A METHOD OF DIAGNOSING PRECLINICAL DIABETES

Abstract: The present invention relates to a method of diagnosing preclinical insulin-dependent diabetes mellitus (IDDM), the method comprising contacting fetal antigen 1 (FA1) with T cells of a subject to be diagnosed for preclinical IDDM and detecting any T cell response to the FA1, such a response being indicative of preclinical IDDM in the subject.

Description: A METHOD OF DIAGNOSING PRECLINICAL DIABETES FIELD OF INVENTION The present invention relates to a method of diagnosing preclinical stages of insulin-dependent diabetes mellitus by determining the T cell response to a specific islet cell antigen or the presence of autoantibodies against a specific islet cell antigen in serum, a test kit for use in the method, as well as the use of the islet cell antigen in therapy and a pharmaceutical composition for said use. BACKGROUND OF THE INVENTION Insulin-dependent diabetes mellitus (IDDM) is an autoimmune disease characterized by the gradual destruction of the insulin-producing pancreatic islet /3-cells. Clinical symptoms of diabetes set in at a fairly late stage of this process, at a point where about 90% of the 3-cells have been destroyed. However, in recent years -it has been found that a number of circulating autoantibodies against 0-cells associated with IDDM are present in serum before the clinical onset of the disease. Such circulating autoantibodies include one against a 64 kD islet /3-cell autoantigen (S. Baekkeskov et al., Nature 298. 1982, pp. 167-169). The 64 kD autoantibody has been found to be present in the serum of more than 80% of the patients with newly diagnosed IDDM and has furthermore been found in serum up to several years before the clinical onset of the disease (S. Baekkeskov et al., J. Clin. Invest. 79. 1987, pp. 926-934; M. R. Atkinson et al., Lancet 335. 1990, pp. 1357-1360; E. Sigurdsson and S. Baekkeskov, Curr. Top. Microbiol. Immun. 164, 1990, pp. 143-167) . The early detection of the 64 kD autoantibody would be of great value for the study of the development of IDDM as well as for devising preventive therapies. The 64 kD autoantigen has been identified (S. Baekkeskov et al., Nature 347 , 1990, pp. 151-156) as the enzyme glutamic acid decarboxylase (GAD) which is otherwise known to be involved i the biosynthesis of gamma-amino butyric acid in the centra nervous system. The use of GAD for the diagnosis of preclinica IDDM has been suggested in WO 92/04632 and WO 92/05446. A 38 kD 3-cell antigen recognised by a T cell clone isolate from the blood of a recently diagnosed IDDM patient i described in WO 91/17186. It is suggested to use the antigen i the diagnosis or therapy of IDDM. SUMMARY OF THE INVENTION It has surprisingly been found that an antigen originall isolated from amniotic fluid and known as fetal antigen 1 i recognized by T cells from newly diagnosed IDDM patients Experiments have established that the antigen does not reac with T cells of patients with long-established IDDM or with th T cells of healthy controls. Detection of T cell response t GAD or the 38kD 0-cell antigen disclosed in WO 91/17186 may b indicative of preclinical-IDDM, but such response can also b found in healthy subjects and is not found in all individual that develops IDDM. Accordingly, the present invention relates to a method o diagnosing preclinical insulin-dependent diabetes mellitu (IDDM) , the method comprising contacting fetal antigen 1 (FAl with T cells of a subject to be diagnosed for preclinical IDD and detecting any T cell response to the FAl, such a respons being indicative of preclinical IDDM in the subject. The method is useful for diagnosing and/or monitoring th development of preclinical stages of IDDM in a patient and thu presents a valuable opportunity to initiate preventive o ameliorative treatment of IDDM. FAl was originally isolated from human amniotic fluid (cf. T.N Fay et al., Eur. J. Obstet. Gynecol. Reprod. Biol. 2 , 1988 pp. 73-85. The presence of FAl in fetal pancreatic tissue and in islet /3-cells of adult pancreatic tissue is reported in D. Tornehave et al., Anat. Embryol. 187. 1993, pp. 335-341. FAl has been characterized as a single-chain glycoprotein with a molecular weight of 32-38 kD. The amino acid composition and 37 N-terminal amino acids of the protein appear from CH. Jensen et al., Human Reproduction §., 1993, pp. 635-641. The protein has been further characterized and shown to be located in the 3-cell granules. Furthermore, the complete amino acid sequence is shown in CH. Jensen et al., Eur. J. Biochem. 225. 1994, pp. 83-92. Human FAl has been found to 99% identical to a translated human dlk mRNA isolated from the adrenal gland (cf. Laborda et al., J. Biol. Chem. 268. 