# Patent

## Title
Method for diagnosing kidney disease comprising detecting the level of annexin A2

## Abstract

The present invention provides biomarkers for detecting kidney disease, selected from the oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6 or combinations thereof. Moreover, the present invention also provides an assay kit and a method for kidney disease detecting, practically for the kidney disease resulting from acute tubular necrosis.

## Background
CROSS-REFERENCES TO RELATED APPLICATIONS
This application is a divisional of U.S. application Ser. No. 11/407,101 filed on Apr. 20, 2006, now abandoned, and clams the benefit of Taiwan Patent Application No. 095100063 filed Jan. 6, 2006.


BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention is related to an innovative method to select acute tubular necrosis-related acute renal failure patient by detecting protein or nucleotide of annexin A2 and/or S100A6.
2. Description of the Prior Art
Acute tubular necrosis (ATN) is the most common pathologic entity responsible for the clinical state of acute renal failure (ARF) [1, 2]. The two main causes of ATN are ischemic and toxic injuries [3]. In the latter type, a variety of renal environmental substances that include heavy metals such as mercury, lead, and uranium are known to cause ARF. Nephrotoxic ATN is histologically evident as epithelial cell necrosis, mainly in the proximal convoluted tubules, with preservation of the tubular basement membrane, and usually intact distal tubular segments [4].
Although severely damaged by toxin, the kidney has the ability to completely recover structurally and functionally. Normally, quiescent cells undergo dedifferentiation and regain their potential to divide after enhancement of DNA synthesis in ATN. Consequent to cell proliferation, the new cells differentiate to restore the functional integrity of the nephron [5]. Little is known of the mechanism (s) by which regeneration of renal tubules is mediated. The observations that hepatocyte growth factor, epidermal growth factor, and bone morphogenetic protein-7 are among the potent regulators of kidney organogenesis, and that these agents can also promote tubular regeneration after a variety of insults [6], are consistent with the idea that the regeneration process may be partially controlled by a mechanism similar to that operating during development. Tubular cell calcium concentration and content are increased following acute renal injury induced by ischemic and toxic insults. The divalent calcium cation (Ca2+)-signaling system operate by binding to effector molecules, Ca2+-binding proteins, that mediate stimulation of numerous Ca2+-dependent processes such as transcription and cell proliferation. Two large families of the Ca2+-binding proteins are the annexins and the EF-hand motif S100 proteins [7]. The annexins are a family of 5 phospholipids binding proteins that share a common property of interacting with membranes and target molecules in a Ca2+-dependent manner [8, 9]. S100 proteins represent the largest subgroup in the EF-hand Ca2+-binding protein family. A unique feature of S100 proteins is that individual members are localized in specific cellular compartments from which some are able to relocate upon Ca2+ activation, thus transducing the Ca2+ signal in a temporal and spatial manner by interacting with different targets specific for each S100 protein [10]. Interactions between annexins and S100 proteins are now known to include several members of these protein families.
Therefore, it's helpful to search useful biomarkers in annexins and S100 protein groups for detecting the reason of acute kidney failure in clinical medical diagnosis.
SUMMARY OF THE INVENTION
To address the problem of detecting acute kidney failure, the present invention provides a biomarker for detecting kidney disease, selected from the oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6 or combinations thereof.
Another object of the present invention is to provide a biomarker for detecting kidney disease, selected from the oligonucleotide sequence, complementary sequence or derivatives of SEQ ID NO: 1, SEQ ID NO: 11, SEQ ID NO: 3 or SEQ ID NO: 9, amino acid sequence or derivatives, fragment, variants, antibody of SEQ ID NO: 2, SEQ ID NO: 12, SEQ ID NO: 4 or SEQ ID NO: 10 or combinations thereof.
Yet another object of the present invention is to provide an assay kit for kidney disease, comprising biomarkers. The biomarkers are selected from the oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6 or combinations thereof.
Another object of the present invention is to provide a diagnosis method for kidney disease, comprising the following steps: (a) providing a sample; (b) providing biomarkers which are selected from: oligonucleotide sequence, complementary sequence or derivatives of SEQ ID NO: 1, SEQ ID NO: 11, SEQ ID NO: 3 or SEQ ID NO: 9, amino acid sequence or derivatives, fragments, variants, antibody of SEQ ID NO: 2, SEQ ID NO: 12, SEQ ID NO: 4 or SEQ ID NO: 10, or combinations thereof; (c) contacting said biomarkers in step (b) with the substance of the sample in step (a), the substance is selected from the oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6 or combinations thereof; (d) detecting the products of the biomarkers reacting with the substance in step (c).



