# Patent

## Title
Diagnosis of multiple sclerosis

## Abstract

The present invention relates to methods and kits for diagnosing multiple sclerosis (MS) in a subject. Particularly, the present invention relates to methods and kits for diagnosing a subtype of MS in a subject, the subtype selected from relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS) and a pathologic sub-type of MS lesions selected from Pattern I and Pattern II MS lesion.

## Background
RELATED APPLICATION DATA
This application is the U.S. National Stage of PCT/IL2009/001066, filed Nov. 12, 2009, which claims the benefit of U.S. Provisional Patent Application No. 61/113,645, filed Nov. 12, 2008, the contents of each of which are herein incorporated by reference for all purposes.


INCORPORATION-BY-REFERENCE OF MATERIAL ELECTRONICALLY FILED
Incorporated by reference in its entirety herein is a computer-readable nucleotide/amino acid sequence listing submitted concurrently herewith and identified as follows: One 96,669 byte ASCII (text) file named “Seq_List” created on May 11, 2011.
FIELD OF THE INVENTION
The present invention relates to methods and kits for diagnosing multiple sclerosis (MS) in a subject. Particularly, the present invention relates to methods and kits for diagnosing a subtype of MS in a subject, the subtype selected from relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS) and a pathologic sub-type of MS lesions selected from Pattern I and Pattern II MS lesion.
BACKGROUND OF THE INVENTION
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) of presumed autoimmune etiology. MS is characterized by focal lesions (plaques) in the brain and spinal cord leading to progressive neurological dysfunction. The etiology of MS is unknown, but it is thought to result from a combination of genetic and environmental factors. Currently, there is no specific test for diagnosing MS and the diagnosis relies on recognition of the clinical history of the subject. The diagnosis can be supported by MRI of the brain and spinal cord, analysis of the cerebrospinal fluid, and evoked potential studies of the visual and somatosensory pathways. In addition, systemic or infectious etiologies with similar presentation must be excluded. Multiple sclerosis may progress and regress unpredictably; however, there are several patterns of symptoms. Approximately 85-90% of patients begin with a relapsing-remitting (RRMS) course and 40% eventually become progressive (secondary progressive MS, SPMS); in 10%, MS presents a primary progressive course (PPMS). The different MS subtypes are characterized by the past course of the disease (e.g. unpredictable relapses, remissions and progression of neurologic decline). From a clinical perspective, patients with different disease courses show different treatment responses. For instance, patients with relapsing-remitting MS are more likely to respond to immunomodulatory therapy than those with a progressive disease course (Bitsch and Bruck, CNS Drugs, 2002; 16(6):405-18). Thus, characterizing the MS subtype is important not only for prognosis but also for therapeutic decisions.
MS is not only heterogeneous in its clinical symptoms and rate of progression, but also in its response to therapy and histopathological findings (Lucchinetti et al., 2000, Ann Neurol 47, 707-17). The pattern of active demyelination is identical among multiple lesions examined from a given MS patient, yet heterogeneous between patients, suggesting pathogenic heterogeneity. Pattern I is characterized by T-cell/macrophage-mediated demyelination. Pattern II is characterized by antibody/complement-associated demyelination. Pattern III is defined by a distal oligodendrogliopathy, and pattern IV is characterized by oligodendrocyte degeneration in the periplaque white matter; to date pattern IV has only been identified in autopsy cases. Patterns I and II lesions show the typical perivenous distribution and sharp borders that are the pathological hallmarks of MS lesions and are thought to result from classical autoimmune mechanisms (Lucchinetti, et al., 2004, Ann Neurol 56, 308). MRI is commonly used to visualize MS lesions in vivo. The use of MRI to study MS lesions is limited, however, because it cannot provide information about the pathological composition of the lesions. From a clinical standpoint patients with Pattern II, but not Pattern I, have been reported to respond to plasmapheresis (Keegan et al., 2005, Lancet 366, 579-82). Thus, there is a need for identifying patients that would be responsive to treatment with plasmapheresis.
The McDonald criteria was introduced in 2001, and revised in 2005 (Polman et al., 2006, Ann Neurol.; 59(4):727-8), as guidelines to facilitate early and accurate diagnosis of multiple sclerosis (MS). Diagnostic classifications are reduced to a) having MS, b) not having MS, or c) having possible MS. Advantages to the Criteria include the capability of making a definitive diagnosis of MS either after a monosymptomatic presentation or in the context of a primary progressive course. However, the diagnostic classification scheme and MRI criteria remain complicated and tedious, and this complexity limits their use in everyday practice. Furthermore, the specificity of these criteria is relatively low, emphasizing the importance of clinical judgment in excluding other diagnoses. In addition, studies have observed that standard MS disease-modifying medications can benefit patients who do not yet fulfill these diagnostic criteria. Finally, the McDonald criteria decreased the time required for MS diagnosis substantially, however it is still limited for those individuals who are diagnosed with possible MS, or those who will eventually receive a diagnosis of PPMS.
Although MS is considered a T cell mediated disease, several pieces of evidence support a role for B cells in the disease (Archelos et al., 2000, Ann Neurol. 47, 694-706). B cells can contribute to MS progression by their secretion of antibodies and cytokines, or by acting as antigen presenting cells (APC) to activate pathogenic T cells. B cells are significantly more efficient in processing and presenting antigens recognized by the antibodies they produce. Thus, it is not surprising that linear B and T cell epitopes are co-localized in CNS antigens targeted by the autoimmune response in human and experimental models of MS (Meinl et al., 2006, Ann Neurol. 59, 880-92; Wucherpfennig et al., 1997, J Clin Invest. 100, 1114-22).
Immune System Biomarkers
The immune system in both its innate and adaptive arms can be viewed as a type of biological health-maintenance system. In physiological terms, the cells and molecules comprising the immune system are considered to act to manage inflammation (Cohen, 2000, Academic Press, London). Inflammation is classically defined as the collective processes activated by injury that lead to healing. The immune system, by the way it initiates and manages inflammation, maintains the body by healing wounds, containing pathogens, organizing the structure of connective tissue, growing (angiogenesis) or destroying blood vessels, triggering regeneration of certain organs, activating the apoptosis of aged cells and those with irreparable DNA damage, degrading accumulations of abnormal molecules, disposing of waste, and performing other vital activities (Cohen, 2000). These varied expressions of inflammation maintain the integrity of the organism in response to its relentless post-developmental decomposition due to neoplasia, environmental injuries and infections, accumulations of metabolic products, waste, and other intoxications, and the inexorable advance of entropy.
The possibility that cerebrospinal fluid (CSF) antibodies in MS patients are generated as a response to myelin self-antigens has been investigated in detail. Antibodies reactive with several CNS antigens have been described, including those directed against myelin oligodendrocyte glycoprotein (MOG), oligodendrocyte-specific protein (OSP), myelin basic protein (MBP), proteolipid protein (PLP), myelin associated glycoprotein, 2′,3′-cyclic nucleotide 3′ phosphodiesterase (CNPase) and ab-crystallin. When analyzed, the subclasses of these antibodies correlated with a pro-inflammatory immune response. Many of these autoantibodies have been detected also in blood (Lalive et al., 2006, Proc Natl Acad Sci US. 103, 2280-5). In addition, higher titers of antibodies reactive with non myelin autoantigens (Annunziata et al., 1999, J Neurol Sci. 168, 32-6; Barned et al., 1995, Neurology. 45, 384-5; Colaco et al., 1987, Clin Exp Immunol. 68, 313-9; Roussel et al., 2000, J Autoimmun. 14, 259-65; Spadaro et al., 1999, Mult Scler. 5, 121-5) and to pathogens (Cepok et al., 2005, J Clin Invest. 115, 1352-60) have been also found in MS patients.
The role played by antibodies in MS still awaits further clarification. Antibodies to conformational epitopes in MOG have been purified from MS lesions and shown to alter the physiology of CNS cells (Lalive et al., 2006). Accordingly, U.S. Pat. App. Pub. No. 2005/0009096 provides methods utilizing detection or quantification of autoantibodies to specific epitopes of myelin/MOG components for diagnosis or prognosis of MS.
Antibodies reactive with linear epitopes in CNS antigens have also been isolated from MS lesions (Dalakas, 2006, Pharmacol Ther. 112, 57-70; Genain et al., 1999, Nat. Med. 5, 170-5), suggesting that they also play a direct role in MS pathology. Moreover, antibodies to MBP isolated from MS patients have been shown to have direct proteolytic activity (Ponmarenko et al., 2006, Proc Natl Acad Sci US. 103, 281-6). U.S. Pat. App. Pub. No. 2003/0092089 relates to an assay for detecting MBP autoantibodies, and alternatively in conjunction with the measurement of other biochemical markers associated with MS and related diseases.
Biomarkers are anatomic, physiologic, biochemical or molecular parameters associated to specific disease states. The search for MS biomarkers has been focused on indicators of the general activity of the inflammatory process. Several biomarkers aim at following not the inflammatory process itself, but its consequences such us neurodegeneration and axonal loss. Thus, altered levels of neurofilament light chains, tau and 14-3-3 protein have been described to correlate with axonal loss in MS patients.
Since MS is felt to be an organ specific autoimmune disorder, immune biomarkers have the potential to reflect disease activity and its response to therapy. Several large-scale proteomic studies have attempted the characterization of antibodies in CSF and serum, aiming to identify yet unknown targets of the autoimmune attack in MS patients (Lefran et al., 2004, J Immunol 172, 669-78). Moreover, specific antibodies have been investigated as biomarkers in MS, resulting in the identification of several up-regulated antibody responses to myelin antigens in CSF and/or serum. However, these biomarkers were not generalizable to the majority of MS patients or could not be validated in independent studies (Rinaldi and Gallo, 2005, Neurol Sci. 26, S215-7; Lim et al., 2005, Mult Scler. 11, 492-4). Similarly to what has been observed in other autoimmune diseases such as diabetes (Quintana et al., 2004, Proc Natl Acad Sci, 14615-21) and systemic lupus erythematosus (Li et al., 2005, J Clin Invest. 115, 3428-39), it is possible that no single biomarker will be conclusive, but rather a pattern of several biomarkers forming a fingerprint will be required.
The Antigen Chip
Antigen microarrays are newly developed tools for the high-throughput characterization of the immune response (Robinson et al., 2002, Nat Med 8, 295-301), and have been used to analyze immune responses in vaccination and in autoimmune disorders (Robinson et al., 2002; Robinson et al., 2003, Nat. Biotechnol. 21, 1033-9; Quintana et al., 2004; Kanter et al., 2006, Nat Med 12, 138-43). It has been hypothesized, that patterns of multiple reactivities may be more revealing than single antigen-antibody relationships (Quintana et al., 2006, Lupus 15, 428-30) as shown in previous analyses of autoimmune repertoires of mice (Quintana et al., 2004; Quintana et al., 2001, J Autoimmun 17, 191-7) and humans (Merbl et al., 2007, J Clin Invest 117, 712-8; Quintana et al., 2003, J Autoimmun 21, 65-75) in health and disease. Thus, autoantibody repertoires have the potential to provide both new insights into the pathogenesis of the disease and to serve as immune biomarkers (Cohen, 2007, Nat Rev Immunol. 7, 569-74) of the disease process.
Antigen microarrays have been used to characterize serum autoantibodies in systemic lupus erythematosus, rheumatoid arthritis and neuromyelitis optica. However, high-affinity specific antibodies in MS have not been reported with any regularity in serum (Meinl et al., 2006, Ann Neurol. 59, 880-92; O'Connor et al., 2007, Nat Med 12, 12; Zhou et al., 2006, Proc Natl Acad Sci US. 103, 19057-62). In contrast to autoantibodies in serum, Kanter and associates have used microarrays to detect lipid (Kanter et al., 2006) and αB-crystallin (Ousman et al., 2007, Nature. 448, 474-9) reactive antibodies in the CSF. Strikingly, the antibodies to αB-crystallin were of low affinity, detectable at 1:20 dilution (Ousman et al., 2007).
PCT Pub. No. WO 02/08755 to some of the inventors of the present invention is directed to a method, system and an article of manufacture for clustering and thereby identifying predefined antigens reactive with undetermined immunoglobulins of sera derived from patient subjects in need of diagnosis of disease or monitoring of treatment. The '755 publication discloses the use of antigen arrays for identifying antigens reactive with immunoglobulins of sera derived from subjects afflicted with various diseases. Further disclosed are diagnostic methods, and systems useful in these methods, employing the step of clustering a subset of antigens of a plurality of antigens, said subset of antigens being reactive with a plurality of antibodies being derived from a plurality of patients having an impaired immune system and suffering from a disease, and associating or deassociating the antibodies of a subject with the resulting cluster. While WO 02/08755 discloses methods useful in diagnosis of MS among other autoimmune diseases, there is no disclosure of diagnosing different subtypes of MS or monitoring MS progression.
U.S. Pat. App. Pub. No. 2005/0260770 to some of the inventors of the present invention discloses an antigen array system and diagnostic uses thereof. The application provides a method of diagnosing an immune disease, and particularly type 1 diabetes, or a predisposition thereto in a subject, comprising determining a capacity of immunoglobulins of the subject to specifically bind each antigen probe of an antigen probe set. The antigen probe set comprises a plurality of antigen probes selected from the group consisting of at least a portion of a cell/tissue structure molecule, at least a portion of a heat shock protein, at least a portion of an immune system molecule, at least a portion of a homopolymeric polypeptide, at least a portion of a hormone, at least a portion of a metabolic enzyme, at least a portion of a microbial antigen, at least a portion of a molluscan antigen, at least a portion of a nucleic acid, at least a portion of a plant antigen, at least a portion of a plasma molecule, and at least a portion of a tissue antigen, wherein the binding capacity of the immunoglobulin of the subject is indicative of the immune disease or the predisposition thereto. However, none of the prior art discloses an antigen array that can provide a specific, reliable, accurate and discriminatory assay for diagnosing MS, specifically for discriminating between different subtypes of MS and predicting or monitoring disease progression. Such discriminatory assays would be highly valuable in tailoring adequate therapeutic approach for each patient.
PCT Pub. No. WO 07/137,410 relates to methods for the diagnosis MS, different forms of MS or another demyelinating disorder. Particularly, WO 07/137,410 relates to specific metabolites, identified by their molecular masses, found to have different abundances or intensities between clinically diagnosed MS or other neurological disorders, and normal patients. Nevertheless, WO 07/137,410 does not disclose nor mention the use of testing an antibody reactivity pattern for identifying unique signature patterns in different subtypes of MS, and to further differentiate between patients having MS and those afflicted with other neurological disorders.
Thus, there remains a need for improved diagnostic methods and kits useful in diagnosing MS and particularly, diagnosing subtypes of MS in a subject.
SUMMARY OF THE INVENTION
The present invention provides methods and kits for diagnosing multiple sclerosis (MS) in a subject, antigen probe arrays for practicing such a diagnosis, and antigen probe sets for generating such arrays. Particularly, the present invention provides methods and kits for diagnosing a subtype of MS in a subject, wherein the subtype of MS is selected from relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS) and a pathologic sub-type of MS lesions selected from Pattern I and Pattern II MS lesion.
The present invention is based in part on the unexpected results obtained when testing the antibody reactivity of MS patients using an antigen array. The analysis resulted in the identification of unique signature patterns of autoantibody reactivities. It is now disclosed for the first time that unique autoantibody signature patterns characterize sub-types of MS, namely relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS) based on reactivity to central nerve system (CNS) antigens, heat shock proteins (HSP) and lipid antigens. Strikingly, the unique autoantibody signature patterns distinguished the MS subtype from other neurologic or autoimmune driven diseases including Alzheimer's disease (AD), adrenoleukodystrophy (ALD) and lupus erythematosus. It is further disclosed that unique autoantibody signature patterns characterize different immunopathologic patterns of MS lesions, based on the reactivity to lipids and CNS-derived peptides, thus providing for the first time a biomarker-based assay for sub-typing MS classes and stages.
Thus, the present invention relates to methods and kits for the diagnosis of a subtype of MS. According to the principles of the invention the kits comprise a plurality of antigens also referred to herein as antigen probe sets. These antigen probe sets comprising a plurality of antigens are reactive specifically with the sera of subjects having MS. According to the principles of the invention, the plurality of antigens may advantageously be used in the form of an antigen array. According to some embodiments the antigen array is conveniently arranged in the form of an antigen chip.
The present invention identifies clusters of antigens relevant to subtypes of MS and defines the reactivity observed with test sera versus control sera. While no single antigen was identified that was sufficient on its own to adequately diagnose a subject with MS or a subtype of MS, specific combinations of these antigens, as detailed in Table 1 to 4 herein below, were significantly more accurate and reliable in discriminating patients and control subjects than each antigen alone. Table 1, as detailed below, contains SEQ ID NOS: 7, 14, 23-83 and 98-100, fragments derived from SEQ ID NOS: 4-6, 10 and 12, and the non-peptide moiety lactocerebroside. Table 2, as detailed below, contains SEQ ID NOS: 7, 8, 13, 16, 22, 29, 42, 51, 60, 67-71 84, 85 and 101, fragments derived from SEQ ID NOS: 4-6, 9, 10, 12 and 20, and the non-peptide moieties S. minnesota LPS, E. coli LPS and chondroitin 4-sulfate. Table 3, as detailed below, contains SEQ ID NOS: 6, 7, 19, 21, 25, 26, 28, 29, 31, 32, 35-38, 40-42, 44, 48, 53, 55, 56, 64, 70, 73, 75, 85-96, 100, 102 and 103, fragments derived from SEQ ID NOS: 4-6, 10, 12 and 15, and the non-peptide moieties asialoganglioside-GM2, cardiolipin and cholesterol. Table 4, as detailed below, contains SEQ ID NOS: 17, 29, 43, 85 and 97, fragments derived from SEQ ID NOS: 5 and 12, and the non-peptide moieties: 15-ketocholestane, 15α-hydroxycholestene, Ganglioside-GM4, 15-ketocholestene, Tetrasialoganglioside-GQ1B, Brain L-α-lysophosphatidylserine and Lactosylceramide.







