilage derangement seen in patients with more damaged joints (Saxne & Heineg{dot over (a)}rd 1995).
A number of non-collagen cartilage proteins have been described although not all of these proteins are specific in cartilage, they play important structural and/or functional roles in the tissue, and may potentially serve as markers of cartilage turnover.
Cartilage intermediate layer protein (CILP) is noncollagenous cartilage protein composed of a single polypeptide chain with a molecular weight of 91.5 kDa, including N-linked oligosaccharides (Lorenzo et al. 1998a and 1998b). The protein is synthesized by chondrocytes and located to the interterritorial cartilage. It is neither found in the superficial nor deepest regions of the articular cartilage. CILP has been reported to increase with age and has been suggested to be a marker of early OA.
Cartilage Oligomeric Matrix Protein (COMP) is a non-collagenous extra-cellular matrix protein found predominantly in cartilage, but also in tendon, ligament and meniscus (Muller et al 1998). Several mesenchymal cells including synoviocytes and dermal fibroblasts produce substantial amounts of COMP (Dodge et al 1998). The physiological function of the protein is not known. COMP is a large disulfide-linked pentameric protein with a molecular weight of each monomer of about 100 kDa. The protein belongs to the thrombospondin family and it displays a high homology to thrombospondin 1-4 (Adams & Tucker 2000). In vitro data indicate that COMP may mediate cell binding within the cartilage matrix in accordance with the function of other members of the thrombospondin family. Furthermore, it is likely that COMP participates in regulation of collagen fibril formation (Rosenberg et al 1998). The major source of COMP within the joint appears to be fibroblastic cells in sub-synovial tissue. In cartilage COMP may be found as both the intact pentamer and in various fragments (43-160 kDa) generated by the action of MMP's as well as other proteases (Saxne & Heineg{dot over (a)}rd 1992, Ganu et al 1998). In OA cartilage the proportion of degraded COMP is higher than in normal cartilage even though the total amounts of COMP appears to be similar (Vilim et al 1997, Niedhart et al 1997). In RA cartilage there is a net loss of COMP, and the COMP fragments appear to be of smaller size than those seen in OA (Clarke et al 1999, Vingsbo-Lundberg et al 1998).
A number of COMP assays based on both polyclonal and monoclonal antibodies have been described in the literature, but the exact epitope specificity of the assays is generally not characterized (Saxne & Heineg{dot over (a)}rd 1992, Niedhart et al 1997). A number of cross-sectional studies have demonstrated elevated COMP levels in patients with OA, RA and other diseases affecting joint metabolism (Sharif et al 1995, Vingsbo-Lundberg et al 1998, Clarke et al 1999, Niedhart et al 1997).
Perlecan is a heparin sulphate proteoglycan that is expressed in all basement membranes, cartilage and several other mesenchymal tissues during development. Perlecan binds growth factors and interacts with various extracellular matrix proteins and cell adhesion molecules. Relatively high levels of perlecan have been found in mature cartilage, and in vitro experiments have suggested that perlecan supports chondrocyte differentiation (Costell et al 1999).
Biglycan and decorin belong to the family of small leucine rich proteoglycans. They are relatively highly expressed in foetal cartilage, but are found in lower amounts in adult cartilage. Their functional role in cartilage is not fully elucidated but they may be involved in maintaining the structural integrity of the collagen fiber network and the hyaluronic acid mesh (Knudson & Knudson 2001). Furthermore they may play a role in chondrogenesis and cartilage degradation.
Fibrillin-1 (Fib-1) is a connective tissue protein, with an estimated molecular mass of 350,000 D. Fibrillin 1 is found in extracellular microfibrils in a variety of connective tissues. The protein has a widespread distribution in the connective tissue matrices of skin, lung, kidney, vasculature, cartilage, tendon, muscle, cornea, and ciliary zonule (Sakai et al 1986). The functional relationships between this glycoprotein and other components of the microfibrils and elastic fibers are unknown. Synthesis of fibrillin-1 correlates with late morphogenesis and the appearance of well-defined organ structures (Zhang and Ramirez 1995). It is widely expressed in developing limbs and digits, especially in the perichondrium (Keene et al 1997). Fib-1 appears as a loose meshwork of fibers within cartilage matrix by 20 weeks of fetal gestation. Until early adolescence, Fib-1 forms loose bundles of microfibrils within cartilage (Keene et al; 1997). However, by late adolescence, broad banded fibers composed of Fib-1 are found accumulated pericellularly within cartilage probably as laterally packed and crosslinked microfibrils. It has been proposed that fibrillin-1 provides force-bearing structural support to extracellular microfibrils and that it may growth-regulating functions in the perichondrium (Keene et al. 1997, Zhang and Ramirez 1995).
Protocadherins constitute a large family belonging to the cadherin superfamily and function in different tissues of a wide variety of multicellular organisms. Protocadherins have unique features that are not found in classic cadherins. Little is known about the Protocadherin subfamily gamma.
In joint diseases, the rate of degradation of matrix often exceeds the rate of synthesis, and, as consequence, the tissue becomes thin and mechanically weak (Heineg{dot over (a)}rd et al 1999). As the catabolic processes dominate in the arthritic disease states, fragments of cartilage proteins is produced, and such fragments can be measured in synovial fluid, serum and urine as markers of the cartilage degradation.
Joint diseases and related conditions involving abnormalities in the metabolism of cartilage cause widespread disability. Erosion of the articular cartilage is a typical finding in degenerative and inflammatory joint diseases, such as OA and RA.
BRIEF SUMMARY OF THE INVENTION
Hypothesis Underlying the Invention
This invention describes a novel approach for identifying markers of cartilage degradation, and for development of diagnostic and prognostic assays for monitoring joint diseases. This approach is applicable not only for the identification of cartilage derived biochemical markers, but also as a generally applicable method for identification of proteins or protein fragments of an extra-cellular matrix tissue or organ of a mammal that may be suited as markers for turnover of the specific tissue or organ. We show that specific components of articular cartilage are prone to isomerisation and optical inversion (Example 1) and we identify specific isomerisation/optical inversion prone sites in several cartilage proteins. We also demonstrate that isomerised and/or optically inverted fragments of cartilage protein are found in circulation, and that measurements of such fragments provide an index of joint cartilage degradation.