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1a shows the value of serum creatinine in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 1b shows the value of serum BUN in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 1c shows day 0 of renal tissue sections in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 1d shows day 3 of renal tissue sections in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 1e shows day 7 of renal tissue sections in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 1f shows day 14 of renal tissue sections in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 1g shows polygon of renal necrosis score in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 1h shows polygon of renal regeneration score in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 2a-d shows immunohistochemical staining of renal section in uranyl-nitrate induced ATN animal mode of the example 1. A dedifferentiation marker-anti-vimentin antibody is used. FIG. 2a, normal kidney cells (day 0); FIG. 2b, day 3 after induction; FIG. 2c, day 7 after induction; and FIG. 2d, day 14 after induction.
FIG. 3a shows gene expression of S100A6, S100A10, S100A11, annexin A1, and annexin A2 with RT-PCR in the example 1.
FIG. 3b shows relative fold change of S100A6 in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 3c shows relative fold change of annexin A2 in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 4a-h shows expression and renal distribution of S100A6 protein and annexin A2 protein with immunofluorescence staining of S100A6 protein and annexin A2 protein in uranyl-nitrate induced ATN animal model of the example 1. FIG. 4a, expression of S100A6 of control animal (day 0); FIG. 4b, expression of annexin A2 of control animal (day 0); FIG. 4c, expression of S100A6 at day 3; FIG. 4d, expression of annexin A2 at day 3; FIG. 4e, expression of S100A6 at day 7; FIG. 4f, expression of annexin A2 at day 7; FIG. 4g, expression of S100A6 at day 14; and FIG. 4h, expression of annexin A2 at day 14.
FIG. 4i shows expression amount of S100A6 protein and annexin A2 protein with Western-blot in uranyl-nitrate induced ATN animal model of the example 1.
FIG. 5 shows proliferation morphology of renal tube and the co-expression of S100A6 protein and annexin A2 protein with in-situ hybridization in uranyl-nitrate induced ATN animal model of the example 1. FIG. 5a, expression of S100A6; FIG. 5b, expression of annexin A2; FIG. 5c, results of semi-quantitative scoring analysis; and FIG. 5d, results of S100A6 and annexin A2 double staining
FIG. 6 shows expression and renal distribution of S100A6 protein and annexin A2 protein in the nephrotoxin model of folic acid induced ATN and rapid acute renal failure model of ischemia-reperfusion injury (IRI). FIG. 6a, temporal pattern of S100A6 expression in folic acid ATN model; FIG. 6b, temporal pattern of S100A6 expression in IRI ARF model; FIG. 6c, temporal pattern of annexin A2 expression in folic acid ATN model; and FIG. 6d, temporal pattern of annexin A2 expression in IRI ARF model.



