Diagnostic methods employing antibodies

Abstract: Antibodies are described which are reactive with activated human platelets, and substantially unreactive with resting hu­ man platelets, with the azurophilic granules of monocytes, and with granulocytes, and which may be used in diagnosis to de­ tect and/or locate platelet-containing sites in a human patient, or used in an assay for activated platelets. A substantially pure glycoprotein associated with activated platelets is also de­ scribed.

Description: This invention relates to antibodies and their use in diagnosis. More particularly, it relates to such use in the diagnosis in a human patient of vascular injury and disease and like conditions characterised by activated platelet-containing sites in the body and in the evaluation of the efficacy in a human patient of thrombolytic agents. Platelets are anucleate cells which circulate in the blood in a resting, inactive form. During the initiation of hemostasis these cells are activated and undergo major functional changes which can be observed biochemically and morphologically. Studies comparing surface structures on resting and activated platelets have identified actin and an additional high molecular weight protein expressed on activated platelets. (George et al . (1980) J. Clin. Invest. 66 , 1-9). Niewenhuis et al . (1983) Thomb. Haemostasis 50 , 100 describes a monoclonal antibody said to react with activated human platelets, azurophilic granules of granulocytes, and monocytes. An article entitled "A Platelet Membrane Protein Expressed during Platelet Activation and Secretion", [1984] J. Biol. Chem. 259(14): 9121-9126, of which the present inventors were among the co-authors, describes binding ¹²⁵I-labelled KC4 Ab to a membrane protein on thrombin-activated platelet preparations in vitro and preparation of the protein. Prior to the present invention, no simple and essentially non-invasive technique was available for locating activated platelet-containing sites in the human body and thus of diagnosing vascular injury and disease or for evaluating the efficacy in a human patient of thrombolytic agents. The present invention provides, in accordance with a first aspect thereof, a monoclonal antibody which is reactive with activated human platelets, and substantially unreactive with resting human platelets and the azurotrophic granules of monocytes and granulocytes, and which is labelled, and preferably radiolabelled, or complexed with a paramagnetic ion to form an NMR contrast agent, for use in the diagnosis in a human patient of vascular injury and disease and like conditions characterised by activated platelet-containing sites in the body and in the evaluation of the efficacy in a human patient of thrombolytic agents by a method including administration to said patient of the labelled antibody and the detection thereafter in said patient of labelled immune complexes. In accordance with a second and alternative aspect thereof, the invention provides, for use in the manufacture of a diagnostic agent, which is labelled, and preferably radiolabelled, or complexed with a paramagnetic ion to form an NMR contrast agent, for diagnosis in a human patient of vascular injury and disease and like conditions characterised by activated platelet-containing sites in the body and for the evaluation of the efficacy in a human patient of thrombolytic agents by a method including administration to said patient of the said diagnostic agent and the detection thereafter in said patient of labelled immune complexes: a monoclonal antibody which is reactive with activated human platelets, and substantially unreactive with resting human patients and the azurotrophic granules of monocytes and granulocytes. According to a third alternative aspect of this invention, there is provided a method for in vivo imaging in the detection and location of activated platelet-containing sites in a human patient, characterised in that a monoclonal antibody which is reactive with activated human platelets, and substantially unreactive with resting human platelets, and with the azurotrophic granules of monocytes and granulocytes, said monoclonal antibody being labelled, and preferably radiolabelled, or complexed with a paramagnetic ion to form an NMR contrast agent, is administered to the patient, and in that an effective picture is formed of location within the patient of activated platelet-containing sites by a non-invasive