SCREENING METHOD FOR DIABETIC CONDITION

Abstract: A screening method for preliminary indication of the diabetic state in mammals comprises an assay of urine samples collected from suspect patients for the presence of D-chiroinositol. The absence of D-chiroinositol indicates an absence of insulin mediators and therefore a diabetic condition. The assay may be used to detect genetic predisposition to the development of diabets in asymptomatic individuals.

Description: Screening Method For Diabetic Condition Technical Field This invention pertains to the diabetic condition in mammals, and specifically, a method for screening individual patients for possible diabetes to be confirmed by subsequent analysis. The screening method provides a non-invasive, low- cost, quick method for conducting a preliminary assay for diabetes in mammals, including humans. Background Art Diabetes is perhaps the most common of the serious metabolic diseases of humans. The diabetic condition is a disease prevalent among most mammals. Occasionally, diagnosis of diabetes may be quite simple. If conventional symptoms, attributable to osmotic diuresis are identified, together with hyperglycemia, there is general agreement that the diabetic condition is present. Moreover, persistently elevated fasting plasma glucose concentrations are a strong indication of the diabetic condition, even in the absence of other conventional systems. However, these diagnoses require sophisticated knowledge, on the part of patients, of the appropriate symptoms, or at least persistent medical care and inquiry. Frequently, these are not available. The alternative, fast and low-cost screening method, the oral glucose tolerance test, is unreliable. Some subjects testing positive, i.e., indicating the diabetic condition, never develop conventional diabetes. Additionally, many patients can move from the non-diabetic condition, and back, merely as a function of weight. Indeed control of obesity in those at risk, is a common preventive measure. In addition, the glucose tests are invasive, presenting infection concerns and complications related thereto. The result is that diabetes remains difficult to accurately diagnose in many cases. As a result, estimates conclude that roughly half of those with type II (insulin-resistant) diabetes in this country have not been diagnosed. At the same time, the oral glucose tolerance test frequently results in false positives, and remains an incomplete screening method. Accordingly, it remains an object of the art to provide a non-invasive, relatively inexpensive, and quick method for screening potential diabetics in the general population. Such a diagnostic test may not be definitive, but may identify potential candidates for further consideration. Even if not complete, however, a preferred screening method should be relatively insensitive to other conditions which might result in false positives, and not require, at least initially, detailed symptomatic knowledge on the part of the patient. Disclosure of the Invention The above objects, and others that will become apparent upon review of the specification set forth below, are achieved by an assay for the presence of D-chiroinositol in the urine of patients to be screened for the diabetic condition. The urine is simply treated, and of course, can be obtained and analyzed on an out-patient basis. The absence of D-chiroinositol in the urine specimen is a strong indication of the diabetic condition. By "absence", it is indicated that the urine sample contains either no D-chiroinositol, or such extremely low levels as to be effectively absent in vivo. The diagnostic or screening method addressed herein is based on work reported in U.S. Patent Application Serial No. 07/320,484 in the names of Lamer, Kennington, Huang and Shen, reporting the purification of at least two insulin mediators. These mediators appear to be formed after the interaction between insulin and the insulin receptor, from precursors which fall into a class of compounds known as glycophospholipid "anchor" substances, being compounds which attach a number of proteins to the cell membrane and apparently aid in transfer of information across the cell membrane into the interior of the cell by interacting with insulin-sensitive enzyme systems. The work reported in U.S. Patent Application Serial No. 07/320,484 by Lamer et al, confirms the presence in these insulin mediators, of D- chiroinositol. The diagnostic portion of this invention is based on the observation that the diabetic condition may be associated with chiroinositol. The inventors are unaware of any combination of conditions or states which would permit a patient to avoid diabetes, without the production of D-chiroinositol. Accordingly, absence thereof is a strong indication of the diabetic condition, and can be used as a preliminary screening device, to identify patients who should be studied more rigorously for the possible disease state. Best Mode for Carrying Out the Invention The diabetic condition may be associated with an absence of insulin mediators, or compounds intermediate in the pathway from insulin to the end product or reaction involved. These reactions include the inhibition of cyclic AMP-dependent protein kinase, as well as glucose transport and the stimulation of pyruvate dehydrogenase phosphatase. As the insulin mediators are believed to be produced in response to the presence of insulin, the absence of insulin or the failure to respond to insulin may result in or from an absence of the mediators, thus, an absence of D-chiroinositol may be a strong indication of an absence of insulin mediators from the patient's system. To screen for the possible diabetic state, a 24-hour urine sample is collected. A fraction of the sample is adsorbed in a mixed anion/cation exchange resin bed, and eluted with distilled, deionized water. The recovered fraction is further purified with a solid phase extraction on an octadecyl material, such as a C18 SEP-PAK column, available from Waters, Inc. The sample is selectively eluted with distilled water, the eluant being collected, and lyophilized twice, followed by derivatization. The derivatized sample is extracted into hexane and subjected to gas chromatography/mass spectrometry. CLINICAL EXAMPLE Twenty 24-hour urine samples were obtained from twenty different human patients. The patients were collected from a pool at the University of Virginia Hospital, Charlottesville, Virginia, as well as the NIH-Diabetes Center, Phoenix, Arizona. Each sample was frozen and stored with 1-3% sodium azide. The storage conditions are necessary to prevent the growth of bacteria. Bacteria in the sample produce D-chiroinositol, which may of course give rise to a false positive. Of course, if the samples are used immediately, no specific storage conditions need be observed. A 10 ml aliquot of each sample was adsorbed onto a mixed anion/cation exchange resin bed and eluted with 5 ml of distilled, deionized water. The recovered fraction was reduced to approximately 5 ml and loaded onto an octadecyl solid phase extraction column, such as the C18 SEP-PAK cartridge, obtained from Waters, Inc. and again eluted with deionized, distilled water. The collected fraction has a light yellow color. Each fraction was lyophilized twice, and derivatized with heptafluorobutyrlimidazole for six hours at 50°C and twelve hours at ambient temperatures. The derivatized samples were extracted into hexane, and submitted to gas chromatography/mass spectrometric analysis. Of the twenty samples, one false negative, i.e., an indication of the absence of the diabetic condition, when in fact the patient was diabetic, was detected. In addition, the screening procedure gave three false positives, that is diabetes was indicated (an absence of D-chiroinositol) where the patient was not in fact symptomatically diabetic. The single false negative, and the three false positives were all taken from the samples obtained from the NIH-Diabetic Center, which was drawn from a relatively closed community of American Indians. It is believed that the false readings may be due to physiognomic anomalies due to the sampling of an extremely small gene pool. ADDITIONAL EXAMPLE Repeated testing demonstrates a difference in the concentration of D-chiroinositol in the urine of diabetics, and non-diabetics that is at least 3 orders of magnitude, in samples drawn from the general populace. Thus, the drop in D- chiroinositol of diabetics is easily recognized. ALTERNATIVE ASSAYS In the above testing, the presence of D-chiroinositol was assayed for by use of a gas chromatograph/mass spectrometer. This was conveniently practiced in the laboratory, with good sensitivity. However, other assays may be used without departing from the scope of the invention. Alternative assays include paper chromatography employing chiral-sensitive chromatography paper. Such paper is currently available, and the migration rate of D-chiroinositol may be determined. Alternate assay formats include an enzyme reduction/oxidation potential measurement. Thus, an enzyme specific for D-chiroinositol may be immobilized on an electrode. The electrode is introduced to the sample, across which a current potential is applied. The presence of D-chiroinositol in the sample will result in the enzyme-catalyzed reaction going forward and alter the electrical environment detected by the electrode on which the enzyme is immobilized. The immobilization of the enzyme itself, in e.g., polyvinylpyrrolidone, or other suitable matrix, is conventional and does not constitute an aspect of the invention. There are, of course, a wide variety of sensitive assays made available by designed antibodies. Thus, an antibody to a D-chiroinositol-ligand compound substance can be prepared and employed in an ELISA or agglutination assay, as are well known in the art, and may be employed in the context of the invention claimed herein. It should be noted that many diabetics become symptomatic only upon reaching middle age, upon sudden weight gain, etc. The absence of insulin mediators and, therefore, D-chiroinositol, appears to be genetically controlled. It may be, accordingly, possible to detect a genetic predisposition to the development of diabetes in asymptomatic individuals by use of the assay disclosed herein. The above invention has been described with reference to specific examples and materials. It should be clear that these specifics can be varied without departing from the scope of the invention. In particular, alternative resins in the purification format, alteration of the purification sequence, and alternate assay forms, sensitive to D-chiroinositol may be employed, without departing from the scope of the invention, as embraced by the claims appended hereto.