1993, pp. 3817-3820; GenBank/EMBL accession number Z12171) . It is therefore aasumed that the protein is is the post-translationally modified gene product of the human dlk mRNA. In another aspect, the present invention relates to a method of determining the presence of autoantibodies against fetal antigen 1 (FAl autoantibodies) in serum, which method comprises contacting a serum sample with FAl or a fragment thereof capable of binding FAl autoantibodies, and detecting any binding of autoantibodies to the FAl. In a further aspect, the invention relates to a test kit for determining the presence of FAl autoantibodies in serum, which comprises, in separate containers, (a) fetal antigen 1 immobilised on a solid support, and (b) a labelled reagent capable of binding to FAl autoantibodies. Alternatively, the present invention relates to a test kit for determining the presence of FAl autoantibodies in serum, which comprises, in separate containers, (a) fetal antigen 1 immobilised on a solid support, and (b) a labelled antibody which is capable of competing with t FAl autoantibody for binding to FAl. DETAILED DISCLOSURE OF THE INVENTION FAl has been found to be present in fetal pancreas, liver a adrenal cortex, and in the pancreatic ,9-cells and adren cortex of adults. It is assumed that FAls from these tissu are sufficiently homologous to be useful in the present meth regardless of their origin. However, it may be preferred to u pancreatic FAl for the purpose of diagnosing IDDM or preclinical stage thereof in patient serum. Likewise, it contemplated that FAl derived from different mammalian source such as cattle, pigs, rats, mice, dogs or cats, may be used i the present method. For the purpose of diagnosing IDDM in human patient it will, however, typically be preferred to u FAl derived from a human source. The FAl employed for the present purposes may be in differe forms, e.g. in the form of a pre-pro-peptide, a pro-peptid various processed forms thereof, mature FAl or vario glycosylated forms thereof (e.g. as described in CH. Jensen al., Eur. J. Biochem. 225. 1994, pp. 83-92, vide specificall Fig. 2). Allelic variants of FAl, i.e. an altered FAl protei encoded by a mutated gene, but having substantially the sa activity as the FAl described in CH. Jensen et al., supra. a also included in the scope of the present inventio Furthermore, fragments of FAl which are capable of reacti with T cells of prediabetic patients or with FAl autoantibodie of prediabetic patients are intended to be included within t scope of the present invention. In addition, homologues of FAl may be employed provided tha they are capable of reacting with T cells of prediabeti patients or with FAl autoantibodies of prediabetic patients. homologue of FAl may, in the present context, be defined as a protein comprising an amino acid sequence exhibiting a degree of identity of at least about 60% with the amino acid sequence of FAl. The degree of identity may be determined by conventional methods, see for instance, Altshul et al., Bull. Math. Bio. 48: 603-616, 1986, and Henikoff and Henikoff, Proc. Natl. Acad. Sci. USA 8_9: 10915-10919, 1992. Briefly, two amino acid sequences are aligned to optimize the alignment scores using a gap opening penalty of 10, a gap extension penalty of 1, and the "blosum 62" scoring matrix of Henikoff and Henikoff, supra. Alternatively, the FAl homologue may be one encoded by a nucleotide sequence hybridizing with an oligonucleotide probe prepared on the basis of the nucleotide sequence encoding FAl under conditions using approximately 2XSSC and a hybridization temperature of about 50 β C FAl homologues may have one or more amino acid substitutions, deletions or additions. These changes are preferably of a minor nature, including conservative amino acid substitutions that do not significantly affect the folding or activity of the protein, small deletions, small amino- or carboyxyl-terminal extensions, such as an amino-terminal methionine residue. Examples of conservative substitutions are within the group of basic amino acids (such as arginine, lysine, histidine) , acidic amino acids (such as glutamic acid and aspartic acid) , polar amino acids (such as glutamine and asparagine) , hydrophobic amino acids (such as leucine, isoleucine, valine) , aromatic amino acids (such as phenylalanine, tryptophan, tyrosine) and small amino acids (such as glycine, alanine, serine, threonine, methionine) . It will be apparent to persons skilled in the art that such substitutions may be made outside the regions critical to the function of the molecule without impairing the activity of the resulting FAl homologue. Amino acids essential to the activity of the polypeptide of the invention, and therefore preferabl not subject to substitution, may be identified according t procedures known in the art, such as site-directed mutagenesi or alanine-scanning mutagenesis (Cunningham and Wells, Scienc 5244. 1081-1085, 1989) . In the latter technique mutations ar introduced at every residue in the molecule, and the resultin mutant molecules are tested for FAl activity to identify amin acid residues that are critical to the activity of th molecule. 0 A FAl homologue may be isolated by preparing a geno ic or cDN library of a cell of the species or tissue in question, an screening for DNA sequences coding for all or part of th homologue by using synthetic oligonucleotide probes i accordance with standard techniques, e.g. as described b 5 Sambrook et al.. Molecular Cloning:A Laboratory Manual. 