TABLE 1







Antigens Discriminating RRMS and healthy controls (HC)









Antigen
Type
Sequence/SEQ ID NO:





MBP 31-50
peptide
derived from SEQ ID NO: 6


 


HSP70 481-500
peptide
ANGILNVTATDKSTGKANKI (SEQ ID NO: 23)


 


PLP 65-84
peptide
derived from SEQ ID NO: 12


 


GFAP
protein
SEQ ID NO: 14


 


HSP70 511-530
peptide
KEEIERMVQEAEKYKAEDEV (SEQ ID NO: 24)


 


MBP 41-60
peptide
derived from SEQ ID NO: 6


 


HSP60 286-305
peptide
LVLNRLKVGLQVVAVKAPGF (SEQ ID NO: 25)


 


HSP60 496-515
peptide
QSSSEVGYDAMAGDFVNMVE (SEQ ID NO: 26)


 


HSP70 151-170
peptide
NDSQRQATKDAGVIAGLNVL (SEQ ID NO: 27)


 


HSP60 526-545
peptide
RTALLDAAGVASLLTTAEVV (SEQ ID NO: 28)


 


MBP 11-30
peptide
derived from SEQ ID NO: 6


 


OSP 61-80
peptide
GLYHCKPLVDILILPGYVQA (SEQ ID NO: 29)


 


HSP70 31-50
peptide
NDQGNRTTPSYVAFTDTERL (SEQ ID NO: 30)


 


CNP 286-305
peptide
ISALFVTPKTTGARVELSEG (SEQ ID NO: 31)


 


HSP60 255-275
peptide
QSIVPALEIANAHRKPLVIIA (SEQ ID NO: 32)


 


HSP60 106-125
peptide
NEEAGDGTTTATVLARSIAK (SEQ ID NO: 33)


 


OSP 31-50
peptide
VVTCGYTIPTCRKLDELGSK (SEQ ID NO: 34)


 


P2 61-80
peptide
derived from SEQ ID NO: 10


 


MBP 84-94
peptide
derived from SEQ ID NO: 6


 


HSP60 376-395
peptide
EQLDVTTSEYEKEKLNERLA (SEQ ID NO: 35)


 


HSP70 286-305
peptide
SLFEGIDFYTSITRARFEEL (SEQ ID NO: 36)


 


HSP60 136-155
peptide
NPVEIRRGVMLAVDAVIAEL (SEQ ID NO: 37)


 


HSP70 136-155
peptide
GYPVTNAVITVPAYFNDSQR (SEQ ID NO: 38)


 


P2 46-65
peptide
derived from SEQ ID NO: 10


 


OSP 136-155
peptide
VATIWFPVCAHRETTIVSFG (SEQ ID NO: 39)


 


P2 1-20
peptide
derived from SEQ ID NO: 10


 


MOG 91-110
peptide
derived from SEQ ID NO: 5


 


HSP60 361-380
peptide
KGDKAQIEKRIQEIIEQLDV (SEQ ID NO: 40)


 


HSP70 451-470
peptide
KDNNLLGRFELSGIPPAPGV (SEQ ID NO: 41)


 


HSP70 210-229
peptide
TIDDGIFEVKATAGDTHLGG (SEQ ID NO: 42)


 


HSP60 240-259
peptide
QDAYVLLSEKKISSIQSIVP (SEQ ID NO: 43)


 


HSP60 271-290
peptide
LVIIAEDVDGEALSTLVLNR (SEQ ID NO: 44)


 


OSP 76-95
peptide
GYVQACRALMIAASVLGLPA (SEQ ID NO: 45)


 


PLP 178-191
peptide
derived from SEQ ID NO: 12


 


CNP 271-290
peptide
QDVLKKSYSKAFTLTISALF (SEQ ID NO: 46)


 


P2 76-95
peptide
derived from SEQ ID NO: 10


 


HSP70 631-640
peptide
GSGPTIEEVD (SEQ ID NO: 47)


 


PLP 248-259
peptide
derived from SEQ ID NO: 12


 


HSP60 195-214
peptide
RKGVITVKDGKTLNDELEII (SEQ ID NO: 48)


 


CNP 61-80
peptide
SGKSTLARVIVDKYRDGTKM (SEQ ID NO: 49)


 


MOG 196-215
peptide
derived from SEQ ID NO: 5


 


HSP60 46-65
peptide
LLADAVAVTMGPKGRTVIIE (SEQ ID NO: 50)


 


HSP70 195-214
peptide
LIFDLGGGTFDVSILTIDDG (SEQ ID NO: 51)


 


HSP70 436-455
peptide
PGVLIQVYEGERAMTKDNNL (SEQ ID NO: 52)


 


HSP60 166-185
peptide
EEIAQVATISANGDKEIGNI (SEQ ID NO: 53)


 


MBP 104-123
peptide
derived from SEQ ID NO: 6


 


MBP 71-92
peptide
derived from SEQ ID NO: 6


 


PLP 180-199
peptide
derived from SEQ ID NO: 12


 


HSP70 255-275
peptide
NKRAVRRLRTACERAKRTLS (SEQ ID NO: 54)


 


MOBP 166-185
peptide
derived from SEQ ID NO: 4


 


CNP 240-259
peptide
YFGKRPPGVLHCTTKFCDYG (SEQ ID NO: 55)


 


HSP60 16-35
peptide
RVLAPHLTRAYAKDVKFGAD (SEQ ID NO: 56)


 


HSP60 301-320
peptide
KAPGFGDNRKNQLKDMAIAT (SEQ ID NO: 57)


 


MOBP 151-170
peptide
derived from SEQ ID NO: 4


 


CNP 91-110
peptide
GARGAFSEEYKRLDEDLAAY (SEQ ID NO: 58)


 


HSP70 106-125
peptide
SYKGETKAFYPEEISSMVLT (SEQ ID NO: 59)


 


CNP 406-421
peptide
TQGSRKGGALQSCTII (SEQ ID NO: 60)


 


HSP60 421-440
peptide
VTDALNATRAAVEEGIVLGG (SEQ ID NO: 61)


 


HSP60 61-80
peptide
TVIIEQSWGSPKVTKDGVTV (SEQ ID NO: 62)


 


AB10-20
peptide
YEVHHQKLVFF (SEQ ID NO: 98)


 


HSP60 511-530
peptide
VNMVEKGIIDPTKVVRTALL (SEQ ID NO: 63)


 


LACTOCEREBROSIDE
lipid
PubChem Subtance ID: 24892591


 


HSP70 406-425
peptide
AGGVMTALIKRNSTIPTKQT (SEQ ID NO: 64)


 


MOG 76-95
peptide
derived from SEQ ID NO: 5


 


HSP70 316-335
peptide
PVEKALRDAKLDKAQIHDLV (SEQ ID NO: 65)


 


HSP60 225-244
peptide
SPYFINTSKGQKCEFQDAYV (SEQ ID NO: 66)


 


HSP60 76-95
peptide
DGVTVAKSIDLKDKYKNIGA (SEQ ID NO: 67)


 


MOG 106-125
peptide
derived from SEQ ID NO: 5


 


HSP70 466-485
peptide
PAPGVPQIEVTFDIDANGIL (SEQ ID NO: 68)


 


CNP 1-20
peptide
MNRGFSRKSHTFLPKIFFRK (SEQ ID NO: 69)


 


HSP70 166-185
peptide
GLNVLRIINEPTAAAIAYGL (SEQ ID NO: 70)


 


HSP70 121-140
peptide
SMVLTKMKEIAEAYLGYPVT (SEQ ID NO: 71)


 


AB1-42
peptide
DAEFRHDSGYEVHHQKLVFFAEDVGSNKGAIIGL




MVGGVVIA (SEQ ID NO: 99)


 


MBP 89-101
peptide
derived from SEQ ID NO: 6


 


CNP 301-320
peptide
ELSEQQLQLWPSDVDKLSPT (SEQ ID NO: 72)


 


HSP70 1-20
peptide
MAKAAAVGIDLGTTYSCVGV (SEQ ID NO: 73)


 


MBP 51-70
peptide
derived from SEQ ID NO: 6


 


HSP70 496-515
peptide
KANKITITNDKGRLSKEEIE (SEQ ID NO: 74)


 


CNP 16-35
peptide
IFFRKMSSSGAKDKPELQFP (SEQ ID NO: 75)


 


CNP 76-95
peptide
DGTKMVSADAYKITPGARGA (SEQ ID NO: 76)


 


PLP 10-29
peptide
derived from SEQ ID NO: 12


 


PLP 190-209
peptide
derived from SEQ ID NO: 12


 


HSP60 346-365
peptide
GEVIVTKDDAMLLKGKGDKA (SEQ ID NO: 77)


 


HSP60 151-170
peptide
VIAELKKQSKPVTTPEEIAQ (SEQ ID NO: 78)


 


HSP70 376-395
peptide
QAAILMGDKSENVQDLLLLD (SEQ ID NO: 79)


 


bovineMBP
protein
SEQ ID NO: 7


 


HSP70 556-575
peptide
GLKGKISEADKKKVLDKCQE (SEQ ID NO: 80)


 


CNP 391-410
peptide
RAIFTGYYGKGKPVPTQGSR (SEQ ID NO: 81)


 


MOG 211-230
peptide
derived from SEQ ID NO: 5


 


PLP 220-249
peptide
derived from SEQ ID NO: 12


 


HSP70 616-635
peptide
PGPGGFGAQGPKGGSGSGPT (SEQ ID NO: 82)


 


AB1-12
peptide
DAEFRHDSGYEV (SEQ ID NO: 100)


 


HSP60 556-573
peptide
PGMGAMGGMGGGMGGGMF (SEQ ID NO: 83)


 


PLP 250-269
peptide
derived from SEQ ID NO: 12
















TABLE 2







Antigens Discriminating PPMS and healthy controls (HC)









Antigen
Type
Sequence/SEQ ID NO:





PLP 215-232
peptide
derived from SEQ ID NO: 12


 


mMBP
protein
SEQ ID NO: 8


 


HSP70 195-214
peptide
LIFDLGGGTFDVSILTIDDG (SEQ ID NO: 51)


 


smLPS (Salmonella
lipid +



minnesota LPS)
saccharide



 


HSP70 210-229
peptide
TIDDGIFEVKATAGDTHLGG (SEQ ID NO: 42)


 


Chondroitin 4-Sulfate
saccharide



 


HSP70 166-185
peptide
GLNVLRIINEPTAAAIAYGL (SEQ ID NO: 70)


 


bovineMBP
protein
SEQ ID NO: 7


 


PLP 137-150
peptide
derived from SEQ ID NO: 12


 


MOG 46-65
peptide
derived from SEQ ID NO: 5


 


CNP 406-421
peptide
TQGSRKGGALQSCTII (SEQ ID NO: 60)


 


P2 31-50
peptide
derived from SEQ ID NO: 10


 


CNP 1-20
peptide
MNRGFSRKSHTFLPKIFFRK (SEQ ID NO: 69)


 


MOG 16-35
peptide
derived from SEQ ID NO: 5


 


P2 76-95
peptide
derived from SEQ ID NO: 10


 


Neurofilament 68 kDa
peptide
SEQ ID NO: 16


 


Amyloid Beta (AB)
protein
DAEFRHDSGYEVHHQKLVFFAEDVGSNKGAII




GLMVGGVVIAT (SEQ ID NO: 13)


 


HSP70 466-485
peptide
PAPGVPQIEVTFDIDANGIL (SEQ ID NO: 68)


 


AB 1-40
peptide
DAEFRHDSGYEVHHQKLVFFAEDVGSNKGAII




GLMVGGVV (SEQ ID NO: 101)


 


PLP 161-180
peptide
derived from SEQ ID NO: 12


 


PLP 40-59
peptide
derived from SEQ ID NO: 12


 


PLP 137-150
peptide
derived from SEQ ID NO: 12


 


HSP60 76-95
peptide
DGVTVAKSIDLKDKYKNIGA (SEQ ID NO: 67)


 


MOG 151-170
peptide
derived from SEQ ID NO: 5


 


P2 1-20
peptide
derived from SEQ ID NO: 10


 


OSP 61-80
peptide
GLYHCKPLVDILILPGYVQA (SEQ ID NO: 29)


 


Secreted APPalpha
peptide
derived from SEQ ID NO: 20


 


PLP 178-191
peptide
derived from SEQ ID NO: 12


 


gpMBP
protein
derived from SEQ ID NO: 9


 


HSP70 16-35
peptide
SCVGVFQHGKVEIIANDQGN (SEQ ID NO: 84)


 


MBP 104-123
peptide
derived from SEQ ID NO: 6


 


SOD
protein
SEQ ID NO: 22


 


ecLPS (E. Coli LPS)
lipid +




saccharide



 


HSP70 121-140
peptide
SMVLTKMKEIAEAYLGYPVT (SEQ ID NO: 71)


 


MOBP 61-80
peptide
derived from SEQ ID NO: 4


 


OSP 1-20
peptide
MVATCLQVVGFVTSFVGWIG (SEQ ID NO: 85)
















TABLE 3







Antigens Discriminating SPMS and RRMS









Antigen
Type
Sequence/SEQ ID NO:





MOG 61-80
peptide
derived from SEQ ID NO: 5


 


HSP60 376-395
peptide
EQLDVTTSEYEKEKLNERLA (SEQ ID NO: 35)


 


MOG 31-50
peptide
derived from SEQ ID NO: 5


 


CNP 361-380
protein
GEEVGELSRGKLYSLGNGRW (SEQ ID NO: 86)


 


Amyloid beta 1-23
peptide
DAEFRHDSGYEVHHQKLVFFAED (SEQ ID NO:




102)


 


CNP 346-365
peptide
LDLLEILRQEKGGSRGEEVG (SEQ ID NO: 87)


 


HSP60 496-515
peptide
QSSSEVGYDAMAGDFVNMVE (SEQ ID NO: 26)


 


OSP 1-20
peptide
MVATCLQVVGFVTSFVGWIG (SEQ ID NO: 85)


 


HSP60 511-530
peptide
VNMVEKGIIDPTKVVRTALL (SEQ ID NO: 63)


 


OSP 61-80
peptide
GLYHCKPLVDILILPGYVQA (SEQ ID NO: 29)


 


HSP60 286-305
peptide
LVLNRLKVGLQVVAVKAPGF (SEQ ID NO: 25)


 


CNP 240-259
peptide
YFGKRPPGVLHCTTKFCDYG (SEQ ID NO: 55)


 


HSP70 601-620
peptide
VCNPIISGLYQGAGGPGPGG (SEQ ID NO: 88)


 


HSP60 210-229
peptide
ELEIIEGMKFDRGYISPYFI (SEQ ID NO: 89)


 


HSP60 451-470
peptide
LDSLTPANEDQKIGIEIIKR (SEQ ID NO: 90)


 


MOBP 166-185
peptide
derived from SEQ ID NO: 4


 


HSP60 166-185
peptide
EEIAQVATISANGDKEIGNI (SEQ ID NO: 53)


 


MBP 138-147
peptide
derived from SEQ ID NO: 6


 


CNP 195-214
peptide
KKSSETLRKAGQVFLEELGN (SEQ ID NO: 91)


 


MBP 1-20
peptide
derived from SEQ ID NO: 6


 


HSP60 526-545
peptide
RTALLDAAGVASLLTTAEVV (SEQ ID NO: 28)


 


P2 1-20
peptide
derived from SEQ ID NO: 10


 


HSP70 286-305
peptide
SLFEGIDFYTSITRARFEEL (SEQ ID NO: 36)


 


MBP 155-178
peptide
derived from SEQ ID NO: 6


 


P2 46-65
peptide
derived from SEQ ID NO: 10


 


HSP60 195-214
peptide
RKGVITVKDGKTLNDELEII (SEQ ID NO: 48)


 


P2 31-50
peptide
derived from SEQ ID NO: 10


 


HSP60 271-290
peptide
LVIIAEDVDGEALSTLVLNR (SEQ ID NO: 44)


 


HSP60 136-155
peptide
NPVEIRRGVMLAVDAVIAEL (SEQ ID NO: 37)


 


CNP 286-305
peptide
ISALFVTPKTTGARVELSEG (SEQ ID NO: 31)


 


HSP70 210-229
peptide
TIDDGIFEVKATAGDTHLGG (SEQ ID NO: 42)


 


HSP70 136-155
peptide
GYPVTNAVITVPAYFNDSQR (SEQ ID NO: 38)


 


PLP 150-163
peptide
derived from SEQ ID NO: 12


 


HSP70 166-185
peptide
GLNVLRIINEPTAAAIAYGL (SEQ ID NO: 70)


 


HSP60 255-275
peptide
QSIVPALEIANAHRKPLVI IA (SEQ ID NO: 32)


 


HSP60 16-35
peptide
RVLAPHLTRAYAKDVKFGAD (SEQ ID NO: 56)


 


bovineMBP
protein
SEQ ID NO: 7


 


CNP 181-199
peptide
LEKDFLPLYFGWFLTKKS SE (SEQ ID NO: 92)


 


CNP 121-140
peptide
LDDTNHERERLEQLFEMADQ (SEQ ID NO: 93)


 


Asialoganglioside-
lipid



GM2




 


Amyloid beta 1-12
peptide
DAEFRHDSGYEV (SEQ ID NO: 100)


 


OSP 121-140
peptide
QLAGVLLILLALCALVATIW (SEQ ID NO: 94)


 


Secreted APPbeta
protein
SEQ ID NO: 21


 


Cardiolipin
lipid



 


HSP70 406-425
peptide
AGGVMTALIKRNSTIPTKQT (SEQ ID NO: 64)


 


HSP60 361-380
peptide
KGDKAQIEKRIQEIIEQLDV (SEQ ID NO: 40)


 


Amyloid beta 17-40
peptide
LVFFAEDVGSNKGAIIGLMVGGVV (SEQ ID NO:




103)


 


Cholesterol
lipid
PubChem Substance ID: 24893094


 


Amyloid beta 1-42
peptide
DAEFRHDSGYEVHHQKLVFFAEDVGSNKGAIIGL




MVGGVVIA (SEQ ID NO: 73)


 


PLP 80-99
peptide
derived from SEQ ID NO: 12


 


PLP 65-84
peptide
derived from SEQ ID NO: 12


 


PLP 40-59
peptide
derived from SEQ ID NO: 12


 


PLP 1-19
peptide
derived from SEQ ID NO: 12


 


PLP 151-173
peptide
derived from SEQ ID NO: 12


 


HSP70 421-440
peptide
PTKQTQIFTTYSDNQPGVLI (SEQ ID NO: 95)


 


huMBP
protein
SEQ ID NO: 6


 


MOBP 16-35
peptide
derived from SEQ ID NO: 4


 


CNP 16-35
peptide
IFFRKMSSSGAKDKPELQFP (SEQ ID NO: 75)


 


RBP
protein
SEQ ID NO: 19


 


HSP70 331-350
peptide
IHDLVLVGGSTRIPKVQKLL (SEQ ID NO: 96)