Aspartic acid and asparagine (Asx) and glutamic acid and glutamine (Glx) residues will in some susceptible proteins undergo a spontaneous re-arrangement where the normal peptide bond between the Asx or Glx residue and the adjacent residue is transferred from the normal α-carboxyl group to the β-carboxyl group (α-carboxyl group for the Glx residues) of the side chain (Clarke 1987). The isomerisation reaction proceeds via a succinimide intermediate, which upon spontaneous hydrolysis may result in one of four forms: the normally occurring αL, the isoform βL, or the two optically inverted forms αD and βD as outlined in the following reaction scheme for aspartic acid—glycine (The reaction occurs analogously for other susceptible Asx and Glx containing sequences):




The above reaction scheme shows the authentic αL (A) form of the peptide bond as well as the three isomerised and/or optically inverted forms (βL (C), αD (G) and βD (I). The attack by the peptide backbone nitrogen on the side chain carbonyl group of an adjacent aspartyl residue can result in the formation of a succinimide ring, (A→B). The succinimide ring is prone to hydrolysis and optical inversion yielding peptides and iso-peptides in both the D and L configurations. Optical inversion proceeds through a carbanion intermediate (D, E and F) either through direct proton abstraction (A⇄D⇄G or C⇄F⇄I) or via the succinimide pathway (B⇄E⇄H). Throughout the figure the peptide backbone is shown as a bold line.
Cyclic imide formation (and thus isomerisation/optical inversion) can only occur, where the three-dimensional structure surrounding the Asx (asparagine or aspartic acid) or Glx (Glutamine or glutamic acid) has an optimal conformation and sufficient flexibility (Clarke 1987). Isomerisation and optical inversion via the succinimide intermediate as outlined above is a spontaneous reaction occurring with a slow rate under physiological conditions (Geiger & Clarke 1987, Fledelius et al 1997). As for all chemical reactions, increasing temperature can accelerate the reaction speed.
The introduction of such structural changes in a protein or peptide has profound effects on its function, stability and physical and chemical properties. Among other properties, the proteolytic degradation of proteins and peptides containing isomerised and/or optically inverted peptide linkages is significantly reduced compared to proteins and peptides composed exclusively of αL amino acids (Rafferty et al. 1988). Thus, protein fragments containing such modifications are not degraded to the same extent during normal tissue turnover (Van Regenmortel & Muller 1998) and they are much more likely to be present in circulation in measurable concentrations. Furthermore, by measuring proteins, or protein fragments containing isomerised and/or optically inverted peptide linkages, newly synthesized molecules will not contribute to the measurements, and it will thus reflect ongoing degradation processes.
In WO01/38872 (not published at the priority date hereof) we demonstrated that articular cartilage, a tissue with a very slow metabolism, contain proteins which are subject to isomerisation and optical inversion and we demonstrated that measurement of these proteins, or fragments thereof, can provide an index of joint cartilage degradation of diagnostic potential for assessing and monitoring joint diseases such as RA and OA.
We furthermore provided a method which is of general use for identification of markers of catabolic processes in mammalian tissues or organs, based on identification of isomerisation and/or optical inversion sites in extra-cellular matrix proteins and development of diagnostic assays specific for such isomerised and/or optically inverted proteins or protein fragments. By measuring protein fragments containing isomerised or optically inverted residues contributions from anabolic or tissue formation processes is minimized. We have found that isomerised and/or optically inverted fragments of aggrecan as well as collagen type I are found in serum, and that the measurements of such fragments reflect cartilage and bone resorption respectively.
Thus the invention described in WO01/38872 provided a novel approach to identification of biochemical markers of catabolic processes in mammalian tissues or organs, different from previous markers which have been reported as potential markers of i.e. arthritic disease such as YKL-40 (Johansen et al 1993, Johansen et al 1996, Harvey et al 1998), aggrecan (Heineg{dot over (a)}rd et al 1985) or cartilage oligomeric matrix protein (COMP) (Niedhart et al 1997, Saxne et al 1992, Saxne et al 1996). These markers rely on measurement of cartilage proteins in synovial fluid or serum, but as these cartilage proteins can be released during both anabolic and catabolic processes in the cartilage tissue it is not known whether they provide a specific measure of cartilage degradation. By measuring isomerised and/or optically inverted fragments of extra-cellular matrix derived proteins it is ensured that the marker is derived from tissue degradation as the isomerisation process occurs with relatively slow kinetics, and thus only in aged proteins significant isomerisation/optical inversion will have occurred (Radkiewicz et al 1996). Thus, no contribution from tissue formation (anabolic) processes is influencing measures of markers developed from isomerised and/or optically inverted extra-cellular matrix proteins.
The proteins covered by this previous application were aggrecan, cartilage link protein (CLP), cartilage oligomeric protein (COMP) and cartilage intermediate layer protein (CILP).
The present invention now provides in a first aspect a method of assay, comprising measuring in a biological sample the amount or presence of an isomerised and/or optically inverted protein or of one or more isomerised and/or optically inverted fragments from such a protein, wherein said protein is perlecan (SEQ ID NO 1), biglycan (SEQ ID NO 5), decorin (SEQ ID NO 3), fibrillin-1 (SEQ ID NO 10), or protocadherin (SEQ ID NO 8).
The SEQ ID NO's given above are only meant as examples of these proteins, homologous sequences from other mammals also lie within the scope of the present invention.