method determined by the nature of said label. The antibody, because of its specificity for an antigenic determinant expressed only on activated, but not resting, platelets, can provide highly accurate information regarding the location of activated platelet-containing sites (e.g., thrombi) with very little background from resting platelets or other biological particles such as monocytes and granulocytes. Monoclonal antibodies for use in diagnosis in accordance with the invention may be produced by hybrid cells made using conventional hybridization and screening techniques. As is well known in the monoclonal antibody field, each independently-produced hybrid cell line which produces a monoclonal antibody specific for the same antigenic determinant is nonetheless different from all others, as is each of the monoclonal antibodies so produced. Thus, while repetition of the procedure described herein will result in the production of a hybrid cell line which produces monoclonal antibody useful in diagnosis in accordance with the invention, being specific for the described antigenic determinant on activated platelets, it is highly unlikely that it will yield a cell line which produces a monoclonal antibody which is chemically an exact copy of the particular monoclonal antibodies described below. The invention is hereinafter more particularly described by way of example only with reference to the accompanying drawings, in which:- Fig. 1 is a graph showing the comparative interaction of an example of our antibody with resting and activated platelets; Fig. 2 is a pair of immunofluorescence photomicrographs illustrating the binding of an example of our antibody to resting (A) and thrombin-activated (B) platelets; Fig. 3 is a graph of a Scatchard analysis of the interaction of our antibody with activated platelets; Fig. 4 is a graph illustrating the effects of calcium and EDTA on the binding of an example of our antibody to activated and resting platelets; Fig. 5 is a graph illustrating the relationship between secretory function and activated platelet-specific antigen expression in activated platelets; and Fig. 6 is a gel electrophoresis graph showing that the antigen recognized by an example of our antibody is distinct from glycoprotein IIa. Preparation of Activated Platelets A monoclonal antibody was made as follows, beginning with the isolation of activated platelets. Blood was obtained from normal human donors and anticoagulated with Ware's solution (0.1M citrate buffer) at a 9:1 (v/v) ratio. Platelet-rich plasma (PRP), prepared by centrifugation of the citrated blood at 160 X g for 15 min., was applied to a BSA discontinuous gradient, and the platelet concentrates were isolated. The platelets were further purified by gel filtration on a Sepharose 2B column equilibrated with HEPES buffer, pH 7.35. Thrombin-activated platelets were prepared by the addition of thrombin to a final concentration of 0.15 unit/ml to the gel-filtered platelet suspension and incubated without stirring for 2 min. Thrombin-activated platelets were fixed by the addition of 3% glutaraldehyde. The suspension was stirred slowly for 30 min., washed twice with TBS (20 mM Tris-HCl, 0.15M NaCl, pH 7.5), and stored at -70°C in 60% (v/v) glycerol. Preparation of Anti-platelet Monoclonal Antibodies Specific for Activated Platelets Balb/c mice were immunized intraperitoneally with 1-5 x 10⁹ thrombin-activated aggregated platelets suspended in 250 ul of HEPES buffer, pH 7.35. These mice were boosted with a similar platelet preparation from different donors biweekly for two months. The mice were rested for three months and a final boost was performed three days before cell fusion. The fusion was performed by the method described in Kohler and Milstein, Nature (1975) 256 :495-497, using sp2/0 cells as a fusion partner. The supernatant medium from fused cells was assayed for anti-platelet antibody production. Selected positive cultures were cloned by the limiting dilution method described in McKearn, (1980) Monoclonal Antibodies (Kennett, R.H., McKearn, T.J., and Bechtol, K., eds) Plenum Press, New York, and a clone, designated "KC4", was isolated by carrying out an ELISA antibody screening procedure, as follows. Glutaraldehyde-fixed thrombin-activated platelets or acetylsalicylate-treated resting platelets were suspended in TBS, pH 7.5, at a concentration of 1 x 10⁸ platelets/ml. The platelet suspension (100 ul) was added to each