Abstract:
The present invention is directed to diagnostic methods based upon the detection of peptides derived from the degradation of CA125. In particular, it is concerned with assays of urine samples collected from women for the purpose of determining whether they are at increased risk for having ovarian cancer, have decreased their risk as the result of clinical or non-clinical procedures, to monitor the efficacy of a treatment method, or to determine whether cancer has recurred or advanced.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims priority to, and the benefit of, U.S. provisional application 61/006,783 filed on Jan. 31, 2008 the contents of which is hereby incorporated by reference in its entirety 
     
    
     STATEMENT OF GOVERNMENT FUNDING 
       [0002]    The United States Government has a paid-up license in this invention and the right in limited circumstances to require the patent owner to license others at reasonable terms as provided for by the terms of NIH Grant No. R21CA111949-01 awarded by the Department of Health and Human Services. 
     
    
     FIELD OF THE INVENTION 
       [0003]    The present invention is in the field of tumor cell markers and is particularly concerned with methods of detecting ovarian cancer by assaying urine samples for CA125 peptides. Any method for determining CA125 peptide levels may be used, including mass spectroscopy assays, radioimmunoassays and ELISA assays. 
       BACKGROUND OF THE INVENTION 
       [0004]    Ovarian cancer is the fifth leading cause of death from cancer in US women. In most instances, a diagnosis is not made until the cancer is in an advanced state, at a time when the five year survival rate of patients is only about 28% (Ries, et al.,  SEERC Cancer Stat. Rev.  1973-1995 (1998)). In contrast, the five year survival rate for women diagnosed with localized disease is about 95%. These statistics provide an incentive to search for new diagnostic tests for this disease, especially those that can be used in screening patients and which may detect cancer at an early stage. 
         [0005]    Over the last several years, efforts at the discovery of biomarkers for ovarian cancer have focused primarily on serum and plasma. Relatively little attention has been paid to urinary biomarkers despite advantages that urine-based tests have in terms of non-invasiveness, convenience and cost. Although urine assays have been traditionally used for urinary tract diseases, more recent studies have indicated that these assays are also valuable in the detection of other diseases as well (Pisitkun, et al.,  Mol. Cell. Proteomics  5:1760-1771 (2006)) including lung cancer (Tantipaiboonwong, et al.,  Proteomics  5:1140-1149 (2005) and breast cancer (Roy, et al.,  J. Biol. Chem.  279:51323-51330 (2004)). Assays of glycosylated forms of eosinophil-derived neurotoxin and COOH-terminal peptides of osteopontin in urine have been found to be associated with ovarian cancer malignancy (Ye, et al.,  Clin. Cancer Res.  12:432-441 (2006); Chambers, et al.,  Clin. Cancer Res.  12:323-327 (2006); U.S. Pat. No. 7,288,383; US 2005009120). 
         [0006]    The most commonly used plasma assay for detecting ovarian cancer is for the CA125 biomarker. However this test is of limited sensitivity and is poor at detecting ovarian cancer in its early stages, when the disease is most treatable. These limitations may be, at least in part, due to the complicated structure of the CA125 protein and interference from high levels of other plasma proteins. An assay of urine for peptides generated during the breakdown of CA125 may avoid these problems and would be well suited to the widespread screening of patients. 
       SUMMARY OF THE INVENTION 
       [0007]    Human CA125 is a heavily glycosylated protein of 1890 amino acids that has been completely sequenced (Yin, et al.,  J. Biol. Chem.  276:27371-27375 (2001), incorporated herein by reference in its entirety) and which is used as a serum marker for ovarian cancer. The present invention is based upon the discovery that peptides generated during the degradation of CA125 are present in the urine of patients with ovarian cancer but are essentially absent in urine samples from normal, healthy women or women with benign ovarian tumors. There is a correlation between serum levels of CA125 and urine levels of Ca125 peptides suggesting that assays of the urine peptides may be used in a similar manner to serum assays. However, a urine based assay should be easier to perform, is noninvasive and is amenable to use in kits for testing at home. In addition, urine has far fewer proteins likely to interfere with assays than serum and may therefore be more sensitive and reliable. 
         [0008]    In its first aspect, the invention is directed to a method of diagnostically evaluating a woman for the presence of ovarian cancer. This is accomplished by obtaining a test urine sample from the woman and then assaying it to determine the amount or concentration of at least one CA125 peptide present. The term “CA125 peptide” refers to degradation products of the 1890 amino acid human CA125 found in serum. A CA125 peptide will always have an amino acid sequence matching a segment of the CA125 protein but will be shorter in length. Peptides may be 10-500 amino acids in length but are preferably 10-60 amino acids long and more preferably 10-20 amino acids long. 