DETAILED DESCRIPTION OF THE INVENTION
One of the objects in the present invention is to provide a biomarker for detecting kidney disease, selected from the oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody or combination of annexin A2 or S100A6. The kidney disease is acute renal failure, specifically, resulting from acute tubular necrosis.
Aforesaid oligonucleotide sequence of annexin A2 is selected from SEQ ID NO: 1 or SEQ ID NO: 11.
Aforesaid amino acid sequence of annexin A2 is selected from SEQ ID NO: 2 or SEQ ID NO: 12.
Aforesaid oligonucleotide sequence of S100A6 is selected from SEQ ID NO: 3 or SEQ ID NO: 9.
Aforesaid amino acid sequence of S100A6 is selected from SEQ ID NO: 4 or SEQ ID NO: 10.
Aforesaid variants of annexin A2 or S100A6 have 80% or more than 80% similarity with the amino acid sequence of annexin A2 or S100A6.
Aforesaid derivatives are to modify the 3′ terminal or 5′terminal of said oligonucleotide sequence or complementary sequence and keeping 70% or more than 70% similarity with the oligonucleotide sequence of annexin A2 or S100A6. Selectively, the similarity is keeping 90% or more than 90%.
Another object of the present invention is to provide a biomarker for detecting kidney disease, selected from the oligonucleotide sequence, complementary sequence or derivatives of SEQ ID NO: 1, SEQ ID NO: 11, SEQ ID NO: 3 or SEQ ID NO: 9, amino acid sequence or derivatives, fragment, variants, antibody of SEQ ID NO: 2, SEQ ID NO: 12, SEQ ID NO: 4 or SEQ ID NO: 10 or combinations thereof. The kidney disease is acute renal failure, specifically, resulting from acute tubular necrosis.
Aforesaid variants have 80% or more than 80% similarity with the amino acid sequence of SEQ ID NO: 2, SEQ ID NO: 12, SEQ ID NO: 4 or SEQ ID NO: 10.
Aforesaid derivatives of SEQ ID NO: 1, SEQ ID NO: 11, SEQ ID NO: 3 or SEQ ID NO: 9 are to modify the 3′ terminal or 5′terminal of said oligonucleotide sequence or complementary sequence and keeping 70% or more than 70% similarity with the oligonucleotide sequence.
Aforesaid derivatives of SEQ ID NO: 1, SEQ ID NO: 11, SEQ ID NO: 3 or SEQ ID NO: 9 are to modify the 3′ terminal or 5′terminal of said oligonucleotide sequence or complementary sequence and keeping 90% or more than 90% similarity with the oligonucleotide sequence.
Yet another object of the present invention is to provide an assay kit for kidney disease, including one or more biomarkers. The biomarkers can be selected from oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6. The preceding candidates of annexin A2 or S100A6 can be selected in any combination at will. The kidney disease is acute renal failure, specifically, resulting from acute tubular necrosis.
Aforesaid oligonucleotide sequence of annexin A2 is selected from SEQ ID NO: 1 or SEQ ID NO: 11.
Aforesaid amino acid sequence of annexin A2 is selected from SEQ ID NO: 2 or SEQ ID NO: 12.
Aforesaid oligonucleotide sequence of S100A6 is selected from SEQ ID NO: 3 or SEQ ID NO: 9.
Aforesaid amino acid sequence of S100A6 is selected from SEQ ID NO: 4 or SEQ ID NO: 10.
The kit can comprise secondary antibodies of any amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6 or combinations thereof.
Another object of the present invention is to provide a diagnosis method for kidney disease. First, a sample is supplies. Then, biomarkers are provided, which are selected from: the oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6 or combinations thereof. The biomarkers then are contacted with the substance of the sample, selecting from the oligonucleotide sequence, complementary sequence or derivatives, amino acid sequence or derivatives, fragment, variants, antibody of annexin A2 or S100A6 or combinations thereof. Finally, the product of the biomarkers reacting with the substance is detected by biotechnology. Note should be added that the biotechnology can be, for example, but not limit to, enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA), immunofluorescence, reverse-transcription polymerase chain reaction (RT-PCR) or in situ hybridization. Furthermore, the biomarkers can be fixed on substrate before contacted with the sample. The substrate is ELISA plate or bio-chips.