2nd Ed. Cold Spring Harbor Laboratory, Cold Spring Harbor, Ne York, 1989, or by means of polymerase chain reaction (PCR using specific primers as described in, e.g. PCR Protocols 1990, Academic Press, San-Diego, California, USA. 0 The FAl employed in the method of the present invention may b produced by extraction from tissues containing it, but it i preferred to produce it by recombinant DNA techniques in manner known per se. A DNA sequence encoding FAl suitably be o obtained by preparing a genomic or cDNA library and screenin 5 for DNA sequences coding for all or part of the FAl b hybridization using synthetic oligonucleotide probes i accordance with standard techniques (cf. Sambrook et al. supra) . The probes may suitably be prepared on the basis of th published amino acid sequence of FAl. For the present purpose 0 the DNA sequence encoding the FAl is preferably of human origi i.e. derived from a human genomic DNA or cDNA library. The DNA sequence encoding the FAl may also be prepare synthetically by established standard methods, e.g. th phosphoamidite method described by Beaucage and Caruthers Tetrahedron Letters 22 (1981), 1859 - 1869, or the method described by Matthes et al., EMBO Journal 2 (1984), 801 - 805. According to the phosphoamidite method, oligonucleotides are synthesized, e.g. in an automatic DNA synthesizer, purified, annealed, ligated and cloned in suitable vectors. The DNA sequence encoding FAl may also be prepared by polymerase chain reaction using specific primers, for instance as described in US 4,683,202, Saiki et al., Science 239 (1988), 487 - 491, or PCR Protocols. 1990, Academic Press, San Diego, California, USA. Suitable PCR primers may, for instance, be prepared on the basis of the published dlk mRNA sequence described by Laborda et al., supra. The DNA sequence encoding FAl may be introduced into host cells on a recombinant vector which may be any vector which may conveniently be subjected to recombinant DNA procedures. The choice of vector will often depend on the host cell into which it is to be introduced. Thus, the vector may be an autonomously replicating vector, i.e a vector which exists as an extrachromosomal entity, the replication of which is independent of chromosomal replication, e.g. a plasmid. Alternatively, the vector may be one which, when introduced into a host cell, is integrated into the host cell genome and replicated together with the chromosome(s) into which it has been integrated. The vector is preferably an expression vector in which the DNA sequence encoding the FAl is operably linked to additional segments required for transcription of the DNA. In general, the expression vector is derived from plasmid or viral DNA, or may contain elements of both. The term, "operably linked" indicates that the segments are arranged so that they function in concert for their intended purposes, e.g. transcription initiates in a promoter and proceeds through the DNA sequence coding for the FAl. The promoter may be any DNA sequence which show transcriptional activity in the host cell of choice and may b derived from genes encoding proteins either homologous o heterologous to the host cell. The host cell into which the DNA construct or the recombinant vector of the invention is introduced may be any cell which is capable of producing the present polypeptide and includes bacteria, yeast, fungi and higher eukaryotic cells. However, to provide correct glycosylation of FAl, the host cell is preferbly a mammalian cell. Examples of suitable mammalian cell lines are the COS (e.g. ATCC CRL 1650), BHK (e.g. ATCC CRL 1632, ATCC CCL 10), CHL (e.g. ATCC CCL39) or CHO (e.g. ATCC CCL 61) cell lines. Methods of transfecting mammalian cells and expressing DNA sequences introduced in the cells are described in e.g. Kaufman and Sharp, J. Mol. Biol. 159 (1982), 601 - 621; Southern and Berg, J. Mol. APPI. Genet. 1. (1982), 327 - 341; Loyter et al. , Proc. Natl. Acad. Sci. USA 7_9 (1982), 422 - 426; Wigler et al.. Cell 14 (1978) , 725; Corsaro and Pearson, Somatic Cell Genetics 1_ (1981), 603, Graham and van der Eb, Viroloσv 52 (1973), 456; and Neumann et al., EMBO J. 1 (1982), 841 - 845. Examples of suitable promoters for directing the transcription of the DNA encoding the polypeptide of the invention in mammalian cells are the SV40 promoter (Subramani et al., Mol. Cell Biol. 1 (1981), 854 -864), the MT-1 (metallothionein gene) promoter (Palmiter et al., Science 222 (1983), 809 - 814) or the adenovirus 2 major late promoter. The DNA sequence encoding the FAl may also, if necessary, be operably connected to a suitable terminator, such as the human growth hormone terminator (Palmiter et al., op. cit.) . The vec¬ tor may further comprise elements such as polyadenylation signals (e.g. from SV40 or the adenovirus 5 Elb region) , transcriptional enhancer sequences (e.g. the SV40 enhancer) and translational enhancer sequences (e.g. the ones encoding adenovirus VA RNAs) . Transfected host cells may then be cultured in a suitable nutrient medium under conditions permitting the expression of the FAl which is subsequently recovered from the culture. The medium used to culture the cells may be any conventional medium suitable for growing the host cells, such as minimal or complex media containing appropriate supplements. Suitable media are available from commercial suppliers or may be prepared according to published recipes (e.g. in catalogues of the American Type Culture Collection) . The FAl produced by the cells may then be recovered from the culture medium by conventional procedures including separating the host cells from the medium by centrifugation or filtration, precipitating the proteinaceous components of the supernatant or filtrate by means of a salt, e.g. ammonium sulphate, purification by a variety-of chromatographic procedures, e.g. ion exchange chromatography, gelfiltration chromatography, affinity chromatography, or the like. In the method according to the invention, the T cell response to FAl may be determined