In a preferred embodiment, the method is based on the competitive binding of a isomerised and/or optically inverted protein or protein fragments produced in vivo or in vitro upon tissue degradation in biological fluids (body fluids or cell culture fluids) and of synthetic peptides essentially derived from such molecules to immunological binding partners.
In second preferred embodiment, the method is carried out using an immunological binding partner specific for a fragment containing an isomerised or optically inverted residue.
For purposes of the present invention, as disclosed and claimed herein, the following terms are defined below:
Antibody: a monoclonal or polyclonal antibody or immunoreactive fragment thereof (i.e. capable of binding the same antigenic determinant), including—but not limited to—Fab, Fab′ and F(ab′)2 fragments.
*Asx: denotes one of the isomerised or optically inverted forms of aspargine or aspartic acid, which are αD-Asp, αD-Asn, βL-Asp or βD-Asp.
*Glx: denotes one of the isomerised or optically inverted forms of glutamine or glutamic acid, which are αD-Glu, αD-Gln, γL-Glu or γD-Glu.
Isomerised residues: Amino acid residues within a (poly)peptide where said residues are bound to their adjacent residue through an isopeptide bond (e.g. a bond proceeding through the side-chain β or γ-carboxyl group).
Optically inverted residues: D-amino acid residues.
Isomerised (about antigens, peptides, proteins and sequences): Molecules containing isomerised residues (isopeptide bonds).
Optically inverted (about antigens, peptides, proteins and sequences): Molecules containing D-amino acid residues.
Native (about antigens, peptides, proteins and sequences): Antigens/peptides/proteins and sequences composed of L-amino acid residues linked together by normal peptide bonds.
Test kit: A combination of reagents and instructions for use in conducting an assay.
Essentially derived (about structures): Structures with similar antigenicity, i.e. with an ability, above the level of a non-related peptide, to inhibit the binding of any of the mentioned synthetic peptides to an immunological binding partner immunoreactive with said synthetic peptide.
Biological fluid: Body fluids including urine, blood, serum, plasma saliva, sweat and synovial fluid, as well as fluids derived from cells in culture (e.g. supernatants from bone and cartilage cell cultures).
It is contemplated that the method may be used for assaying isopeptide or optically inverted fragments in biological fluids. It can also be used during pre-clinical and clinical testing of drugs to assess the impact of these drugs on metabolism and arthritic disease.
A method according to the invention may preferably determine the amount or presence of at least one of the above mentioned *Asx or *Glx containing proteins or protein fragments in said biological sample, wherein *Asx is αD-Asp, αD-Asn, βL-Asp or βD-Asp and *Glx is αD-Glu, αD-Gln, γL-Glu or γD-Glu.
Such a method may measure the amount of at least one protein or protein fragment containing the perlecan derived amino acid sequence YPVRIESSSASLANGHTL (SEQ ID NO 2) or a fragment thereof containing the E and/or N residue, wherein N denote αL-Asn or an amino acid covered by the term *Asx and E denote αL-Glu or an amino acid covered by the term *Glx (although in view of the requirement that the detected material is isomerised or optically inverted, N will not denote αL-Asn when E denotes αL-Glu).
Such a method may measure the amount of a least one protein or protein fragment containing the decorin derived amino acid sequence IADTNITSIPQGLPPSLTELLDG (SEQ ID NO 4) or a fragment thereof containing the D, E, N and/or Q residue, wherein N denotes αL-Asn or an amino acid covered by the term *Asx, D denotes αL-Asp or an amino acid covered by the term *ASX, E denotes αL-Glu or an amino acid covered by the term *Glx and Q denotes αL-Gln or an amino acid covered by the term *Glx (but for similar reasons not all will be αL).
Such a method may measure the amount of at least one protein or protein fragment containing the biglycan derived amino acid sequence FTLDDGPFMMNDE (SEQ ID NO 6) or a fragment thereof containing the D and/or E residue, wherein D denotes L-Asp or an amino acid covered by the term *Asx and E denotes L-Glu or an amino acid covered by the term *Glx (again not all four will be αL).
Such a method may measure the amount of at least one protein or protein fragment containing the protocadherin derived amino acid sequence YEQFRDLELRVIARDS (SEQ ID NO 8) or a fragment thereof containing the D and/or E residue, wherein D denotes αL-Asp or an amino acid covered by the term *AsX and E denotes αL-Glu or an amino acid covered by the term *Glx (all four will not be αL in the same detected molecule).
Such a method may measure the amount of at least one protein or protein fragment containing the fibrillin-1 derived amino acid sequence YEQFSGGCQDINE (SEQ ID NO 11) or a fragment thereof containing the D, E, N and/or Q residue, wherein N denotes αL-Asn or an amino acid covered by the term *Asx, D denotes αL-Asp or an amino acid covered by the term *Asx, E denotes αL-Glu or an amino acid covered by the term *Glx and Q denotes αL-Gln or an amino acid covered by the term *Glx (again not all will be in the αL form).
Such a method may measure the amount of at least one protein or protein fragment containing the protocadherin derived amino acid sequence YEQFRDLELR (SEQ ID NO 9) or a fragment thereof containing the D and/or E residue, wherein D denotes αL-Asp or an amino acid covered by the term *Asx and E denotes αL-Glu or an amino acid covered by the term *Glx (but not all will be αL).