microtiter well (Immulon II, Dynatech Laboratories, Inc.) and centrifuged at 1000 g for 5 min. After the plates were washed with TBS, 200 ul of TBS with 0.5% gelatin and 50 ug/ml of human IgG were added and the plates incubated at 37°C for 30 min. The microtiter wells were washed three times with TBS, and 100 ul of hybridoma culture supernatant were added and incubated at 37°C for 1 hour. The microtiter wells were washed three times with TBS, 2 mM B-mercaptoethanol, 1.5 mM MgCl₂, and then 50 ul of sheep antimouse immunoglobulin conjugated with B-galactosidase (Bethesda Research Laboratories) were added and incubated at 22°C for 2 hours. After washing three times with TBS, 2 mM B-mercaptoethanol, 100 ul of p-nitrophenyl B-D-galactoside (1 mg/ml) in 0.05 M sodium phosphate, 1.5 mM MgCl₂, pH 7.2, were added. The release of p-nitrophenol, as a measure of platelet/antibody binding, was monitored over 30-60 minutes at 405 nm on a Dynatech MR580 MICROELISA Auto-Reader. The KC4 clone was isolated as producing antibody preferentially reactive with activated, compared to resting, platelets. Hybrid cells of the KC4 clone, which produced anti-platelet antibody ("KC4 antibody"), were injected intraperitoneally into Balb/c mice. The ascites which developed was recovered and the KC4 antibody was isolated using protein A-Sepharose affinity chromatography. The bound immunoglobulin was eluted by 0.1M sodium citrate, pH 6.0. This antibody preparation yielded a single band in SDS gels under nonreducing conditions and two bands, corresponding to the heavy and light chain, in SDS gels under reducing conditions. The purified antibody was IgG₁k, as determined by Ouchterlony immunodiffusion using type-specific antisera. Binding Specificity of KC4 Antibody Purified KC4 monoclonal antibody was labeled with ¹²⁵I using chloramine-T. The interactions of this antibody with unfixed gel-filtered thrombin-activated platelets and unfixed gel-filtered resting platelets were studied in a solution phase radioimmunoassay. As shown in Fig. 1, the monoclonal antibody displayed marked preference for the activated platelets. The interaction of KC4 antibody with thrombin-activated platelets was saturable. However, the binding of the KC4 antibody to resting platelets was minimal. Untreated platelets as well as platelets treated with adenosine and acetylsalicylate yielded equivalent results. The preference of the monoclonal antibody for activated over resting platelets is also illustrated in the photomicrographs of Fig. 2. Binding of KC4 antibody to resting and thrombin activated platelets was detected using a fluorescence-labeled second antibody. As shown in Fig. 2, there was virtually no binding to resting platelets (panel A), compared to the binding to activated platelets (panel B). The binding of KC4 antibody to thrombin-activated platelets was also evaluated using a Scatchard analysis. Using representative data from experiment 4 in Table I, below, a plot of the bound antibody concentration divided by the free antibody concentration versus the concentration of bound antibody yielded a straight line (Fig. 3). These results indicate a single class of antibody-binding sites on the platelet surface. Based on the analysis of this experiment, the binding constant, Kd, for the interaction of antibody with thrombin-activated platelets was 6.9 nM. Each platelet contained about 10,000-17,000 (in the case of this donor, 10,000) binding sites recognized by the KC4 antibody. These results further confirm the monoclonality of the antibody, manifested by homogeneity of the apparent binding constant measured. The results of four independent experiments performed on platelets from four different donors are shown in Table I. There is excellent concordance of these data, with an average binding constant, K , of 7.2 ± 0.4 nM. The average number of binding sites per platelet was 13,400 ± 3,000. Since platelet activation is associated with the secretion of proteins, such as thrombospondin, that bind to the plasma membrane in the presence of calcium ions, the effect of calcium or EDTA on KC4 antibody-platelet interaction was evaluated. As shown in Fig. 4, the binding curves of KC4 antibody-platelet interaction are unaltered by calcium ions or EDTA. These results indicate that the KC4 antibody is not directed against a platelet antigen whose antigenic structure is stabilized by metal ions nor is this antigen associated with the platelet surface through