Patent Publication Number: US-2004048274-A1

Title: Assay for directly detecting an inflammatory indicator in a body fluid sample

Description:
TECHNICAL FIELD  
       [0001] The present invention relates to a method for rapid detection of at least one inflammatory indicator contained in a body fluid sample. The method is used for rapidly diagnosing an infectious and/or inflammatory condition in an individual.  
       [0002] The method comprises the further steps of detecting a plurality of infection and/or inflammatory response agents, preferably cytokines, and performing a profile of such agents. The profile is a further indication of the condition being diagnosed.  
       [0003] The method further comprises a step of detecting at least one inflammatory response agent, such as at least one immune system agent, preferably autoantibodies, and optionally performing a profile of such agents. The agent may be the only or the first indication of the condition being diagnosed or it may contribute as a further indication of the condition being diagnosed.  
       [0004] The methods of the invention are performed by contacting i) a body fluid sample potentially comprising an infection and/or inflammatory response agent, including cytokines and autoantibodies, with ii) a targeting species that is preferably quantifiably detectable and capable of specifically recognising a predetermined infectious agent and/or a predetermined infection response agent. It is preferred that the contacting takes place essentially without pretreatment of the body fluid sample.  
       [0005] The targeting species preferably comprises an antibody capable of contacting one or both of an infectious agent and an infection response agent. The targeting species may also comprise a visible label capable of being detected when the complex of the targeting species with either one or both of an infectious agent and an infection response agents is in contact with a solid test area on e.g. a lateral flow device.  
       BACKGROUND OF THE INVENTION  
       [0006] U.S. Pat. No. 5,587,285 describes a highly sensitive anti-HIV antibody detection assay. The assay detects the presence of anti-HIV antibodies through the use of a non-denatured HIV antigenic determinant which immunoreactivity binds anti-HIV antibodies in a biological sample. The non-denatured HIV antigenic determinant has provided a means for detecting anti-HIV antibodies in serum samples testing seronegative for the presence of HIV antibodies directed against denatured HIV antigens.  
       [0007] U.S. Pat. No. 5,093,230 relates to an assay method for detecting IgM antibodies to a retrovirus selected from the group consisting of HIV-1, HIV-2, HTLV-I, and HTLV-II. The method is carried out within 70 minutes and comprises the steps of i) contacting nitrocellulose paper containing blotted, resolved retrovirus antigen protein obtained from gel electrophorectically resolved viral lysate with a test sample, and incubating under predetermined conditions the nitrocellulose paper and test sample to permit binding of antibodies present in the sample to the protein on the nitrocellulose paper, iii) contacting the incubated nitrocellulose paper of step i) with an anti-IgM enzyme conjugated antiserum reactive with said antibodies, and incubating to permit binding of the antiserum to said antibodies, iii) contacting the incubated nitrocellulose paper of step ii) with an enzyme substrate specific for the enzyme of step ii), and incubating to produce a colour, iv) stopping the colour producing reaction of step iii); and v) evaluating the amount of colour produced as an indication of the presence of antibodies to the viral lysate.  
       [0008] A plurality of cytokines have been detected in the prior art. U.S. Pat. No. 5,587,294 relates to a method for measuring endogenous cytokines in blood. Cytokines are measured in the presence of substances that bind the cytokines and causes conventional methods to give inaccurate results. The invention also pertains to non-invasive measurement of cytokines in biological fluids such as saliva and nasal secretions. In one embodiment the invention relates to a method for monitoring cytokine therapy in a human, wherein the cytokine is able to bind a carrier molecule, with the proviso that the cytokine is not IL-1. The method comprises the steps of i) obtaining a human body fluid sample potentially comprising a cytokine, ii) forming an assay mixture by combining the sample from step i) with a) an antibody capable of binding specifically to substantially all of the cytokine, wherein the antibody is immobilized on a solid phase support, and b) a labeled binding epitope of the cytokine, wherein the labeled binding epitope competes with the cytokine for antibody binding, iii) incubating the assay mixture to allow the immobilized antibody to bind specifically to either the cytokine or the labeled binding epitope, iv) washing unbound, labeled binding epitope from the solid phase support, v) detecting bound label on the solid phase support, vi) determining the amount of the cytokine in the sample. In a further step the determination of the amount of cytokine is compared to the amount of the cytokine in the sample with a determination of the cytokine in a previous body fluid sample. Preferred cytokines are interleukin-2, interleukin-6, interferon-α, interferon-γ and tumor necrosis factor-α.  
       SUMMARY OF THE INVENTION  
       [0009] In first aspect there is provided a method for detecting at least one predetermined inflammatory indicator present in a sample in an amount of less than 100 nanograms (100×10 −9  grams) per millilitre (10 −3  litre). The method comprises the steps of  
       [0010] i) contacting the sample with a kit comprising  
       [0011] a) a solid support, and  
       [0012] b) a plurality of a first targeting species bound to the solid support, said targeting species being capable of directly detecting said predetermined inflammatory indicator when it is present in a sample that is brought into contact with the solid support, and  
       [0013] c) a conjugate comprising a polymeric carrier molecule bound to i) at least one first and/or second targeting species capable of directly detecting said predetermined inflammatory indicator when it is present in a sample that is brought into contact with the solid support, and ii) at least one labelling species, and  
       [0014] ii) detecting a targeting species capable of targeting the predetermined inflammatory indicator,  
       [0015] wherein the detection of the targeting species is indicative of the presence of the predetermined inflammatory indicator in the sample.  
       [0016] By the term inflammatory indicator or agent is meant an indicator of inflammatory and/or immune system activity, such indicators for example being cytokines and autoantibodies.  
       [0017] In a further aspect there is provided a method for diagnosing an infectious condition in an individual, said method comprising the steps of  
       [0018] i) detecting a predetermined inflammatory indicator present in a body fluid sample according to the method of the invention, and  
       [0019] ii) diagnosing said infectious condition.  
       [0020] In yet a further aspect there is provided a method for diagnosing an inflammatory condition in an individual, said method comprising the steps of  
       [0021] iii) detecting at least one predetermined inflammatory indicator present in a body fluid sample according to the method of the invention, and  
       [0022] iv) diagnosing said inflammatory condition.  
       [0023] In yet another aspect there is provided a method for treating an infectious and/or inflammatory condition in an individual, said method comprising the steps of  
       [0024] i) performing a diagnosis according to any of the methods of the invention, and  
       [0025] ii) treating the condition based on the diagnosis.  
       [0026] Still further aspects of the invention relates to a kit according to the invention for use in i) a method for detecting a predetermined inflammatory indicator, ii) a method for diagnosing an infectious and/or inflammatory condition in an individual, and/or a method for treating an infectious and/or inflammatory condition in an individual. 
     
    
    
     DRAWINGS  
     [0027]FIG. 1 shows a schematic view of selected autoantibodies detectable according to the present invention. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
     [0028] In one preferred embodiment the present invention relates to a kit for directly detecting a predetermined inflammatory indicator present in a sample said kit comprising  
     [0029] i) a solid support, and  
     [0030] ii) a plurality of a first targeting species bound to the solid support, said targeting species being capable of directly detecting said predetermined inflammatory indicator when it is present in a sample that is brought into contact with the solid support, and  
     [0031] iii) a conjugate comprising a polymeric carrier molecule bound to at least  
     [0032] a) one first and/or second targeting species being capable of directly detecting said predetermined inflammatory indicator when it is present in a sample that is brought into contact with the solid support, and  
     [0033] b) at least one labelling species,  
     [0034] wherein the polymeric carrier molecule comprises a plurality of at least one reactive, functional group, at least one connecting moiety attached to the at least one reactive, functional group, and at least one molecular species selected from the group of molecular species consisting of targeting species and labelling species,  
     [0035] wherein each of the molecular species comprises at least one functional group that is reactive with at least one connecting moiety attached to the reagent, and  
     [0036] wherein the conjugate comprises at least one molecular species covalently attached thereto via a connecting moiety.  
     [0037] In a preferred embodiment the kit is suitable for detecting an inflammatory indicator present in the sample in an amount of less than about than 100 nanograms (100×10 −9  grams) per millilitre (10 −3  litre).  
     [0038] The polymeric carrier molecule preferably comprises reactive, functional groups in an amount of from about 5 to about 5,000 μmoles per gram of polymeric carrier.  