 


MBP 113-132
peptide
derived from SEQ ID NO: 6


 


beta Crystallin
protein
derived from SEQ ID NO: 15


 


PLP 178-191
peptide
derived from SEQ ID NO: 12
















TABLE 4







Antigens discriminating lesion Pattern I and Pattern II









Antigen
Type
Sequence/SEQ ID NO:





15-ketocholestane
lipid



 


15α-hydroxycholestene
lipid



 


Ganglioside-GM4
lipid



 


15-ketocholestene
lipid



 


Tetrasialoganglioside-
lipid



GQ1B




 


Brain L-α-
lipid



lysophosphatidylserine




 


Lactosylceramide
lipid



 


160 kDa. neurofilament
peptide
SEQ ID NO: 17


 


HSP60 240-259
peptide
QDAYVLLSEKKISSIQSIVP (SEQ ID NO: 43)


 


OSP 166-185
peptide
VLCLVGGCVILCCAGDAQAF (SEQ ID NO: 97)


 


MOG 196-215
peptide
derived from SEQ ID NO: 5


 


OSP 61-80
peptide
GLYHCKPLVDILILPGYVQA (SEQ ID NO: 29)


 


OSP 1-20
peptide
MVATCLQVVGFVTSFVGWIG (SEQ ID NO: 85)


 


PLP 215-232
peptide
derived from SEQ ID NO: 12
















TABLE 5







Accession No. and SEQ ID NO. of the proteins listed in Table 1 to 4










Protein

Accession



(abbreviation)
Protein
No.
SEQ ID NO:





HSP60
60 kDa Heat Shock Protein
GI: 41399285
SEQ ID NO: 1


HSP70
70 kDa Heat Shock Protein
GI: 38327039
SEQ ID NO: 2


CNP
2′,3′-cyclic nucleotide 3′-
GI: 94721261
SEQ ID NO: 3



phosphodiesterase


MOBP
Myelin-Associated
GI: 1408050
SEQ ID NO: 4



Oligodendrocytic Basic



Protein


MOG
Myelin/oligodendrocyte
GI: 56788381
SEQ ID NO: 5



glycoprotein


MBP/huMBP
human Myelin Basic Protein
GI: 68509930
SEQ ID NO: 6


bovineMBP
Bos Taurus Myelin Basic
GI: 74268137
SEQ ID NO: 7



Protein


mMBP
Mus musculus Myelin Basic
GI: 6754658
SEQ ID NO: 8



Protein


gpMBP
Cavia porcellus Myelin
GI: 3309629
SEQ ID NO: 9



Basic Protein


P2
Myelin Protein 2
GI: 4505909
SEQ ID NO: 10


OSP
Oligodendrocyte-Specific
GI: 3283415
SEQ ID NO: 11



Protein


PLP
Proteolipid Protein
GI: 41349499
SEQ ID NO: 12


GFAP
Glial fibrillary acidic protein
GI: 4503979
SEQ ID NO: 14


beta Crystalline

GI: 12056461
SEQ ID NO: 15


Neurofilament 68 kDa

GI: 105990539
SEQ ID NO: 16


Neurofilament 160 kDa

GI: 157738649
SEQ ID NO: 17


Amyloid beta

GI: 41406057
SEQ ID NO: 18


RBP
Retinol-binding protein 4,
GI: 55743122
SEQ ID NO: 19



plasma precursor


APP alpha
amyloid beta protein
GI: 4502167
SEQ ID NO: 20



precursor isoform b


APP beta
amyloid beta protein
GI: 41406055
SEQ ID NO: 21



precursor isoform a


SOD
superoxide dismutase 1
GI: 4507149
SEQ ID NO: 22









According to a first aspect, the present invention provides a method of diagnosing a subtype of multiple sclerosis (MS) in a subject, the method comprising determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 1 to 4, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern, wherein the subtype of MS is selected from the group consisting of:

    
    
        (i) relapsing remitting multiple sclerosis (RRMS) wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 1;
        (ii) primary progressive multiple sclerosis (PPMS) wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 2;
        (iii) secondary progressive multiple sclerosis (SPMS) wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 3; and
        (iv) a pathologic subtype of MS selected form MS characterized by Pattern I lesions and Pattern II lesions wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 4.
    
    


According to certain embodiments of this aspect, a significant difference between the reactivity pattern of said sample obtained from the subject compared to a reactivity pattern of a control sample is an indication that the subject is afflicted with a subtype of MS.
As used herein, the “reactivity of antibodies in a sample” to “a plurality of antigens” refers to the immune reactivity of each antibody in the sample to a specific antigen selected from the plurality of antigens. The immune reactivity of the antibody to the antigen, i.e. its ability to specifically bind the antigen, may be used to determine the amount of the antibody in the sample. The reactivity pattern of the sample thus reflects the levels of each one of the tested antibodies in the sample.
Typically, determining the reactivity of antibodies in the sample to the plurality of antigens is performed using an immunoassay. Advantageously, the plurality of antigens may be used in the form of an antigen array.
A “significant difference” between reactivity patterns refers, in different embodiments, to a statistically significant difference, or in other embodiments to a significant difference as recognized by a skilled artisan. Advantageously, the methods of the invention may employ the use of learning and pattern recognition analyzers, clustering algorithms and the like, in order to discriminate between reactivity patterns of control subjects to those of patients having a subtype of MS. As such, this term specifically includes a difference measured by, for example, determining the reactivity of antibodies in a test sample to a plurality of antigens, and comparing the resulting reactivity pattern to the reactivity patterns of negative and positive control samples (e.g. samples obtained from control subjects which are not afflicted with a subtype of MS or patients afflicted with the tested MS subtype, respectively) using such algorithms and/or analyzers. According to certain embodiments, the control sample is obtained from patients afflicted with another subtype of MS (i.e. the sample may be tested for SPMS while the control sample is obtained form RRMS patients). The difference may also be measured by comparing the reactivity pattern of the test sample to a predetermined classification rule obtained in such manner.
Thus, in another embodiment, a significant difference between the reactivity pattern of a test sample compared to a reactivity pattern of a control sample, wherein the difference is computed using a learning and pattern recognition algorithm, indicates that the subject is afflicted with a subtype of MS. For example, the algorithm may include, without limitation, supervised or non-supervised classifiers including statistical algorithms including, but not limited to, principal component analysis (PCA), partial least squares (PLS), multiple linear regression (MLR), principal component regression (PCR), discriminant function analysis (DFA) including linear discriminant analysis (LDA), and cluster analysis including nearest neighbor, artificial neural networks, coupled two-way clustering algorithms, multi-layer perceptrons (MLP), generalized regression neural network (GRNN), fuzzy inference systems (FIS), self-organizing map (SOM), genetic algorithms (GAS), neuro-fuzzy systems (NFS), adaptive resonance theory (ART).
According to certain embodiments of the methods of the present invention, the control is selected from the group consisting of a sample from at least one individual, a panel of control samples from a set of individuals, and a stored set of data from control individuals.
According to additional embodiments the sample is a serum sample. According to another embodiment the sample is cerebrospinal fluid (CSF). In other particular embodiments, the test sample and control samples may comprise IgG and/or IgM antibodies. In another embodiment, tables 1 to 4 of the methods and kits of the invention comprise duplicates of particular antigens (e.g. PLP 215-232, bovineMBP and CNP 1-20 in table 2 and PLP 1-19, OSP 121-140 and CNP 240-259 in Table 3) for determining the reactivity of IgG and IgM antibodies. In another embodiment, the reactivity of one antibody to a specific antigen (from the plurality of antigens) is up-regulated. In another embodiment, the reactivity of one antibody to a specific antigen is down-regulated.
According to some embodiments, the method further comprises diluting the sample e.g. 1:10 or more before determining the reactivity of antibodies in the sample.
According to other embodiments, the plurality of antigens is used in the form of an antigen array. According to some embodiments the antigen array is arranged in the form of an antigen chip.
According to certain embodiments, the subtype of MS is relapsing remitting multiple sclerosis (RRMS) and the plurality of antigens is selected from Table 1. According to this particular embodiment, the control reactivity pattern is obtained from healthy patients or a stored set of data from healthy patients. According to specific embodiments, the plurality of antigens comprises at least 5, at least 10, at least 15, at least 20, at least 25, at least 30, at least 35, at least 40, at least 45, at least 50, at least 55, at least 60, at least 65, at least 70, at least 75, at least 80, at least 85, at least 90 different antigens of the antigens listed in Table 1. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 1. Preferably the antigen set required to provide a reliable and accurate correlation between the diagnosis and the patient's condition consists of no more than 100, preferably no more than 115, more preferably no more than 130, and most preferably no more than 150 antigens. In another embodiment, the plurality of antigens consists of the antigens listed in Table 1. Each possibility represents a separate embodiment of the present invention.
According to certain embodiments, the subtype of MS is primary progressive multiple sclerosis (PPMS) and the plurality of antigens is selected from Table 2. According to this particular embodiment, the control reactivity pattern is obtained from healthy patients or a stored set of data from healthy patients. According to specific embodiments, the plurality of antigens comprises at least 5, at least 10, at least 15, at least 20, at least 25, at least 30, at least 35 different antigens of the antigens listed in Table 2. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 2. Preferably the antigen set required to provide a reliable and accurate correlation between the diagnosis and the patient's condition consists of no more than 50, preferably no more than 70, more preferably no more than 80, and most preferably no more than 100 antigens. In another embodiment, the plurality of antigens consists of the antigens listed in Table 2. Each possibility represents a separate embodiment of the present invention.
According to certain embodiments, the subtype of MS is secondary progressive multiple sclerosis (SPMS) and the plurality of antigens is selected from Table 3. According to this particular embodiment, the control reactivity pattern is selected from the group consisting of a sample from at least one individual afflicted with RRMS, a panel of control samples from a set of individuals afflicted with RRMS, and a stored set of data from control individuals afflicted with RRMS. According to specific embodiments, the plurality of antigens comprises at least 5, at least 10, at least 15, at least 20, at least 25, at least 30, at least 35, at least 40, at least 45, at least 50, at least 55, at least 60 different antigens of the antigens listed in Table 3. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 3. Preferably the antigen set required to provide a reliable and accurate correlation between the diagnosis and the patient's condition, consists of no more than 80, preferably no more than 90, and most preferably no more than 100 antigens. In another embodiment, the plurality of antigens consists of the antigens listed in Table 3. Each possibility represents a separate embodiment of the present invention.
According to some embodiments, the subtype of MS is a pathologic pattern of MS selected from Pattern I MS lesion and Pattern II MS lesions and the plurality of antigens is selected from Table 4. According to one embodiment, the present invention provides a method for diagnosing Pattern I lesions in a subject with MS and the control reactivity pattern is obtained from patients having Pattern II lesions. According to another embodiment, the present invention provides a method for diagnosing Pattern II lesions in a subject with MS and the control reactivity pattern is obtained from patients having Pattern I lesions. According to another embodiment, the present invention provides a method for distinguishing between subjects having lesion Pattern I and subjects having lesion Pattern II in subjects afflicted with MS. According to specific embodiments, the plurality of antigens comprises at least 4, at least 6, at least 8, at least 10, at least 12 different antigens of the antigens listed in Table 4. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 4. Preferably the antigen set required to provide a reliable and accurate correlation between the diagnosis and the patient's condition, consists of no more than 20, preferably no more than 30, and most preferably no more than 50 antigens. In another embodiment, the plurality of antigens consists of the 14 antigens listed in Table 4. Each possibility represents a separate embodiment of the present invention.
According to certain embodiments, the present invention provides a method for diagnosing a subtype of MS in a subject, the method comprising:

    
    
        (a) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 1, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from healthy subjects;
        (b) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 2, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from healthy subjects;
        (c) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 3, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from subjects afflicted with RRMS;
        (d) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 4, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from subjects having Pattern I lesions, and/or to a control reactivity pattern obtained from subjects having Pattern II lesions;

wherein:

        (i) a significant difference between the reactivity pattern of (a) compared to said control reactivity pattern is an indication that the subject is afflicted with RRMS;
        (ii) a significant difference between the reactivity pattern of (b) compared to said control reactivity pattern is an indication that the subject is afflicted with PPMS;
        (iii) a significant difference between the reactivity pattern of (c) compared to said control reactivity pattern is an indication that the subject is afflicted with SPMS; and
        (iv) a significant difference between the reactivity pattern of (d) compared to a control reactivity pattern obtained from subjects having Pattern I lesions is an indication that the subject is afflicted with Pattern II lesions, and a significant difference between the reactivity pattern of (d) compared to a control reactivity pattern obtained from subjects having Pattern II lesions is an indication that the subject is afflicted with Pattern I lesions.
    
    


According to some embodiments, the control reactivity pattern for Table 1 and Table 2 is obtained from healthy control subjects or a stored set of data from healthy control subjects. According to another embodiment, the control reactivity pattern for Table 3 is obtained from subjects afflicted with RRMS or a stored set of data from subjects afflicted with RRMS.
According to another aspect, the present invention provides a kit for the diagnosis of a subtype of MS comprising:

    
    
        (i) a plurality of antigens for the diagnosis of RRMS selected from the group consisting of the antigens listed in Table 1;
        (ii) a plurality of antigens for the diagnosis of PPMS selected from the group consisting of the antigens listed in Table 2;
        (iii) a plurality of antigens for the diagnosis of SPMS selected from the group consisting of the antigens listed in Table 3; and
        (iv) a plurality of antigens for discriminating between Pattern I lesions to Pattern II lesions in a subject with MS, selected from the group consisting of the antigens listed in Table 4.
    
    


According to certain embodiments, the present invention provides a kit for the diagnosis of RRMS, comprising a plurality of antigens selected from the group consisting of the antigens listed in Table 1. According to specific embodiments, the plurality of antigens comprises at least 5, at least 10, at least 15, at least 20, at least 25, at least 30, at least 35, at least 40, at least 45, at least 50, at least 55, at least 60, at least 65, at least 70, at least 75, at least 80, at least 85, at least 90 different antigens of the antigens listed in Table 1. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 1. Each possibility represents a separate embodiment of the present invention.
According to certain embodiments, the present invention provides a kit for the diagnosis of PPMS, comprising a plurality of antigens selected from the group consisting of the antigens listed in Table 2. According to specific embodiments, the plurality of antigens comprises at least 5, at least 10, at least 15, at least 20, at least 25, at least 30, at least 35 different antigens of the antigens listed in Table 2. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 2. Each possibility represents a separate embodiment of the present invention.
According to certain embodiments, the present invention provides a kit for the diagnosis of SPMS, comprising a plurality of antigens selected from the group consisting of the antigens listed in Table 3. According to specific embodiments, the plurality of antigens comprises at least 5, at least 10, at least 15, at least 20, at least 25, at least 30, at least 35, at least 40, at least 45, at least 50, at least 55, at least 60 different antigens of the antigens listed in Table 3. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 3. Each possibility represents a separate embodiment of the present invention.
According to certain embodiments, the present invention provides a kit for discriminating between Pattern I lesions to Pattern II lesions in a subject with MS, comprising a plurality of antigens selected from the group consisting of the antigens listed in Table 4. According to specific embodiments, the plurality of antigens comprises at least 4, at least 6, at least 8, at least 10, at least 12 different antigens of the antigens listed in Table 4. According to another embodiment, the plurality of antigens comprises all the antigens listed in Table 4. Each possibility represents a separate embodiment of the present invention.
In other embodiments, the kit may further comprise means for determining the reactivity of antibodies in a sample to the plurality of antigens. For example, the kit may contain reagents, detectable labels and/or containers which may be used for measuring specific binding of antibodies to the antigen probes of the invention. In a particular embodiment, said kit is in the form of an antigen array. In other embodiments, said kit may further comprise negative and/or positive control samples. For example, a negative control sample may contain a sample from at least one healthy individual or at least one individual identified with another subtype of MS (e.g. samples obtained from at least one individual afflicted with RRMS are used as a negative control while the kit is for means of diagnosing SPMS in a test sample). A positive control may contain a sample from at least one individual afflicted with the sub-type of MS which is being diagnosed. Other non-limiting examples are a panel of control samples from a set of healthy individuals or diseased individuals, or a stored set of data from control individuals.
In other embodiments, the kit may further comprise means for comparing reactivity patterns of antibodies in different samples to the plurality of antigens. In a specific embodiment, the means for comparing reactivity patterns comprises a learning and pattern recognition analyzer (e.g. utilizing learning and pattern recognition algorithms as detailed herein).
According to other embodiments, the methods and kits of the present invention are useful for monitoring MS progression.
According to another aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 1. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 1, as detailed herein.
According to another aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 2. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 2, as detailed herein.
According to another aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 3. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 3, as detailed herein.
According to another aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 4. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 4, as detailed herein.
According to another aspect, the present invention provides an article of manufacture comprising the antigen probe set of the present invention.
According to another aspect, the present invention provides use of an antigen probe set for the preparation of a diagnostic composition for diagnosing a subtype of MS, the antigen probe set containing a plurality of antigens selected from the group consisting of the antigens listed in one of Tables 1 to 4, wherein the subtype of MS is selected from the group consisting of:

    
    
        (i) RRMS wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 1;
        (ii) PPMS wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 2;
        (iii) SPMS wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 3; and
        (iv) a pathologic subtype of MS selected form Pattern I lesions and Pattern II lesions wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 4.
    