According to the method of the present invention, one more steps of recognizing antibody with secondary antibody can be added before detecting the product of the biomarkers reacting with the substance.
Preferably, the substance in the sample can be further labelled by fluorescence prior to contacting with biomarkers.
Aforesaid kidney disease is acute renal failure, specifically, resulting from acute tubular necrosis.
The present invention opens the possibilities of utilizing oligonucleotide sequence or amino acid sequence of annexin A2 and/or S100A6 as biomarkers for detecting the type of acute renal failure (especially acute tubular necrosis) and proceeding clinical diagnosis and treatment.
The advantages of the present invention are further depicted with the illustration of examples. The following is a description of the exemplary case of carrying out the platelets provided by the invention for bioactivity testing. This exemplary case is not to be taken in a limiting sense, but is made merely for the purpose of further illustrating the materials and methods for practicing the present invention.
EXAMPLES
Animal Models
Urany-nitrate induced ATN. Female 8-week-old C57BL/6 mice were purchased from the National Laboratory Animal Breeding and Research Center (Taipei, Taiwan). All mice received a single tail vein injection of uranyl nitrate ((UO2(NO3)2).6H20; 100 μg in 100 μL of 5% NaHCO3). The mice were sacrificed at 0, 3, 7 and 14 days after the injection. Blood and urine were collected for clinical evaluation, and kidneys were removed for molecular and histopathology studies. Samples intended for histopathology were fixed in formalin according to a standard protocol.
Ischemic reperfusion injury. This model was induced as previously described [11]. Briefly, bilateral ischemic reperfusion injury was generated in female Balb/c mice (25-30 g) by occluding the renal pedicles with microvascular clamps for 30 min under ketamine-xylazine anesthesia. Completeness of ischemia was verified by blanching of the kidneys, signifying the stoppage of blood flow. The blood flow to the kidneys was reestablished by removal of the clamps (reperfusion) with visual verification of blood return. Mice subjected to sham operation (identical treatment except that the renal pedicles were not clamped) were used as controls. During the procedure, animals were well hydrated and their body temperature maintained with an adjustable heating pad. At 4, 12, 24, and 72 hours post-ischemia, mice were killed, and their kidneys were removed for RNA extraction.
Folic acid induced acute renal failure. Folic acid (240 mg/kg) was administered into female Balb/c mice (25-30 g) in vehicle (0.2 ml of 0.3MNaHCO3) or vehicle only by intraperitoneal injection [12]. The control kidneys were analyzed before folic acid or vehicle administration. The mice were sacrificed, and their kidneys were collected at 1, 3, 7, and 14 days at each time point.
Renal Function
Blood samples collected through the retro-orbital venous plexus were centrifuged (3000×g, 10 min), and the supernatant containing the serum was withdrawn and stored at −70° C. until assayed. Renal function was assessed by measuring the elevation in plasma levels of creatinine and blood urea nitrogen (BUN). These analyses, which utilized Fuji DRI-CHEM 3030 (Fuji Photo Film Co. Ltd., Tokyo, Japan), were obtained within 15 min once the serum samples thawed.
Renal Histopathology
The formalin-fixed renal tissues were dehydrated in a graded series of ethanol solutions and embedded in paraffin as described elsewhere [13]. Three-micron sections were obtained and stained with H&E. For typical lesions of ATN, tubular cell necrosis, of which some of them were sloughed into the tubular lumina accompanied by casts [14].