     [0039] In another embodiment the polymeric carrier molecule comprising e.g. a dextran chain according to the invention comprises less than about 400 labelling species, preferably in the form of visibly detectable targeting species or fluorescently detectable labelling species, such as less than 380 labelling species, for example less than 360 labelling species, such as less than 340 labelling species, for example less than 320 labelling species, such as less than 300 labelling species, for example less than 280 labelling species, such as less than 260 labelling species, for example less than 240 labelling species, such as less than 220 labelling species, for example less than 200 labelling species, such as less than 180 labelling species, for example less than 160 labelling species, such as less than 140 labelling species, for example less than 120 labelling species, such as less than 100 labelling species, for example less than 80 labelling species, such as less than 70 labelling species, for example less than 60 labelling species, such as less than 50 labelling species, for example less than 40 labelling species, such as less than 30 labelling species, for example less than 25 labelling species, such as less than 20 labelling species, for example less than 15 labelling species, such as less than 12 labelling species, for example less than 10 labelling species, such as less than 8 labelling species, for example less than 4 labelling species, such as less than 3 labelling species, for example less than 2 labelling species.  
     [0040] The molecular weight of a polymeric dextran chain is preferably about 500,000 Da, but molecular weights from about 100,000 Da to about 900,000 Da can also be used.  
     [0041] Each dextran chain in one embodiment comprises approximately 2,700 glucose units of which 20-22% are activated, preferably with divinyl sulfon, although other connecting moieties can also be used as described herein below in detail.  
     [0042] In one embodiment about half of the about 600 connecting moieties, preferably, but not limited to, divinyl sulfon groups, per dextran chain react with targeting species and labelling species according to the invention, and this provides the figure of less than about 400 labelling species per dextran chain. However, it is clear that more than about half of the 600 connecting moieties may well react with a labelling species, and the number of labelling species may thereofre be higher than about 400.  
     [0043] The number of labelling species and targeting species in a single polymeric carrier molecule according to the invention influences the minimum amount inflammatory indicators that can be detected according to the invention. In one embodiment the minimum amount of cells detectable is less than 100 nanograms per millilitre sample specimen, such as less than 95 nanograms per millilitre, for example less than 90 nanograms per millilitre, such as less than 85 nanograms per millilitre, for example less than 70 nanograms per millilitre, such as less than 75 nanograms per millilitre, for example less than 70 nanograms per millilitre, such as less than 65 nanograms per millilitre, for example less than 60 nanograms per millilitre, such as less than 55 nanograms per millilitre, for example less than 50 nanograms per millilitre, such as less than 45 nanograms per millilitre, for example less than 40 nanograms per millilitre, such as less than 35 nanograms per millilitre, for example less than 30 nanograms per millilitre, such as less than 25 nanograms per millilitre, for example less than 20 nanograms per millilitre, such as less than 15 nanograms per millilitre, for example less than 10 nanograms per millilitre, such as less than 5 nanograms per millilitre, for example less than 1 nanograms per millilitre, such as less than 0.5 nanograms per millilitre, for example less than 0.1 nanograms per millilitre, such as less than 0.05 nanograms per millilitre, for example less than 0.01 nanograms per millilitre, such as less than 0.005 nanograms per millilitre, for example less than 0.001 nanograms per millilitre sample specimen.  
     [0044] The inflammatory indicator including a cytokine and/or an autoantibody present in a sample specimen such as e.g. a body fluid sample is preferably detected and recorded as a positive diagnostic result according to one method of the invention in less than about 20 minutes, such as less than 15 minutes, for example less than 10 minutes, such as less than 8 minutes, for example less than 7 minutes, such as less than 6 minutes, for example less than 5 minutes, such as less than 4 minutes, for example less than 3 minutes, such as less than 2 minutes, for example less than 1 minute, such as less than 45 seconds, for example less than 30 seconds, such as less than 15 seconds.  
     [0045] The preferred statistical quality parameters for the present invention when the test is capable of detecting an amount of indicators as specified above within a predetermined time period may be summarised as follows:  
     [0046] Sensitivity: at least 80%, such as at least 85%, such as at least 90%  
     [0047] Specificity: at least 80%, such as at least 85%, such as at least 90%  
     [0048] Positive predictive value: at least 80%, such as at least 85%, such as at least 90%  
     [0049] Negative predictive value: at least 80%, such as at least 85%, such as at least 90%, more preferably at least 99.5%  
     [0050] The positive and the negative predictive value is closely related to the prevalence of the disease in the population, to be tested. In the present context it is preferred that the statistical calculations are based on a type of population that are realistic for using the test. Thus, the statistical calculations are not based only on a population known to have acquired the disease, but also on individuals that might turn out as negatives for the disease. Due to the validity and sensitivity of the kit according to the present invention the kit is particular suitable for testing of populations having a prevalence of the condition being tested for less than 100%, such as less than 90%, such as less than 80%, more preferably less than 70%, even more preferred less than 60%, such as about 50%.  
     [0051] The present invention provides in another embodiment a method for detection of inflammatory indicators in a specimen, wherein said specimen, optionally treated to remove undesired components, is contacted with an extended solid phase having conjugated thereon a targeting species, preferably an antibody, directed against the inflammatory indicator. The contacting results in the case of an antibody being used in the formation of immuno-complexes with antigens characteristic of the inflammatory indicators to be targeted.  
     [0052] The extended solid phase is separated from the specimen; said separated extended solid phase is contacted with a mobile solid phase comprising a polymeric carrier molecule according to the invention having conjugated thereto a predetermined tergeting species such as an antibody. The antibody results in the binding of said polymeric carrier molecules according to the invention to said immuno-complexes; the extended solid phase is subsequently separated from said mobile solid phase; and the presence of polymeric carrier molecules according to the invention bound to said extended solid phase is detected, whereby the presence of inflammatory indicators in said specimen is detected or determined.  
     [0053] Also, the invention provides an inflammatory indicator detection kit which comprises as individual components: (a) an extended solid phase having conjugated thereon a targeting species, preferably an antibody capable of forming immuno-complexes with antigens characteristic of the inflammatory indicators to be detected: and (b) a mobile solid phase consisting of dispersed polymeric carrier molecules according to the invention having conjugated thereto said targeting species, or a different target species, preferably an antibody, characteristic of the inflammatory indicators to be detected.  
     [0054] A specimen which may comprise an inflammatory indicator of types to be detected is in one embodiment exposed to an extended solid phase component which is coated at least in one location with a targeting species which will form complexes with the antigens of the inflammatory indicators to be detected.  
     [0055] The extended solid phase is in one embodiment separated from the specimen, such as by washing the specimen off the extended solid phase, and the separated extended solid phase is then contacted with a mobile solid phase of dispersed polymeric carrier molecules according to the invention comprising the same or different targeting species, preferably an antibody. If immuno-complexes of antigens of inflammatory indicators to be detected (“target” inflammatory indicators) have formed on the extended solid phase, the polymeric carrier molecules according to the invention will be bound to such complexes.  
     [0056] The unbound polymeric carrier molecules according to the invention of the mobile solid phase then are removed, such as by washing, and the extended solid phase is examined to determine the presence of polymeric carrier molecules according to the invention bound to the extended solid phase. These may be visually detected in some cases, for example when the polymeric carrier molecules according to the invention have been initially stained or dyed. Microscopic examination may be employed. The use of tracers or labels for the polymeric carrier molecules according to the invention enables the use of other detection methods as described herein below in more detail.  
     [0057] By this means, the presence or absence of bound polymeric carrier molecules according to the invention enables detection of the presence or absence of the target inflammatory indicators, and an evaluation of the quantity of bound polymeric carrier molecules according to the invention enables determination of the quantity of inflammatory indicators in the specimen, for example by comparison with standard results for the assay of known samples.  
     [0058] The extended solid phase used in the present invention may be employed in a variety of forms or structures. The solid phase has a location where a targeting species, preferably an antibody, can bind or associate, and the formation of such a solid phase with said targeting species, preferably an antibody, enables contacting a specimen and other materials used in the method of the invention. Preferred specimens are body fluid samples as described in more detail herein below.  
     [0059] The extended solid phase is best formed in a way which enables simple manipulation for easy contact with the specimen and other reagents. For this purpose, the extended solid phase may form at least part of a dipstick, syringe, tube or container.  
     [0060] The specimen and other reagents can be drawn in and ejected from a syringe, caused to flow through a tube, or deposited in a container such as a test tube shaped container. In such devices, the extended solid phase can form the whole of the device, or part of it, where, in the case of a syringe, tube or container, the part formed of the extended solid phase will at least be exposed at the inside of the device to permit contact with specimen and reagents. Targeting species, preferably an antibody, is preferably concentrated at one location of the extended phase, to be exposed to the specimen.  