the action of metal ions. Furthermore, human plasma did not inhibit antibody binding to platelets, indicating that normal human plasma does not contain this platelet antigen. Buffers of high ionic strength (Tris buffer containing 1M NaCl) or buffers with a pH from 4 to 10 did not alter the binding of the KC4 antibody to platelets. Secretion-dependent Expression of the Platelet Antigen The interactions of KC4 antibody with thrombin-activated platelets and platelets activated with other agonists were compared. In preliminary experiments, the KC4 antibody bound to platelets that were activated and aggregated with collagen, ADP, epinephrine, or thrombin (Table II). This interaction was also observed in unstirred thrombin-activated gel-filtered platelets which did not aggregate. Therefore, the binding of KC4 antibody to platelets appeared to be substantially independent of agonist and platelet aggregation. Binding of KC4 antibody to platelets activated by various agonists Antibody bound Thrombin (0.15 unit/ml) 100 ADP (10 µM) 46 Epinephrine (10 µM) 66 Collagen (0.45 mg/ml) 72 No agonist 0 To evaluate whether the expression of the activated platelet-specific antigen was associated with secretion, platelets were loaded with [¹⁴C] serotonin. The release of [¹⁴C] serotonin from platelets upon activation by various agonists was compared to the binding of ¹²⁵I-labeled KC4 antibody to these platelets. As shown in Fig. 5, antibody binding to the activated platelets correlated directly with secretion. Thrombin-activated platelets demonstrated maximal antibody binding and maximal secretion. Stimulation with ADP, epinephrine, or collagen resulted in lower levels of secretion and antibody binding. Platelets initially treated with acetylsalicylate (which impairs secretion) and activated with ADP, collagen, or epinephrine did not express the activation-specific antigen. These results suggest that the expression of the activation-specific antigen is secretion-dependent, but agonist- and aggregation-independent. The activation-specific antigen is designated the "PADGEM" glycoprotein (for P latelet A ctivation- D ependent G ranule to E xternal M embrane). It is believed that the PADGEM glycoprotein exists as a part of an internal granule membrane in resting platelets, and that the PADGEM glycoprotein is exposed when, during activation and secretion, the granule membrane fuses with the external plasma membrane. Antigen Specificity The antigenic specificity of the KC4 antibody for a platelet antigen was determined using the Western blot method. Platelet proteins from platelets were solubilized in SDS and analyzed. The KC4 antibody bound to a single band in the solubilized platelets. This band migrated with an apparent molecular weight of 139,000. Platelets, surface-labeled with ¹²⁵I using the lactoperoxidase method, were run for comparison. The characteristic band pattern of the ¹²⁵I-labeled platelets showed GPIIb, GPIIa, and GPIII. The glycoprotein antigen of the KC4 antibody migrated between glycoproteins IIb and IIa and was distinct from them as well as distinct from glycoprotein III. Red blood cells, neutrophils, monocytes, lymphocytes, GM4672 (a lymphocytoid cell line), and Alexander PLC/PRF/5 (a human hepatoma cell line) were solubilized in SDS and their proteins similarly examined for binding to the KC4 antibody using the Western blot method. None of these cells contained proteins which bound to this antibody. Purification of the PADGEM Glycoprotein The PADGEM glycoprotein was purified from crude platelet membranes by affinity chromatography. The proteins were extracted from the membranes using Triton X-100, and these proteins applied to an affinity column containing the KC4 antibody covalently coupled to agarose. The material applied to the column was heterogeneous, and most of these proteins failed to bind to the KC4-agarose. The bound protein, eluted with diethylamine, migrated as a major diffuse band on SDS gels upon electrophoresis under nonreducing conditions, indicating substantial (greater than 80%) purity. The dominant protein band corresponded to an apparent molecular weight of 140,000. The character of this band was unchanged in the presence of Ca⁺⁺ or EDTA. In SDS gels run under reducing conditions, the purified PADGEM glycoprotein migrated as a single narrow band, also with a molecular weight of 140,000. These results indicate that the PADGEM glycoprotein is composed of a single polypeptide