Claims: Claims 1. A method for screening mammalian patients for the possible presence of a diabetic state, comprising: 1) collecting a urine sample from said patient, 2) maintaining said sample in a bacteria-free environment, and 3) assaying said sample for the presence of D- chiroinositol, wherein the absence of D-chiroinositol is indicative of the diabetic state. 2. The method of Claim 1, wherein said sample is purified by adsorption onto, and elution from a mixed anion/cation exchange resin chromatographic column and an actadecyl solid phase extraction column in sequence, followed by lyophilization prior to said assay step. 3. The process of Claim 1, wherein said assay step is practiced using an assay selected from the group consisting of gas chromatographic/mass spectrometric analysis, paper chromatography, D-chiroinositol enzyme specific reduction oxidation analysis, enzyme linked immunosorbent assay employing antibody to D-chiroinositol, an agglutination assay employing an antibody sensitive to D-chiroinositol and mixtures thereof. 4. The method of Claim 1, wherein said urine sample is purified on a mixed ion exchange resin and eluted therefrom, lyophilized and derivatized, prior to said assay step. 5. The method of Claim 1, wherein said method is non- patient-invasive. 6. A method for determining possible genetic predisposition to the development of diabetes in asymptomatic individuals, comprising: 1) collecting a urine sample from an individual asymptomatic for diabetes, 2) maintaining said urine sample in a bacteria-free environment, and 3) assaying said sample for the presence of D- chiroinositol, wherein an absence of D-chiroinositol in said sample is indicative of a genetic predisposition to the development of diabetes in said asymptomatic individual.

Inventors: KENNINGTON ALISON, LARNER JOSEPH, SHEN TSUNG Y, KENNINGTON, ALISON, LARNER, JOSEPH, SHEN, TSUNG, Y.
Applicants: UNIV VIRGINIA, THE UNIVERSITY OF VIRGINIA ALUMNI PATENTS FOUNDATI
Application year: 1990
Main classification: G01N33
IPC codes: C12Q1, G01N33