Quantitative analysis of renal tubular necrosis was performed by optical microscopy. Briefly, 100 intersections were examined for each kidney and a score from 0 to 3 was given for each tubular profile involving an intersection: 0, normal histology; 1, tubular cell swelling, brush border loss, nuclear condensation, with up to one third of tubular profile showing nuclear loss; 2, as for score 1, but greater than one third and less than two thirds of tubular profile shows nuclear loss; and 3, greater than two thirds of tubular profile shows nuclear loss. The total score for each kidney was is calculated by addition of all 100 scores with a maximum score of 300. There was also evidence of tubular cell regeneration, it was defined as flattened epithelial cells with hyperchromatic nuclei and mitotic figures [14]. Quantitative analysis of renal tubular regeneration was performed by optical microscopy. Briefly, 100 intersections were examined for each kidney and a score from 0 to 3 was given for each tubular profile involving an intersection: 0, normal histology; 1, flattened epithelial cells with hyperchromatic nuclei and mitotic figures with up to one third of tubular profile showing hyperchromatic nuclei and mitotic figures; 2, as for score 1, but greater than one third and less than two thirds of tubular profile shows hyperchromatic nuclei and mitotic figures; and 3, greater than two thirds of tubular profile shows hyperchromatic nuclei and mitotic figures. The total score for each kidney was calculated by addition of all 100 scores with a maximum score of 300.
Reverse-transcriptase Polymerase Chain Reaction (RT-PCR)
Total RNA was extracted with Trizol reagent (Invitrogen Corporation, Carlsbad, Calif.) from total kidney. For first strand cDNA synthesis, 1.5 μg of total RNA was used in a single-round RT-reaction. The reaction mixture consisted of 0.9 μL Oligo (dT)12-18 primer, 1.0 mM dNTPs, 1× first strand buffer, 0.4 mM DTT, 80 units RNaseout recombinant ribonuclease inhibitor, and 300 units of superscript II RNase H (Invitrogen Corporation, Carlsbad, Calif.). PCR was run by using 1 μL of the RT reaction mixture as the template, 0.4 μM of gene specific primers, 1×PC2 buffer, 0.25 mMdNTPs, and 1.5 units of KlenTaq DNA polymerase (Ab Peptides Inc., St. Louis, Mo.). The amplification was carried out at 94° C. for 2 min, then for 25 cycles at 94° C. for 30 sec, 58° C. for 45 sec, and 72° C. for 30 sec, followed by a final extension at 72° C. for 10 min. The primers were list in table. 1. β-actin and each target gene product were electrophoretically-separated on a 1% agarose gel and stained with ethidium bromide.
Real-time PCR was performed on an ABI Prism 7700 Sequence Detection System (Applied Biosystems, Foster City, Calif., USA). All of the probes and primers were Assays-on-Demand Gene expression products (Applied Biosystems). Real-time PCR reactions were using 10 μl of cDNA, 12.5 μl of TaqMan Universal PCR Master Mix (Applied Biosystems), 1.25 μl of the specific probe/primer mixed in a total volume of 25 μl. The thermal cycler conditions were as follows: 1×2 min 50° C., 1×10 min 95° C., 40 cycles denaturation (15 sec, 95° C.) and combined annealing/extension (1 min, 60° C.). Amplifications were normalized to β-actin using 2-CT method (Applied Biosystems).
Western Blot Analysis
Each sample was run on a 12% SDS-PAGE gel. The gel was electro-blotted onto a nitrocellulose membrane, incubated for 1 h in 20 ml of blocking buffer (TBS, 5% skim milk), washed three times in TEST, and incubated with goat anti-S100a6, goat anti-Anxa2, rabbit anti-PCNA antibodies (Santa Cruz Biotechnology Inc., Santa Cruz, Calif.) at 4° C. overnight. Blots were washed three times and incubated horseradish peroxidase-conjugated rabbit anti-goat or goat anti-rabbit antibodies (Pierce, Ill., USA) for 1 h at room temperature. Membranes were washed three times, and the membranebound antibody detected was incubated chemiluminescent reagent plus (PerinElmer Life Sciences, MA, USA) and captured on x-ray film.
Immunohistochemical Staining
Immunohistochemical staining was performed on formaldehyde-fixed and paraffin-embedded tissues using the avidin-biotin immunoperoxidase method [15]. The antibodies used included goat anti-annexin A2, goat anti-S100A6, rabbit anti-PCNA (Santa Cruz Biotechnology Inc., Santa Cruz, Calif.) and goat anti-vimentin (ICN Biomedicals Inc., Irvine, Calif.). Paraffin was removed from sections and followed by rehydration. Endogenous peroxidase activity was quenched and the sections were blocked with 1% w/v BSA in PBS for 1 hour. The sections were then incubated with a 1:100 dilution of goat polyclonal anti-S100A6 antibody in PBS. After incubation with a biotinylated secondary