    


In one embodiment, the diagnostic composition is useful for determining the reactivity of antibodies in a sample, thereby determining the reactivity pattern of the sample to said plurality of antigens, wherein a significant difference between the reactivity pattern of said sample compared to a reactivity pattern of a control sample is an indication for a subtype of MS.
Other objects, features and advantages of the present invention will become clear from the following description and drawings.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows the performance of antigen microarrays. RRMS or healthy controls (HC) serum samples were hybridized on antigen microarrays at different concentrations and the mean IgG (FIG. 1A) and IgM (FIG. 1B) reactivity to the CNS, HSP or lipid antigens spotted on the microarrays were measured. Results are presented as mean±SEM of the IgG or IgM reactivity for CNS, HSP or lipid antigens at each dilution. *P<0.05, **P<0.01 and ***P<0.001 (two-way ANOVA) when compared to HC samples tested at the same dilution. FIG. 1C shows RRMS sera (1:10 dilution) preincubated with different concentrations of PLP261-277 or HSP601-20 and their IgG reactivity to PLP261-277 was measured on antigen microarrays. **P<0.01 and ***P<0.001 (one-way ANOVA) when compared to samples that were pre-incubated with no competitor.
FIG. 2 shows the serum antibody reactivity in RRMS, PPMS and SPMS. FIGS. 2A and 2B show antibody reactivities discriminating RRMS (FIG. 2A) or PPMS (FIG. 2B) from HC. Heatmap in which each column represents a patient, color-coded at the bottom to indicate whether it corresponds to a RRMS (FIG. 2A), PPMS (FIG. 2A) or HC (FIG. 2A and FIG. 2B) sample, and each row shows the normalized antibody reactivity (detailed in the Examples 2 and 3 below) to an antigen according to the colorimetric scale shown on the left. FIGS. 2C-2D show the antigen specificity in RRMS and PPMS. The specificity of the discriminating antibodies in RRMS and PPMS is shown as the relative contribution of CNS, HSP and lipid antigens (% relative to total number of discriminating antigens) found to be up- or down-regulated (FIGS. 2C and 2D respectively) in MS relative to HC. FIG. 2E shows heatmap depicting the antibody reactivities in SPMS and RRMS samples. FIGS. 2F and 2G show the antigen specificity in SPMS, shown as the relative contribution of CNS, HSP and lipid antigens (% relative to total number of discriminating antigens) found to be up- or down-regulated (FIGS. 2F and 2G respectively) in SPMS relative to RRMS. FIG. 2H is a diagram summarizing the immune signature associated with RRMS, SPMS and PPMS.
FIG. 3 shows the antibody reactivity associated with brain pathology. Heatmap in which each column represents a patient, color-coded at the bottom to indicate whether it corresponds to a Pattern I or Pattern II sample, shows the normalized antibody reactivity to an antigen according to the colorimetric scale shown on the left. The antibody reactivities used to construct this heatmap are listed in Example 5 below.
FIG. 4 shows the effect of administration of oxidized cholesterol derivatives to EAE. FIG. 4A shows that the administration of oxidized cholesterol derivatives to EAE worsens EAE. FIGS. 4B-BD depict quantification of the cellular infiltrate (FIG. 4B), demyelination (FIG. 4C) and axonal loss on the spinal cord (FIG. 4D) of MOG35-55, MOG35-55+oxChol or MOG35-55+oxChol+AIQ mice.



DETAILED DESCRIPTION OF THE INVENTION
The present invention provides methods of diagnosing multiple sclerosis (MS) in a subject, using antigen probe arrays for practicing such a diagnosis, and identifies specific antigen probe sets for generating such arrays. According to some embodiments, the present invention relates to an autoantibody-based biomarker test for early diagnosis and for monitoring the progress of MS. Particularly, the methods and kits of the present invention can distinguish the form of MS (namely RRMS, SPMS or PPMS) in a subject. Further, the methods and kits of the invention can distinguish the lesion pattern, particularly between lesion pattern I to lesion pattern II, in MS patients.
As exemplified herein below, antigen-microarray analysis of autoantibodies can identify serum and CSF autoantibody signatures associated with different clinical forms and pathologic subtypes of MS; the signatures were based on collective autoantibody patterns, not single autoantibody reactivities. These informative patterns emerged from autoantibodies that bound peptides of myelin molecules and HSP, proteins and lipids. Moreover, the informative patterns included decreases as well as increases of autoantibody reactivities relative to those found in HC.
Further, the unique antibody patterns were associated with different patterns of MS pathology. Pattern II MS pathology was associated with increased IgG antibodies to HSP60, OSP, MOG and PLP peptide epitopes, whereas increased antibody reactivity to gangliosides, lactosylceramide and L-α-lysophosphatidylserine was linked to pattern I. Antibodies to lactosylceramide and L-α-lysophosphatidylserine have been described in the CSF of MS patients and EAE mice (Kanter et al., 2006). Pattern I serum samples also contained antibodies to oxidized cholesterol derivatives (15-ketocholestene, 15-ketocholestane and 15a-hydroxycholestene). Increased levels of 7-ketocholesterol, a related oxidized derivative of cholesterol, have been found in the CSF of MS patients. Notably, 7-ketocholesterol and gangliosides activate microglial cells by PARP and toll-like receptor 4 dependent pathways, respectively.
A significant finding of the studies presented herein was that the antibody repertoires in CSF and serum of MS patients were clearly distinct. These results are consistent with the compartmentalization of the immune response in the CSF of MS subjects. Although antibodies in the CSF have been extensively investigated in MS, the unique antibody immune signatures as described herein have not been described before.
Initial studies suggest that unique signatures may be associated with response to therapy and disease progression. For example, approximately 50% of RMSS patients become SPMS, and this conversion is associated with changes in immunological and neurodegenerative mechanisms. As exhibited herein below, studies of SPMS with antigen arrays revealed antibody signatures that share characteristics of both RRMS and PPMS patients, suggesting that antigen arrays are useful to monitor this change in disease pattern. Moreover, if these antibody patterns are established early in the course of the disease, they will be useful for early diagnosis and screening for MS susceptibility as they can be measured in small quantities of serum. Thus, the findings presented herein demonstrate that serum microarray antibody patterns provide a new avenue both to monitor MS, e.g., to determine the prognosis of the disease, and to characterize immunopathogenic mechanisms of the disease.
Antigen Probes and Antigen Probe Sets
According to further embodiments, the invention provides antigen probes and antigen probe sets useful for diagnosing MS, as detailed herein.
According to the principles of the invention, the invention further provides a plurality of antigens also referred to herein as antigen probe sets. These antigen probe sets comprising a plurality of antigens are reactive specifically with the sera of subjects having MS. According to the principles of the invention, the plurality of antigens may advantageously be used in the form of an antigen array. According to some embodiments the antigen array is conveniently arranged in the form of an antigen chip.
A “probe” as used herein means any compound capable of specific binding to a component. According to one aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 1. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 1. According to certain embodiments, the antigen probe sets of the invention comprise a plurality of antigens selected from Table 1, as detailed herein, for the diagnosis of RRMS. Preferably, the plurality of antigens comprises a set of the antigens listed in Table 1. Yet in other embodiments, the antigen probe set comprises or consists of a subset thereof, e.g. at least 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90 different antigens each selected from the list as specified in Table 1 wherein each possibility represents a separate embodiment of the invention. Such subsets may be selected so as to result in optimal sensitivity and/or specificity of the diagnostic assay. In other embodiments, the probe set comprises up to 115, or in other embodiments up to 130 or 150 different antigens. In other embodiments, a probe set consisting of the antigens as specified in Table 1 is sufficient to discriminate between RRMS patients, and healthy individuals that are not afflicted with RRMS. It should be noted, that while such probe sets are considered sufficient for reliably identifying a subject with RRMS, the antigen probe sets of the invention may conveniently be used, in certain embodiments, in the form of antigen arrays comprising a greater number of antigens, e.g. about 130 antigens or more. According to another aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 2. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 2. According to other embodiments, the antigen probe sets of the invention comprise a plurality of antigens selected from Table 2, as detailed herein, for the diagnosis of PPMS. Preferably, the plurality of antigens comprises a set of the antigens listed in Table 2. Yet in other embodiments, the antigen probe set comprises or consists of a subset thereof, e.g. at least 5, 10, 15, 20, 25, 30, 35 different antigens each selected from the list as specified in Table 2 wherein each possibility represents a separate embodiment of the invention. Such subsets may be selected so as to result in optimal sensitivity and/or specificity of the diagnostic assay. In other embodiments, the probe set comprises up to 50, or in other embodiments up to 70 or 100 different antigens. In other embodiments, a probe set consisting of the antigens as specified in Table 2 is sufficient to discriminate between PPMS patients, and healthy individuals that are not afflicted with PPMS. It should be noted, that while such probe sets are considered sufficient for reliably identifying a subject with PPMS, the antigen probe sets of the invention may conveniently be used, in certain embodiments, in the form of antigen arrays comprising a greater number of antigens, e.g. about 100 antigens or more.
According to another aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 3. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 3. According to certain embodiments, the antigen probe sets of the invention comprise a plurality of antigens selected from Table 3, as detailed herein, for the diagnosis of SPMS. Preferably, the plurality of antigens comprises a set of the antigens listed in Table 3. Yet in other embodiments, the antigen probe set comprises or consists of a subset thereof, e.g. at least 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60 different antigens each selected from the list as specified in Table 3, wherein each possibility represents a separate embodiment of the invention. Such subsets may be selected so as to result in optimal sensitivity and/or specificity of the diagnostic assay. In other embodiments, the probe set comprises up to 80, or in other embodiments up to 100 or 150 different antigens. In other embodiments, a probe set consisting of the antigens as specified in Table 3 is sufficient to discriminate between SPMS patients and RRMS patients. It should be noted, that while such probe sets are considered sufficient for reliably identifying a subject with SPMS, the antigen probe sets of the invention may conveniently be used, in certain embodiments, in the form of antigen arrays comprising a greater number of antigens, e.g. about 130 antigens or more.
According to another aspect, the present invention provides an antigen probe set comprising the antigen probes listed in Table 4. According to certain embodiments, the antigen probe set comprises a subset of the antigens listed in Table 4. According to certain embodiments, the antigen probe sets of the invention comprise a plurality of antigens selected from Table 4, as detailed herein, for distinguishing between Pattern I and Pattern II MS lesions. Preferably, the plurality of antigens comprises a set of the 14 antigens listed in Table 4. Yet in other embodiments, the antigen probe set comprises or consists of a subset thereof, e.g. 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 different antigens each selected from the list as specified in Table 4, wherein each possibility represents a separate embodiment of the invention. Such subsets may be selected so as to result in optimal sensitivity and/or specificity of the diagnostic assay. In other embodiments, the probe set comprises up to 20, or in other embodiments up to 30 or 50 different antigens. In other embodiments, a probe set consisting of 14 antigens as specified in Table 4 is sufficient to discriminate between patients having Pattern I or Pattern II MS lesions. It should be noted, that while such probe sets are considered sufficient for reliably identifying a MS pattern, the antigen probe sets of the invention may conveniently be used, in certain embodiments, in the form of antigen arrays comprising a greater number of antigens, e.g. about 50 antigens or more.
Antigen probes to be used in the assays of the invention may be purified or synthesized using methods well known in the art. For example, an antigenic protein or peptide may be produced using known recombinant or synthetic methods, including, but not limited to, solid phase (e.g. Boc or f-Moc chemistry) and solution phase synthesis methods (Stewart and Young, 1963; Meienhofer, 1973; Schroder and Lupke, 1965; Sambrook et al., 2001). One of skill in the art will possess the required expertise to obtain or synthesize the antigen probes of the invention. Some of the antigen probes are also commercially available, e.g. from Sigma (St. Louis, Mo., USA), Abnova (Taipei City, Taiwan), Matreya LLC (Pleasant Gap, Pa., USA), Avanti Polar Lipids (Alabaster, Ala., USA), Calbiochem (San Diego, Calif., USA), Chemicon (Temecula, Calif., USA), GeneTex (San Antonio, Tex., USA), Novus Biologicals (Littleton, Colo., USA) Assay Designs (Ann Arbor, Mich., USA), ProSci Inc. (Poway, Calif., USA), EMD Biosciences (San Diego, Calif., USA), Cayman Chemical (Ann Arbor, Mich., USA), HyTest (Turku, Finland), Meridian Life Science (Memphis, Tenn. USA) and Biodesign International (Saco, Me., USA), as detailed herein below.
It should be noted, that the invention utilizes antigen probes having the amino acid sequences as set forth in Table 1 to table 4, as well as homologs, fragments and derivatives thereof, as long as these homologs, fragments and derivatives are immunologically cross-reactive with these antigen probes. The term “immunologically cross-reactive” as used herein refers to two or more antigens that are specifically bound by the same antibody. The term “homolog” as used herein refers to a peptide which having at least 70%, at least 75%, at least 80%, at least 85% or at least 90% identity to the antigen's amino acid sequence. Cross-reactivity can be determined by any of a number of immunoassay techniques, such as a competition assay (measuring the ability of a test antigen to competitively inhibit the binding of an antibody to its known antigen).
The term peptide typically refers to a polypeptide of up to about 50 amino acid residues in length. According to particular embodiments, the antigenic peptides of the invention may be 10-50 amino acids in length and are typically about 10-30 or about 15-25 amino acids in length.
The term encompasses native peptides (either degradation products, synthetically synthesized peptides, or recombinant peptides), peptidomimetics (typically, synthetically synthesized peptides), and the peptide analogues peptoids and semipeptoids, and may have, for example, modifications rendering the peptides more stable while in a body or more capable of penetrating into cells. Such modifications include, but are not limited to: N-terminus modifications; C-terminus modifications; peptide bond modifications, including but not limited to CH2—NH, CH2—S, CH2—S═O, O═C—NH, CH2—O, CH2—CH2, S═C—NH, CH═CH, and CF═CH; backbone modifications; and residue modifications.
The antigens of the invention may be used having a terminal carboxy acid, as a carboxy amide, as a reduced terminal alcohol or as any pharmaceutically acceptable salt, e.g., as metal salt, including sodium, potassium, lithium or calcium salt, or as a salt with an organic base, or as a salt with a mineral acid, including sulfuric acid, hydrochloric acid or phosphoric acid, or with an organic acid e.g., acetic acid or maleic acid.
Functional derivatives consist of chemical modifications to amino acid side chains and/or the carboxyl and/or amino moieties of said peptides. Such derivatized molecules include, for example, those molecules in which free amino groups have been derivatized to form amine hydrochlorides, p-toluene sulfonyl groups, carbobenzoxy groups, t-butyloxycarbonyl groups, chloroacetyl groups or formyl groups. Free carboxyl groups may be derivatized to form salts, methyl and ethyl esters or other types of esters or hydrazides. Free hydroxyl groups may be derivatized to form O-acyl or O-alkyl derivatives. The imidazole nitrogen of histidine may be derivatized to form N-im-benzylhistidine. Also included as chemical derivatives are those polypeptides, which contain one or more naturally occurring or modified amino acid derivatives of the twenty standard amino acid residues. For example: 4-hydroxyproline may be substituted for proline; 5-hydroxylysine may be substituted for lysine; 3-methylhistidine may be substituted for histidine; homoserine may be substituted or serine; and ornithine may be substituted for lysine.
The amino acid residues described herein are in the “L” isomeric form, unless otherwise indicated. However, residues in the “D” isomeric form can be substituted for any L-amino acid residue, as long as the peptide substantially retains the desired antibody specificity.
Suitable analogs may be readily synthesized by now-standard peptide synthesis methods and apparatus or recombinant methods. All such analogs will essentially be based on the antigens of the invention as regards their amino acid sequence but will have one or more amino acid residues deleted, substituted or added. When amino acid residues are substituted, such conservative replacements which are envisaged are those which do not significantly alter the structure or antigenicity of the polyeptide. For example basic amino acids will be replaced with other basic amino acids, acidic ones with acidic ones and neutral ones with neutral ones. In addition to analogs comprising conservative substitutions as detailed above, analogs comprising non-conservative amino acid substitutions are further contemplated, as long as these analogs are immunologically cross reactive with a peptide of the invention.
In other aspects, there are provided nucleic acids encoding these peptides, vectors comprising these nucleic acids and host cells containing them. These nucleic acids, vectors and host cells are readily produced by recombinant methods known in the art (see, e.g., Sambrook et al., 2001). For example, an isolated nucleic acid sequence encoding an antigen of the invention can be obtained from its natural source, either as an entire (i.e., complete) gene or a portion thereof. A nucleic acid molecule can also be produced using recombinant DNA technology (e.g., polymerase chain reaction (PCR) amplification, cloning) or chemical synthesis. Nucleic acid sequences include natural nucleic acid sequences and homologs thereof, including, but not limited to, natural allelic variants and modified nucleic acid sequences in which nucleotides have been inserted, deleted, substituted, and/or inverted in such a manner that such modifications do not substantially interfere with the nucleic acid molecule's ability to encode a functional peptide of the present invention.
The lipid antigens to be used in the assays of the invention may be purified or synthesized using methods well known in the art (see, for example, Biochemistry of Lipids, Lipoproteins, and Membranes, 4.sup.th Ed. (2002; Vance D E and Vance, J E, editors; Elsevier, Amsterdam, Boston); Enzymes in Lipid Modification (2000; Bornsheuer, U T, editor; Wiley-VCH, Weinheim, N.Y.); Lipid Synthesis and Manufacture (1999; Gunstone, F D, editor; Sheffield Academic Press, Sheffield, England; CRC Press, Boca Raton, Fla.); Lipid Biochemistry, 5.sup.th Ed (2002; Gun, M I, Harwood, J L, and Frayn, K N, editors; Blackwell Science, Oxford, Malden, Mass.). In another embodiment, the lipid antigens to be used in the assays of the invention may be commercially purchased as detailed herein below.
Diagnostic Methods
According to some embodiments, the invention provides diagnostic methods useful for the detection of MS, particularly RRMS, PPMS and SPMS. In anther embodiment, the invention provides diagnostic methods useful for discriminating MS demyelination patterns, particularly Pattern I and Pattern II MS lesions.
According to some embodiments, the methods of the invention are effected by determining the reactivity of antibodies in a sample obtained from a test subject to a plurality of antigens selected from the group consisting of the antigens listed in Table 1 to Table 4, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern. In one embodiment, a significant difference between the reactivity pattern of said sample compared to a reactivity pattern of a control sample indicates that the subject is afflicted with MS. According to one embodiment, the antigens are selected from Table 1 for the diagnosis of RRMS and the control reactivity pattern is obtained from healthy patients. According to another embodiment, the antigens are selected from Table 2 for the diagnosis of PPMS and the control reactivity pattern is obtained from healthy patients. According to another embodiment, the antigens are selected from Table 3 for the diagnosis of SPMS and the control reactivity pattern is obtained from patients afflicted with RRMS. According to another embodiment, the antigens are selected from Table 4 for discriminating between Pattern I and Pattern II MS lesions (i.e. the sample is tested for Pattern I MS and the control reactivity pattern is obtained from patients having Pattern II MS lesions; or the sample is tested for Pattern II MS and the control reactivity pattern is obtained from patients having Pattern I MS lesions). According to particular embodiments, the antigens are selected from the group consisting of the antigens listed in any one of Tables 1 to Table 4, and said reactivity pattern of said sample indicates the stage of MS in the subject, wherein (i) a significant difference between the control reactivity pattern compared to the reactivity pattern of the sample to the plurality of antigens selected from Table 1 indicates the subject has RRMS; (ii) a significant difference between the control reactivity pattern compared to the reactivity pattern of the sample to the plurality of antigens selected from Table 2 indicates the subject has PPMS; (iii) a significant difference between the control reactivity pattern compared to the reactivity pattern of the sample to the plurality of antigens selected from Table 3 indicates the subject has SPMS; and (iv) a significant difference between the control reactivity pattern compared to the reactivity pattern of the sample to the plurality of antigens selected from Table 4 indicates the subject has Pattern I or Patter II MS lesions.
As used herein, the “reactivity of antibodies in a sample” to “a plurality of antigens” refers to the immune reactivity of each antibody in the sample to a specific antigen selected from the plurality of antigens. The immune reactivity of the antibody to the antigen, i.e. its ability to specifically bind the antigen, may be used to determine the amount of the antibody in the sample. The calculated levels of each one of the tested antibodies in the sample are selectively referred to as the reactivity pattern of the sample to these antigens. For instance, in the Examples below, the reactivity of each antigen was calculated and presented as the scaled mean log intensity of each spot (antigen).
In other embodiments, the methods comprise determining levels of antibodies directed to a plurality of antigens selected from the group consisting of the antigens listed in Table 1 to 4 in a sample obtained from the subject, wherein a statistically significant difference between the level of the antibodies in the sample obtained from the subject compared to a level of the antibodies in a control population, is an indication that the subject is afflicted with a subtype of MS, wherein the subtype of MS is selected from the group consisting of: (i) RRMS wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 1; (ii) PPMS wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 2; (iii) SPMS wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 3; and (iv) a pathologic subtype of MS selected form Pattern I lesions and Pattern II lesions wherein said plurality of antigens is selected from the group consisting of the antigens listed in Table 4.
An antibody “directed to” an antigen, as used herein is an antibody which is capable of specifically binding the antigen. Determining the levels of antibodies directed to a plurality of antigens includes measuring the level of each antibody in the sample, wherein each antibody is directed to a specific antigen of the antigens listed in Tables 1 to 4. This step is typically performed using an immunoassay, as detailed herein.
In other embodiments, the methods comprise determining the levels of a plurality of antibodies in a sample obtained from the subject, each antibody being directed to an antigen selected from the group consisting of the antigens listed in Tables 1 to 4, wherein a significant difference between the levels of the antibodies in the sample obtained from the subject compared to a control level of the antibodies is an indication that the subject is afflicted with a subtype of MS selected from the group consisting of: (i) RRMS wherein said antigen is selected from the antigens listed in Table 1; (ii) PPMS wherein said antigen is selected from the antigens listed in Table 2; (iii) SPMS wherein said antigen is selected from the antigens listed in Table 3; and (iv) a pathologic subtype of MS selected form Pattern I lesions and Pattern II lesions wherein said antigen is selected from the antigens listed in Table 4.
In other embodiments, determining the reactivity of antibodies in said sample to said plurality of antigens, (and the levels of each one of the tested antibodies in the sample) is performed by a process comprising:

    
    
        contacting the sample, under conditions such that a specific antigen-antibody complex may be formed, with an antigen probe set comprising said plurality of antigens, and
        quantifying the amount of antigen-antibody complex formed for each antigen probe.
        The amount of antigen-antibody complex is indicative of the level of the tested antibody in the sample (or the reactivity of the sample with the antigen).
    
    


According to certain embodiments, the present invention provides a method for the differential diagnosis of MS in a subject, the method comprising:

    
    
        (a) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 1, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from healthy subjects;
        (b) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 2, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from healthy subjects;
        (c) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 3, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from subjects afflicted with RRMS;
        (d) determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 4, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern obtained from subjects having Pattern I lesions, and/or to a control reactivity pattern obtained from subjects having Pattern II lesions;

wherein:

        (i) a significant difference between the reactivity pattern of (a) compared to said control reactivity pattern is an indication that the subject is afflicted with RRMS;
        (ii) a significant difference between the reactivity pattern of (b) compared to said control reactivity pattern is an indication that the subject is afflicted with PPMS;
        (iii) a significant difference between the reactivity pattern of (c) compared to said control reactivity pattern is an indication that the subject is afflicted with SPMS; and
        (iv) a significant difference between the reactivity pattern of (d) compared to a control reactivity pattern obtained from subjects having Pattern I lesions is an indication that the subject is afflicted with Pattern II lesions, and a significant difference between the reactivity pattern of (d) compared to a control reactivity pattern obtained from subjects having Pattern II lesions is an indication that the subject is afflicted with Pattern I lesions.
    
    


According to some embodiments, the control reactivity pattern for Table 1 and Table 2 is obtained from healthy control subjects or a stored set of data from healthy control subjects. According to another embodiment, the control reactivity pattern for Table 3 is obtained from subjects afflicted with RRMS or a stored set of data from subjects afflicted with RRMS. According to another embodiment, the control reactivity pattern of the methods and kits of the present invention is obtained from subjects afflicted for other autoimmune or degenerative diseases (e.g. SLE, ALD and AD). According to another embodiment, the reactivity pattern of the sample is compared to a control reactivity pattern previously obtained from the same subject (e.g. kept as a stored set of data), for monitoring disease progression. It should be understood that antibody repertoires of the control sample and the sample obtained from the subject are obtained from the same compartment (e.g. an antibody repertoires of a serum control sample is compared to an antibody repertoires of the sample obtained from the subject's serum).
In another embodiment, there is provided a method of diagnosing a subtype of MS (i.e. RRMS, PPMS, SPMS, lesion Pattern I and lesion Pattern II) in a subject in need thereof, the method comprising:

    
    
        a) obtaining an antibody-containing biological sample (e.g. serum) from a subject;
        b) contacting the sample, under conditions such that an antigen-antibody complex may be formed, with an antigen probe set comprising plurality of antigens as specified in Table 1 to Table 4 herein (or immunogenic fragments, analogs, derivatives and salts thereof); and
        c) determining the capacity of antibodies of said sample to specifically bind a plurality of antigens of the antigen probe set;
    
    