In an alternative aspect, the invention includes a method of assay, comprising measuring in a sample the amount or presence of an isomerised or optically inverted fragment of a protein, wherein

    (a) said protein is aggrecan and said fragment contains one of the amino acid sequences: LYPNQTGLPDPLSR (SEQ ID NO 12), SAIIATEQLQAAYEDGFHQC (SEQ ID NO 13), LATTGQLYLAWQAGMDM (SEQ ID NO 14), TGEDFVDIPENFFGV (SEQ ID NO 15), TGEDFVDIPEN (SEQ ID NO 16) or VSLPNYPAIPSDATLEVQSLRSNDSGVYR (SEQ ID NO 17) or a fragment thereof containing the D, E, N and/or Q residue, wherein N denotes αL-Asn or an amino acid covered by the term *Asx, D denotes αL-Asp or an amino acid covered by the term *Asx, E denotes αL-Glu or an amino acid covered by the term *Glx and Q denotes αL-Gln or an amino acid covered by the term *Glx.;
    (b) said protein is type II collagen and said fragment contains the amino acid sequence EGSXGADGPXGRDG (SEQ ID NO 18) or a fragment thereof containing the D and/or E residue, wherein D denotes αL-Asp or an amino acid covered by the term *Asx and E denotes αL-Glu or an amino acid covered by the term *Glx;
    (c) said protein is COMP and said fragment contains the amino acid sequence AQEDSDH (SEQ ID NO 19) or a fragment thereof containing the D, E and/or Q residue, wherein D denotes αL-Asp or an amino acid covered by the term *Asx, E denotes αL-Glu or an amino acid covered by the term *Glx and Q denotes αL-Gln or an amino acid covered by the term *Glx.; or
    (d) said protein is CILP and said fragment contains the amino acid sequence LLTQTDSDGR (SEQ ID NO 20) or a fragment thereof containing the D and/or Q residue, wherein D denotes αL-Asp or an amino acid covered by the term *Asx and Q denotes αL-Gln or an amino acid covered by the term *Glx.


Fragments for detection as described above may preferably contain at least 4 amino acids, more preferably at least 8 amino acids.
In all of the above sequences, the amino acids marked by bold type face are of particular interest as sites of isomerisation or optical inversion. Only one of these sites need to be in an isomerised or optically inverted state in order to carry out the present invention.
The measurement performed in the methods of the present invention maybe carried out using an immunological binding partner which specifically binds an amino acid sequence comprising *Asx or *Glx.
Said immunological binding partner may be an antibody raised against a synthetic peptide having an amino acid sequence comprising *Asx or *Glx, or fragment of such an antibody having immunological binding specificity.
Preferably, said amino acid sequence corresponds to a characteristic sequence of a protein or fragment thereof covered by the present invention, with *Asx or *Glx substituting αL-Asp, -Asn, -Gln, or -Glu in said protein sequence.
Said measurement may provide an index of cartilage turnover relevant for conditions and diseases affecting joint tissue turnover.
Optionally the method further comprises carrying out a measurement of a second index of joint disease and determining the value of a parameter mathematically combining said two indices.
Thus the invention includes the use of ratios between measurements for monitoring a pathological situation or therapeutic intervention in a mammal, applying two or more assays specific for isomerised and/or optically inverted proteins or protein fragments from an extracellular matrix protein as described in the above.
The ratios can be generated from any such marker consisting of an isomerised and/or optically inverted protein or protein fragment from an extracellular matrix protein measured by the assays as described and other markers of tissue metabolism and/or tissue function for monitoring a pathological situation or therapeutic intervention in a mammal.
The invention includes the use of an isomerised and/or optically inverted protein or of one or more isomerised and/or optically inverted fragments from such a protein in an in vitro method of assay for the diagnosis or the assessment of the severity of OA or RA, comprising measuring in a biological sample the amount or presence of an isomerised and/or optically inverted protein or of one or more isomerised and/or optically inverted fragments from such a protein, wherein said protein is perlecan, biglycan, decorin, fibrillin-1, or protocadherin.
The invention include the use of an immunological binding partner which specifically binds an amino acid sequence comprising *Asx or *Glx flanked by amino acid residues of perlecan, biglycan, decorin, fibrillin-1, or protocadherin in an in vitro method for use in the diagnosis or the assessment of the severity of OA or RA.
In another aspect, the invention provides an immunological binding partner which specifically binds an amino acid sequence comprising *Asx or *Glx flanked by amino acid residues of perlecan, biglycan, decorin, fibrillin-1 or protocadherin.
The immunological binding partner may specifically bind a sequence set out above.
The invention includes a cell line producing a monoclonal antibody which is an immunological binding partner described herein.
The invention further includes a peptide of up to 20 (e.g. 4 to 20 or 8 to 20) amino acids in length containing *Asx or *Glx flanked by amino acid residues of perlecan, biglycan, decorin, fibrillin-1, or protocadherin.
The peptides described maybe used in assays providing therapeutic information for treating a pathological condition in a mammal.
The invention includes a method of immunoassay in which a biological sample is contacted with an immunological binding agent in the presence of a peptide, as described, acting as a competition agent for binding to said immunological binding agent.
In a further aspect there is provided a test kit comprising (a) an immunological binding partner as described herein or (b) a peptide as described herein. Versions of the test kit combine (a) and (b), optionally in combination with one or more apparatus in which to perform an immunoassay, an antibody-enzyme conjugate, a substrate for an enzyme component of an antibody-enzyme conjugate, an enzyme-substrate reaction stopping composition, or a wash solution, a carrier bound to said binding partner or a detectable label bound to said binding partner.
The invention also includes cell lines (e.g. hybridomas) that produce monoclonal antibodies immunoreactive with the above-mentioned proteins, fragments thereof or synthetic peptides. The invention further includes monoclonal antibodies produced by the fused cell hybrids, and those antibodies (as well as binding fragments thereof, e.g. Fab) coupled to a detectable marker. Examples of detectable markers include, but are not limited to, enzymes, chromophores, fluorophores, co-enzymes, enzyme inhibitors, chemiluminescent materials, paramagnetic metals, spin labels and radioisotopes.
The methods of the invention typically involve quantitating in a biological fluid the concentration of particular isopeptide fragments derived from tissue degradation. In a representative assay, isopeptide fragments in the biological fluid and a synthetic peptide immobilized on a solid support are contacted with an immunological binding partner, which is immunoreactive with the synthetic peptide as well as the isopeptide fragments, thereby generating a competition assay.