         [0009]    Results obtained from the assay of the test urine sample are compared with results obtained from similar assays performed on one or more control samples and it is concluded that the woman from which the urine sample was obtained is positive for ovarian cancer if the concentration or amount of CA125 peptide in the test sample is higher than the concentration or amount found in the control sample. Methods for selecting appropriate controls are well known in the art. For example, controls may be urine samples obtained from women believed to be free from malignant disease or they may simply be urine samples obtained from the general population of women. It will be understood that once a normal range for the peptide is established, test sample values may be simply compared to the normal range without the need to run new control samples with each assay. Although no assay short of a full biopsy is 100 percent reliable in predicting cancer, the finding that a sample is “positive” for ovarian cancer due to elevated urine CA125 peptide levels means that the woman from which the sample is derived is at an increased risk of having the disease and is in need of further evaluation. 
         [0010]    In general, there should be no/or less detectable CA125 peptides in the urine of healthy women or of women with benign tumors. At a minimum, the CA125 peptide will be 3 times higher in women with ovarian cancer. Any means for detecting and quantitating the presence of the urine peptides is compatible with the invention. Examples of assays that can be used include: radioimmunoassays (RIAs), Enzyme Linked Immunosorbent Assays (ELISAs), chromatographic assays and mass spectroscopic assays. Specific peptides may be separated from one another using standard techniques and identified as being a CA125 degradation product based upon their sequence or based upon their reactivity with CA125 specific antibodies. Monoclonal antibodies recognizing only specific peptides may also be used. If necessary CA125 peptides may be deglycosylated prior to assay using standard techniques. 
         [0011]    The urine assays described above for the detection of CA125 may be combined with other tests for ovarian cancer to gain further information on the likelihood of this disease being present. For example, the assay of urine for CA125 peptides may be used in conjunction with standard assays for serum or plasma levels of CA125 protein. The most preferred peptides for analysis in the urine assays are: 
         [0000]                                    a)   DSLYVNGFTHQSSMTTTR;   (SEQ ID NO: 1)                       b)   SSGVTFSRPDPTSKK;    (SEQ ID NO: 2)           and                               c)    HPFSSPEPDSAGHTK.    (SEQ ID NO: 3)            
All sequences shown are from the N to C terminus and use standard one letter abbreviations for amino acids.
 
         [0012]    It will be understood that the peptides being assayed may be glycosylated to varying degrees, due to glycosylation of the intact CA125 from which they are derived. If present, glycosylation would typically be found at the hydroxy oxygen of serine or threonine or at the amide nitrogen of asparagine. Glycosylation may be removed or left in place depending upon the type of assay used. 
         [0013]    Modifications may also be deliberately made in synthetic peptides, for example to increase antigenicity. For example, prior to the generation of antibodies one or more amino acid residues may be conservatively substituted with a functionally similar residue. Examples of conservative substitutions include: the substitution of one hydrophobic aliphatic residue, such as isoleucine, valine, leucine or alanine, for another; the substitution of one hydrophobic aromatic residue, such as phenylalanine, tryptophan and tyrosine, for another; the substitution of one polar (hydrophilic) residue for another, such as between glutamine and asparagine, or between cysteine, methionine, threonine and serine; the substitution of one basic residue such as lysine, arginine or histidine for another, or the substitution of one acidic residue, such as aspartic acid or glutamic acid for another. 
         [0014]    Peptides may also undergo standard chemical derivatization procedures if desired. For example, free amino groups may be derivatized to form amine hydrochlorides, p-toluene sulfonyl groups, carbobenzoxy groups, t-butyloxycarbonyl groups, chloroacetyl groups or formyl groups. Free carboxyl groups may be derivatized to form salts, methyl and ethyl esters or other types of esters or hydrazides. Free hydroxyl groups may be derivatized to form O-acyl or O-alkyl derivatives. The imidazole nitrogen of histidine may be derivatized to form N-im-benzylhistidine. Also included as chemical derivatives are peptides which are modified to contain one or more naturally-occurring amino acid derivatives of the twenty standard amino acids. For examples: 4-hydroxyproline may be substituted for proline; 5-hydroxylysine may be substituted for lysine; 3-methylhistidine may be substituted for histidine; homoserine may be substituted for serine; and ornithine may be substituted for lysine. 
         [0015]    The assay methods described above may be used on women that have not been previously diagnosed as having ovarian cancer (e.g., in a screening assay) to help evaluate whether cancer is present. They may also be used for women that have been diagnosed as having ovarian cancer to determine the efficacy of treatment, or to determine if the cancer has recurred or advanced. 