wherein a significant difference in said capacity compared to the capacity of a control sample (e.g. a sample obtained from a subject not having MS) is indicative that the subject is afflicted with a subtype of MS.
According to another embodiment, the present invention provides a method of diagnosing relapsing remitting multiple sclerosis (RRMS) in a subject, the method comprising determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Table 1, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern (e.g. a sample obtained from a healthy control), wherein a significant difference between the reactivity pattern of said sample obtained from the subject compared to the reactivity pattern of the control sample is an indication that the subject is afflicted with RRMS.
According to another embodiment, the present invention provides a method of diagnosing primary progressive multiple sclerosis (PPMS) in a subject, the method comprising determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Table 2, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern (e.g. a sample obtained from a healthy control), wherein a significant difference between the reactivity pattern of said sample obtained from the subject compared to the reactivity pattern of the control sample is an indication that the subject is afflicted with PPMS.
According to another embodiment, the present invention provides a method of diagnosing secondary progressive multiple sclerosis (SPMS) in a subject, the method comprising determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Table 3, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern (e.g. a sample obtained from a patient afflicted with RRMS), wherein a significant difference between the reactivity pattern of said sample obtained from the subject compared to the reactivity pattern of the control sample is an indication that the subject is afflicted with SPMS.
According to another embodiment, the present invention provides a method of discriminating (i.e. distinguishing) between subjects having lesion pattern I and subjects having lesion pattern II in subjects with MS, the method comprising determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Table 4, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern. According to certain embodiments, a difference (e.g. an increase) in the reactivity of an antibody to a plurality of antigens selected from the group consisting of 15-ketocholestane, 15a-hydroxycholestene, ganglioside-GM4, tetrasialoganglioside-GQ1B, brain L-α-lysophosphatidylserine, lactosylceramide or 160 kDa neurofilament is an indication that the subject has pattern I lesions and wherein a difference (e.g. an increase) in the reactivity of an antibody to a plurality antigens selected from the group consisting of HSP60, MOG, OSP and PLP peptide epitopes is an indication that the subject has pattern II lesions. In another embodiment, the antibodies for discriminating between subjects having lesion pattern I and subjects having lesion pattern II, are selected form IgM and/or IgG antibodies. In a particular embodiment, all of the antibodies reactive with the antigens listed in Table 4 are IgG antibodies, excluding the antibody reactive with 160 kDa neurofilament, which is an IgM antibody.
In certain embodiments, the test sample and control samples may comprise IgG and/or IgM antibodies. In another embodiment, the reactivity of at least one antibody to a specific antigen, from the plurality of antigens listed in Tables 1 to 4, is up-regulated. In another embodiment, the reactivity of at least one antibody to a specific antigen is down-regulated.
According to particular embodiments, the reactivity pattern for distinguishing RRMS from healthy patients consists of 94 antibody reactivities. According to one embodiment, said reactivity pattern consists of 90 up-regulated reactivities and 4 down-regulated reactivities. In another embodiment, the antibody in the sample obtained from the subject is an IgG antibody wherein the antibody is reactive with an antigen selected from the group consisting of: MBP 31-50; HSP70 481-500; PLP 65-84; and GFAP. In another embodiment, the antibody in the sample obtained from the subject is an IgM antibody wherein the antibody is reactive with an antigen selected from the group consisting of: HSP70 511-530; MBP 41-60; HSP60 286-305; HSP60 496-515; HSP70 151-170; HSP60 526-545; MBP 84-94; OSP 61-80; HSP70 31-50; CNP 286-305; HSP60 255-275; HSP60 106-125; OSP 31-50; P2 61-80; MBP 11-30; HSP60 376-395; HSP70 286-305; HSP60 136-155; HSP70 136-155; P2 46-65; OSP 136-155; P2 1-20; MOG 91-110; HSP60 361-380; HSP70 451-470; HSP70 210-229; HSP60 240-259; HSP60 271-290; OSP 76-95; PLP 178-191; CNP 271-290; P2 76-95; HSP70 631-640; PLP 248-259; HSP60 195-214; CNP 61-80; MOG 196-215; HSP60 46-65; HSP70 195-214; HSP70 436-455; HSP60 166-185; MBP 104-123; MBP 71-92; PLP 180-199; HSP70 255-275; MOBP 166-185; CNP 240-259; HSP60 16-35; HSP60 301-320; MOBP 151-170; CNP 91-110; HSP70 106-125; CNP 406-421; HSP60 421-40; HSP60 61-80; Amyloid beta 10-20; HSP60 511-530; Lactocerebroside; HSP70 406-425; MOG 76-95; HSP70 316-335; HSP60 225-244; HSP60 76-95; MOG 106-125; HSP70 466-485; CNP 1-21; HSP70 166-185; HSP70 121-140; Amyloid beta 1-42; MBP 89-101; CNP 301-320; HSP70 1-20; MBP 51-70; HSP70 496-515; CNP 16-35; CNP 76-95; PLP 10-29; PLP 190-209; HSP60 346-365; HSP60 151-170; HSP70 376-395; bovineMBP; HSP70 556-575; CNP 391-410; MOG 211-230; PLP 220-249; HSP70 616-635; Amyloid beta 1-12; HSP60 556-573; and PLP 250-269.
According to additional embodiments, the reactivity of at least one antibody to a specific antigen selected from the plurality of antigens listed in Table 1, or a subset thereof, is up-regulated, wherein the antigen is selected from HSP70 511-530, MBP 41-60, HSP60 286-305, HSP60 496-515, HSP70 151-170, HSP60 526-545, MBP 84-94, OSP 61-80, HSP70 31-50, CNP 286-305, HSP60 255-275, HSP60 106-125, OSP 31-50, P2 61-80, MBP 11-30, HSP60 376-395, HSP70 286-305, HSP60 136-155, HSP70 136-155, P2 46-65, OSP 136-155, P2 1-20, MOG 91-110, HSP60 361-380, HSP70 451-470, HSP70 210-229, HSP60 240-259, HSP60 271-290, OSP 76-95, PLP 178-191, CNP 271-290, P2 76-95, HSP70 631-640, PLP 248-259, HSP60 195-214, CNP 61-80, MOG 196-215, HSP60 46-65, HSP70 195-214, HSP70 436-455, HSP60 166-185, MBP 104-123, MBP 71-92, PLP 180-199, HSP70 255-275, MOBP 166-185, CNP 240-259, HSP60 16-35, HSP60 301-320, MOBP 151-170, CNP 91-110, HSP70 106-125, CNP 406-421, HSP60 421-40, HSP60 61-80, Amyloid beta 10-20, HSP60 511-530, Lactocerebroside, HSP70 406-425, MOG 76-95, HSP70 316-335, HSP60 225-244, HSP60 76-95, MOG 106-125, HSP70 466-485, CNP 1-21, HSP70 166-185, HSP70 121-140, Amyloid beta 1-42, MBP 89-101, CNP 301-320, HSP70 1-20, MBP 51-70, HSP70 496-515, CNP 16-35, CNP 76-95, PLP 10-29, PLP 190-209, HSP60 346-365, HSP60 151-170, HSP70 376-395, bovineMBP, HSP70 556-575, CNP 391-410, MOG 211-230, PLP 220-249, HSP70 616-635, Amyloid beta 1-12, HSP60 556-573 and PLP 250-26. According to other embodiments the reactivity of at least one antibody to a specific antigen selected from the plurality of antigens listed in Table 1, or a subset thereof, is down-regulated, wherein the antigen is selected from MBP 31-50, HSP70 481-500, PLP 65-84 and GFAP.
According to particular embodiments, the reactivity pattern for distinguishing PPMS from healthy patients consists of 39 antibody reactivities. In another embodiment, the antibody in the sample obtained from the subject is an IgG antibody wherein the antibody is reactive with an antigen selected from the group consisting of: PLP 215-232; HSP70 195-214; HSP70 166-185; bovineMBP; PLP 137-150; MOG 46-65; CNP 406-421; P2 31-50; CNP 1-20; MOG 16-35; P2 76-95; HSP70 466-485; HSP60 76-95; MOG 151-170; P2 1-20; OSP 61-80; PLP 178-191; HSP70 16-35; HSP70 121-140; and OSP 1-20. In another embodiment, the antibody in the sample obtained from the subject is an IgM antibody wherein the antibody is reactive with an antigen selected from the group consisting of: PLP 215-232; mMBP; smLPS; HSP70 210-229; Chondroitin 4-Sulfate; bovineMBP; Neurofilament 68 kDa; Beta Amyloid; AB 1-40; PLP 161-180; PLP 40-59; PLP 137-150; Secreted APPalpha; gpMBP; MBP 104-123; SOD; CNP 1-20; ecLPS; and MOBP 61-80.
According to additional embodiments, the reactivity of at least one antibody to a specific antigen selected from the plurality of antigens listed in Table 2, or a subset thereof, is up-regulated, wherein the antigen is selected from Beta Amyloid, HSP70 466-485, AB 1-40, PLP 161-180, PLP 40-59, PLP 137-150, HSP60 76-95, MOG 151-170, P2 1-20, OSP 61-80, Secreted APPalpha, PLP 178-191, gpMBP, HSP70 16-35, MBP 104-123, SOD, CNP 1-20, ecLPS, HSP70 121-140, MOBP 61-80 and OSP 1-20. According to other embodiments the reactivity of at least one antibody to a specific antigen selected from the plurality of antigens listed in Table 2, or a subset thereof, is down-regulated, wherein the antigen is selected from PLP 215-232, PLP 215-232, mMBP, HSP70 195-214, smLPS, HSP70 210-229, Chondroitin 4-Sulfate, HSP70 166-185, bovineMBP, PLP 137-150, MOG 46-65, CNP 406-421, P2 31-50, CNP 1-20, MOG 16-35, P2 76-95 and Neurofilament 68 kDa.
According to particular embodiments, the reactivity pattern for distinguishing SPMS from healthy patients consists of 66 antibody reactivities. In another embodiment, the antibody in the sample obtained from the subject is an IgM antibody wherein the antibody is reactive with an antigen selected from the group consisting of: MOG 61-80; HSP60 376-395; MOG 31-50; CNP 361-380; Amyloid beta 1-23; CNP 346-365; HSP60 496-515; OSP 1-20; HSP60 511-530; OSP 61-80; HSP60 286-305; CNP 240-259; HSP70 601-620; HSP60 210-229; HSP60 451-470; MOBP 166-185; HSP60 166-185; MBP 138-147; CNP 195-214; MBP 1-20; HSP60 526-545; P2 1-20; HSP70 286-305; MBP 155-178; P2 46-65; HSP60 195-214; P2 31-50; HSP60 271-290; HSP60 136-155; CNP 286-305; HSP70 210-229; HSP70 136-155; PLP 150-163; HSP70 166-185; HSP60 255-275; HSP60 16-35; bovineMBP; CNP 181-199; CNP 121-140; Asialoganglioside-GM2; Amyloid beta 1-12; OSP 121-140; Secreted APPbeta; Cardiolipin; HSP70 406-425; and IgM_PLP 1-19. In another embodiment, the antibody in the sample obtained from the subject is an IgG antibody wherein the antibody is reactive with an antigen selected from the group consisting of: HSP60 361-380; Amyloid beta 17-40; Cholesterol; Amyloid beta 1-42; PLP 80-99; PLP 65-84; PLP 40-59; PLP 1-19; PLP 151-173; HSP70 421-440; huMBP; MOBP 16-35; CNP 16-35; RBP; HSP70 331-350; OSP 121-140; MBP 113-132; beta Crystallin; CNP 240-259; and PLP 178-191.
According to additional embodiments, the reactivity of at least one antibody to a specific antigen selected from the plurality of antigens listed in Table 3, or a subset thereof, is up-regulated, wherein the antigen is selected from Amyloid beta 17-40, Cholesterol, Amyloid beta 1-42, PLP 80-99, PLP 65-84, PLP 40-59, PLP 1-19, PLP 1-19, PLP 151-173, HSP70 421-440, huMBP, MOBP 16-35, CNP 16-35, RBP, HSP70 331-350, OSP 121-140, MBP 113-132, beta Crystallin, CNP 240-259 and PLP 178-191. According to other embodiments the reactivity of at least one antibody to a specific antigen selected from the plurality of antigens listed in Table 3, or a subset thereof, is down-regulated, wherein the antigen is selected MOG 61-80, HSP60 376-395, MOG 31-50, CNP 361-380, Amyloid beta 1-23, CNP 346-365, HSP60 496-515, OSP 1-20, HSP60 511-530, OSP 61-80, HSP60 286-305, CNP 240-259, HSP70 601-620, HSP60 210-229, HSP60 451-470, MOBP 166-185, HSP60 166-185, MBP 138-147, CNP 195-214, MBP 1-20, HSP60 526-545, P2 1-20, HSP70 286-305, MBP 155-178, P2 46-65, HSP60 195-214, P2 31-50, HSP60 271-290, HSP60 136-155, CNP 286-305, HSP70 210-229, HSP70 136-155, PLP 150-163, HSP70 166-185, HSP60 255-275, HSP60 16-35, bovineMBP, CNP 181-199, CNP 121-140, Asialoganglioside-GM2, Amyloid beta 1-12, OSP 121-140, Secreted APPbeta, Cardiolipin, HSP70 406-425 and HSP60 361-380.
In some embodiments, the methods of the present invention employ an antigen microarray system for informatically characterizing informative patterns of antibodies as specific biomarkers for subtypes of MS, as detailed herein.
Antibodies, Samples and Immunoassays
Antibodies, or immunoglobulins, comprise two heavy chains linked together by disulfide bonds and two light chains, each light chain being linked to a respective heavy chain by disulfide bonds in a “Y” shaped configuration. Each heavy chain has at one end a variable domain (VH) followed by a number of constant domains (CH). Each light chain has a variable domain (VL) at one end and a constant domain (CL) at its other end, the light chain variable domain being aligned with the variable domain of the heavy chain and the light chain constant domain being aligned with the first constant domain of the heavy chain (CH1). The variable domains of each pair of light and heavy chains form the antigen binding site.
The isotype of the heavy chain (gamma, alpha, delta, epsilon or mu) determines immunoglobulin class (IgG, IgA, IgD, IgE or IgM, respectively). The light chain is either of two isotypes (kappa, κ or lambda, λ) found in all antibody classes.
It should be understood that when the terms “antibody” or “antibodies” are used, this is intended to include intact antibodies, such as polyclonal antibodies or monoclonal antibodies (mAbs), as well as proteolytic fragments thereof such as the Fab or F(ab′)2 fragments. Further included within the scope of the invention (for example as immunoassay reagents, as detailed herein) are chimeric antibodies; recombinant and engineered antibodies, and fragments thereof.
Exemplary functional antibody fragments comprising whole or essentially whole variable regions of both light and heavy chains are defined as follows:
(i) Fv, defined as a genetically engineered fragment consisting of the variable region of the light chain and the variable region of the heavy chain expressed as two chains;
(ii) single-chain Fv (“scFv”), a genetically engineered single-chain molecule including the variable region of the light chain and the variable region of the heavy chain, linked by a suitable polypeptide linker.
(iii) Fab, a fragment of an antibody molecule containing a monovalent antigen-binding portion of an antibody molecule, obtained by treating whole antibody with the enzyme papain to yield the intact light chain and the Fd fragment of the heavy chain, which consists of the variable and CH1 domains thereof;
(iv) Fab′, a fragment of an antibody molecule containing a monovalent antigen-binding portion of an antibody molecule, obtained by treating whole antibody with the enzyme pepsin, followed by reduction (two Fab′ fragments are obtained per antibody molecule); and
(v) F(ab′)2, a fragment of an antibody molecule containing a monovalent antigen-binding portion of an antibody molecule, obtained by treating whole antibody with the enzyme pepsin (i.e., a dimer of Fab′ fragments held together by two disulfide bonds).
The term “antigen” as used herein is a molecule or a portion of a molecule capable of being bound by an antibody. The antigen is typically capable of inducing an animal to produce antibody capable of binding to an epitope of that antigen. An antigen may have one or more epitopes. The specific reaction referred to above is meant to indicate that the antigen will react, in a highly selective manner, with its corresponding antibody and not with the multitude of other antibodies which may be evoked by other antigens. An “antigenic peptide” is a peptide which is capable of specifically binding an antibody.
In another embodiment, detection of the capacity of an antibody to specifically bind an antigen probe may be performed by quantifying specific antigen-antibody complex formation. The term “specifically bind” as used herein means that the binding of an antibody to an antigen probe is not competitively inhibited by the presence of non-related molecules.
In certain embodiments, the method of the present invention is performed by determining the capacity of a peptide of the invention to specifically bind antibodies of the IgG isotype, or, in other embodiments, antibodies of the IgM or IgE isotypes, isolated from a subject.
Methods for obtaining suitable antibody-containing biological samples from a subject are well within the ability of those of skill in the art. Typically, suitable samples comprise whole blood and products derived therefrom, such as plasma and serum. In other embodiments, other antibody-containing samples may be used, e.g. CSF, urine and saliva samples. A non-limitative example of obtaining serum samples from test subjects is presented in the Examples section below.
In accordance with the present invention, any suitable immunoassay can be used with the subject peptides. Such techniques are well known to the ordinarily skilled artisan and have been described in many standard immunology manuals and texts. In certain preferable embodiments, determining the capacity of the antibodies to specifically bind the antigen probes is performed using an antigen probe array-based method. Preferably, the array is incubated with suitably diluted serum of the subject (e.g. diluted 1:10) so as to allow specific binding between antibodies contained in the serum and the immobilized antigen probes, washing out unbound serum from the array, incubating the washed array with a detectable label-conjugated ligand of antibodies of the desired isotype, washing out unbound label from the array, and measuring levels of the label bound to each antigen probe.
According to some aspects the methods of the present invention may be practiced using antigen arrays as disclosed in WO 02/08755 and U.S. 2005/0260770 to some of the inventors of the present invention. WO 02/08755 is directed to a system and an article of manufacture for clustering and thereby identifying predefined antigens reactive with undetermined immunoglobulins of sera derived from patient subjects in need of diagnosis of disease or monitoring of treatment. Further disclosed are diagnostic methods, and systems useful in these methods, employing the step of clustering a subset of antigens of a plurality of antigens, said subset of antigens being reactive with a plurality of antibodies being derived from a plurality of patients, and associating or disassociating the antibodies of a subject with the resulting cluster. U.S. Pat. App. Pub. No. 2005/0260770 to some of the inventors of the present invention discloses an antigen array system and diagnostic uses thereof. The application provides a method of diagnosing an immune disease, particularly diabetes type 1, or a predisposition thereto in a subject, comprising determining a capacity of immunoglobulins of the subject to specifically bind each antigen probe of an antigen probe set. The teachings of said disclosures are incorporated in their entirety as if fully set forth herein.
In other embodiments, various other immunoassays may be used, including, without limitation, enzyme-linked immunosorbent assay (ELISA), flow cytometry with multiplex beads (such as the system made by Luminex), surface plasmon resonance (SPR), elipsometry, and various other immunoassays which employ, for example, laser scanning, light detecting, photon detecting via a photo-multiplier, photographing with a digital camera based system or video system, radiation counting, fluorescence detecting, electronic, magnetic detecting and any other system that allows quantitative measurement of antigen-antibody binding.
Various methods have been developed for preparing arrays suitable for the methods of the present invention. State-of-the-art methods involves using a robotic apparatus to apply or “spot” distinct solutions containing antigen probes to closely spaced specific addressable locations on the surface of a planar support, typically a glass support, such as a microscope slide, which is subsequently processed by suitable thermal and/or chemical treatment to attach antigen probes to the surface of the support. Conveniently, the glass surface is first activated by a chemical treatment that leaves a layer of reactive groups such as epoxy groups on the surface, which bind covalently any molecule containing free amine or thiol groups. Suitable supports may also include silicon, nitrocellulose, paper, cellulosic supports and the like.
Preferably, each antigen probe, or distinct subset of antigen probes of the present invention, which is attached to a specific addressable location of the array is attached independently to at least two, more preferably to at least three separate specific addressable locations of the array in order to enable generation of statistically robust data.
In addition to antigen probes of the invention, the array may advantageously include control antigen probes or other standard chemicals. Such control antigen probes may include normalization control probes. The signals obtained from the normalization control probes provide a control for variations in binding conditions, label intensity, “reading” efficiency and other factors that may cause the signal of a given binding antibody-probe ligand interaction to vary. For example, signals, such as fluorescence intensity, read from all other antigen probes of the antigen probe array are divided by the signal (e.g., fluorescence intensity) from the normalization control probes thereby normalizing the measurements. Normalization control probes can be bound to various addressable locations on the antigen probe array to control for spatial variation in antibody-ligand probe efficiency. Preferably, normalization control probes are located at the corners or edges of the array to control for edge effects, as well as in the middle of the array.
The labeled antibody ligands may be of any of various suitable types of antibody ligand. Preferably, the antibody ligand is an antibody which is capable of specifically binding the Fc portion of the antibodies of the subject used. For example, where the antibodies of the subject are of the IgM isotype, the antibody ligand is preferably an antibody capable of specifically binding to the Fc region of IgM antibodies of the subject.
The ligand of the antibodies of the subject may be conjugated to any of various types of detectable labels. Preferably the label is a fluorophore, most preferably Cy3. Alternately, the fluorophore may be any of various fluorophores, including Cy5, fluorescein isothiocyanate (FITC), phycoerythrin (PE), rhodamine, Texas red, and the like. Suitable fluorophore-conjugated antibodies specific for antibodies of a specific isotype are widely available from commercial suppliers and methods of their production are well established.
Antibodies of the subject may be isolated for analysis of their antigen probe binding capacity in any of various ways, depending on the application and purpose. While the subject's antibodies may be suitably and conveniently in the form of blood serum or plasma or a dilution thereof (e.g. 1:10 dilution), the antibodies may be subjected to any desired degree of purification prior to being tested for their capacity to specifically bind antigen probes. The method of the present invention may be practiced using whole antibodies of the subject, or antibody fragments of the subject which comprises an antibody variable region.
Data Analysis
Advantageously, the methods of the invention may employ the use of learning and pattern recognition analyzers, clustering algorithms and the like, in order to discriminate between reactivity patterns of subjects having a subtype of MS to control subjects. For example, the methods may include determining the reactivity of antibodies in a test sample to a plurality of antigens, and comparing the resulting pattern to the reactivity patterns of negative and positive control samples using such algorithms and/or analyzers.
In certain embodiments, one or more algorithms or computer programs may be used for comparing the amount of each antibody quantified in the test sample against a predetermined cutoff (or against a number of predetermined cutoffs). Alternatively, one or more instructions for manually performing the necessary steps by a human can be provided.
Algorithms for determining and comparing pattern analysis include, but are not limited to, principal component analysis, Fischer linear analysis, neural network algorithms, genetic algorithms, fuzzy logic pattern recognition, and the like. After analysis is completed, the resulting information can, for example, be displayed on display, transmitted to a host computer, or stored on a storage device for subsequent retrieval.
Many of the algorithms are neural network based algorithms. A neural network has an input layer, processing layers and an output layer. The information in a neural network is distributed throughout the processing layers. The processing layers are made up of nodes that simulate the neurons by the interconnection to their nodes. Similar to statistical analysis revealing underlying patterns in a collection of data, neural networks locate consistent patterns in a collection of data, based on predetermined criteria.
Suitable pattern recognition algorithms include, but are not limited to, principal component analysis (PCA), Fisher linear discriminant analysis (FLDA), soft independent modeling of class analogy (SIMCA), K-nearest neighbors (KNN), neural networks, genetic algorithms, fuzzy logic, and other pattern recognition algorithms. In some embodiments, the Fisher linear discriminant analysis (FLDA) and canonical discriminant analysis (CDA) as well as combinations thereof are used to compare the output signature and the available data from the database.
In other embodiments, principal component analysis is used. Principal component analysis (PCA) involves a mathematical technique that transforms a number of correlated variables into a smaller number of uncorrelated variables. The smaller number of uncorrelated variables is known as principal components. The first principal component or eigenvector accounts for as much of the variability in the data as possible, and each succeeding component accounts for as much of the remaining variability as possible. The main objective of PCA is to reduce the dimensionality of the data set and to identify new underlying variables.
Principal component analysis compares the structure of two or more covariance matrices in a hierarchical fashion. For instance, one matrix might be identical to another except that each element of the matrix is multiplied by a single constant. The matrices are thus proportional to one another. More particularly, the matrices share identical eigenvectors (or principal components), but their eigenvalues differ by a constant. Another relationship between matrices is that they share principal components in common, but their eigenvalues differ. The mathematical technique used in principal component analysis is called eigenanalysis. The eigenvector associated with the largest eigenvalue has the same direction as the first principal component. The eigenvector associated with the second largest eigenvalue determines the direction of the second principal component. The sum of the eigenvalues equals the trace of the square matrix and the maximum number of eigenvectors equals the number of rows of this matrix.
In another embodiment, the algorithm is a classifier. One type of classifier is created by “training” the algorithm with data from the training set and whose performance is evaluated with the test set data. Examples of classifiers used in conjunction with the invention are discriminant analysis, decision tree analysis, receiver operator curves or split and score analysis.
The term “decision tree” refers to a classifier with a flow-chart-like tree structure employed for classification. Decision trees consist of repeated splits of a data set into subsets. Each split consists of a simple rule applied to one variable, e.g., “if value of “variable 1” larger than “threshold 1”; then go left, else go right”. Accordingly, the given feature space is partitioned into a set of rectangles with each rectangle assigned to one class.
The terms “test set” or “unknown” or “validation set” refer to a subset of the entire available data set consisting of those entries not included in the training set. Test data is applied to evaluate classifier performance.
The terms “training set” or “known set” or “reference set” refer to a subset of the respective entire available data set. This subset is typically randomly selected, and is solely used for the purpose of classifier construction.
Advantageously, the discrimination between patients having a form (e.g. subtype) of MS and control individuals (e.g. healthy individuals or individuals afflicted with another form of MS) is performed in multi-dimensional space. For example, a diagnostic test performed with an antigen array consisting of the antigens listed in Table 1 herein is performed in 94 dimensions. Conveniently, such analysis is performed by dividing the space into a region characteristic of patients and one for control individuals, as exemplified below.
The following examples are presented in order to more fully illustrate some embodiments of the invention. They should, in no way be construed, however, as limiting the broad scope of the invention.
EXAMPLES
Procedures
ELISA
Antigens (1 mg/ml in phosphate-buffered saline for proteins, 5 mg/ml in ethanol for lipids) were coated in 96-well Maxisorp ELISA plates (NalgeNunc, Rochester, N.Y.), and ELISA was performed as described (Quintana et al., J Autoimmun 21, 65-75, 2003).
Antigen Microarray Chips
Antigens diluted in PBS were placed in 384-well plates at a concentration of 0.1-1 milligram/ml. A robotic MicroGrid arrayer with solid spotting pins of 0.2 mm in diameter (BioRobotics, Cambridge, U.K.) was used to spot the antigens onto ArrayIt SuperEpoxi microarray substrate slides (TeleChem, Sunnyvale, Calif.). Each antigen was spotted in three or four replicates. The spotted microarrays were stored at 4° C.
The chips were washed with PBS, blocked for 1 h at 37° C. with 1% BSA, and incubated for 2 hours at 37° C. with a 1:10 dilution of the test serum in blocking buffer under a coverslip in a humid environment. The arrays were then washed and incubated for 45 min at 37° C. with a 1:500 dilution mixture of goat anti-human IgG Cy3-conjugated antibody and a goat anti-human IgM conjugated to Cy5, (both purchased from Jackson ImmunoResearch, West Grove, Pa. The arrays were scanned with a ScanArray 4000× scanner (GSI Luminomics, Billerica, Mass., USA) and the IgM and IgG results were recorded separately. The results were recorded as TIFF files.
Image and Data Processing
The pixels that comprised each spot in the TIFF files and the local background were identified by using histogram segmentation. The intensity of each spot and its local background were calculated as the mean of the corresponding pixel intensities. None of the spots containing antigens showed saturation. Technically faulty spots were identified by visual inspection and were removed from the data set. For each spot, the local background intensity was subtracted from the spot intensity. Spots with negative intensities were removed from the data set.
A log-base-2 transformation of the intensities resulted in reasonably constant variability at all intensity levels. The log intensity of each antigen was calculated as the mean of the log intensities of the replicates on each slide. The coefficient of variability between replicates on each array was under 10%. To remove overall differences in intensities between arrays, the mean log intensity of each antigen on each array was scaled by subtracting the median of the mean log intensities of all antigens on the array. The scaled mean log intensity of an antigen is denoted the reactivity of the antigen.
Raw data were normalized and analyzed using the GeneSpring software (Silicon Genetics, Redwood City, Calif.). Antigen reactivity was defined by the mean intensity of binding to the replicates of that antigen on the microarray. The data were analyzed with the non-parametric Wilcoxon-Mann-Whitney test, using the Benjamini and Hochberg method with a false discovery rate of 0.05 (analysis of RRMS and PPMS samples) or 0.2 (analysis of immunopathology pattern I and II samples) to determine significance. The leave-one-out cross-validation analysis (LOOCV) in the training set and the classification of samples on the test set was carried out using a support vector machine that classified samples based on the antibody reactivities identified to be discriminatory on the training set.
Patients and Sera Samples
Serum samples were collected at the Partners MS Center from untreated RRMS during clinical remission, PPMS patients or HC. The patients did not present with other autoimmune disorders. Sixty-two patients with biopsy proven CNS inflammatory demyelinating disease were identified from an original cohort of 780 central nervous system inflammatory demyelinating disease (CNS IDD) biopsy cases belonging to the MS Lesion Project (MSLP). The MSLP database consists of a unique collection of biopsy-proven CNS IDD cases with detailed pathological, clinical, imaging and serological material (NMSS RG3184-B-3-02). Active demyelinating lesions were classified into either pattern I or II based on previously published criteria (Lucchinetti et al., 2000). Sera and face to face neurological assessment was obtained on all included patients at the time of follow-up. Paired CSF and serum samples were collected at the University Hospital, School of Medicine, University of Sevilla from RRMS patients with confirmed intratecal IgG secretion and IgG oligoclonal bands. The clinical characteristics of the patients, pathological cohorts and healthy controls are listed in Table 6 herein below. Control samples were pair-wise matched for age, gender and ethnicity.