by measuring the proliferation of T cells, e.g. in a lymphocyte stimulation assay as described in B.O. Roep et al., "T cell reactivity to 3-cell membrane antigen associated with /3-cell destruction", Diabetes, in press, using FAl as the antigen. Thus, T cells isolated from the blood of a subject may be cultured in the presence of FAl for several days, such as for 5 days, after which a radioactive marker such as 3 H-thymidine is added, and incorporation of the marker by the T cells is measured by scintillation counting. In this embodiment, FAl may conveniently be reacted with T cells of a sample taken from a subject to be diagnosed for preclinical IDDM. The sample may suitably be blood (serum) or a tissue sample, such as a pancreatic or lymph node sample. Alternatively, the T cells may be T cell clones isolated fro the blood or tissue of the subject, e.g. as described in W 91/17186. Peptide sequences corresponding to full-length or partial T cell receptor(s) reacting with FA-1 may be used as antigens t generate antibodies which may then be used to block the T-cel response recognising FA-1, thereby blocking the immune repons of the T cells against FA-1. Alternatively, such antibodies, directed against FA-1 T-cell receptor peptide sequences can b used as diagnostic agents themselves to determine if T-cell reactive with FA-1 are present in a given individual, e.g. b means of immunohistochemistry, FACS analysis, immunoprecititation analysis, Western blotting analysis, o ELISA analysis with T-cells/lymphocytes. PCR analysis of (c)DN isolated from lymphocytes using primers corresonding t fragment(s) of a DNA sequence encoding a given T cell recepto recognising FAl may also be used to determined if T-cell reactve with FA-1 are present in a given individual. T cell response to FAl may also be measured in a cytotoxicit assay in which target cells expressing FAl (either inherentl or because they have been transfected with a DNA sequenc coding for FAl) are labelled with a radioisotope, e.g. 51 Cr, o a fluorescent label incorporated in the cells. Effector cell (T cells) are then incubated with the target cells. If th target cells are killed upon such contact, the radioisotope o fluorescent label is released from the cells and may b detected in the incubation media. Cytokine profiles may b measured in the T-cell assay in order to determine T-cell activity, e.g. gamma interferon, IL-10, IL-2, IL-12 and IL-4 (e.g. as described Romagnani et al., Immunol. Today 13. 1992, pp. 379-81) . The T-cell reactivity can also be characterize using light microscopy. In a particular embodiment of the present method, FAl may b administered subcutaneously to the subject and any skin reaction at the site of administration is subsequently detected, such skin reaction being indicative of a T cell response to FAl. The skin reaction may be visible as a localized reddening or swelling of the skin at the site of administration, e.g. as described in T.M. Kύndig et al., Proc. Natl. Acad. Sci. USA 89. 1992, pp. 7757-7761. For this purpose, a composition comprising FAl together with a suitable diluent or carrier may be prepared. Such a composition may conveniently be in the form of an injectable preparation containing FAl dissolved or suspended in a suitable diluent such as isotonic saline. For use in the test, this preparation may be injected directly under the skin of the patient. In the method according to the invention of determining the presence of FAl autoantibodies in serum, the serum sample may conveniently be contacted with FAl immobilised on a solid support, after which the-solid support is contacted with a labelled reagent capable of binding to any autoantibody bound to the FAl, detection of any label bound to the solid support indicating the presence of FAl autoantibodies in the sample. The FAl may be immobilized directly on the solid support by physical adsorption or be bound covalently or through bridging molecules such as protein A, polylysine or an antibody (preferably reactive with an epitope of FAl which does not participate in binding the FAl autoantibodies) to the solid support. The solid support employed in the method and test kit of the invention preferably comprises a polymer. The polymer may be selected from the group consisting of a plastic (e.g. latex, a polystyrene, polyvinylchloride, polyurethane, polyacrylamide, polyvinylalcohol , nylon, polyvinylacetate, and any suitable copolymer thereof), cellulose (e.g. various types of paper, such as nitrocellulose paper and the like) , a silicon polymer (e.g. siloxane) , a polysaccharide (e.g. agarose or dextran) , or an ion exchange resin (e.g. conventional anion o cation exchange resins) . The physical shape of the solid support is not critical although some shapes may be more convenient than others for th present purpose. Thus, the solid support may be in the shape o a plate, e.g. a microtiter plate, or a paper strip, dipstick membrane (e.g. a nylon membrane or a cellulose filter) or soli particles (e.g. latex beads) . The labelled reagent used in the method and test kit of th invention may be an antibody reactive with the FAl autoantibod (e.g. an anti-human antibody) including an anti-idiotyp antibody (i.e. an antibody directed against the epitope-bindin site of the FAl autoantibody) . The labelled reagent may also b a T-cell receptor for the FAl autoantibody or a fragmen thereof capable of binding to the FAl