antibody (DAKO, Glostrup, Denmark), the tissue sections were treated with an avidin-biotin-peroxidase complex (DAKO, Glostrup, Denmark). The reaction was visualized by use of a 3,3′-diaminobenzidine chromogen (DAKO, Glostrup, Denmark) following tissue counterstaining with hematoxylin. For double staining, the slides were incubated with the first antibody, which was demonstrated by the ABC method described above and microwaved with citrate buffer. Subsequently, the slides were incubated with the second antibody for 1 h, which was visualized by an alkaline phosphatase mediated reaction as described previously [16]. Quantitative analysis for S100A6, annexin A2, and PCNA was performed at high power (200×) by optical microscopy. Twenty randomly selected cortical fields were examined in each section. Preliminary examinations established that the renal tubules were the major portion that was positively stained.
A proportion score and intensity score were assigned. The proportion score represented the estimated the percentages of positive tubular cells (1=0-20%, 2=20-40%, 3=40-60%, 4=60-80% and 5=80-100%). The intensity score represented the estimated average staining intensity of tubular cells (0=none, 1=weak, 2=intermediate, 3=strong). The overall amount of positive staining was then expressed as the sum of the proportion and intensity scores.
Immunoelectron Microscopic (IEM) Study
Samples were fixed in a mixture of 4% paraformaldehyde and 0.5% glutaraldehyde in PBS, pH 7.4 and prepared routinely for electron microscopy with final embedding in LR White resin as described previously [15]. Ultra-thin sections were cut and placed on nickel grids. Primary (goat anti-annexin A2; 1:100; Santa Cruz, Calif.) and secondary antibodies (1:40; gold labeled, British Biocell International, Cardiff, UK) were applied. The presence and localization of the 10 nm gold particles were examined under an electron microscope.
In Situ Hybridization
In brief, 3 μm paraffin sections were mounted on charged glass slides and stored in airtight boxes at 70° C. Riboprobes were generated by using a pGEMT-EASY plasmid containing cDNA insert of mouse annexin A2 and S100A6 to generate antisense transcripts for in situ hybridization. In vitro transcription was carried out using a commercial kit. For in situ hybridization, Dig-labeled mRNAs were diluted 100-fold in hybridization buffer containing 2 mMEDTA (pH 7.5), 20 mMTris (pH 7.5), 0.6 M NaCl, 2×Denhardt's solution, 20% dextran sulfate, 0.1 mg/ml tRNA, and 0.2 M dithiothreitol. After deparaffinization, kidney sections were digested with 20 μg/ml proteinase K in PBS for 20 mins. Sections were acetylated using 0.25% acetic anhydride in 0.1M triethanolamine for 10 min. A volume of 25-50 μl of hybridization mixture was placed on each section and covered with a siliconized glass coverslips.
Hybridization was performed in moist chambers at 42° C. for 16 h. Coverslips were removed by washing in 1× saline sodium citrate (SSC) at room temperature and 0.2×SSC for 10 min at room temperature. Slides were then washed in 0.05×SSC for 10 min at room temperature followed by a washing step in 0.025×SSC for 30 min at 37° C.
After rinsing the slides in maleic buffer (0.1M maleic acid, pH 7.5; 0.15M NaCl) for 1 min at room temperature and blocking with 1× blocking buffer 60 mins then incubated with riboprobes (1:200) at 42° C. over night. Wash with maleic buffer and develop with NBT/BCIP solution in dark. With double staining, slides were microwaved with citrate buffer and treated for IHC as reported previously in this article.
Statistical Analysis
All results were expressed as means±standard deviations. Comparisons between two groups were made by unpaired Student's t-test. Differences among multiple groups were determined with the one-way ANOVA using Tukey's method for post-hoc analysis. P<0.05 was considered statistically different.
Example 1
Detecting ATN with Biomarkers in the Present Invention