TABLE 6







Characteristics of the patients and healthy controls (HC)














Gender





Group
N
(F/M)
Age
Disease Duration
EDSS





RRMS
39
31/8
42 (22-58)
13.0 (6.0-27.0) 
1.5 (0.0-3.5)


(USA)


RRMS
51
33/17
44 (20-55)
2.3 (0.0-24.0)
1.3 (0.0-3.5)


(Spanish


Cohort)


SPMS
30
23/7
50 (31-64)
  8 (2.0-27.0)
6.0. (1.5-8.5) 


PPMS
37
20/17
55 (34-73)
4.5 (0.0-25.0)
6.0. (1.5-9.5) 


Pattern I
15
10/5
42 (20-70)
4.1 (1.4-16.1)
  3 (0.0-7.0)


Pattern II
53
25/28
44 (20-71)
3.3 (0.6-37.8)
  2 (0.0-8.0)


HC
30
18/12
51 (20-72)
NA
NA









As used herein “EDSS” refers to the Kurtzke Expanded Disability Status Scale (EDSS), which is known in the art as a method for quantifying disability in multiple sclerosis. The EDSS quantifies disability in eight functional systems (i.e. pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, cerebral, and other systems) and allows neurologists to assign a functional system score in each system. EDSS steps 1.0 to 4.5 refer to people with MS who are fully ambulatory. EDSS steps 5.0 to 9.5 are defined by the impairment to ambulation.
Serum and CSF samples from Alzheimer's disease patients were provided by Dr. Denis Selkoe of the Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Serum samples from SLE patients were provided by Dr. Peter H. Schur of the Department of Rheumatology/Immunology, Brigham and Women's Hospital, Boston, Mass.
The samples were collected as follows: blood samples were collected into sterile test tubes and allowed to clot, by leaving the test tubes at room temperature for 30 minutes. Next, the tubes were centrifuged at 2000 g for 15 minutes. The liquid phase was transferred to new test tubes, divided into aliquots and stored at ≦−20° C.
Antigens
Peptides were synthesized at the Biopolymers Facility of the Department of Biological Chemistry and Molecular Pharmacology of Harvard Medical School (HMS). Recombinant proteins and lipids were purchased from Sigma (St. Louis, Mo., USA), Abnova (Taipei City, Taiwan), Matreya LLC (Pleasant Gap, Pa., USA), Avanti Polar Lipids (Alabaster, Ala., USA), Calbiochem (San Diego, Calif., USA), Chemicon (Temecula, Calif., USA), GeneTex (San Antonio, Tex., USA), Novus Biologicals (Littleton, Colo., USA) Assay Designs (Ann Arbor, Mich., USA), ProSci Inc. (Poway, Calif., USA), EMD Biosciences (San Diego, Calif., USA), Cayman Chemical (Ann Arbor, Mich., USA), HyTest (Turku, Finland), Meridian Life Science (Memphis, Tenn. USA) and Biodesign International (Saco, Me., USA).
The antigens used in the construction of antigen microarrays were as follows: Heat shock Proteins 27 kDa (HSP27), HSP32, HSP40, HSP47, HSP60, M. tuberculosis HSP65, HSP70, M. tuberculosis HSP71, HSP90 and GroEL (all purchased from Stressgen); HSP60 peptides consisting of amino acids 106-125, 1-20, 121-140, 136-155, 151-170, 16-35, 166-185, 181-199, 195-214, 210-229, 225-244, 240-259, 255-275, 271-290, 286-305, 301-320, 31-50, 316-335, 331-350, 346-365, 361-380, 376-395, 391-410, 406-425, 421-440, 436-455, 451-470, 466-485, 46-65, 481-500, 496-515, 511-530, 526-545, 541-560, 556-573, 61-80, 76-95 and 91-110 (all synthesized at Biopolymers Facility, HMS); HSP70 peptides consisting of amino acids 106-125, 1-20, 121-140, 136-155, 151-170, 16-35, 166-185, 181-199, 195-214, 210-229, 225-244, 240-259, 255-275, 271-290, 286-305, 301-320, 31-50, 316-335, 331-350, 346-365, 361-380, 376-395, 391-410, 406-425, 421-440, 436/55, 451-470, 466-485, 46-65, 481-500, 496-515, 511-530, 526-545, 541-560, 556-575, 571-590, 586-605, 601-620, 616-635, 61-80, 631-640, 76-95 and 91-110 (all synthesized at Biopolymers Facility, HMS).
CNS proteins 2′,3′-cyclic nucleotide 3′-phosphodiesterase peptides (CNP) consisting of amino acids 106-125, 1-20, 121-140, 136-155, 151-170, 16-35, 166-185, 181-200, 195-215, 211-230, 226-245, 241-260, 256-275, 271-290, 286-305, 301-320, 31-50, 316-335, 331-350, 346-365, 361-380, 376-395, 391-410, 406-421, 46-65, 61-80, 76-95 and 91-110 (all synthesized at Biopolymers Facility, HMS); Acetyl Cholinesterase, ADAM-10, beta-Cristallin, bovine Myelin Basic Protein, Brain Extract I, Brain Extract II, Brain Extract III, guinea pig Myelin Basic Protein, human Myelin Basic Protein (all purchased from Sigma Aldrich); alpha-Cristallin (purchased from Stressgen); Glial Filament Acidic Protein (GFAP) (purchased from Research Diagnostic); Myelin-Associated Oligodendrocytic Basic Protein (MOBP) peptides consisting of amino acids 106-125, 1-20, 121-140, 136-155, 151-170, 16-35, 166-185, 181-200, 31-50, 46-65, 61-80, 76-95 and 91-110 (all synthesized at Biopolymers Facility, HMS); Myelin/oligodendrocyte glycoprotein (MOG) peptides consisting of amino acids 106-125, 1-20, 121-140, 136-155, 151-170, 16-35, 166-185, 181-200, 196-215, 211-230, 226-247, 31-50, 35-55, 46-65, 61-80, 76-95 and 91-110 (all synthesized at Biopolymers Facility, HMS); murine Myelin Basic Protein (mMBP) and Myelin Associated Glycoprotein (purchased from Sigma Aldrich); Myelin Basic Protein (MBP) peptides consisting of amino acids 104-123, 11-30, 113-132, 1-20, 121-138, 124-142, 138-147, 141-161, 143-168, 155-178, 26-35, 31-50, 41-60, 51-70, 61-80, 71-92, 84-94, 89-101 and 93-112 (all synthesized at Biopolymers Facility, HMS); Myelin Protein 2 (P2) peptides consisting of amino acids 106-125, 1-20, 121-132, 16-35, 31-50, 46-65, 61-80, 76-95 and 91-110 (synthesized at Biopolymers Facility, HMS); Neurofilament 160 kd, Neurofilament 200 kd, Neurofilament 68 kd (all purchased from Chemicon); Neuronal Enolase (purchased from Calbiochem); Nicastrin (purchased from GeneTex); NMDA receptor (purchased from Novus Biologicals); NOGO (purchased from Sigma Aldrich); Olygodendrocyte-Specific Protein (OSP) peptides consisting of amino acids 106-125, 1-20, 121-140, 136-155, 151-170, 16-35, 166-185, 181-199, 195-217, 31-50, 46-65, 61-80, 76-95 and 91-110 (all synthesized at Biopolymers Facility, HMS); Proteolipid Protein (Abnova); Proteolipid Protein peptides consisting of amino acids 100-119, 10-29, 110-129, 1-19, 125-141, 137-150, 137-154, 150-163, 151-173, 158-166, 161-180, 178-191, 180-199, 190-209, 20-39, 205-220, 215-232, 220-239, 220-249, 248-259, 250-269, 265-277, 35-50, 40-59, 50-69, 65-84, 80-99 and 91-110 (all synthesized at Biopolymers Facility, HMS); Retinol Binding Protein, Super Oxide Dismutase, beta Synuclein, gamma Synuclein (Sigma Aldrich); and S100beta protein (Assay Designs).
Tissue antigens (purchased from ProSci Inc.): Amydgala, Amydgala AD, Brain lysate, Brain Tissue Membrane, Cerebellar pedunculus, Cerebral meninges, Corpus Callosum, Corpus Callosum AD, Diencephalon, Fetal brain, Frontal lobe, Frontal lobe AD, Hippocampus, Hippocampus AD, Insula, Occipital lobe, Occipital lobe AD, Olfactory region, Optic Nerve, Parietal lobe, Parietal lobe AD, Pons, Pons AD, Postcentral gyrus, Postcentral gyrus AD, Precentral gyrus, Precentral gyrus AD, Spinal cord, Temporal lobe, Temporal lobe AD, Thalamus and Thalamus AD.
AD related antigens: Amyloid beta (AB), AB 10-20, AB 1-12, AB 12-28, AB 1-23, AB 1-38, AB 17-40, AB 25-35, AB 34-42, Amyloid bri protein precursor 227, Amyloid DAN Protein, Fragment 1-34, Amyloid Precursor Protein, Amyloid protein no AB component, Secreted amyloid precursor protein (SAP) beta, Tau isoform variant 0N3R, Tau isoform variant 1N3R, Tau isoform variant 0N4R, Tau isoform variant 2N3R, Tau phospho Ser412, Tau phospho Ser441 and Tau phospho Thr181 (all purchased from Sigma Aldrich); and Tau Protein human (purchased from EMD Biosciences).
Lipid antigen: 1 Palmitoyl-2-(5′ oxo-Valeroyl)-sn-Glycero-3-Phosphocholine, 15a-hydroxycholestene, 15-ketocholestane, 15-ketocholestene, 1-Palmitoil-2-(9′ oxo-Nonanoyl)-sn-Glycero-3-Phosphocholine, 1-Palmitoil-2-Azelaoyl-sn-Glycero-3-Phosphocholine, 1-Palmitoil-2-Glutaroyl-sn-Glycero-3-Phosphocholine, 5α-cholestane-3 β,15 α-diol, Brain ceramides, Brain D-erythrosphingosine, Brain lysophosphatidylethanolamine, Brain L-α-lysophosphatidylserine, Brain L-α-phosphatidylcholine, Brain L-α-phosphatidyl-ethanolamine, Brain L-α-phosphatidylserine, Brain polar lipid extract, Brain sphingomyelin, Brain sulfatide, Brain total lipid extract, Gangliotetraosylceramide asialo-GM1, Total brain gangliosides and Total cerebroside (all purchased from Avanti Polar Lipids); 9(S)-HODE, (±)9-HODE, Isoprostane F2 I (Cayman Chemical); Asialoganglioside-GM1, Asialoganglioside-GM2, Cardiolipin, Ceramide, Ceramide 1-phosphate, Cholesterol, Disialogaglioside-GD1B, Disialogaglioside-GD2, Disialoganglioside GD1a, Galactocerebrosides, Ganglioside Mixture, HDL, Hexacosanoic acid (26), Hydroxy fatty acid ceramide, Lactocerebrosides, LDL, Lipid A, diphosphoryl, from Salmonella enterica, Lipopolysaccharides from Escherichia coli, Lipopolysaccharides from Pseudomona aeruginosa, Lipopolysaccharides from Salmonella enterica, Monosialoganglioside GM1, Monosialoganglioside GM2, N-Hexanoyl-D-sphingosin, Non-hydroxy fatty acid ceramide, Phosphatidylinositol-4 phosphate, Squalene, Sulfatides, Tetracosanoic acid (24), TNPAL Galactocerebrosideand Trisialoganglioside-GT1B (Sigma Aldrich); Disialoganglioside GD3 and Trisialoganglioside GT1a (HyTest); Fucosyl-GM1, Ganglioside-GM4, Lactosylceramide, Lyso-GM1 and Tetrasialoganglioside-GQ1B (Calbiochem); and Monosialoganglioside GM3 (all purchased from Meridian).
Example 1
Conditions to Detect Specific Microarray Autoantibodies in MS
Antigen microarrays were constructed using 362 myelin and inflammation-related antigens (listed herein above) that encompassed CNS antigens suspected of being associated with MS, CNS antigens suspected of being associated with other neurological diseases and heat shock proteins (HSP). Antigens were spotted on epoxy glass slides using a robotic arrayer as previously described (Quintana et al., 2004).
The sensitivity of the antigen-microarray technique was compared to that of a standard ELISA technique using commercially available monoclonal and polyclonal antibodies directed against CNS, HSP and lipid antigens. The antigen microarray detected antigen reactivities at log10 dilutions that were 1-2 logs greater than the reactivities detected by using the ELISA method (Table 7). Thus, the antigen microarray appears to be more sensitive than a standard ELISA assay.