     [0061] One more preferred form of the extended solid phase is a dipstick. In such a dipstick, it is further preferred that the extended solid phase should be included at at least one end, and that the targeting species, preferably an antibody, conjugated on the extended solid phase should be concentrated at the end of the dipstick. The extended solid phase can however comprise the entire dipstick, with the targeting species, preferably an antibody, concentrated at one end, or in more than one location.  
     [0062] The dipstick may be entirely formed from the extended solid phase, at one end of which has been conjugated a coating of targeting species, preferably an antibody. In another embodiment the dipstick has an extended solid phase one end of which is adhered to a body portion. A coating of targeting species, preferably an antibody, is conjugated to the extended solid phase. In yet another embodiment the extended solid phase entirely forms a tubular container into which a specimen can be placed. Coatings of targeting species. preferably an antibody, are located near the bottom of the container and are concentrated in one or more locations.  
     [0063] The extended solid phase is composed of any material onto which the desired targeting species, preferably an antibody, can be effectively bound. For covalent binding with antibody protein, the solid phase material can be chosen to contain a functional carboxyl surface, with use of a water-soluble carbodiimide as a conjugation reagent. A preferred material is acrylic resin, which has a carboxylated surface that enables binding the desired targeting species, preferably an antibody, by conjugation. For materials with amino surface groups, reactive carboxyl intermediates can be prepared by reacting with succinic anhydride. A variety of inorganic supports, typically glass, can also be prepared for covalent coupling with targeting species, preferably an antibody,. Reference is made, for example, to “Enzymology, A Series of Textbooks and Monographs,” Vol. 1, Chapter 1, 1975, the disclosure of which is incorporated herein by reference.  
     [0064] Extended solid phase materials capable of binding targeting species, preferably an antibody, are selected from materials which do not cause serious interference with the assay steps.  
     [0065] The presence of non-specific agglutinators in a tissue specimen, particularly those coupled to immunoglobulins, can result in error by causing the binding of mobile polymeric carrier molecules according to the invention to the extended solid phase even in the absence of specific Ag. Repeated washes during the assay would reduce the non-specific binding, but removal of the non-specific agglutinators is necessary in order to avoid such undesired binding. A simple polystyrene latex surface, for example, can passively delete some of the agglutinators, whereas an Ig G-coated surface provides a better affinity.  
     [0066] For convenience in the following description, the extended solid phase will be referred to as the preferred dipstick, although other forms may be used as explained herein above.  
     [0067] Monoclonal antibodies directed against the inflammatory indicators can provide consistent and reproducible binding. With a proper supply of specific antibody, the present direct binding immunoassay, in contradistinction with competitive binding immunoassay practiced in radioimmunoassay, can be a reliable and very rapid procedure since the incubation time for a kinematic equilibrium needed in competitive binding assays is not presently required.  
     [0068] In accordance with the method of the present invention, antibody targeting species, either from the usual Ig fraction of the antisera or from monoclonal antibodies, is conjugated respectively with a solid phase dip stick as well as with a mobile solid phase, or the so called “monodispersed” polymeric carrier molecules according to the invention.  
     [0069] The functions of the dip stick are for the handling and the separation of bound from free antigens, whereas that of the mobile polymeric carrier molecules according to the invention are for the detection of the formed immuno-complexes. Coupling techniques between the antibody protein and various solid phase materials are well developed (see, for example, the above-mentioned W. J. Dreyer, U.S. Pat. No. 3,853,987).  
     [0070] In one embodiment of the method of the present invention described above, the resulting immunocomplex is a multilayered “sandwich” comprising:  
     [0071] Dip stick+targeting species, preferably an antibody+antigen+targeting species, preferably an antibody+polymeric carrier molecule comprising a labelling species.  
     [0072] The amount of antibody required for covalent binding, however, can be less than a thousand times that of passive adsorption to a plastic such as polyvinyl chloride and the economics of using such an amount of highly specific targeting species, preferably an antibody, can be prohibitive.  
     [0073] An alternative way of binding that retains some strength of the covalent binding as well as the specificity of targeting species, preferably an antibody, is to bridge the targeting species and the solid phase with a first antibody, an antispecies antibody targeted against the Fc portion of the targeting antibody. Such an Fc portion is illustrated e.g. in “Immunology” (1981), The Upjohn Company, Kalamazoo, Mich.  
     [0074] That is, an inexpensive first antibody may initially be covalently bound to the solid phase, and the bound first antibody attracts the species-specific Fc portion of a targeting antibody, leaving the functional epitope of the targeting antibody unaltered with regard to an antigen of an inflammatory indicator. Bridged with such a first antispecies antibody, the immunoassay of the present invention brings about the following coupling “sandwich” in the case of detection of a species:  
     [0075] Dip Stick+antispecies antibody+targeting antibody+antigen+targeting antibody+antispecies antibody+polymeric carrier molecule comprising a labelling species.  
     [0076] In the direct binding assay of the present invention, the couplings between the dipstick and targeting species, preferably an antibody, as well as the couplings between the polymeric carrier molecules according to the invention and targeting species, preferably an antibody, are prepared in advance, and elements of non-specific agglutination in the fluid specimen are removed or deactivated for pretreatment prior to the direct binding assaying as mentioned above.  
     [0077] The assaying procedure according to one embodiment of the invention is therefore simplified to the following steps.  
     [0078] (1) Insert the dipstick into an optionally pretreated specimen in the form of a body fluid sample.  
     [0079] (2) Incubate dipstick and sample.  
     [0080] (2) Wash the dipstick.  
     [0081] (3) Insert the dipstick into a dispersion of polymeric carrier molecules comprising at least one targeting species, preferably an antibody, and at least one labelling species, unless the polymeric carrier molecules have previously been added to the specimen.  
     [0082] (4) Optionally wash the preparation obtained under (3).  
     [0083] (5) Detect the polymeric carrier molecules according to the invention on the dipstick by detecting either the targeting species or the labelling species.  
     [0084] In order to use a minimal amount of wet chemistry, the present detection of attached polymeric carrier molecules according to the invention on a dip stick is made independent of the immune chemistry. By concentration of the targeting species, preferably an antibody, at one end of the dipstick, the bound polymeric carrier molecules according to the invention are concentrated at one location, which simplifies detection.  
     [0085] The polymeric carrier molecules according to the invention can include any dye or fluorescent compound for direct visual observation, or have metal elements or iron oxide doped or entrapped within in order to provide X-ray fluorescent or electromagnetic signals. Enzymatic amplification can also be designed into the polymeric carrier molecules according to the invention.  
     [0086] In one embodiment, the present method employs a direct binding assay instead of a competitive binding assay where a dynamic equilibrium necessitates lengthy incubation. The disclosed method can, of course, be employed in a competitive protein binding assay as well. The roles of the immune analytes antibody and antigen can also be interchanged, still making use of the immobilized solid phase for the signal amplification. Binding of antibody or various antigen molecules to the solid phase matter is well known, in passive adsorption as well as in covalent coupling.  
     [0087] In the immunoassay of the present invention, the antigen characteristic for an inflammatory indicator, which optionally appears in high multiplicity, is used as a bridge to connect the mobile and the immobilized solid phases. This connection can obviously also be served by various other antigens with multiple antibody binding sites. In cases of certain antigen without repetitive binding sites which cannot specifically connect more than one monoclonal antibody, polyvalent antibodies may also be used instead.  
     [0088] The method of the invention can also be designed to assay several analytes in a single procedure where each analyte is represented by a particular pair of corresponding binding partners including antibodies, antigens, and the same or different polymeric carrier molecules comprising one or more targeting species.  
     [0089] Detection of different types of inflammatory indicators can be done in accordance with the invention by conjugating a plurality of different targeting species, preferably an antibody, proteins capable of forming complexes with corresponding antigens of different inflammatory indicators to the extended solid phase and to the mobile solid phase. The visual observation or other detection of any bound microspheres following the assay indicates that one or more of the different inflammatory indicators is present in the specimen, and this assay, if positive, can be followed by assays for individual inflammatory indicators of the different ones which were tested for simultaneously.  
     [0090] In another embodiment, the different inflammatory indicators can be both simultaneously and individually detected. For such a test, the different targeting species, preferably an antibody, corresponding to the antigens of a plurality of different types of inflammatory indicators are conjugated to microspheres which are correspondingly labelled with different metal elements.  