chain. The protein is stained with periodic acid-Schiff reagent, indicating that it is a glycoprotein. Distinctiveness of PADGEM Glycoprotein Referring to Fig. 6, the distinctiveness of the PADGEM glycoprotein from GPIIb and GPIIa was demonstrated using gel electrophoresis, as follows. Purified PADGEM glycoprotein was labeled with ¹²⁵I to give ¹²⁵I-labeled PADGEM glycoprotein. Resting platelets were labeled with ¹³¹I using the lactoperoxidase method to surface-label the platelet membrane proteins, including GPIIb, GPIIa, and GPIII, with ¹³¹I. After treatment with sodium dodecyl sulfate, the ¹³¹I-labelled platelet glycoproteins (o) and the ¹²⁵I-labelled PADGEM glycoprotein (o) were co-analyzed by gel electrophoresis. Padgem glycoprotein migrated between GPIIb and GPIIa, demonstrating its physical distinctiveness from GPIIa. Padgem Glycoprotein Use The PADGEM, glycoprotein can be used as an immunogen to produce monoclonal antibodies useful in diagnosis in accordance with this invention.Production of antibodies using the PADGEM glycoprotein has the advantage, compared to the use of activated platelets as the immunogen, of producing only antibodies to the PADGEM, glycoprotein, and not to antigens expressed on the surface of both activated and resting platelets. The PADGEM glycoprotein has been used to immunize mice to produce monoclonal antibody-producing hybridoma cells with functional properties similar to those of KC4 antibody. A Balb/C mouse was immunized intraperitoneally once with 25 µg of PADGEM glycoprotein in complete Freund's adjuvant, and then twice, at two-week intervals, with 20 µg of PADGEM glycoprotein in saline. After an additional six-week period, mice were given a final boost with 20 µg PADGEM glycoprotein in saline, administered intravenously. A primary culture of these monoclonal antibody-producing cells has been deposited in the American Type Culture Collection, Rockville, MD, and given ATCC Accession No. HB 8670. Antibody Use The antibodies can be used to detect and localize activated platelets in vivo , particularly aggregates of immobilized activated platelets known to accumulate in thrombi resulting from vascular injury and disease, e.g., thrombosis, ischemic heart disease, gastric intestinal bleeding, and peripheral and cerebral vascular disease. Background and false positive results are avoided because the antibody not only fails to react with resting platelets, but also with other blood components such as granulocytes. The high binding affinity of the antibody provides good sensitivity. The antibodies are labeled using any conventional label, e.g., a radiolabel or a fluorophore. A preferred radiolabel is ¹¹¹Indium, which has a half-life appropriate for defining platelet dynamics in humans. ¹¹¹In-labeled antibodies can be prepared by modifying the antibody with diethylenediamine penta-acetic acid (DTPA) anhydride and subsequent chelation of ¹¹¹Indium, according to the method described in Eckelman et al., 1975) Pharm. Sci., 64 :704. Such ¹¹¹Indium-labelled antibodies have been shown to bind to activated platelets in vitro . To carry out in vivo imaging in the detection and localization of thrombi and activated platelets, a patient can be given an intravenous injection of approximately 500 µCi of sterile, pyrogen-free ¹¹¹In-antibody in physiological saline. Whole body scan scinitigrams can then be taken using a gamma camera interfaced with a computer and fitted with a medium energy, parallel hole collimator and ¹¹¹Indium images obtained about the ¹¹¹Indium photopeaks. Our antibodies can also be labeled with a paramagnetic ion, e.g. Gd⁺⁺⁺ or Mn⁺⁺, to provide a targeted NMR contrast agent. The paramagnetic ion can be complexed with the antibody via a chelating agent such as DTPA using conventional techniques, e.g., the method described in Khaw et al. (1982) J. Nucl. Med. 23(11): 1011-1019. The contrast agent can be administered to a patient and NMR imaging carried out; the agent will provide NMR contrast between activated platelets, to which the targeted agents are bound, and other areas of the circulatory system. In addition to being useful for localizing and characterizing activated platelets, in vivo imaging using our labeled antibody can provide a sensitive means for evaluating the efficacy of thrombolytic agents, e.g., urokinase, streptokinase, and tissue plasminogen activator, in reducing the degree of myocardial necrosis following acute coronary thrombosis.