In uranyl-nitrate induced ATN animal model, creatinine and BUN (Blood Urea Nitrogen) are measured in different time course. The result are shown in FIG. 1. In mice that received a single dose of uranyl nitrate, the levels of serum creatinine (Cr) rapidly increased to reach 1.554±0.371 mg/dL by day 3, as compared to normal controls (0.13±0.03 mg/dL) (FIG. 1a). This difference was significant (p<0.05). Thereafter, Cr levels gradually declined. By day 14 following uranyl nitrate injection, the Cr levels (0.29±0.19 mg/dL) approached control values (FIG. 1a). A similar trend and significance (FIG. 1b) was observed for serum BUN 127.85±11.76 mg/dL on day 3 and 26.53±8.76 mg/dL on day 14, compared to 24.58±1.78 mg/dL in normal controls, p<0.05.
Microscopic examination of renal tissue sections from the mice that received uranyl nitrate showed focal necrosis of renal tubules 3 days after injection (FIG. 1d, g), followed by a more diffuse and intense pattern on day 7 (FIG. 1e, g). Regeneration of renal tubules was noted on day 7 (FIG. 1h). On day 14 the histological alterations were mild and had been mostly replaced by regenerating tubules (FIG. 1f, h) and a normal background (FIG. 1a). Immunohistochemical staining of renal section with anti-vimentin, a cellular dedifferention marker, showed the proximal tubular cells undergo cell dedifferentiation to re-enter the cell cycle during the 14 days of disease progression. In normal kidney cells, vimentin expression was restricted to podocytes of glomeruli and fibroblasts in the interstitium (FIG. 2a). However, the regenerating tubular cells of the ATN mouse model strongly expressed the vimentin protein on day 7 (FIG. 2c). A gradual decline in the protein level occurred thereafter and then declined gradually on day 14 (FIG. 2d).
The expression of genes encoding S100A6, S100A10, S100A11, annexin A2, annexin A1, and annexin A11 was examined by using regular RT-PCR followed by quantification by real-time RT-PCR. As shown in FIG. 3, there was an increase of S100A6 and annexin A2 in the progressive of uranyl-nitrate induced ATN. In contrast, there was no significant change in the expression of S100A10, S100A11, annexin A1 and annexin A11. These results indicate that during the period of dedifferentiation and regeneration in uranyl nitrate-induced ATN, the Ca2+-binding proteins S100A6 and annexin A2 are selectively associated with the induction and recovery process.
To examine the cellular distribution and association of S100A6 and annexin A2 with ARF, immunohistochemical staining was performed. Paraffin-embedded renal sections from control and from uranyl nitrate induced-mice kidneys were harvested at timed intervals (0, 3, 7 and 14 days) after induction. The expression of S100A6 and annexin A2 results indicated that in the kidneys of control animals (day 0), the S100A6 (FIG. 4a) and annexin A2 (FIG. 4b) are expressed in a very limited number of renal tubular epithelial cells (<0.10). However, the expression of S100A6 and annexin A2 increased significantly at 7 day after induction. At this time point, both the number of the renal tubular epithelial cells expressing S100A6 (FIG. 4e) and annexin A2 (FIG. 4f) and the intensity of their staining increased significantly. Expression of S100A6 (FIG. 4c) and annexin A2 (FIG. 4d) at day 3 was greater than that of the control but considerably less than that at day 7. S100A6 and annexin A2 staining in kidney sections after day 7 indicates considerable variation, with some tubules demonstrating no labeling in any cell, whereas in some tubules all cells expressed S100A6 and annexin A2. The results indicate that S100A6 and annexin A2-positive cells are primarily located in the inner cortical and outer medullary regions (corticomedullary junction) of the kidney, a region that contains the S3 segment of the proximal tubules.
Similarly, the expression of annexin A2 protein in the kidney showed the same pattern as that of the S100A6, with the intensity of protein staining being less than the S100A6 by Western blot analysis (FIG. 4i). Besides, the expression pattern of these proteins in the kidney sections was similar to that of vimentin during the recovery phase.