     [0091] When more than one type of the differently labelled microspheres are bound to the extended solid phase in the assay of the invention, they may be separately and simultaneously detected. In this way, the presence of corresponding individual types of inflammatory indicators in the specimen are simultaneously and separately detected. This is particularly relevant when determining profiles of inflammatory indicators, such as cytokine profiles or autoantibody profiles.  
     [0092] The extended solid phase and the dispersed microspheres which are conjugated with targeting species, preferably an antibody, prepared as described above as individual components useful for the assay method of the invention, can be provided in the form of a inflammatory indicator detection kit comprising such components. Different kits may be provided, which differ as to the targeting species, preferably an antibody, coatings, and thus as to the inflammatory indicator to be detected.  
     [0093] Such a kit may further include as an individual component, a latex solid phase for removing non-specific agglutinators from a specimen prior to the assay. The preferred latex for this purpose is polystyrene coated with gamma immunoglobulin.  
     [0094] The extended solid phase and mobile solid phase components of the kit of the invention may be provided with targeting species, preferably an antibody, bound to an antispecies antibody as disclosed above. Also as disclosed above, the microsphere component may be labelled, and the extended solid phase can take the form of part or all of a dipstick, syringe, tube or container, coated with targeting species, preferably an antibody, in at least one location, as disclosed.  
     [0095] Furthermore, the extended solid phase component may be provided with a plurality of different targeting species, preferably an antibody, capable of forming complexes with corresponding antigens of different types of inflammatory indicators. When it is so provided, the individual mobile solid phase component can be provided either to have the same plurality of targeting species, preferably an antibody, conjugated to each of the polymeric carrier molecules thereof, or a mixture of different types polymeric carrier molecules can be provided, each type having conjugated thereto a different targeting species, preferably an antibody, of said plurality; or in a further variation, the mobile solid phase component can be provided in the form of separate batches of polymeric carrier molecules, each batch having conjugated thereto a different targeting species, preferably an antibody, of said plurality.  
     [0096] Although it is preferred to use a polymeric carrier molecule comprising a targeting species and a labelling species as described herein above, the invention can also be exercised by using spherical particles including microspheres comprising a targeting species and optionally also a labelling species. Such microspheres may in particular be used in connection with a micro system comprising the kit according to the invention.  
     [0097] The kit according to the invention may also be applied in a micro system, such as a micro flow system described in WO 98/10267, one such system being marketed by Torsana Biosensor A/S, Denmark.  
     [0098] The principle behind the technology of a micro flow system is that by controlling the flow rate of at least two guiding streams, a sample stream can be accurately positioned on a target surface.  
     [0099] By controlling the flow ratios between the guiding streams and the sample stream, the sample stream can be focused to a width of a few mm. The sample stream carries the molecules to interact with the surface.  
     [0100] Immobilized lanes of the system are interacted with liquid streams containing unknown samples in the y-dimension.  
     [0101] Thousands of unique intersection points are created where reaction can occur.  
     [0102] The fact that no turbulence occurs in very narrow fluid streams results in diffusion being the only phenomena perturbing the focus of the sample stream. In effect, the technology permits the precise positioning of a liquid stream on a planar surface. In this way it is possible to position material with a precision of a few mm.  
     [0103] The microfluidic system allows for control of very narrow streams of liquid carrying the material (DNA, proteins, cells) to be interacted with the surface of the chip.  
     [0104] The micro flow system enables immobilization of reactant streams, in the present context streams of conjugate comprising the polymeric carrier and subsequent testing with one or several samples creating a weave with thousands of intersection points where chemical reactions occur and are detected. The entire procedure is performed in a closed fluidic system providing the flexibility in terms of sample—and reactant application, choice of immobilization—and detection chemistries, and array layout.  
     [0105] In particular when using the kit for testing for a plurality of inflammatory indicators and/or inflammatory indicators, such as providing profiles of inflammatory indicators or a profile of autoantibodies, the invention suitably includes the use of the kit in a microsystem.  
     [0106] In addition to micro systems, the kit according to the invention may also form part of a conventional macro system such as e.g. a lateral flow device. Examples of such devices are listed herein below.  
     [0107] U.S. Pat. No. 5,610,077 (Unilever) discloses a process for performing a specific binding assay. Accordingly, there is provided a method according to the invention for carrying out a specific binding assay comprising the steps of reacting (a) a sample under assay comprising an inflammatory indicator with (b) a specific binding partner for the inflammatory indicator being tested for, including a polymeric carrier molecule according to the invention, immobilised on a solid Support, and (c) a specific binding partner for the inflammatory indicator being tested for, including a polymeric carrier molecule according to the invention, which is conjugated to a detectable marker, thereby to form a sandwich complex by reaction between whatever quantities are present of the inflammatory indicator being tested for with reagents (b) and (c) and immobilising the marker to the support via the inflammatory indicator being tested for, the marker being detected or assayed as an index of the quantity of the inflammatory indicator being tested for present in the sample (a), the improvement which comprises using reagents (b) and (c) together for reaction with sample (a) and avoiding competitive interference between the binding reactions of the inflammatory indicator being tested for and reagents (b) and (c) by using as reagents (b) and (c), monoclonal antibodies each of narrow and different, non-interfering specificity, the binding reagent (b) being immobilised on the surface of a displacer body which occupies a majority of the volume of a well or cup containing aqueous liquid in which the specific binding reaction takes place.  
     [0108] The narrow specificity required of the antibody is a capacity to bind specifically with the inflammatory indicator under test but without preventing the binding reaction between the inflammatory indicator under test and its other specific binding partner. The conjugate between antibody and the enzyme or other marker, and/or the antibody (if any) which is coupled to the solid surface, may comprise a monoclonal antibody or other antibody of sufficiently narrow specificity to ensure that the desired assay reaction or reactions are not impeded by competition between the conjugate and the immunosorbent in their reactions with whatever quantities are present of the inflammatory indicator being tested for in the sample under assay. An antibody of sufficiently narrow specificity may also be obtained in the (polyclonal) immunoglobulins of antisera raised against discrete chemical or physical molecular fragments of the material under test, for example, antibody against Fc fragments (or against smaller peptide fragments) of immunoglobulins to be tested for, or against sub-units or peptides of protein antigens to be tested for. The object in each case is to ensure substantial freedom from interference which can arise particularly, for example, in carrying out immunoassays of the “sandwich” or “antiglobulin” test configurations.  
     [0109] In a “sandwich” test configuration, antigen under test can be specifically adsorbed to a first antibody bound to a solid surface, and a second antibody carrying an enzymic or other (e.g. fluorescent or radioactive) marker is specifically bound to the adsorbed antigen under test. Marker specifically so bound is used for measurement and determination of the antigen under test, e.g. by direct measurement, such as radiometry or fluorimetry, or exposure of enzyme marker to substrate followed by product measurement. Thus, in preferred sandwich tests, the two antibodies used can have different, non-interfering specificity with respect to the same antigen under test.  
     [0110] In an “antiglobulin” test configuration, sometimes also referred to as a “sandwich” test configuration, the position is analogous: the material under test is itself an immunoglobulin; the material bound to a solid surface is its corresponding antigen or hapten; and the material carrying the marker is an antiglobulin corresponding to the species and immunoglobulin type of the antibody under test. In preferred antiglobulin tests, the antiglobulin can have sufficiently narrow specificity as not to interfere with the subsequent adsorption of its corresponding globulin to the insolubilised antigen.  
     [0111] If antibodies from ordinary antisera raised against unmodified antigen (polyclonal antibodies) are used in sandwich or antiglobulin tests, there is a very likely risk that if all ingredients are mixed in a single step there will be interference between the two specific adsorption reactions. When such tests are carried out according to the present invention, using apparatus as described herein, such interference can be avoided either by using antibodies of narrow specificity as described, or else by ensuring that the binding of test material to the solid surface takes place before exposure of test material to the other (marker-conjugated) binding agent if there is a risk that binding by that other agent would prevent subsequent adsorption to the solid surface. Such a sequence can be ensured by arranging for slow release of the other (marker-conjugated) binding agent.  
     [0112] Particular instances of suitable assay specificities, antibody specificities, and slow-release forms of conjugated reagent (c) are described for example below.  
     [0113] It has also been found that in carrying out such specific binding assays, a worthwhile improvement in reaction kinetics can be obtained if the reaction liquid containing ingredients (a), (b) and (c) is contained in a well or cup of which the majority of the volume is occupied by a displacer body. (The use of inserts of various rod or ball shaped forms is known in connection with other kinds of immunoassay, as described in G. B. Specification Nos. 1,414,479 and 1,485,729.)  