The biological fluid may be used as it is, or it may be purified prior to the contacting step. This purification step may be accomplished using a number of standard procedures, including but not limited to, cartridge adsorption and elution, molecular sieve chromatography, dialysis, ion exchange, alumina chromatography, hydroxyapatite chromatography, and combinations thereof.
The invention also includes test kits useful for quantifying in a body fluid (or cell supernatant) the amount of isopeptide fragments derived from the degradation of tissue. The kits comprise at least one immunological binding partner, e.g. a monoclonal or polyclonal antibody specific for a peptide derived from the degradation of a relevant protein. If desired, the immunological binding partner of the test kit may be coupled to detectable markers such as the ones described above. Generally speaking, the immunological binding partner is therefore also useful as a diagnostic agent.
Various non-immunological methods of assay may also be employed for analysis and identification of isoaspartyl, D-aspartyl and D-isoaspartyl within proteins or peptides.
The presence isoapartyl (D-aspartyl and D-isoaspartyl) within a peptide or protein may be determined by methods well known in the art. These methods include the use of 1) chromatographic methods, 2) electrophoretic techniques, 3) enzymatic methods 4) immunological methods, 5) chemical methods or combinations thereof. A review of current methods for detection and quantitation of isoaspartate is provided in by Aswad and Guzzetta (Aswad and Guzzetta, 1995).
Chromatographic methods maybe used, such as reversed phase HPLC (Cloos and Fledelius 2000) and hydrophobic interaction chromatography (Di Donato et al 1993). The structural alterations associated with isoaspartyl (D-aspartyl and D-isoaspartyl) formation can produce significant changes in the retention of peptides in various chromatographic methods.
Electrophoretic techniques as native gel-electrophoresis (Potter et al 1993), capillary electrophoresis (Stevenson et al 1993) and thin-layer electrophoresis (Aswad et at 1987) can be used to separate and may be used as means to identify such changes.
Enzymatic methods, including the use of the IAMT enzyme (EC 2.1.1.77) or of specific proteases specifically cleaving at the N or C of isoaspartyl residues may be used to identify such changes.
The enzyme IsoAspartyl (D-aspartyl) MethylTransferase (IAMT), EC 2.1.1.77 provides a method for selectively labelling isoaspartyl (D-aspartyl) sites with-methyl groups. This enzyme has the ability to recognise and methylate atypical isoAsp and D-Asp residues. By employing a radioactively labelled methyl-donor (3H or 14C-methyl), isomerised (or optically inverted) proteins or peptides incubated with this enzyme will be radioactively labelled, and labelling of the protein can be detected by measuring the incorporated radioactivity. A kit (IsoQuantTM), based on this principle is commercially available.
Alternative methods for IAMT-dependent isoAsp analysis have recently been described. Thus isoAsp formation has been detected utilizing HPLC in conjunction with UV-detection to monitor production of S-adenosyl-L-Homocysteine (Aswad et al 2000).
Proteases that selectively cleave at the N or C of isoaspartyl (D-aspartyl or D-isoaspartyl) may be useful for isoAsp analysis. As an example of this the Carboxypeptidase Y recognises L-isoaspartyl sites as if they were C-terminal amino acids and thereby acts as an “endoproteinase iso-asp-N” (Johnson and Aswad 1990). This action combined with normal CP-Y sequential clipping at the real terminus, can result in the production isoaspartyl dipeptides that can be charactized by amino acid analysis techniques. Such an approach may be useful in tracking down sites of isoAspartyl formation in proteins or peptides.
The Edman degradation is an important method for determining the location of an Asx alteration in a peptide, especially when used in conjunction with a complementary technique such as mass spectrometry or enzymatic methylation of isoaspartate. It has long been known that the presence of an isopeptides bond causes blockage of the Edman degradation because the extra carbon(s) in the backbone of isopeptides prevent cyclization of the phenylthiocarbamyl peptide to form the anilinothiazolone derivative (Smyth et al 1963). Thus a sequencing block at Asx (or Glx) sites provides powerful, albeit indirect, evidence for the presence of an isopeptide bond.
Matsuo and Narita have described a method based on Oxasolone Formation for selectively labelling the C-terminal α-carboxylamino acid of a peptide (Matsuo and Narita 1975). This method can be used to label internal isoaspartyl residues since they contain a free α-carboxyl. As an example of this Di Donato and colleagues have used 3H-labelling to confirm the presence of isoaspartate in peptides derived from bovine seminal ribonuclease and pancreatic ribonuclease.
Alkaline hydroxylamine has been used to cleave proteins mainly at Asn-Gly bonds The relative selectivity of this method is due to the propensity of Asn-Gly to be rapidly deamidated via the succinimide pathway at alkaline pH.



BRIEF DESCRIPTION OF THE DRAWINGS
The invention will be further described and illustrated by the following examples, in which reference is made to the accompanying drawings, in which:
FIG. 1 shows in panels A and B the results of size exclusion chromatography of trypsin digested extracted (soluble fraction) and non-extractable (pellet) proteins from cartilage as described in Example 1.
FIG. 2 shows the results of reverse phase HPLC fractionation of low molecular weight fraction from tryptic digest of Gnd-HCl pellet, with typing of isoAsp/DAsp sites, as described in Example 1.
FIG. 3 shows results from the competitive β-COMP assay of example 3. Peptide standard curves with 20 μl/well of the isomerised (β) form and the non-isomerised (α) form of COMP peptide. 50% inhibition of the signal (Bo) was obtained with 38 ng/ml β-COMP peptide and 435 ng/ml α-COMP peptide.
FIG. 4 shows the results of β-COMP measurements in serum from 26 healthy individuals and 36 Osteo-arthritis patients. The samples were measured in the β-COMP ELISA (example 3). The significance of the difference between the groups was calculated by non-parametric T-Test to p=0.0015.