autoantibody. The label substance for the reagents used for binding to th FAl autoantibody is preferably selected from the grou consisting of enzymes, coloured or fluorescent substances an radioactive isotopes. Examples of enzymes useful as label substances are peroxidase (such as horseradish peroxidase) , phosphatases (such as acid o alkaline phosphatase) , β-galactosidase, urease, glucos oxidase, carbonic anhydrase, acetylcholinesterase glucoamylase, lysozyme, malate dehydrogenase, glucose-6 phosphate dehydrogenase, β-glucosidase, proteases, pyruvat decarboxylase, esterases, luciferase, etc. Enzymes are not in themselves detectable but must be combine with a substrate to catalyse a reaction the end product o which is detectable. Thus, a substrate may be added afte contacting the support with the labelled reagent, resulting i the formation of a coloured or fluorescent substance. Example of substrates which may be employed according to the inventio include hydrogen peroxide/tetramethylbenzidine or chloronaphthole or o-phenylenediamine or 3-(p-hydroxyphenyl) propionic acid or luminol, indoxyl phosphate, p-nitrophenyl- phosphate, nitrophenyl galactose, 4-methyl umbelliferyl-D- galactopyranoside, or luciferin. Alternatively, the label substance may comprise coloured or fluorescent substances, including gold particles, coloured or fluorescent latex particles, dye particles, fluorescein, phycoerythrin or phycocyanin. Radioactive isotopes which may be used for the present purpose may be selected from 1-125, 1-131, H-3, P-32, P-33 and C-14. In an alternative embodiment, the serum sample may be contacted with FAl immobilised on a solid support simultaneously with contacting the immobilised FAl with a predetermined amount of a labelled antibody competing with the autoantibody for binding to FAl, detection of any decrease in the amount of labelled antibody bound to the solid support relative to the amount of labelled antibody added indicating the presence of FAl autoantibodies in the sample. In this case, the labelled antibody is suitably one which is reactive with the epitope of FAl which binds the FAl autoantibody. Thus, the antibody may be one which is raised against a peptide fragment comprising this epitope. In this embodiment, the solid support and label substance may be as described above. The antibody raised against a peptide fragment of FAl may conveniently be used in the method and test kit of the invention as the labelled reagent, labelled antibody or antibody immobilised on the solid support to which the FAl is subsequently bound, as indicated above. In the present context, the term "antibody" is used to indicate any substance formed in the human or animal body or by a human or animal cell as response to exposure to the antigen. The antibody may be polyclocal or monoclonal antibody or may be one prepared b recombinant DNA techniques. The term also includes antibod fragments, such as Fab', F(ab') 2 or Fv fragments as well a single-domain antibodies. Monoclonal antibodies may be obtained by well-establishe methods, e.g. as described in A. Johnstone and R. Thorpe Immunochemistrv in Practice. 2nd. Ed. , Blackwell Scientifi Publications, 1987, pp. 35-43. When prepared by recombinant DN techniques, the antibody may be produced by cloning a DN sequence coding for the antibody or a fragment thereof into suitable cell, e.g. a microbial, plant, animal or human cell and culturing the cell under conditions conducive to th production of the antibody or fragment in question an recovering the antibody or fragment thereof from the culture Possible strategies for the preparation of cloned antibodie are discussed in, for instance, L. Riechmann et al.. Natur 332. 24 March 1988, p. 323 ff. , describing the preparation o chimeric antibodies of rat variable regions and human constan regions; M. Better et al.. Science 240. 20 May 1988, p. 104 ff., describing the preparation of chimeric mouse-human Fa fragments; A. Sharra and A. Plύckthun, Science 240. 20 Ma 1988, pp. 1038-1040, describing the cloning of a immunoglobulin Fv fragment containing antigen-binding variabl domains; and E.S. Ward et al.. Nature 341. 12 October 1989, pp 544-546, describing the cloning of isolated antigen-bindin variable domains ("single-domain antibodies") . The peptide fragment against which the antibody is raised ma be prepared by conventional peptide synthesis using a devic available from Applied Biosystems as described in D. Atar e al., J. Immunol. 143. 1989, pp. 533-538. In particular for use as the labelled reagent or as th antibody immobilised on the solid support, the antibody i advantageously one which is raised against an epitope of FAl which does not participate in binding autoantibodies so as not to interfere with the binding of any FAl autoantibodies present in the sample or so as to ensure optimal binding of the labelled reagent to any FAl autoantibodies bound to FAl in the assay. If, on the other hand, the antibody is intended for use as the labelled antibody competing with any antibodies in the sample for binding to the immobilised FAl, the antibody is preferably one which is raised against an epitope of FAl which binds the FAl autoantibody. DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE DIAGNOSTIC METHOD In one embodiment, the test kit of the invention comprises, in separate containers, (a) fetal antigen 1 (FAl) immobilised on a solid support, and (b) a labelled reagent