     [0114] The displacer body can, for example, be of a shape substantially complementary to and slightly smaller than that of the cup or well, so that the liquid phase containing one of the specific binding reagents is approximately in the form of a shell occupying the space between the displacer and the cup or well. The displacer can be loose-fitting and not fixedly mounted, i.e. movable relatively to the cup or well, so that by relative motion between displacer and well the liquid between them can be given a stirring or agitation motion.  
     [0115] For example, a round well can have a round displacer therein with an external diameter slightly smaller than the diameter of the well. The presence of the displacer can reduce the space available for liquid in the well by a factor of for example 2-10, e.g. 3-8, comparing volumes based on similar liquid levels in the well, e.g. when filled to its normal operating level, or its maximum capacity. For example, a microtitre well designed to have 300 microlitre of liquid filled into it during a normal assay, can be used with a displacer leaving 30-150 microlitre liquid space, e.g. 50-100 microlitre.  
     [0116] The use of wells or cups together with displacers as described herein can improve the efficiency of the assay reaction steps because, in the first place, it allows more concentrated reagents to be used with no increase in the weight of reagent or decrease in the size of the microtitre wells, compared with the normal conditions encountered in microtitre wells of given size; and in the second place, it increases the sensitised surface area available to react with a given liquid reagent volume, so that comparatively faster adsorption kinetics can be achieved without having to increase specific reagent density on the sensitised surface or encountering problems of crowding.  
     [0117] A set of displacer bodies can be preferably present in certain embodiments of the invention, e.g. as an integral part of a lid which can be fitted onto a microtitre plate, e.g. a standard plate of 8 times 12 wells. The set can be large enough to fit all wells of the plate or a sub-set thereof, e.g. a row. The dimensions of the displacers and the volume of liquid to be dispensed into the well can be chosen relative to the well in the manner described above, and preferably so that the liquid to be tested is in contact with substantially the major part and preferably the whole inner surface of the well.  
     [0118] The immobilised specific binding partner (reagent (b) for the inflammatory indicator to be assayed can be immobilised on the wall of the well or cup in which the assay. reaction takes place. Alternatively, according to a feature of the invention independently capable of providing advantage and convenience in use, a liquid displacer, for example in the form of a stick, peg or stud, for dipping into a liquid assay reagent, can have an immunosorbent surface. This allows the portion of the assay materials needing to be carried over from one reagent to the next, and the associated manipulations, to be handled more easily than when the sensitised surface is part of a hollow well. An alternative form for such a liquid displacer body is a tuft of bristles or leaves of suitable material, or equivalent body with large surface area. A further alternative form is a stud or peg with relatively hollowed-out and projecting portions of its surface, e.g. with grooves and associated ribs, e.g. annular grooves. Such an arrangement can give robustness, increased sensitised surface area, and better reactivity.  
     [0119] Test apparatus according to related embodiments of the invention can thus comprise a set of sensitised liquid-displacer bodies of one or more of such forms, joined to a common handling-bar, link or lid, and for use in combination with a complementary set or sets of wells containing any of the remaining materials used in the assay. The several displacer bodies of the set can have the same or different sensitisation so that one or a plurality of different assay types can be carried through simultaneously. If desired, the displacer bodies can be removably and exchangeably mounted on the handling bar, link, or lid, so that sets of desired specificity can be built up at will from a common stock for carrying out large numbers of tests according to a desired pattern.  
     [0120] One advantage of such arrangements is that a number of displacer bodies can be sensitised in the same body of liquid ragent, avoiding fluctuating conditions of concentration, etc., resulting from dosing aliquots into wells.  
     [0121] The displacer bodies can, in this embodiment, be of any material suitable for the preparation of an immunosorbent by covalent bonding or adsorption: e.g. polystyrene, nylon, or cellulose acetate. (The nature of the displacer surface does not matter provided it is inert, when the sensitisation is to be on the well surface rather than the displacer surface.) Linkage of antibodies, antigens, etc., to the displacer bodies can be carried out by linking methods known in themselves, e.g. partial acid hydrolysis of nylon surface, substitution of exposed amine surface with glutaraldehyde, and coupling of material to be bound, e.g. antibody or antigen to immobilised aldehyde groups. Suitable methods among a wide variety are given for example by Inman &amp; Hornby (1972) Biochem. J. 129, 255; Campbell, Hornby &amp; Morris (1975) Biochim. Biophys. Acta 384, 307; Mattiasson &amp; Nilsson (1977) F.E.B.S. Letters 78, 251;, and G.B. patent specifications Nos. 1,470,955 and 1,485,122.  
     [0122] It can be seen that the invention also provides a kit of test materials for carrying out a specific protein-binding assay, comprising (i) an immobilised specific binding partner for an inflammatory indicator to be tested for, including a polymeric carrier molecule according to the invention, carried on a solid support, and (ii) a marker-conjugated specific binding partner for the inflammatory indicator to be tested for, including a polymeric carrier molecule according to the invention which can be added to a reaction liquid contacting immobilised reagent (i) either as a slow-release form, or in any form provided that the specific binding partners in reagents (i) and (ii) include an antibody of narrow specificity so that reagents (i) and (ii) do not interfere with each other&#39;s binding reactions with the inflammatory indicator to be tested. Optionally the kit can also comprise materials for later estimation of the amount of marker immobilised during the assay.  
     [0123] Reagent (i) can be immobilised on either a displacer body for a reaction well, or on a reaction well wall, as described above. A slow-release form of reagent (ii) can be for example a sucrose or equivalent glaze on a complementary surface of either the displacer or the well wall, also as described above. The narrow-specificity antibody can be selected for example from monoclonal antibodies in the manner already described.  
     [0124] U.S. Pat. No. 5,501,949 (Murex) pertains to a method for detection or quantitation of an analyte in a solution. Accordingly, the present invention in one embodiment pertains to a method comprising the steps of:  
     [0125] (a) contacting the solution with insoluble particles or a polymeric carrier molecule according to the invention having attached thereto a binding component specific for the analyte, so as to form a suspension comprising a first complex wherein the first complex comprises the analyte, the binding component and the insoluble particle;  
     [0126] (b) applying the suspension to at least a portion of a semi-permeable membrane having interstices of dimensions relative to the insoluble particles or the polymeric carrier molecules according to the invention and having a thickness such that the insoluble particles or the polymeric carrier molecules according to the invention are retained throughout the thickness of the semi-permeable membrane, the portion of the semi-permeable membrane retaining the particles or polymeric carrier molecules defining an assay zone;  
     [0127] (c) contacting the semi-permeable membrane containing the assay zone with a labeling component, preferably comprised in a particle or a polymeric carrier molecule according to the invention and forming part thereof, said particle or polymeric carrier molecule being capable of specifically binding to the first complex so as to form a second complex wherein the second complex comprises the first complex including the labeling component, wherein the semi-permeable membrane permits the labeling component which is not bound to the first complex to pass out of the assay zone; and  
     [0128] (d) measuring the signal produced by the labeling component of the second complex as an indicator of the presence or amount of the analyte present in the solution.  
     [0129] U.S. Pat. No. 5,155,021 (EASTMAN KODAK) discloses a diagnostic kit useful for the determination of a herpes simplex virus. Accordingly, the present invention in one embodiment relates to a diagnostic kit comprising:  
     [0130] i) polymeric particles which are substantially free of chemical or biological materials, having an average diameter of from about 0.01 to about 10 micrometers, and which have a surface area of from about 0.1 to about 600 m 2 /g of particles, which particles are capable of having inflammatory indicator antigen directly bound thereto,  
     [0131] ii) a disposable test device comprising a microporous membrane which has an average pore size of from about 0.1 to about 20 μm, and  
     [0132] iii) antibodies which bind to an inflammatory indicator according to the invention.  
     [0133] The antibodies may be labeled with enzyme or they may be unlabeled, in which case the kit further comprises labeled antibodies which bind to said inflammatory indicator. Test device comprises three test wells, each well having a microporous membrane prepared from a polyamide mounted therein. Polymeric particles are supplied on the microporous membrane of said test device—particles are supplied in an aqueous suspension.  