ATN involves both the loss of epithelial cell polarity and the onset of proliferative response. Therefore, to determine the relevance of the S100A6 and annexin A2 to these processes, we examined the proliferative status of renal tubular epithelial cells and co-expression of these two proteins. Kidney sections, obtained on day 7 after uranyl nitrate treatment, were double stained with ribo-probes against both S100A6 and annexin A2 mRNA and with the antibody against PCNA, a marker of cell proliferation. The majority of cells (>80%) expressing S100A6 (dark blue color—FIG. 5a) and annexin A2 (dark blue color—FIG. 5b) and were also PCNA positive (red color—FIG. 5).
Semi-quantitative scoring analysis revealed concordant patterns of abundance among the three proteins (FIG. 5c). Besides, co-localization of both S100A6 and annexin A2 was evaluated by double staining. Most of the regenerating tubular cells were found to express the proteins simultaneously (FIG. 5d).
Example 2
Detecting ATN with Biomarkers in the Present Invention
To determine the general relevance of S100A6 and annexin A2 expression to the pathophysiology of acute renal failure, we examined their expression in two different mouse models. In the nephrotoxin model of folic acid induced acute renal failure, the temporal pattern of S100A6 and annexin A2 expression (FIG. 6a, c) was reminiscent of uranyl nitrate model that peaked between day 3 and 7 and returned to normal level by day 14. The expression of PCNA also peaked between day 3 and day 7. More importantly, in the rapid acute renal failure model of ischemia-reperfusion injury, the expression of S100A6 and annexin A2 (FIG. 6b, d) were elevated early (12 hours) and declined to normal level (72 hours) as a respective sensor of tubular injury and recovery.
During the course of our studies on global gene expression profiling in a mouse model of uranyl nitrate-induced acute renal failure, we observed dramatic up-regulation in the expression of S100A6 (calcyclin) and annexin A2. Accordingly, we postulated these interactive effector molecules might play a role in the pathophysiology of acute renal failure and their expression might be useful biomarkers of the temporal events and processes of the tubular epithelial cell in ATN.
In summary, oligonucleotide sequence and/or amino acid sequence of annexin A2 and/or S100A6 in the present invention are effective biomarkers for detecting ATN-related ARF and deserved to be applied in clinical acute renal failure diagnosis.
OTHER EMBODIMENTS
All features disclosed herein may be combined in any form with other methods and replaced by other features with identical, equivalent or similar purpose. Thus except for the part that is specifically emphasized, all features disclosed herein constitute only one embodiment among the numerous equivalent or similar features.
All modifications and alterations to the descriptions disclosed herein made by those skilled in the art without departing from the spirits of the invention and appended claims shall remain within the protected scope and claims of the invention.
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## Claims

1. A method for diagnosing a kidney disease in a subject, comprising
providing a renal sample obtained from a subject, wherein the renal sample is a renal cortical tissue,
detecting in the renal sample a level of a biomarker, which is Annexin A2, and
determining, based on the level of the biomarker thus detected, whether the subject suffers from a kidney disease, which is acute kidney failure or acute tubular necrosis; wherein an elevated level of the biomarker in the subject relative to that in a healthy subject indicates that the subject suffers from the kidney disease.

2. The method of claim 1, wherein the detecting step is performed by examining the protein level of Annexin A2.

3. The method of claim 2, wherein the protein level of Annexin A2 is determined by an immune assay selected from the group consisting of ELISA, Western Blot, and immunohistochemical staining.

4. The method of claim 3, wherein the immune assay is ELISA.

5. The method of claim 3, wherein the immune assay is Western Blot.

6. The method of claim 3, wherein the immune assay is immunohistochemical staining.

7. The method of claim 1, wherein the detecting step is performed by examining the messenger RNA level of Annexin A2.

8. The method of claim 7, wherein the RNA level of Annexin A2 is determined by real-time PCR.

9. The method of claim 7, wherein the RNA level of Annexin A2 is determined by in situ hybridization.