EXAMPLE 1
Purification of Isomerised and/or Optically Inverted Protein Fragments Derived from Cartilage, and Identification of Specific Isomerisation and/or Optical Inversion Sites in Cartilage Proteins







Cartilage samples from two deceased human subjects (each approximately 20 mg wet-weight) (obtained from the department of forensic pathology of Copenhagen university hospital), were homogenized (with an ultra-turax homogeniser) and treated with 4 M guanidinium hydrochloride (Gnd-HCl) for 48 h at 4° C. The extraction mixture was subsequently centrifuged at 27,000×g and the supernatant and pellet separated. Gnd-HCl was removed by extensive dialysis against Milli-Q water (MWCO=10 kDa, spectropor dialysis membranes) and lyophilised. Aliquots of the “Pellet” and “supernatants” were subsequently digested with trypsin (enzyme:substrate 1:25). Tryptic digests (of Gnd-HCl pellet and Gnd-HCl supernatant from extraction of cartilage) were subjected to size-exclusion chromatography (SEC) on a 500 ml Sephadex G-75 column. Eluents were collected in fractions and measured in relevant assays (IAMT, CartiLaps and AG1-ELISA). The eluate from the size exclusion column was analysed by OD214 nm, and after lyophilization and re-solubilization in phosphate buffered saline (PBS) in an enzyme assay using IAMT for detection of isomerised aspartate residues. IAMT-reactivity was found primarily in the medium and low-molecular weight fractions. No CartiLaps activity was found in eluents, and AG1-1 activity was almost exclusively restricted to the medium molecular weight fractions. Results are shown in FIG. 1.
Low molecular fractions were pooled, lyophilised and further separated by reversed phase HPLC. Low molecular fractions from SEC of tryptic digests (of Gnd-HCl supernatant and Gnd-HCl pellet, FIG. 1) were separated by R.P. HPLC. Eluents were collected in fractions and measured in the IAMT assay. Several IAMT-reactive fractions were found, these were further purified by R.P.HPLC and subsequently subjected to amino acid sequencing and mass spectrometry to identify isoAsp (D-Asp)-containing sequences. Results as shown in FIG. 2.
IAMT-positive fractions from the first HPLC separation were isolated and subjected to a second R.P. HPLC run, eluents were collected in fractions and measured in the IAMT assay. Purified fragments were subjected to mass spectrometry and amino acid sequencing for identification of isomerisation/optical inversion sites. The following cartilage protein fragments were identified: 5 in Aggrecan, 1 in Decorin, 1 in Biglycan, 1 in perlecan, 1 in protocadherin, 1 in Fibrillin and 1 in collagen type II.

    Aggrecan site 1 (Pool 3 Frac 7, 8): LYPNOTGLPDPLSR (SEQ ID NO 12)
    Aggrecan site 2 (Pool 2 Frac 82): SAIIATEQLQAAYEDGFHQC (SEQ ID NO 13)
    Aggrecan site 3 (Frac 3.88 pool 1): LATTGOLYLAWQAGMDM (SEQ ID NO 14)
    Aggrecan site 4 (Pool 9 and 10, trial 105): TGEDFVDIPENFFGV (SEQ ID NO 15)
    Aggrecan site 5 (Pool 5, Frac 28): VSLPNYPAIPSDATLEVQSLRSNDS GVYR (SEQ ID NO 17)
    Decorin (Trial 100, Frac 112): IADTNITSIPQGLPPSLTELLDG (SEQ ID NO 4)
    Perlecan (Frac 3.75, pool 2): YPVRIESSSASLANGHTL (SEQ ID NO 2)
    Protocadherin gamma A11 (Frac 3.8, pool 2): YEOFRDLELR (SEQ ID NO 9)
    Fibrillin-1 (Frac 3.8, pool 2): YEOFSGGCQDINE (SEQ ID NO 11)
    Biglycan (Trial 91, Frac 4.36.2): FTLDDGPFMMNDE (SEQ ID NO 6)
    Collagen type II (Trial 91, Frac 4.36.1): EGSXGADGPXGRDG (SEQ ID NO 18)


The amino acid residues given in bold denotes isomerisation and optical inversion prone Aspartate and asparagine residues. The underlined residues denote the amino acids identified by sequencing the rest are extrapolated from the fragment mass identified by mass spectroscopy.
EXAMPLE 2
Development of Antibodies Specific for Isomerised and/or Optically Inverted Proteins or Protein Fragments and Generation of Immunoassays Specific for Isomerised and/or Optically Inverted Proteins or Protein Fragments
Immunogen for generation of a specific antiserum can be generated by two procedures. The authentic protein or fragments of the protein from an extra-cellular tissue can be purified by conventional chromatographic procedures as outlined in example 1. The isomerisation degree of the purified protein or protein fragments can be determined by use of the IAMT assay, and thus proteins or protein fragments containing a high isomerisation degree (i.e. more than 0.5 mol isoAsp/mol protein or protein fragment) can be used for the immunizations. Alternatively synthetic peptides representing the isomerisation sites identified in a given extra-cellular matrix protein can be synthesized by conventional peptide synthesis methods (please refer to ‘Stewart, J. Young, J., “Solid phase peptide synthesis” Pierce Chemical Company, Rockford, Ill., USA 1984’ and ‘Atherton, E., Sheppard, R. C., “Solid phase peptide synthesis: a practical approach”, IRL Press, Oxford, 1989’). Synthetic peptide can be made containing an isomerised and/or racemised Asx or Glx residue and a suitable number of amino acid residues on both sides of the residue (i.e. 1-15 amino acid residues, preferably 2-6) derived from the primary sequence of the given isomerisation prone extra-cellular matrix protein.