Claims: A monoclonal antibody which is reactive with activated human platelets, and substantially unreactive with resting human platelets and the azurotrophic granules of monocytes and granulocytes, and which is labelled, and preferably radiolabelled, or complexed with a paramagnetic ion to form an NMR contrast agent, for use in the diagnosis in a human patient of vascular injury and disease and like conditions characterised by activated platelet-containing sites in the body and in the evaluation of the efficacy in a human patient of thrombolytic agents by a method including administration to said patient of the labelled antibody and the detection thereafter in said patient of labelled immune complexes. For use in the manufacture of a diagnostic agent, which is labelled, and preferably radiolabelled, or complexed with a paramagnetic ion to form an NMR contrast agent, for diagnosis in a human patient of vascular injury and disease and like conditions characterised by activated platelet-containing sites in the body and for the evaluation of the efficacy in a human patient of thrombolytic agents by a method including administration to said patient of the said diagnostic agent and the detection thereafter in said patient of labelled immune complexes: a monoclonal antibody which is reactive with activated human platelets, and substantially unreactive with resting human patients and the azurotrophic granules of monocytes and granulocytes. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 or Claim 2 respectively, wherein said antibody is reactive with an antigenic determinant on the surfaces of activated human platelets and not present on the surfaces of resting human platelets, azurophilic granules of monocytes, or granulocytes. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 or Claim 2 respectively, wherein said antibody recognises an antigenic determinant on activated human platelets, which antigenic determinant is a protein distinct from glycoprotein IIa. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 and Claims 3 or 4 or in Claim 2 and Claims 3 or 4 respectively, wherein said antigenic determinant is a glycoprotein on the surface of activated platelets having a molecular weight of about 140,000. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 and any of Claims 3, 4 or 5 or in Claim 2 and any of Claims 3, 4 or 5 respectively, wherein said antigenic determinant is not susceptible of stabilization, on activated human platelets, by calcium ions. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 and any of Claims 3 to 6 or in Claim 2 and any of Claims 3 to 6 respectively, wherein said antigenic determinant is not a constituent of normal human plasma. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 or Claim 2 respectively, wherein said antibody is of the IgG isotype, and preferably of the IgG₁ isotype. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 and any of Claims 3 to 8 or in Claim 2 and any of Claims 3 to 8 respectively, wherein said antibody recognises between 10,000 and 17,000 binding sites on activated human platelets. For use as specified in Claim 1 or Claim 2, an antibody as defined in Claim 1 and any of Claims 3 to 9 or in Claim 2 and any of Claims 3 to 9 respectively, wherein the binding of said antibody to activated platelets is substantially independent of platelet aggregation. A method for in vivo imaging in the detection and location of activated platelet-containing sites in a human patient, characterised by using a monoclonal antibody which is reactive with activated human platelets, and substantially unreactive with resting human platelets, and with the azurotrophic granules of monocytes and granulocytes, said monoclonal antibody being labelled, and preferably radiolabelled, or complexed with a paramagnetic ion to form an NMR contrast agent. A method according to Claim 11, further characterised in that said monoclonal antibody is reactive with an antigenic determinant on the surfaces of activated human platelets and not present on the surfaces of resting human platelets, azurophilic granules of monocytes or granulocytes. A method according to Claim 11, further characterised in that said monoclonal antibody recognises an antigenic determinant on activated human platelets, said antigenic determinant being a protein distinct from glycoprotein IIa. A method according to Claims 12 or 13, further characterised in that said antigenic determinant is a glycoprotein on the surface of activated platelets having a molecular weight of about 140,000. A method according to any of Claims 12, 13 or 14, further characterised in that said antigenic determinant is not susceptible of stabilization, on activated human platelets, by calcium ions. A method according to any of Claims 12 to 15, further characterised in that said antigenic determinant is not a constituent of normal human plasma. A method according to Claim 11, further characterised in that said antibody is of the IgG isotype, and preferably of the IgG₁ isotype. A method according to any of Claims 11 to 17, further characterised in that said antibody recognises between 10,000 and 17,000 binding sites on activated human platelets. A method according to any of Claims 11 to 18, further characterised in that binding of said antibody to said activated platelets is substantially independent of platelet aggregation.

Inventors: FURIE BARBARA C, FURIE BRUCE E, FURIE, BARBARA C., FURIE, BRUCE E.
Applicants: NEW ENGLAND MEDICAL CENTER INC, NEW ENGLAND MEDICAL CENTER HOSPITALS, INC.
Application year: 1985
Main classification: G01N33
IPC codes: C12R1, C07K14, C12N15, C12P21, C07K16, C12Q1, G01N33, A61K51, A61K39, C07K19, A61K38, A61K49, C12N5