capable of binding to the FAl autoantibody. In this case, the FAl may be bound to an antibody immoblised to the solid support, as indicated above. The labelled reagent is preferably an antibody. In another embodiment, the test kit of the invention comprises, in separate containers, (a) an antibody reactive with an epitope of FAl which does not participate in binding the autoantibodies, the antibody being immobilised on a solid support, (b) FAl, and (c) a labelled reagent capable of binding to the autoantibody. In a further embodiment, the test kit of the invention comprises, in separate containers, (a) fetal antigen 1 (FAl) immobilised on a solid support, and (b) a labelled antibody which is capable of competing with the FAl autoantibody for binding to FAl. The labelled antibody may be one which is raised against a peptide fragment of FAl. The FAl may be bound to an antibody immobilised on the solid support, as indicated above. In a still further embodiment, the test kit of the invention comprises, in separate containers, (a) an antibody reactive with an epitope of FAl which epitope does not participate in binding the FAl autoantibodies, the antibody being immobilised- on a solid support, (b) FAl, and (c) a labelled antibody which is capable of competing with the autoantibody for binding to FAl. It is at present contemplated that the FAl may have a therapeutic use. Thus, it is believed to be of potential use in a method of preventing the development of IDDM, in which method FAl or a fragment thereof is administered to an individual who does not show clinical symptoms of IDDM in a quantity sufficient to induce immunological tolerance to FAl. It is also possible that administration of FAl may be used to treat preclinical IDDM or to ameliorate early clinical IDDM. The proposed therapeutic use of FAl is based on similar attempts to provide immunotherapy of IDDM with other antigens. Immunotherapy with glutamic acid decarboxylase (GAD 65 , the smaller isoform) in animal models of IDDM has been demonstrated by several groups (Kaufman et al., Nature 366. 1993, pp. 69-72, Tisch et al., Nature 2-66, 1993, pp. 72-75, Petersen et al., Diabetes 43 1994, pp. 1478-84 and Elliott et al., Diabetes 43. 1994, pp. 1494-99). By injecting recombinant GAD 65 intravenously into 3 week-old non-obese-diabetic (NOD) mice, Kaufman et al. have completely prevented development of IDDM as well as islet autoimmunity, i.e. mononuclear cell infiltration in the islets (insulitis) . By injecting recombinant GAD 65 into the thymus of 3 week-old non-obese-diabetic (NOD) mice, Tisch et al. have prevented/delayed the development of IDDM as well as islet autoimmunity, i.e. mononuclear cell infiltration in the islets (insulitis) . By injecting GAD 65 affinity purified from rat brains intraperitoneally into neonatal (24h) non-obese-diabetic (NOD) mice, Petersen et al. have prevented/delayed the development of IDDM as well as islet autoimmunity, i.e. mononuclear cell infiltration in the islets (insulitis) . By immunizing NOD mice once with GAD 67 (the larger isoform) , Elliott et al. have completely prevented the onset of clinical diabetes. Furthermore, insulin therapy in animal models of IDDM (Gotfredsen et al., Diabetoloqia 28, 1985, pp. 933-35 and Ackinson et al., Diabetes 39. 1990, pp. 933-37) as well as in humans at high risk of disease (Keller et al., Lancet 341. 1993, pp. 927-28) has also been demonstrated to delay/prevent the onset of diabetes. Keller et al. have demonstrated that low doses of subcutaneous insulin can delay/prevent the onset of clinical IDDM in individuals at high risk of developing the disease. Likewise, in both the BB-rat (Gotfredsen et al.) and in the NOD mice (Ackinson et al.) prophylactic insulin therapy have been demonstrated to prevent/delay the onset of clinical diabetes. H. Zhang et al. (Proc Natl Acad. 88. pp.10252-56) have also demonstrated that oral insulin therapy in NOD mice delays/prevents the onset of IDDM as well as insulitis. Based on these data, it is suggested that FAl administered b injection with or without adjuvant or orally, can be used i immunotherapy of IDDM in individuals at risk of developing th disease, or in recent onset IDDM patients in order t inhibit/prevent the autoimmune 3-cell destruction. The dosage of FAl administered to a patient will vary with th type and severity of the condition to be treated, as well a the form of administration (e.g. oral or intravenous) , but i generally in the range of 100-1000 g per day for about 1 yea (for oral administration) . To this end, the present invention provides a pharmaceutica composition for preventing or treating preclinical IDDM or fo ameliorating early clinical IDDM, the composition comprisin fetal antigen 1 together with a pharmaceutically acceptabl diluent or carrier. In the pharmaceutical composition of the invention, the FAl ma be formulated by any of the established methods of formulatin pharmaceutical compositions, e.g. as described in Remington' Pharmaceutical Sciences. 