A synthetic peptide or protein or protein fragment (‘β-antigen’) containing an isomerised and/or racemised Asx or Glx residue can be used for immunisation of rabbits and generation of a specific antiserum as described in the following. The β-antigen is conjugated to a carrier protein by the use of the covalent cross-linking agent 1-ethyl-3-[3-dimethylaminopropyl]carbodi-imide hydrocloride (CDI) (Pierce, Rockford, Ill., USA). A conjugate of the β-antigen peptide is prepared essentially according to: Greg T. Hermanson, ‘Bioconjugate techniques’ 1996, Academic press, San Diego, USA. Briefly described the CDI conjugates are prepared as follows: One-hundred mg of Thyroglobulin is dissolved in 10 ml to a concentration of 10 mg/ml in 0.05 M MES, 0.5 M NaCl, pH 6.0. One-hundred μl of the two following reagents (to a final concentration of 4 mM CDI, corresponding to approximately 100 fold molar excess of CDI to thyroglobulin, and 10 mM NHS) is added, and the solution is left to mix 15 min at room temperature (18-22° C.). CDI: 0.4 M CDI stock: 76.7 mg in 1 ml water prepared immediately prior to use. NHS: 1 M sulfo-NHS stock: 217.1 mg in 1 ml water prepared immediately prior to use.
Excess cross-linking reactants (CDI) is removed by gel-filtration on four NAP25 de-salting columns (Amersham Pharmacia Biotech, Uppsala, Sweden) into 10 mM Na-Phosphate pH 9.0. The de-salted activated thyroglobulin is pooled and divided into 6 portions of 2 ml. Immediately following the gel-filtration peptide solutions: 2 ml 4 mg/ml in 0.1 M Na-Phosphate pH 9.0 is added to each vial. A control conjugation is carried out with an irrelevant peptide. The coupling reaction is allowed to proceed for two hours at room temperature.
The β-antigen conjugates are changes into PBS (pH 7.4) by gel-filtration on Sephadex G25 columns (Amersham Pharmacia Biotech, Uppsala, Sweden), and the concentration is adjusted to 2 mg/ml in PBS.
Rabbits (strain SSC:CPH), are immunised sub-cutaneously with 1 ml 0.25 mg/ml of the vaccinein phosphate buffered saline (PBS), containing 50% Freunds incomplete adjuvant. Rabbits are boosted after initial immunisations at two weeks intervals. After the three first boosts, subsequent booster immunisations are performed at one month intervals. Pre-immune bleed is collected before immunisation and test bleeds are collected one week after the 2nd immunisation to monitor serum antibody levels. Bleeds are subsequently collected one week after the 5th and 6th immunisation.
The specificity of the rabbit bleed are tested on a micro titre plates (MTP) coated with a β-antigen conjugate prepared with the same β-antigen as used for the immunization. The β-antigen is conjugated to bovine serum albumin (BSA) by us of the bi-functional cross-linker bis[sulfosuccinimidyl] suberate (BS3). This crosslinking reagent is obtained from Pierce (Rockford, Ill., USA) and the conjugation is prepared essentially as disclosed by the manufacturer. Briefly described the following procedure. Peptide stocks (β-antigen) are prepared in freshly filtered PBS to 2 mg/ml. The carrier protein (BSA) is prepared in 3 mg/ml concentration in PBS (approximately 50 fold molar excess of peptide). 200 μl of carrier protein is mixed with 200 μl peptide solution in an Eppendorf tube. BS3 (Bis-(sulfosuccinimidyl) suberate) 6 mg/ml is prepared in 5 mM sodium-citrate pH 5.0 (25 fold molar excess of cross-linker compared to carrier protein). 50 μl of the cross-linker is added to the carrier and peptide solution, which is vortexed and placed on a mixer at room temperature for 30 min. 50 μl 0.25 M glycine pH 7.5 is added to the solutions. The incubation is continued for 15 min., Whereafter the conjugates are desalted on NAP5 column and protein concentrations are determined by the Bradford or Loewry methods. MTP are coated with 10 ng/ml of the BSA-BS3-β-antigen conjugate and used for screening of serum from the immunized rabbits. The rabbit antiserum is diluted in PBS containing 1% BSA and 0.1% Tween in a suitable dilution for obtaining an appropriate ELISA signal (a suitable signal is between 1 and 3 absorbency units and a suitable dilution will typically be in the range between 1000 fold dilution and 100,000 fold dilution). The bound antibody in this competitive assay format was detected by use of a secondary peroxidase conjugated goat anti rabbit antibody and a chromogenic peroxidase substrate.
EXAMPLE 3
Generation of Antibodies Specific for an Isomerised Fragment of Cartilage Oligomeric Matrix Protein (β-COMP) and Development of a β-COMP Specific Immunoassay
Peptide Conjugation
A synthetic peptide derived from human cartilage oligomeric matrix protein (COMP) containing an isomerised Asp residue within the sequence AQEDβSDH(‘β-COMP’) SEQ ID NO: 21 was used for immunisation of mice and generation of a specific antiserum as described in the following. The β-COMP peptide was conjugated to a carrier protein by the use of the covalent cross-linking agent 1-ethyl-3-[3-dimethylaminopropyl]carbodi-imide hydrocloride (CDI) (Pierce, Rockford, Ill, USA). The β-COMP conjugate was prepared essentially according to: Greg T. Hermanson, ‘Bioconjugate techniques’ 1996, Academic press, San Diego, USA. Briefly described the CDI conjugates were prepared as follows: One-hundred mg of thyroglobulin was dissolved to a concentration of 10 mg/ml in 0.05 M MES, 0.5 M NaCl, pH 6.0 in a total volume of 10 ml. One-hundred μl containing a final concentration of 4 mM CDI and 10 mM NHS was added to the thyroglobulin solution. The solution was left to mix 15 mm at room temperature (18-22°C). CDI: 0.4 M CDI stock: 76.7 mg in 1 ml water prepared immediately prior to use. N-hydroxysulfosuccinimide (NHS from Pierce, Rockford, Ill., USA): 1 M NHS stock: 217.1 mg in 1 ml water prepared immediately prior to use.