         [0016]    In another aspect, the invention is directed to a method of diagnostically evaluating a woman for ovarian cancer by: obtaining a test urine sample; performing an immunoassay on the test urine sample to determine the amount or concentration of CA125 antigenic activity present; comparing the results obtained with results from an assay of one or more control urine samples from women without ovarian cancer or from the general population; and concluding that the woman tested is positive for ovarian cancer if the amount or concentration of CA125 antigenic activity is higher in the test urine sample than in the control urine sample. The main difference between this assay and the assays discussed above is that, in the present case, a composite antigenic activity (i.e., activity from all peptides recognized by the antibody) is determined rather than the level of a specific peptide. Depending on the specificity of the antibodies used in the immunoassays, antigenic activity may reflect all or part of the total CA125 peptides present. In general, immunoassays utilizing a polyclonal antibody against CA125 are preferred. As discussed above, this assay may be used on patients not yet diagnosed as having ovarian cancer to test for its presence. Alternatively it may be used in patients known to have ovarian cancer to evaluate whether the disease has recurred or advanced. It may also be used in conjunction with other diagnostic assays such as serum or plasma assays for CA125. 
         [0017]    As suggested above, the peptides that have been determined to be biomarkers for ovarian cancers are: DSLYVNGFTHQSSMTTTR (SEQ ID NO:1); SSGVTFSRPDPTSKK (SEQ ID NO:2); and HPFSSPEPDSAGHTK (SEQ ID NO:3). Antibodies reacting with these peptides may be made for use in the urine assays for ovarian cancer. This can be accomplished by administering the CA125 peptide to an immunocompetent animal, i.e., an animal capable of generating antibodies such as a rabbit, goat or horse. The peptides must be given in an amount sufficient to induce antibody production and may be recovered from animals using methods that are well known in the art. Alternatively monoclonal antibodies may be made by isolating splenocytes from the animals given peptide, fusing these to melanocytes and then producing antibodies using hybridoma technology. 
         [0018]    The biomarker CA125 peptides described above may be sold as part of a kit for performing diagnostic assays for ovarian cancer. In addition to one or more of the peptides, the kit should include other components needed to carry out assays in people. In general, this means that the kit will include at least one antibody (preferably a monoclonal antibody) that reacts specifically with one or more of the CA125 peptides present, i.e., that reacts at least 100 times more strongly with the CA125 peptide(s) than with other peptides. The antibody may optionally be linked to an enzyme that can be used for detecting peptide in an ELISA assay or it can be bound to a radioisotope for use in a radioimmunoassay. The kit may also include other components such as buffers or control samples that can be used in assays. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0019]    The discovery of a correlation between the concentration of CA125 peptides in urine and ovarian cancer is consistent with serum assays on intact CA125 that are presently used clinically. The complete amino acid and nucleotide sequence of human CA125 is known (see Yin, et al.,  J. Biol. Chem.  276:27371-27375 (2001)) and assays that have been used for detecting intact CA125 in serum or plasma samples can be used for the detection of peptide in urine (see e.g., the Examples section herein). Normally such assays would be performed after the fractionation of the peptides by techniques such as electrophoresis or chromatography. Alternatively, non-immunological methods such as mass spectroscopy may be used or peptides may be identified without fractionation if monoclonal antibodies that are highly specific for the peptides are used. 
         [0020]    Any type of quantitative assay is compatible with the invention including immunoassay procedures performed using, for example, commercially available monoclonal or polyclonal antibodies for CA125. Alternatively, CA125 peptides may be synthesized and immunoassays may be developed based upon the production of new antibodies that bind specifically to the peptides. 
         [0021]    Antibodies that bind specifically to a CA125 peptide are defined for the purpose of the present invention as those that have at least a 100 fold greater affinity for the peptide than for any other peptide found in urine. The process for producing such antibodies involves injecting the peptide itself into an appropriate animal. Methods for making and detecting antibodies are well known to those of skill in the art as evidenced by standard reference works such as: Harlow, et al.,  Antibodies, A Laboratory Manual , Cold Spring Harbor Laboratory, NY (1988); Klein,  Immunology: The Science of Self - Nonself Discrimination  (1982); Kennett, et al.,  Monoclonal Antibodies and Hybridomas: A New Dimension in Biological Analyses  (1980); and Campbell, “Monoclonal Antibody Technology,” in:  Laboratory Techniques in Biochemistry and Molecular Biology  (1984). 