     [0134] The microporous membrane may be any suitable membrane, for example selected among the following commercially available pads  
     [0135] Whatman GF/D  
     [0136] Whatman F147-11  
     [0137] Whatman GF/AVA  
     [0138] Whatman 147-02  
     [0139] Whatman GF/DFA  
     [0140] Whatman F147-09  
     [0141] Whatman F075-17*  
     [0142] Millipore Rapid Q24*  
     [0143] Millipore Rapid Q27  
     [0144] Ahistrom A142  
     [0145] Furthermore, an absorbant pad may be provided to absorb the liquid from the aqueous suspension. Absorbant pads are for example  
     [0146] Whatman D28  
     [0147] Whatman 1.5WF*  
     [0148] Whatman 3MM CHR  
     [0149] Further examples of assay devices and diagnostic methods pertaining to the invention includes, but are not limited to:  
     [0150] An assay device preferably comprising:  
     [0151] i) a zone for applying a body fluid sample comprising an indicator of infection and/or inflammation, said zone comprising at least one movable reporter species capable of binding said indicator, said application zone being in liquid contact with  
     [0152] ii) a zone for detecting the presence, amount or concentration of said at least one reporter species bound to said indicator, said zone further comprising a binding species for immobilizing onto said detection zone at least a substantial amount of said indicator comprised in said body fluid sample, and optionally  
     [0153] iii) a positive control zone generating a positive control confirming the transfer of at least part of said body fluid sample from said application zone to said detection zone.  
     [0154] The at least one reporter species comprised in the sample application area preferably comprises an antibody comprising at least one tag, linker or marker that makes it possible at least to detect the presence of said marker, and preferably also makes it possible to quantifiably detect said antibody and/or said reporter species bound to said indicator.  
     [0155] The binding species of the detection zone is preferably also an antibody, but this antibody may not comprise any tag, label or marker. It is thus possible to immobilise onto the detection zone an amount of a quantifiably detectable reporter species that accurately reflects the amount of marker present in the body fluid sample. The at least one tag, label or marker used preferably allows both visual detection, by means of the generation of e.g. electromagnetic radiation or a visible colour, and quantification of e.g. the emitted electromagnetic radiation.  
     [0156] Movable reporter species shall be understood to comprise a reporter species capable of moving on e.g. a solid or semi-solid surface, e.g. when being applied to a lateral flow device.  
     [0157] In one embodiment of this aspect of the invention there is provided an assay device for detecting an indicator of infection and/or inflammation present in a body fluid sample, said device comprising:  
     [0158] i) a hollow casing having a body fluid sample application aperture and a test result observation aperture,  
     [0159] ii) a bibulous body fluid sample receiving member within said hollow casing to receive said body fluid sample applied to said sample application aperture,  
     [0160] iii) a test strip comprising a dry porous carrier such as nitrocellulose within said casing and extending from said bibulous body fluid sample receiving member to and beyond said test result observation aperture, said dry porous carrier having a test result zone observable through said observation aperture,  
     [0161] iv) at least one of said bibulous body fluid sample receiving member and said test strip containing upstream from said test result zone a detectable reporter species capable of specifically binding said indicator to form a first complex,  
     [0162] v) said reporter species comprising at least one particulate label, such as a dye sol, a metallic sol or a coloured latex particle, and optionally also at least one fluorescently detectable label, said label being released into a mobile form by said body fluid sample,  
     [0163] wherein mobility of said label within said test strip is facilitated by either coating at least a portion of said test strip upstream from said test result zone with a material comprising a polysaccharide, or drying said label onto a portion of said test strip upstream from said test zone in the presence of a material comprising a polysaccharide, in an amount effective to reduce interaction between said test strip and said label, and  
     [0164] wherein said dry porous carrier contains in said test result zone a means for binding said first complex, said means for binding comprising specific binding means immobilized in said test result zone, and  
     [0165] wherein migration of said body fluid sample from said bibulous sample receiving member into and through said dry porous carrier conveying by capillarity said first complex to said test result zone of said dry porous carrier whereat said binding means binds said first complex thereby to form a second complex, and  
     [0166] vi) determining the presence, amount or concentration of said second complex being observable through said test result observation aperture.  
     [0167] In another embodiment there is provided an assay device for detecting an indicator of infection and/or inflammation in a body fluid sample, said device comprising a solid support including at least one detectable reporter species on a test area of the solid support, said at least one detectable reporter species being capable of binding said marker, said reporter species further comprising a liposome or a microcapsule comprising a visible particulate dye compound and optionally also a fluorescently detectable marker.  
     [0168] In yet another embodiment there is provided an assay device comprising  
     [0169] i) a sample application area comprising a predetermined amount of a reporter species comprising an antibody capable of binding said indicator deposited thereon, said area being in fluid communication with  
     [0170] ii) a reaction zone comprising a mobilizable reporter species comprising an antibody capable of binding said indicator, said reporter species further comprising at least one visually detectable particle and/or at least one fluorescently detectable particle, and  
     [0171] iii) a detection zone comprising a reporter species comprising an antibody capable of binding said indicator,  
     [0172] wherein, when said body fluid sample comprising said indicator is applied to said sample application area, a threshold amount of the indicator is bound to said antibody and thereby prevented from binding to the antibody being present in the reaction zone, and  
     [0173] wherein the indicator remaining unbound in said body fluid sample passes from the sample application area through said reaction zone, where it is bound to said mobilizable reporter species comprising i) an antibody capable of binding said indicator, and ii) at least one visually detectable particle and/or at least one fluorescently detectable particle, and  
     [0174] wherein the indicator bound to the mobilizable reporter species is brought into contact with the detection zone, where the indicator is bound to said reporter species comprising said antibody capable of binding said indicator, and  
     [0175] wherein said binding of said indicator results in immobilization of said mobilizable reporter species further comprising i) an antibody capable of binding said indicator, and ii) at least one visually detectable particle and/or at least one fluorescently detectable particle.  
     [0176] The present invention employs targeting species, labelling species, and more generally molecular species. The term “molecular species” in the context of the present invention is used to denote, for example: molecules or ionic species which serve as labels or markers (such as enzymes, or fluorescent or luminescent species); or molecules which serve as targetting species, i.e. molecules which are capable of binding selectively or specifically to one or more target molecules, moieties, receptors or epitopes (examples of such targetting species being haptens or hapten conjugates, antigens, antibodies, nucleotide sequences and hormones). The invention in one particular embodiment relates to simultaneously or sequentially using any one or both of a first targeting species and a second targeting species including polyclonal and monoclonal antibodies that may be, respectively, i) identical or non-identical, and ii) specific for the same or different epitopes of antigenic determinants characteristic for an inflammatory indicator according to the invention.  
     [0177] Molecular species according to the invention are to be found among numerous different types of substances, examples being: proteins, such as ferritin, phycoerythrins, phycocyanins or phycobilins; enzymes, such as horseradish peroxidase, alkaline phosphatase, glucose oxidases, galactosidases or ureases; toxins; drugs; dyes; fluorescent, luminescent, phosphorescent or other light-emitting substances; metal-chelating substances, such as iminodiacetic acid, ethylenediaminetetraacetic acid (EDTA), diethylenetriaminepentaacetic acid (DTPA) or desferrioxamine B; substances labelled with a radioactive isotope; or substances labelled with a heavy atom.  
     [0178] Many molecular species will be able to serve as labelling species in conjugates according to the invention. Additional examples of labelling species are listed herein immediately below.  
     [0179] i) Fluorescent substances selected from, e.g., fluorescein (suitably as fluorescein isothiocyanate, FITC), fluoresceinamine, 1-naphthol, 2-naphthol, eosin, erythrosin, morin, ophenylenediamine, rhodamine and 8-anilino-1-naphthalenesulfonic acid.  
     [0180] ii) Radioactive isotopes of relevance may be selected, for example, among isotopes of hydrogen (i.e. tritium,  3 H), carbon (such as  14 C), phosphorus (such as  32 P), sulfur (such as  35 S), iodine (such as  131 I), bismuth (such as  212 Bi), yttrium (such as  90 Y), technetium (such as  99 Tc), palladium (such as  109 Pd) and samarium (such as  153 Sm).  
     [0181] iii) Heavy atoms of relevance may be selected, for example, among Mn, Fe, Co, Ni, Cu, Zn, Ga, In, Ag, Au, Hg, I, Bi, Y, La, Ce, Eu and Gd. Gold (Au) may be used in combination with silver (Ag) as an enhancement reagent and Au is a particularly useful heavy atom in many cases.  
     [0182] Molecular species may also be in the form of targetting species capable of selectively binding to, or selectively reacting with, a complementary molecule or a complementary structural region of a material of biological origin. Examples of relevant targetting species are, for example: antigens; haptens; monoclonal or polyclonal antibodies; gene probes; natural or synthetic oligo- or polynucleotides; certain natural or synthetic mono-, oligo- or polysaccharides; lectins; avidin or streptavidin; biotin; growth factors; hormones; receptor molecules; or protein A or protein G. For examples of appropriate antibodies, reference is made to the working examples given herein. Examples of relevant hormones may be selected from steroid hormones (e.g. estrogen, progesterone or cortisone), amino acid hormones (e.g. thyroxine) and peptide and protein hormones (e.g. vasopressin, bombesin, gastrin or insulin).  