Excess cross-linking reactants (CDI) were removed by gel-filtration on four NAP25 de-salting columns (Amersham Pharmacia Biotech, Uppsala, Sweden) into 10 mM Na-Phosphate pH 9.0. The de-salted activated thyroglobulin was pooled and divided into 6 portions of 2 ml. Immediately following the gel-filtration 2 ml β-COMP peptide solution of 4 mg/ml in 0.1 M Na-Phosphate pH 9.0 was added to each vial. A control conjugation was carried out with an irrelevant peptide. The coupling reaction was allowed to proceed for two hours at room temperature.
The β-COMP conjugates were changed into phosphate buffered saline (PBS) (pH 7.4) by gel-filtration on Sephadex G25 columns (Amersham Pharmacia Biotech, Uppsala, Sweden), and the concentration was adjusted to 0.5 mg/ml in PBS.
Immunisation
Mice (strain Balb/C-J) were immunised sub-cutaneously with 0.2 ml 0.25 mg/ml β-COMP conjugate in PBS, containing 50% Freunds incomplete adjuvant. Mice were boosted after initial immunisations at two weeks intervals. Pre-immune bleeds were collected before immunisation and test bleeds were collected one week after the 2nd immunisation and after subsequent booster immunisations to monitor serum antibody levels.
Specificity
The specificity of the mouse bleeds were tested on strept-avidin micro titer plates (Micro-coat, Munich, Germany) coated with 10 ng/ml biotinylated-β-COMP. The β-COMP biotinylation was prepared using standard conjugation techniques with a succinimide activated form of biotin, according to the manufactures instructions (Pierce, Rockford, USA). The mouse sera were diluted in PBS containing 1% BSA and 0.1% Tween (PBS-BTB) to a dilution giving an appropriate ELISA signal (OD-value of ≈2). Specificity for the isomerised form of the COMP peptide was tested by competition with both the isomerised (β) and the non-isomersied (α) form of the COMP peptide. The mouse serum that showed the highest degree of specificity for β-COMP was used for development of a competitive assay for measurement of β-COMP in serum samples (FIG. 3).
Briefly the assay was set-up as follows; streptavidin precoated micro titer plates (MicroCoat, Munich, Germany) were incubated with 100 μl/well of 0.5 ng/ml biotinylated-β-COMP in PBS-BTB at 20° C. for 30 minutes at a shaking table. The plates were washed 5 times in PBS with 0.1% Tween 20 (PBS-T), followed by overnight incubation at 4° C. with 100 μl/well mouse-anti-β-COMP sera diluted 1:8000 in PBS-BTB and 20 μl/well of standards containing 0.5, 1.5, 4.5, 13.5, 41.5, 125 and 375 ng/ml β-COMP peptide in PBS-BTB or 20 μl/well of serum samples from patients with osteo-arthritis or healthy individuals. The plates were washed five times in PBS-T. 100 μl secondary peroxidase conjugated sheep-anti-mouse IgG antibody (Jackson Immuno Research, Pennsylvania, USA) diluted 1:2000 in PBS-BTB was added to each well and incubated for 60 minutes at 20° C. on a shaking table. After washing five times in PBS-T the amount of bound peroxidase conjugated antibody was detected by 15 minutes incubation with 100 μl/well of a chromogenic peroxidase substrate (3,3′,5,5′-tetramethyl-benzidine (TMB) from KemEnTek, Copenhagen, Denmark) on a shaking table. The reaction was stopped with 100 μl/well of 0.18 M H2SO4 and micro titer plates were read at 450/650 nm.
The amount of β-COMP peptide in serum samples from healthy individuals, patients with osteo-arthritis (OA) (FIG. 4) and rheumatoid arthritis (RA) (not shown) were calculated from the β-COMP peptide standard curve.
Conclusion
It is apparent that circulating levels of β-COMP fragments can be measured in normal adult individuals as well as in patients with arthritis. In the QA and RA patients the levels of β-COMP is significantly elevated compared to the healthy controls. This demonstrates that the β-COMP marker measured in a specific immunoassay employing a polyclonal antiserum specific for the human COMP derived sequence AQEDβSDH (SEQ ID NO: 21) reflects the elevated cartilage turnover associated with the pathologic joint tissue processes in RA and OA.
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The disclosures of all references reported herein are incorporated by reference.
The invention has been described with particular reference to preferred embodiments thereof. However, it will be appreciated that those skilled in the art, upon consideration of this disclosure, may make modifications and improvements within the spirit and scope of the invention.

## Claims

1. A method for measuring an amount of isomerised fragments of cartilage oligomeric matrix protein (COMP), comprising measuring in a sample of blood, serum, plasma, or synovial fluid the amount of isomerised fragments of COMP which comprise the amino acid sequence AQEDβSDH (SEQ ID NO 21) wherein the D residue at position 4 therein is L-aspartic acid bound in the peptide chain via the β carboxylic acid thereof, said measurement being carried out using an antibody or binding fragment of an antibody which specifically recognizes and binds said sequence and which preferentially binds said sequence AQEDβSDH (SEQ ID NO 21) as compared to the non-isomerised COMP fragment containing the sequence AQEDSDH (SEQ ID NO 22) in which the D residue at position 4 therein is bound in the peptide chain via the α carboxylic acid group thereof.

2. A method as claimed in claim 1, wherein said antibody or binding fragment of an antibody is an antibody raised against a synthetic peptide having an amino acid sequence comprising AQEDβSDH (SEQ ID NO 21), or is a binding fragment of a said antibody.

3. A method as claimed in claim 2, wherein said antibody has been raised against a synthetic peptide having an amino acid sequence of COMP containing AQEDβSDH (SEQ ID NO 21).

4. A method as claimed in claim 1, wherein said measurement provides an index of cartilage turnover relevant for conditions and diseases affecting joint tissue turnover.

5. A method as claimed in claim 4, wherein said measurement provides an index indicative of cartilage turnover in a patient suffering from osteoarthritis or rheumatoid arthritis.