TABLE 7





Comparison of antigen microarray with ELISA



















HSP60-1
HSP60-2
HSP60-3













Dilution
Array
ELISA
Array
ELISA
Array
ELISA





1:100
MAX
1.98
MAX
1.77
45,693
1.64


1:1,000
MAX
1.24
MAX
1.29
23,731
0.73


1:10,000
48,930
0.64
39,837
0.83
5,375
0.29


1:100,000
31,513
0
3,489
0.17
1,858
0


1:1,000,000
2,380
0
742
0
0
0


1:10,000,000
0
0
0
0
0
0














MBP
PLP
GM4














Array
ELISA
Array
ELISA
Array
ELISA





1:100
MAX
1.51
MAX
2.31
MAX
3.13


1:1,000
46,314
1.09
MAX
1.16
29,857
1.61


1:10,000
26,384
0.75
42,084
0.53
16,749
0.5


1:100,000
14,423
0.31
12,294
0.3
7,313
0


1:1,000,000
6,916
0
6,837
0
1,598
0


1:10,000,000
1,810
0
1,332
0
0
0









To determine which serum dilution was optimal to investigate immune signatures in MS, the reactivity of healthy controls (HC) and RRMS subjects was analyzed at dilutions of 1:10, 1:100 and 1:1000 for both IgG and IgM antibodies. As shown in FIG. 1A, in MS, the mean IgG antibody reactivity to CNS antigens, lipids and heat shock proteins (HSP) was highest at 1:10 as compared to 1:100 and 1:000 where minimal reactivity was observed (P<0.0001, two-way ANOVA). The mean IgG reactivity was also highest at a 1:10 dilution in HC (P<0.0001, two-way ANOVA), but this reactivity was less than that manifested in MS subjects (P<0.001, P<0.001 and P<0.05 for CNS antigens, lipids and heat shock proteins respectively, two-way ANOVA); indeed, at dilutions of 1:100 and 1:1000, there were no differences between the magnitude of IgG reactivity in MS compared to HC. The IgM reactivities in controls were as high, if not higher than in MS subjects (FIG. 1B). This is consistent with the observation that healthy humans are born with IgM autoantibodies to myelin antigens and heat shock proteins (Merbl et al., 2007, J Clin Invest 117, 712-8). Since MS subjects manifested significantly elevated serum IgG autoantibodies at a 1:10 dilution, serum antibody patterns with antigen microarrays were investigated using this dilution.
To establish that the reactivity detected at a 1:10 dilution was specific, inhibition experiments were carried out and demonstrated that reactivity to PLP261-277 on the antigen array could be inhibited by pre-incubation of the serum with excess unbound PLP261-277, but not with a control peptide, HSP601-20 (FIG. 1C).
Example 2
Autoantibody Pattern Analysis Identifies an Immune Signature for RRMS
To investigate if unique antibody signatures in RRMS could be identified, the antibody repertoire in 38 patients with RRMS and 30 healthy controls (HC) subjects was studied. Samples were allocated into a training set (24 RRMS and 20 controls) and a randomly selected test set (14 RRMS and 10 controls). The training set was used to determine whether patterns of antibody reactivity that could discriminate RRMS from control samples may be identified. If such patterns were found, they were then validated on the test set. The training set was analyzed using the Wilcoxon-Mann-Whitney test; the false discovery rate was controlled using the method of Benjamini and Hochberg (Cohen, I. R., 2007, Nat Rev Immunol. 7, 569-74). The clinical characteristics of the patients and HC are listed in Table 6.
As shown in the heatmap in FIG. 2A, a pattern of reactivity that distinguished RRMS from HC (P<0.0001, Fisher's exact test) was identified. The antibody reactivities included in the heatmap shown in FIG. 2A are listed herein (in the same order as in the heatmap, i.e. from top to bottom): IgG_MBP 31-50; IgG_HSP70 481-500; IgG_PLP 65-84; IgG_GFAP; IgM_HSP70 511-530; IgM_MBP 41-60; IgM_HSP60 286-305; IgM_HSP60 496-515; IgM_HSP70 151-170; IgM_HSP60 526-545; IgM_MBP 84-94; IgM_OSP 61-80; IgM_HSP70 31-50; IgM_CNP 286-305; IgM_HSP60 255-275; IgM_HSP60 106-125; IgM_OSP 31-50; IgM_P2 61-80; IgM_MBP 11-30; IgM_HSP60 376-395; IgM_HSP70 286-305; IgM_HSP60 136-155; IgM_HSP70 136-155; IgM_P2 46-65; IgM_OSP 136-155; IgM_P2 1-20; IgM_MOG 91-110; IgM_HSP60 361-380; IgM_HSP70 451-470; IgM_HSP70 210-229; IgM_HSP60 240-259; IgM_HSP60 271-290; IgM_OSP 76-95; IgM_PLP 178-191; IgM_CNP 271-290; IgM_P2 76-95; IgM_HSP70 631-640; IgM_PLP 248-259; IgM_HSP60 195-214; IgM_CNP 61-80; IgM_MOG 196-215; IgM_HSP60 46-65; IgM_HSP70 195-214; IgM_HSP70 436-455; IgM_HSP60 166-185; IgM_MBP 104-123; IgM_MBP 71-92; IgM_PLP 180-199; IgM_HSP70 255-275; IgM_MOBP 166-185; IgM_CNP 240-259; IgM_HSP60 16-35; IgM_HSP60 301-320; IgM_MOBP 151-170; IgM_CNP 91-110; IgM_HSP70 106-125; IgM_CNP 406-421; IgM_HSP60 421-40; IgM_HSP60 61-80; IgM_Amyloid beta 10-20; IgM_HSP60 511-530; IgM_Lactocerebroside; IgM_HSP70 406-425; IgM_MOG 76-95; IgM_HSP70 316-335; IgM_HSP60 225-244; IgM_HSP60 76-95; IgM_MOG 106-125; IgM_HSP70 466-485; IgM_CNP 1-21; IgM_HSP70 166-185; IgM_HSP70 121-140; IgM_Amyloid beta 1-42; IgM_MBP 89-101; IgM_CNP 301-320; IgM_HSP70 1-20; IgM_MBP 51-70; IgM_HSP70 496-515; IgM_CNP 16-35; IgM_CNP 76-95; IgM_PLP 10-29; IgM_PLP 190-209; IgM_HSP60 346-365; IgM_HSP60 151-170; IgM_HSP70 376-395; IgM_bovineMBP; IgM_HSP70 556-575; IgM_CNP 391-410; IgM_MOG 211-230; IgM_PLP 220-249; IgM_HSP70 616-635; IgM_Amyloid beta 1-12; IgM_HSP60 556-573; and IgM_PLP 250-269.
This pattern consisted of 94 antibody reactivities. Of the 94 reactivities, 90 were up-regulated and 4 were down-regulated in MS versus controls (HC). Thus, RRMS is associated with both a gain and a loss of particular autoreactivities. Of the up-regulated reactivities, 50% were IgM antibodies binding to peptides of CNS antigens and 49% were IgM antibodies binding to peptides of heat shock proteins. The ability to distinguish MS vs. controls was not observed at dilutions of 1:100 or 1:1000.
To validate the discriminating pattern shown in FIG. 2A, a leave-one-out cross-validation analysis (LOOCV) was performed in the training set (Stekel, D., 2003, Microarray Bioinformatics, Cambridge University Press, Cambridge), which was then validated on the test set. For the LOOCV in the training set, the number of true (correct) and false (incorrect) classifications was computed to estimate the success rate, positive predictive value (PPV), negative predictive value (NPV) in the training set. The LOOCV revealed a positive predictive value (PPV)—defined as the fraction of RRMS patients identified as RRMS by their antigen microarray reactivity—of 0.75 and a negative predictive value (NPV)—defined as the fraction of HC identified as HC by their antigen microarray reactivity—of 0.90; the success rate was 0.83 (P<0.0001). The most rigorous validation is to test the patterns identified in the training set to determine whether they can differentiate MS subjects from HC in the test set. Significantly, the pattern identified in the training set was able to classify the test set of samples with a PPV of 0.85, a NPV of 0.80, and with a success rate of 0.83 (P=0.004, Fisher's exact test).
To further validate these findings, 51 untreated RRMS obtained from the University of Seville, Spain, were analyzed to determine if whether RRMS may be distinguished from HC using an independent cohort of samples from another institution and geographic area. The identified pattern was able to discriminate RRMS from HC in this independent cohort with a success rate of 0.69 with a PPV of 0.73 and a NPV of 0.58 (P=0.01, Fisher's exact test).
As a specificity control for the patterns detected in MS, sera from patients with systemic lupus erythematosus (SLE), adrenoleukodystrophy (ALD) and Alzheimer's disease (AD) was investigated. SLE is a chronic autoimmune disease characterized by circulating antibodies to a broad range of self-antigens. ALD is a degenerative disorder characterized by the accumulation of very long-chain fatty acids and a CNS neuroinflammatory process that shares features with MS. AD is not considered an autoimmune disease; however, immune responses to β-amyloid derived peptides have been reported. Significantly, the antibody patterns detected on antigen microarrays discriminated RRMS from SLE, ALD and AD samples (P<0.0001, Fisher's exact test).
Example 3
Autoantibody Pattern Analysis Identifies an Immune Signature for PPMS
PPMS has a different clinical course than RRMS, and it has been suggested that PPMS may involve disease mechanisms different from those in RRMS (Miller & Leary, 2007, Lancet Neurol. 6, 903-12). 24 PPMS and 25 age- and gender-matched HC in a training set, and 13 PPMS and 12 controls in a test set of samples were studied.
The antibody reactivities included in the heatmap shown in FIG. 2B are listed herein (in the same order as in the heatmap, i.e. from top to bottom): IgM_PLP 215-232; IgG_PLP 215-232; IgM_mMBP; IgG_HSP70 195-214; IgM_smLPS; IgM_HSP70 210-229; IgM_Chondroitin 4-Sulfate; IgG_HSP70 166-185; IgG_bovineMBP; IgM_bovineMBP; IgG_PLP 137-150; IgG_MOG 46-65; IgG_CNP 406-421; IgG_P2 31-50; IgG_CNP 1-20; IgG_MOG 16-35; IgG_P2 76-95; IgM_Neurofilament 68 kDa; IgM_Beta Amyloid; IgG_HSP70 466-485; IgM_AB 1-40; IgM_PLP 161-180; IgM_PLP 40-59; IgM_PLP 137-150; IgG_HSP60 76-95; IgG_MOG 151-170; IgG_P2 1-20; IgG_OSP 61-80; IgM_Secreted APPalpha; IgG_PLP 178-191; IgM_gpMBP; IgG_HSP70 16-35; IgM_MBP 104-123; IgM_SOD; IgM_CNP 1-20; IgM_ecLPS; IgG_HSP70 121-140; IgM_MOBP 61-80; and IgG_OSP 1-20.
The heatmap (FIG. 2B) shows the antibody reactivities that passed significance tests and could discriminate PPMS and HC both in the training set (P<0.0001, Fisher's exact test) and the test set (P<0.01, Fisher's exact test). The LOOCV on the learning set revealed an overall efficiency of 86%, with PPV=0.87 and NPV=0.85. The efficiency for the test set was 72%; the PPV=0.79 and the NPV=0.75. As with RRMS, antigen microarrays were able to discriminate PPMS from control subjects at a 1:10 dilution but not at dilutions of 1:100 or 1:1000. Furthermore, as with RRMS, the antigen microarray analysis discriminated between PPMS and other diseases (SLE, ALD, AD; P<0.001, Fisher's exact test).
The discriminating reactivities in PPMS were IgG (51%) and IgM (49%) and were mainly directed against CNS antigens (FIGS. 2B-2D). The CNS antigens in the PPMS immune signature were different from those in the RRMS signature. The RRMS CNS signature was termed CNS1 and the PPMS CNS signature was termed CNS2 (FIG. 2H and Table 8). Further comparison of RRMS and PPMS revealed a pronounced reactivity against HSP60 or HSP70 in RRMS that was not observed in PPMS (FIGS. 2A-2D). Furthermore, 46% of the discriminating reactivities in PPMS consisted of antibodies that were decreased in PPMS compared to HC, whereas in RRMS only 4% of the discriminating antibodies were decreased compared to HC (FIGS. 2B-2D and Tables 8 and 9). There was only a minor overlap between the reactivities that discriminated PPMS and those that discriminated RRMS compared to HC. This finding is compatible with the view that different immune processes occur in these two forms of MS (Miller & Leary, 2007).
Example 4
Autoantibody Pattern Analysis Identifies an Immune Signature for SPMS
Approximately 50% of the RRMS patients become progressive (SPMS). Although there is no consensus on the mechanisms involved in the transition to SPMS, several studies suggest changes in the nature of the inflammatory response and the emergence of neurodegenerative processes occur in the secondary progressive phase of MS. Having identified an autoantibody signature in RRMS which consisted of increased reactivity to HSP and a unique pattern of reactivity to CNS antigens (CNS1), the antibody signature associated with SPMS was studied by comparing antibody reactivity in 37 RRMS vs. 30 SPMS samples (FIG. 2E).
The antibody reactivities included in the heatmap shown in FIG. 2E are listed herein (in the same order as in the heatmap, i.e. from top to bottom): IgM_MOG 61-80; IgM_HSP60 376-395; IgM_MOG 31-50; IgM_CNP 361-380; IgM_Amyloid beta 1-23; IgM_CNP 346-365; IgM_HSP60 496-515; IgM_OSP 1-20; IgM_HSP60 511-530; IgM_OSP 61-80; IgM_HSP60 286-305; IgM_CNP 240-259; IgM_HSP70 601-620; IgM_HSP60 210-229; IgM_HSP60 451-470; IgM_MOBP 166-185; IgM_HSP60 166-185; IgM_MBP 138-147; IgM_CNP 195-214; IgM_MBP 1-20; IgM_HSP60 526-545; IgM_P2 1-20; IgM_HSP70 286-305; IgM_MBP 155-178; IgM_P2 46-65; IgM_HSP60 195-214; IgM_P2 31-50; IgM_HSP60 271-290; IgM_HSP60 136-155; IgM_CNP 286-305; IgM_HSP70 210-229; IgM_HSP70 136-155; IgM_PLP 150-163; IgM_HSP70 166-185; IgM_HSP60 255-275; IgM_HSP60 16-35; IgM_bovineMBP; IgM_CNP 181-199; IgM_CNP 121-140; IgM_Asialoganglioside-GM2; IgM_Amyloid beta 1-12; IgM_OSP 121-140; IgM_Secreted APPbeta; IgM_Cardiolipin; IgM_HSP70 406-425; IgG_HSP60 361-380; IgG_Amyloid beta 17-40; IgG_Cholesterol; IgG_Amyloid beta 1-42; IgG_PLP 80-99; IgG_PLP 65-84; IgG_PLP 40-59; IgG_PLP 1-19; IgM_PLP 1-19; IgG_PLP 151-173; IgG_HSP70 421-440; IgG_huMBP; IgG_MOBP 16-35; IgG_CNP 16-35; IgG_RBP; IgG_HSP70 331-350; IgG_OSP 121-140; IgG_MBP 113-132; IgG_beta Crystallin; IgG_CNP 240-259; and IgG_PLP 178-191.
The results show that SPMS could be discriminated from RRMS with a success rate of 71% (P=0.0073). SPMS was characterized by a decrease in the IgM antibodies to HSP60 and HSP70 that were found in RRMS (FIG. 2E and Tables 8 and 9). Thus, SPMS and PPMS are similar in that both have only minimal reactivity to HSP. Examination of the CNS reactivity in SPMS revealed a decrease in CNS IgM antibodies that were upregulated in RRMS, and an increase in CNS-reactive IgG antibodies. The CNS signature for SPMS differed from both RRMS and PPMS and was termed CNS3 (FIGS. 2E-2H, Table 8).







TABLE 8







Reactivity to CNS antigens in RRMS, PPMS and SPMS




























TABLE 9







Reactivity to HSP in RRMS, SPMS and PPMS















The detection of significant changes in the antibody reactivity to CNP and HSP, in Tables 8 and 9, respectively, is shown as a black square, wherein ‘s’ indicates up regulated and ‘t’ indicates down regulation relative to HC (for RRMS and PPMS) or RRMS (for SPMS).
Example 5
Autoantibody Patterns Distinguish Pathologic Subtypes of MS
Lucchinetti, Bruck and Lassman have defined four immunopathologic patterns of MS (Lucchinetti et al., 200; Lucchinetti et al., 2004). Investigation was performed on serum taken at the time of brain biopsy from 15 Pattern 1 and 30 Pattern II subjects.
The antibody reactivities included in the heatmap shown in FIG. 3 are listed herein (in the same order as in the heatmap, i.e. from top to bottom): IgG—15-ketocholestane; IgG—15α-hydroxycholestene; IgG_Ganglioside-GM4; IgG—15-ketocholestene; IgG Tetrasialoganglioside-GQ1B; IgG_Brain L-α-lysophosphatidylserine; IgG_Lactosylceramide; IgM—160 kDa. Neurofilament; IgG_HSP60 240-259; IgG_OSP 166-185; IgG_MOG 196-215; IgG_OSP 61-80; IgG_OSP 1-20; and IgG_PLP 215-232. As shown in FIG. 3, the autoantibody patterns was able to discriminate pattern I from patterns II (P=0.0082, Fisher's exact test). To validate this finding, analysis was performed on a blinded set of samples that contained the 15 pattern I used for analysis above mixed randomly with 23 new pattern II samples. In this validation test, pattern I was distinguished from pattern II (P=0.0017, Fisher's exact test). The LOOCV on the learning set revealed a success rate of 0.78, with PPV=0.78 and NPV=0.67, the success rate for the test set was 0.78; the PPV=0.82 and the NPV=0.73.
The immune signature that distinguished pattern I from pattern II consisted of 13 IgG and 1 IgM reactivities against lipids, HSP and CNS antigens (FIG. 3). Pattern II subjects showed increased IgG reactivity to HSP60, MOG, OSP and PLP peptide epitopes. Noteworthy, the up-regulated reactivities in pattern I subjects were IgG antibodies to 7 lipids; 3 of these lipids were oxidized derivatives of cholesterol (15-ketocholestene, 15-ketocholestane and 15α-hydroxycholestene).
Example 6
Cholesterol Derivatives Worsen Experimental Autoimmune Encephalomyelitis (EAE)
It has been postulated that the oxidized derivative of cholesterol, 7-ketocholesterol, contributes to MS pathology by activating microglial cells via a poly (ADP-ribose)-polymerase-1 enzyme (PARP) dependent pathway. To explore the relationship between autoantibodies to oxidized cholesterol derivatives (oxChol) and disease pathology, the effect of the lipids found in Example 5 was examined on EAE, an immune model of MS.
EAE was induced in C57BL/6 mice with MOG35-55, and 15-ketocholestene, 15-ketocholestane and 15α-hydroxycholestene were administered at days 0, 4, 7 and 10 after EAE induction (10 μg/mice). AIQ was administered intraperitoneally (60 μg/mice) on daily basis. The course of EAE in these mice is shown as the mean EAE score+s.e.m. (MOG35-55 n=22, MOG35-55+oxChol n=24, MOG35-55+oxChol+AIQ n=18).
Spinal cords were taken on day 19 and stained with hematoxylin and eosin, luxol fast blue or silver stain to quantify the cellular infiltrate, demyelination and axonal loss, respectively. Each column represents the mean±SEM resulting from the analysis of at least 8 sections. Administration of oxChol enhanced EAE as measured clinically (FIG. 4A, P<0.0001, two-way ANOVA), and augmented inflammatory infiltrates (FIG. 4B; P<0.05, one-way ANOVA), demyelination (FIG. 4C; P<0.01, one-way ANOVA) and axonal loss (FIG. 4D; P<0.001, one-way ANOVA); these effects were inhibited by treatment with AIQ (P<0.001, one-way ANOVA).
Further investigations were performed to determine whether the effect of oxChol on EAE was mediated by PARP. Using a PARP inhibitor, 5-Aminoisoquinolinone (AIQ) it was found that AIQ abrogated the worsening of EAE caused by oxChol both clinically (P<0.0001, two-way ANOVA) and histopathologically (P<0.001, one-way ANOVA) (FIGS. 4A-D) but did not affect T cell responses to MOG35-55 as measured by cytokines (IFN-γ and IL-17) or proliferation. In addition, transfer of serum from oxChol-treated mice did not enhance EAE. Taken together, these results suggest that the effect of oxChol on EAE is due to the effect of oxChol through PARP and not through the induction of anti-lipid antibodies or affecting adaptive T cell responses to MOG35-55.
The foregoing description of the specific embodiments will so fully reveal the general nature of the invention that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without undue experimentation and without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. The means, materials, and steps for carrying out various disclosed functions may take a variety of alternative forms without departing from the invention.

## Claims

1. A method of diagnosing a subtype of multiple sclerosis (MS) in a subject, the method comprising determining the reactivity of antibodies in a sample obtained from the subject to a plurality of antigens selected from the group consisting of the antigens listed in Tables 1 to 4, thereby determining the reactivity pattern of the sample to the plurality of antigens, and comparing the reactivity pattern of said sample to a control reactivity pattern, wherein the subtype of MS is selected from the group consisting of:
(i) relapsing remitting multiple sclerosis (RRMS) wherein said plurality of antigens comprises at least 5 different antigens selected from the group consisting of the antigens listed in Table 1;
(ii) primary progressive multiple sclerosis (PPMS) wherein said plurality of antigens comprises at least 5 different antigens selected from the group consisting of the antigens listed in Table 2;
(iii) secondary progressive multiple sclerosis (SPMS) wherein said plurality of antigens comprises at least 5 different antigens selected from the group consisting of the antigens listed in Table 3; and
(iv) a pathologic subtype of MS selected form Pattern I lesions and Pattern II lesions wherein said plurality of antigens comprises at least 5 different antigens selected from the group consisting of the antigens listed in Table 4;

wherein said plurality of antigens is used in the form of an antigen array comprising a glass support, wherein determining the reactivity of antibodies in the sample to the plurality of antigens is performed using a system providing quantitative measurement of antigen-antibody binding by fluorescence detection, and wherein a significant difference between the reactivity pattern of said sample obtained from the subject compared to a reactivity pattern of a control sample is an indication that the subject is afflicted with the subtype of MS.

2. The method of claim 1, wherein the glass support is an epoxy glass support.

3. The method of claim 2, wherein each antigen is attached to at least three separate specific addressable locations of the array.

4. The method of claim 1 for diagnosing relapsing remitting multiple sclerosis (RRMS) in a subject, wherein the plurality of antigens are selected from the antigens listed in Table 1 and the control reactivity pattern is obtained from healthy subjects.

5. The method of claim 1, wherein each antigen is attached to at least three separate specific addressable locations of the array.

6. The method of claim 4, wherein the plurality of antigens comprises all the antigens listed in Table 1.

7. The method of claim 1, for diagnosing primary progressive multiple sclerosis (PPMS) in a subject, wherein the plurality of antigens are selected from the antigens listed in Table 2 and the control reactivity pattern is obtained from healthy subjects.

8. The method of claim 7, wherein the plurality of antigens comprises all the antigens listed in Table 2.

9. The method of claim 1 for diagnosing secondary progressive multiple sclerosis (SPMS) in a subject, wherein the plurality of antigens are selected from the antigens listed in Table 3 and the control reactivity pattern is obtained from RRMS subjects.

10. The method of claim 9, wherein the plurality of antigens comprises all the antigens listed in Table 3.

11. The method of claim 1 for diagnosing Pattern I lesions in a subject with MS, wherein the plurality of antigens is selected from the antigens listed in Table 4 and the control reactivity pattern is obtained from subjects having Pattern II lesions.

12. The method of claim 1 for diagnosing Pattern II lesions in a subject with MS, wherein the plurality of antigens is selected from the antigens listed in Table 4 and the control reactivity pattern is obtained from subjects having Pattern I lesions.

13. The method of claim 1, wherein the control is selected from the group consisting of a sample from at least one individual, a panel of control samples from a set of individuals, and a stored set of data from control individuals.

14. The method of claim 1, wherein the sample is a serum sample.

15. The method of claim 1, further comprising diluting the sample 1:10 before determining the reactivity of antibodies in the sample.

16. The method of claim 1, wherein the subtype of MS is selected from the group consisting of:
(i) relapsing remitting multiple sclerosis (RRMS) wherein said plurality of antigens is HSP70 511-530, HSP60 286-305, LACTOCEREBROSIDE, AB1-42 and AB1-12, listed in Table 1;
(ii) primary progressive multiple sclerosis (PPMS) wherein said plurality of antigens is Chondroitin 4-Sulfate, Neurofilament 68 kDa, Amyloid Beta, Secreted APPalpha and SOD, listed in Table 2;
(iii) secondary progressive multiple sclerosis (SPMS) wherein said plurality of antigens is HSP60 376-395, Amyloid beta 1-23, HSP70 601-620, Cardiolipin and beta Crystallin, listed in Table 3; and
(iv) a pathologic subtype of MS selected from Pattern I lesions and Pattern II lesions wherein said plurality of antigens is 15-ketocholestane, 15α-hydroxycholestene, 15-ketocholestene, Brain L-α-lysophosphatidylserine and 160 kDa. Neurofilament, listed in Table 4.