     [0183] The present invention may in one embodiment employ standard immunohistochemical or cytochemical detection procedures for the detection of the predetermined inflammatory indicator, or any suitable modifications of such procedures. Accordingly, the invention may employ any assay resulting in the recognition of an antigenic determinant mediated by an immunochemical reaction of the antigenic determinant with a specific so-called primary antibody capable of reacting exclusively with the target antigenic determinant in the form of a predetermined inflammatory indicator.  
     [0184] The primary antibody is preferably labelled with an appropriate label capable of generating directly or indirectly—a detectable signal. The label is preferably an enzyme, an isotope, a fluorescent group or a heavy metal such as gold.  
     [0185] In another embodiment, the invention employ the detection of the primary antibody by immunochemical reaction with specific so-called secondary antibodies capable of reacting with the primary antibodies. In this case the secondary antibodies are preferably labelled with an appropriate label such as an enzyme, an isotope, a fluorescent group or a heavy metal such as gold.  
     [0186] In yet another embodiment, the present invention employs a so-called linker antibody as a means of detection of the predetermined inflammatory indicator. This embodiment exploits that the immunochemical reaction between the target antigenic determinant in the form of the predetermined inflammatory indicator and the primary antibody is mediated by another immunochemical reaction involving the specific linker antibody capable of reacting simultaneously with both the primary antibody as well as another antibody to which enzymes have been attached via an immunochemical reaction, or via covalent coupling and the like.  
     [0187] In yet another embodiment according to the present invention, the immunochemical reaction between a target antigenic determinant in the form of a predetermined inflammatory indicator and the primary antibody, or alternatively, between the primary antibody and the secondary antibody, is detected by means of a binding of pairs of complementary molecules other than antigens and antibodies. A complementary pair such as e.g. biotin and streptavidin is preferred. In this embodiment, one member of the complementary pair is attached to the primary or secondary antibody, and the other member of the complementary pair is contacted by any suitable label such as e.g. an enzymes, an isotope, a fluorescent group or a heavy metal such as gold.  
     [0188] A sample potentially containing a predetermined inflammatory indicator to be detected is preferably brought into contact with a polymeric carrier molecule comprising a labelled or non-labelled primary antibody capable of detecting said inflammatory indicator. The antibody becomes immunochemically bound to the predetermined inflammatory indicator comprised in the sample. The inflammatory indicator is then bound to a solid support containing the same or another labelled or non-labelled primary antibody capable of detecting said inflammatory indicator. When a lateral flow device is used, the labelled antibody bound to the predetermined inflammatory indicator is detected by reaction with appropriate reagents, depending on the choice of detection system.  
     [0189] The sample comprising the predetermined inflammatory indicator to be detected and optionally also quantified is in one embodiment of the invention subjected to at least one of the detection reactions described below. The choice of detection reaction is influenced by the targetting species in question as well as by the labeling species it is decided to use.  
     [0190] When an enzyme label is used as a labelling species, the inflammatory indicator bound to a solid support as described herein above is treated with a substrate, preferably a colour developing reagent. The enzyme reacts with the substrate, and this in turn leads to the formation of a coloured, insoluble deposit at and around the location of the enzyme. The formation of a colour reaction is a positive indication of the presence of the inflammatory indicator in the sample.  
     [0191] When a heavy metal label such as gold is used, the sample is preferably treated with a socalled enhancer in the form of a reagent containing e.g. silver or a similar contrasting indicator. Silver metal is preferably precipitated as a black deposit at and around the location of the gold. When a fluorescent label is used, a developing reagent is normally not needed.  
     [0192] It may be desirable to introduce at least one washing step after which some of the constituents of the sample are preferably coloured by reaction with a suitable dye resulting in a desirable contrast to the colour provided by the labeling species in question. After an optional final washing step, the specimen is preferably coated with a transparent reagent to ensure a permanent record for the examination.  
     [0193] Detection of the labeling species in question preferably indicates both the localization and the amount of the target antigenic determinant in the form of the predetermined inflammatory indicator. The detection may be performed by visual inspection, by light microscopic examination in the case of enzyme labels, by light or electron microscopic examination in the case of heavy metal labels, by fluorescence microscopic examination, using irradiated light of a suitable wavelength in the case of fluorescent labels, and by autoradiography in the case of an isotope label. Detection of the presence of the inflammatory indicator—and preferably also the amount of the indicator—by visual inspection of the sample is preferred.  
     [0194] In a particularly preferred embodiment, the visual detection is based on a cut-off point above which one colour indicates the presence of the inflammatory indicator above a certain minimum amount (cut-off point), and below which cut-off point another colour indicates that the inflammatory indicator is present in an amount of less than that indicated by the cut-off point. When fluorescent markers are used the amounts of inflammatory indicator detected is directly correllatable with the fluorescence measured by a detection unit.  
     [0195] Enzyme-Linked Immuno-Sorbent Assays (ELISA) in which the inflammatory indicator is detected directly, initially by detection by a targeting species in the form of an antigen, hapten or antibody, and subsequently by means of an enzyme which is linked such as covalently coupled or conjugated either—when an antigen or hapten is to be determined—to an antibody which is specific for the antigen or hapten in question, or—when an antibody is to be determined—to an antibody which is specific for the antibody in question—are particularly preferred for detecting the predetermined inflammatory indicator according to the present invention.  
     [0196] In one preferred embodiment, the predetermined inflammatory indicator to be detected is bound or immobilized by immunochemically contacting the indicator with a so-called “catching” antibody attached by e.g. non-covalent adsorption to the surface of an appropriate material such as a solid support. Examples of such solid support materials are polymers such as e.g. nitrocellulose or polystyrene, optionally in the form of a stick, a test strip, a bead or a microtiter tray.  
     [0197] Commercially available nitrocellulose membranes are for example  
     [0198] Millipore Hi-Flow Plus HF07504  
     [0199] Millipore Hi-Flow Plus HF09004  
     [0200] Millipore Hi-Flow Plus HF12004  
     [0201] Millipore Hi-Flow Plus HF13504  
     [0202] Millipore Hi-Flow Plus HF18004  
     [0203] Sartorius Unisart CN40  
     [0204] Sartorius Unisart CN90  
     [0205] Sartorius Unisart CN200*  
     [0206] A suitable enzyme-linked specific antibody is allowed to bind to the immobilized inflammatory indicator to be directly detected. The amount of bound specific antibody, i.e. a parameter that is correlatable to the immobilized indicator, is determined by adding a substance capable of acting as a substrate for the linked enzyme. Enzymatic catalysis of the substrate results in the development of a detectable signal such as e.g. a characteristic colour or a source of electromagnetic radiation. The intensity of the emitted radiation can be measured e.g. by spectrophotometry, by colorimetry, or by comparimetry. The determined intensity of the emitted radiation is correlatable—and preferably proportional—to the quantity of the predetermined inflammatory indicator to be detected. Examples of preferred enzymes for use in assays of this type are e.g. peroxidases such as horseradish peroxidase, alkaline phosphatase, glucose oxidases, galactosidases and ureases.  
     [0207] Immunochemical assays of a type analogous to ELISA, but employing other means of detection, are also suitable for detecting directly an inflammatory indicator according to the present invention. Such assays are typically based on the use of specific antibodies to which fluorescent or luminescent labelling species are covalently attached. So-called “time-resolved fluorescence” assays are particularly preferred and typically employ an europium ion label or an europium chelator, even though certain other lanthanide species or lanthanide chelators may also be employed. In contrast to many traditional fluorescent labelling species the fluorescence lifetime of lanthanide chelates is generally in the range of 100-1000 microseconds. In comparison, fluorescein has a fluorescence lifetime of only about 100 nanoseconds or less. By making use of a pulsed light source and a time-gated fluorometer, the fluorescence of lanthanide chelate compounds can be measured in a time-window of about 200-600 microseconds after each excitation. A main advantage of this technique is the reduction of background signals which may arise from more short-lived fluorescence of other substances present in the analysis sample or in the measurement system.  