1985. The composition may be in a for suited for systemic injection or infusion and may, as such, b formulated with sterile water or an isotonic saline or glucos solution. The composition may be sterilized by conventiona sterilization techniques which are well known in the art. Th resulting aqueous solutions may be packaged for use or filtere under aseptic conditions and lyophilized, the lyophilize preparation being combined with the sterile aqueous solutio prior to administration. The composition may contai pharmaceutically acceptable auxiliary substances as required t approximate physiological conditions, such as buffering agents tonicity adjusting agents and the like, for instance sodiu acetate, sodium lactate, sodium chloride, potassium chloride calcium chloride, etc. The pharmaceutical composition of the present invention ma also be adapted for oral, nasal, transdermal or rectal administration. The pharmaceutically acceptable carrier or diluent employed in the composition may be any conventional solid carrier. Examples of solid carriers are lactose, terra alba, sucrose, talc, gelatin, agar, pectin, acacia, magnesium stearate and stearic acid. Similarly, the carrier or diluent may include any sustained release material known in the art, such as glyceryl onostearate or glyceryl distearate, alone or mixed with a wax. For oral administration, the composition may be tabletted, placed in a hard gelatin capsule in powder or pellet form or it can be in the form of a troche or lozenge. The amount of solid carrier will vary widely but will usually be from about 25 mg to about 1 g. The FAl may also be placed in a soft gelatin capsule in a liquid carrier such as syrup, peanut oil, olive oil or water. The present invention is further illustrated by the following example which is not in any way intended to limit the scope of the invention as claimed. EXAMPLE Radioiodination of FAl 200-300 μl of purified FAl (about 150 μg, purified b immunospecific affinity chromatography as described by CH Jensen et al.. Human Reprod. £., 1993, pp. 635-641, wer transferred to glass ampoules precoated with 20 ng iodogen. μl 15 I (specific activity 100 mCi/ml, available from Amersha International) was added and iodination performed durin agitation at room temperature for 15 minutes. Labelled protei was isolated on PD10 columns (Sephadex G 25, available fro Pharmacia) preequilibrated and run with 0.2% (v/v) NP40 in PBS and 600 μl fractions were collected. These fractions wer analysed by trichloroacetic acid (TCA precipitation. To 2 μl of each fraction obtained above, 1 ml 10% (w/v) TCA an 1 ml 0.1% (w/v) BSA in PBS were added. The samples wer incubated on ice for 15-3O minutes and centrifuged at 1500x for 10 minutes. 2 μl supernatant was saved and analysed in gamma scintillation couter together with the pellet and 2 μl o the original fraction. The top fraction was identified, and th iodinated FAl was further purified by size chromatography. Detection of autoantibodies against FA-1 COS-7 cells were transfected with DNA encoding FA-1 in a manne described previously (B. Michelsen et al., Proc. Natl. Acad Sci. USA 88. 1991, pp. 8754-8758) and labelled with 5 mCi 35 S cystine in 10 ml of medium containing 20 x 10 6 transfected COS- cells of for 4 h at 37°C After labelling, the transfected COS- cells were swollen on ice for 10 in in 10 mM HEPES, pH 7.4, mM MgCl 2 and 1 mM EGTA and homogenized using a Polytron spee 4 for 2x40 sec. The cell homogenate was then centrifuged for 1 min at 3000 rpm. The supernatant from the transfected COS- cells was used in immunoprecipitation analysis. Supernatan from approximately 1 x 10 6 cells was incubated with 20μl of serum from either IDDM patients or healthy controls for 16 h at 4*C to form immunocomplexes. The immunocomplexes were isolated by absorption to Protein A-Sepharose (PAS) (Pharmacia, Sweden) 5 (1 mg/μl serum) . Following washing, the PAS pellets were boiled for 3 min. in 1M Tris, 60% v/v sucrose, 15% w/v SDS, 0.01% w/v bromophenol blue, pH 6.8, with 1% 3-mercaptoethanol, centrifuged and the supernatant subjected to analysis by 10% SDS-PAGE. After drying, the gel-immunoprecipitated FA-1 was 10 detected on gels by fluorography. 64% (9 of 14) of recent onset IDDM patients showed antibody reactivity against FA-1 expressed in COS-7 cells, in contrast to 0% (0 of 5) healthy controls. Detection of T-cell reactivity against FA-1 Peripheral blood mononuclear cell (PBMC) were isolated by 15 Ficoll-Metratrizoate density gradient centrifugation from freshly drawn heparinized blood from recent onset IDDM patients, patients with established IDDM and healthy controls. 150.000 PBMC were cultured in tissue-coated, round-bottom 69- well plates (Costar, Cambridge, Massachusetts) for 5 days at 2037 * C, 5% C02, in 150 μl Iscove's modified Dulbecco's medium with 2mM glutamine (Gibco, Paisley, Scotland) , supplemented with 10% human type AB pool serum, 10 U/ml penicillin and lOμg/ml streptomycin (Flow Laboratories, Irvine, Scotland), in the presence of either affinity purified human FA-1 antigen 0- 2525μg/ml or tetanus toxoid (1.5 Lf/ml) or in medium alone. After 5 days, 50 μl RPMI 1640 (Gibco) containing 0.5μCi 3 H-thymidine was added per well, and the incubation was continued for 16 hours. Cultures were then harvested on glass-fibre filters and 3 H-thymidine incorporation was measured by liquid scintillation 30 counting. The results are expressed as stimulation indices (cpm in the presence of antigen divided by cpm in absence of antigen). Only incubations resulting in SI index above 3.0 were considered positive. 77% (10 of 13) of the recent onset IDDM patients were positive compared to 0% (0 of 20) of the controls 35 ((Figure 2) P<10 "4 . Furthermore, 57% (4/7) of IDDM patients with a mean duration of IDDM of 4.5 years were positive (Post-IDDM (Figure 2) .