         [0022]    “Antibody” as used herein is meant to include intact molecules as well as fragments which retain the ability to bind antigen (e.g., Fab and F(ab′) fragments). These fragments are typically produced by proteolytically cleaving intact antibodies using enzymes such as a papain (to produce Fab fragments) or pepsin (to produce F(ab′) 2  fragments). The term “antibody” also refers to both monoclonal antibodies and polyclonal antibodies. Polyclonal antibodies are derived from the sera of animals immunized with the antigen. Monoclonal antibodies can be prepared using hybridoma technology (Kohler, et al., Nature 256:495 (1975)). In general, this technology involves immunizing an animal, usually a mouse, with the CA125 peptide. The splenocytes of the immunized animals are extracted and fused with suitable myeloma cells, e.g., SP 2 O cells. After fusion, the resulting hybridoma cells are selectively maintained in a culture medium and then cloned by limiting dilution (Wands, et al.,  Gastroenterology  80:225-232 (1981)). The cells obtained through such selection are then assayed to identify clones which secrete antibodies capable of binding to CA125 peptide. 
         [0023]    The antibodies or fragments of antibodies described above may be used to detect the presence of the CA125 peptide in any of a variety of immunoassays. For example, antibodies may be used in radioimmunoassays or immunometric assays, also known as “two-site” or “sandwich assays” (see Chard, “Introduction to Radioimmune Assay and Related Techniques,” in:  Laboratory Techniques in Biochemistry and Molecular Biology , North Holland Publishing Co., N.Y. (1978)). In a typical immunometric assay, a quantity of unlabelled antibody is bound to a solid support that is insoluble in the fluid being tested. After the initial binding of antigen to immobilized antibody, a quantity of detectably labeled second antibody (which may or may not be the same as the first) is added to permit the detection and/or quantitation of bound antigen (see e.g.,  Radioimmune Assay Method , Kirkham, et al., ed., pp. 199-206, E&amp;S Livingston, Edinburgh (1970)). Many variations of these types of assays are known in the art and may be employed for the detection of CA125 peptide. 
         [0024]    If desired, antibodies to a CA125 peptide may also be used in the purification of the peptide (see generally, Dean, et al.,  Affinity Chromatography, A Practical Approach , IRL Press (1986)). Typically, antibody is immobilized on a chromatographic matrix such as Sepharose 4B™. The matrix is then packed into a column and the preparation containing the CA125 peptide is passed through under conditions that promote binding, e.g., under conditions of low salt. The column is then washed and bound peptide is eluted using a buffer that promotes dissociation of antibody, e.g., a buffer having an altered pH or salt concentration. The eluted peptide may be transferred into a buffer of choice and either stored or assayed directly. 
       EXAMPLES 
       [0025]    The purpose of this study was to identify urinary peptides and metabolites derived from the cancer biomarker CA125 that may be used as non-invasive biomarkers for ovarian cancer and associated conditions such as benign tumors, and in the detection of early cancer metastasis. 
         [0026]    Materials and Methods 
         [0027]    Urine specimens pre-operatively collected from ovarian cancer patients and normal healthy women were used in this study for protein and peptide identification and measurements. Mass spectrometry was used to identify urine CA125 peptide sequences based upon comparison with a standard CA125 control after trypsin digestion. Monoclonal antibody from a commercially available source was used for Western blot analysis, and dot blot semi-quantification. Commercial ELISA assays and standardized clinical CA125 assays (radioimmune arrays) were performed on the same set of 20 normal, 20 benign and 20 ovarian cancer patients. 
         [0028]    Results 
         [0029]    We found that urine CA125 peptides were detectable in Western blots, dot blots, mass spectrometry profiles and standard CA125 immune assays. Three peptides were identified that were present in samples from cancer patients but either entirely absent from, or greatly reduced in, samples from normal women. Western blots performed using monoclonal antibody revealed a CA125 fragment of about 25 kDa. Using mass spectrometry, two polypeptides (1593, 2045, m/z) were identified in urine specimens of ovarian cancer patients which appeared to be identical to standard CA125 peptides. Protein sequence analysis, revealed that the peptides had the following amino acid sequences: DSLYVNGFTHQSSMTTTR (SEQ ID NO:1); SSGVTFSRPDPTSKK (SEQ ID NO:2); and HPFSSPEPDSAGHTK (SEQ ID NO:3). 
         [0030]    Using a standard CA125 assay on urine specimens collected from age-matched normal healthy women and pre-operative patients with ovarian benign and serous type of ovarian cancer disease, we found that there is a significant correlation between urine CA125 and serum CA125 measurements. Ovarian cancer patients were found to have about 4-5 fold higher level of CA125 activity in urine compared to normal women or women with benign ovarian tumors. 
         [0031]    All references cited herein are fully incorporated by reference. Having now fully described the invention, it will be understood by those of skill in the art that the invention may be performed within a wide and equivalent range of conditions, parameters and the like, without affecting the spirit or scope of the invention or any embodiment thereof.