Claims: CLAIMS 1. A method of diagnosing preclinical insulin-dependent diabetes mellitus (IDDM) , the method comprising contacting fetal antigen 1 (FAl) with T cells of a subject to be diagnosed 5 for preclinical IDDM and detecting any T cell response to the FAl, such a response being indicative of preclinical IDDM in the subject. 2. A method according to claim 1, wherein FAl is contacted with T-cells of a sample taken from the subject. 103. A method according to claim 2 , wherein the sample is a blood or tissue sample. 4. A method according to claim 3, wherein the T cells are T cell clones isolated from the blood or tissue of the subject. 5. A method according to claim 1, wherein FAl is administered 15 subcutaneously to the subject and any skin reaction at the site of administration is subsequently detected, such skin reaction being indicative of a T cell response to FAl. 6. A method according to any of claims 1-5, wherein the FAl is human FAl. 207. A composition for the diagnosis of preclinical IDDM, the composition comprising FAl together with a suitable diluent or vehicle. 8. A method of determining the presence of autoantibodies against fetal antigen 1 (FAl autoantibodies) in serum, which 25 method comprises contacting a serum sample with FAl or a fragment thereof capable of binding FAl autoantibodies, and detecting any binding of autoantibodies to the FAl. 9. A method according to claim 8, wherein the serum sample contacted with FAl immobilised on a solid support, after whi the solid support is contacted with a labelled reagent capabl of binding to any autoantibody bound to the FAl, detection 5 any label bound to the solid support indicating the presence FAl autoantibodies in the sample. 10. A method according to claim 9, wherein the labelled reage is an antibody. 11. A method according to claim 10, wherein the antibody is 10 anti-idiotype antibody. 12. A method according to claim 11, wherein the FAl is bound an antibody immobilised on the solid support, said antibod being reactive with an epitope of FAl which does no participate in binding the FAl autoantibodies. 1513. A method according to claim 12, wherein the antibody is on which is raised against a- peptide fragment of FAl which doe not contain an epitope participating in binding F autoantibodies. 14. A method according to claim 8, wherein the serum sample i 20 contacted with FAl immobilised on a solid suppo simultaneously with contacting the immobilised FAl with predetermined amount of a labelled antibody competing with t FAl autoantibody for binding to FAl, detection of any decreas in the amount of labelled antibody bound to the solid suppor 25 relative to the amount of labelled antibody added indicatin the presence of FAl autoantibodies in the sample. 15. A method according to claim 14, wherein the labelle antibody is one which is raised against a peptide fragment o FAl containing an epitope participating in binding F 30 autoantibodies. 16. A method according to claim 14, wherein the FAl is bound to an antibody immobilised on the solid support, said antibody being reactive with an epitope of FAl which does not participate in binding the FAl autoantibodies. 17. A method according to claim 16, wherein the immobilised antibody is one which is raised against a peptide fragment of FAl which does not contain an epitope participating in binding FAl autoantibodies. 18. A method according to any of claims 8-17, wherein the FAl is human FAl. 19. A method according to any of claims 8-18 for the diagnosis of preclinical IDDM. 20. A test kit for determining the presence of FAl autoantibodies in serum, which comprises, in separate containers, (a) fetal antigen 1 immobilised on a solid support, and (b) a labelled reagent capable of binding to FAl autoantibodies. 21. A test kit according to claim 20, wherein the labelled reagent is an antibody. 22. A test kit according to claim 20, wherein the FAl is human FAl. 23. A test kit for determining the presence of FAl autoantibodies in serum, which comprises, in separate containers, (a) an antibody reactive with an epitope of FAl which does not participate in binding FAl autoantibodies, the antibody being immobilised on a solid support, (b) fetal antigen 1, and (c) a labelled reagent capable of binding to FA autoantibodies. 5 24. A test kit according to claim 23, wherein the labelle reagent is an antibody. 25. A test kit according to claim 23, wherein the FAl is huma FAl. 26. A test kit for determining the presence of FA 10 autoantibodies in serum, which comprises, in separat containers, (a) fetal antigen 1 immobilised on a solid support, and (b) a labelled antibody which is capable of competing with th FAl autoantibody for binding to FAl. 15 27. A test kit according to claim 26, wherein the labelle antibody is one which is raised against a peptide fragment o FAl containing an epitope participating in binding FA autoantibodies. 28. A test kit according to calim 26, wherein the FAl is huma 20 FAl. 29. A test kit for determining the presence of FA autoantibodies in serum, which comprises, in separat containers, (a) an antibody reactive with an epitope of FAl which epitop 25 does not participate in binding FAl autoantibodies, th antibody being immobilised on a solid support. (b) fetal antigen 1, and (c) a labelled antibody which is capable of competing with the FAl autoantibody for binding to FAl. 30. A test kit according to clim 29, wherein the FAl is human 5 FAl. 31. Use of fetal antigen 1 (FAl) for the preparation of a medicament for preventing or treating preclinical IDDM or for ameliorating early clinical IDDM. 32. Use according to claim 31, wherein the FAl is human FAl. 1033. A pharmaceutical composition for preventing or treating preclinical IDDM or for ameliorating early clinical IDDM, the composition comprising fetal antigen 1 together with a pharmaceutically acceptable diluent or carrier.

Inventors: DRAGSBAEK MADSEN OLE, KOCH MICHELSEN BIRGITTE, PETERSEN JACOB STEEN, DRAGSBAEK MADSEN, OLE, KOCH MICHELSEN, BIRGITTE, PETERSEN, JACOB, STEEN
Applicants: DRAGSBAEK MADSEN OLE, KOCH MICHELSEN BIRGITTE, NOVONORDISK AS, PETERSEN JACOB STEEN, DRAGSBAEK MADSEN, OLE, KOCH MICHELSEN, BIRGITTE, NOVO NORDISK A/S, PETERSEN, JACOB, STEEN
Application year: 1996
Main classification: G01N33
IPC codes: C07K14, C12Q1, G01N33