     [0208] Additional assays employing immunochemical detection techniques capable of being exploited in the present invention belong to the group of “immunoblotting” procedures, such as e.g. “dot blot” and “western blot” procedures. In the western blot procedure, which is typically employed for the analysis and identification of antigenic polypeptides or proteins, the predetermined inflammatory indicator of interest is preferably transferred or fixed to a solid support or a membrane sheet such as e.g. a sheet of nitrocellulose or chemically treated paper to which the inflammatory indicator is capable of binding. Binding may be mediated by a targeting species such as e.g. an antibody bound to the support. An appropriate targeting species in the form of a specific antibody is initially added and later followed by a labelled second antibody against the first antibody. Labelled protein-A may be added as an alternative to the addition of labelled second antibody. The label is preferably a radioisotope, a fluorescent dye, an enzyme or a heavy metal such as gold or a colloid thereof. The presence and location of the inflammatory indicator is detected in an appropriate manner as described herein above.  
     [0209] “Connecting moiety” as used herein denotes any chemical species capable of forming a conjugate by binding a molecular species and a polymeric carrier molecule. The establishment, on the polymeric carrier molecule, of covalently bound reactive moieties deriving from divinyl sulfone, and the establishment of covalent bonds between, on the one hand, such moieties, and, on the other hand, molecular species as defined herein, are particularly preferred according to one embodiment of the invention.  
     [0210] Additional examples of connecting moieties, or reactive, functional groups, are chemical species comprising as a reactive group compounds such as e.g. 4-fluoro-3-nitrophenyl azide, acyl azides such as benzoyl azide and p-methylbenzoyl azide, azido formates such as ethyl azidoformate, phenyl azidoformate, sulfonyl azides such as benzenesulfonyl azide, phosphoryl azides such as diphenyl phosphoryl azide and diethyl phosphoryl azide, diazo compounds such as diazoacetophenone and 1-trifluoromethyl-1-diazo-2-pentanone, diazoacetates such as t-butyl diazoacetate and phenyl diazoacetate, beta-keto-alphadiazoacetates such as t-butyl alpha diazoacetoacetate, aliphatic azo compounds such as azobisisobutyronitrile, diazirines such as 3-trifluoromethyl-3-phenyidiazirine, ketenes (—CH═C═O) such as ketene and diphenylketene, photoactivatable ketones such as benzophenone and acetophenone, peroxy compounds such as di-t-butyl peroxide, dicyclohexyl peroxide, diacyl peroxides such as dibenzoyl peroxide and diacetyl peroxide, and peroxyesters such as ethyl peroxybenzoate.  
     [0211] In the case of a vinyl group being the reactive, functional group, the reactivity of the vinyl group in a chemical species, such as e.g. divinyl sulfone, will generally require that the reactive functionality on the polymeric carrier, i.e. the group with which a vinyl group of erg. a divinyl sulfone will react to form a covalent bond, is a nucleophilic function.  
     [0212] Suitable polymeric carriers will then be, for example, polymeric carriers with functional groups such as:  
     [0213] i) O −  (e.g. deprotonated phenolic hydroxy groups, such as deprotonated aromatic hydroxy groups in tyrosine residues of polypeptides or proteins),  
     [0214] ii) S −  (e.g. deprotonated thiol groups on aromatic rings or aliphatic groups, such as deprotonated thiol groups in cysteine residues of polypeptides or proteins),  
     [0215] iii) OH (e.g. aliphatic hydroxy groups on sugar rings, such as glucose or other monosaccharide rings in oligo- or polysaccharides; or alcoholic hydroxy groups in polyols, such as polyethylene glycols; or hydroxy groups in certain amino acid residues of polypeptides or proteins, such as serine or threonine residues),  
     [0216] iv) SH (e.g. thiol groups in cysteine residues of polypeptides or proteins), primary amino groups (e.g. in lysine or ornithine residues of polypeptides or proteins; or in amino-substituted sugar rings in certain polysaccharides or derivatives thereof, such as chitosan) or secondary amino groups (e.g. in histidine residues of polypeptides or proteins).  
     [0217] Accordingly, the functional group in question on molecular species in the context of the invention will also normally be a nucleophilic function, such as a nucleophilic function of one of the above-described types.  
     [0218] In one embodiment the present invention relates to a kit comprising a conjugate comprising a polymeric carrier molecule to which one or more molecular species are covalently attached, each via a connecting moiety in the form of a linking group.  
     [0219] One type of preferred linking groups are derived from divinyl sulfone. In this case the attachment of each of the linking groups to the polymeric carrier molecule is generated by a covalent linkage formed between one of the two vinyl groups of a divinyl sulfone molecule and a reactive functionality on the carrier molecule, and the attachment of a molecular species to the linking group being via a covalent linkage formed between the other vinyl group originating from the divinyl sulfone molecule and a functional group on the molecular species.  
     [0220] In particularly interesting conjugates of the latter type according to the invention, the polymeric carrier molecule further has covalently attached thereto one or more moieties derived from divinyl sulfone, each of which moieties is attached via a covalent linkage formed between one of the two vinyl groups of a divinyl sulfone molecule and a reactive functionality on the polymeric carrier molecule, at least one such said moiety in its attached state having the remaining vinyl group free and capable of reaction with a further molecular species having a functional group which is reactive towards the free vinyl group.  
     [0221] The molecular species attached to a conjugate according to the invention may be divided up into, for example, molecular species having molecular weights of about 2,000 or below, and molecular species having molecular weights of about 2,000 or above. In the former case, the polymeric carrier molecule of the conjugate may have from I to about 10,000 molecular species covalently attached thereto, for example from about 10 to about 1000 molecular species, such as from about 20 to about 500 molecular species covalently attached thereto. In the latter case, i.e. for molecular species of molecular weight about 2,000 or above, the polymeric carrier molecule of the conjugate may have from 1 to about 1000 molecular species covalently attached thereto, for example from 1 to about 500 molecular species, such as from 1 to about 100, from 2 to about 50, or from about 10 to about 50 molecular species covalently attached thereto.  
     [0222] “Polymeric carrier molecule” according to the invention is any polymer capable of binding a molecular species, or capable of modification with the purpose of binding a molecular species. Polymeric carrier molecules and conjugates comprising such polymeric carrier molecules according to the invention may be chosen from a wide variety of polymers, including:  
     [0223] i) natural and synthetic polysaccharides, as well as derivatives thereof, for example dextrans and dextran derivatives, starches and starch derivatives, cellulose derivatives, amylose and pectin, as well as certain natural gums and derivatives thereof, such as gum arabic and salts of alginic acid,  
     [0224] ii) homopoly(amino acid)s having suitable reactive functionalities, such as polylysines, polyhistidines or polyornithines;  
     [0225] iii) natural and synthetic polypeptides and proteins, such as bovine albumin and other mammalian albumins; and  
     [0226] iv) synthetic polymers having nucleophilic functional groups, such as polyvinyl alcohols, polyallyl alcohol, polyethylene glycols and substituted polyacrylates.  
     [0227] One group of preferred polymeric carrier molecules for the purposes of the invention are polysaccharides and derivatives thereof, for example: dextrans, carboxy-methyl-dextrans, hydroxyethyl- and hydroxypropyl-starches, glycogen, agarose derivatives, and hydroxyethyl- and hydroxypropyl-celluloses.  
     [0228] Dextrans have proved to be a group of particularly suitable polymers in connection with the present invention, and dextrans are presently representing one group of most preferred polymers.  
     [0229] The conjugates according to the present invention preferably have no net charge, since the presence of a net positive or negative charge may lead, inter alia, to undesirable non-specific binding of the conjugates to substances and/or materials other than those of interest. In many cases this condition will, unless charged molecular species are introduced, be fulfilled simply by ensuring that the polymeric carrier itself possesses no net charge. In a further embodiment of the invention, the polymeric carrier molecule of a reagent or conjugate of the invention is, in its free state, substantially linear and substantially uncharged at a pH in the range of about 4 to about 10. This pH interval is of practical relevance for the vast majority of immunochemical procedures, hybridization procedures and other applications of, notably, conjugates of the invention. Among various polymers which meet this criterion, are, for example, numerous polysaccharides and polysaccharide derivatives, e.g. dextrans and hydroxyethyl- and hydroxypropylcelluloses.  
     [0230] Depending on the use to which a reagent or conjugate of the invention is to be put, conjugates of the invention may be based on polymeric carrier molecules having molecular weights ranging from rather low to very high. In a further embodiment of the invention the polymeric carrier molecule may have a peak molecular weight in the range of from about 1,000 to about 40,000,000.  
     [0231] Peak molecular weights which are of considerable interest are in the range of about 1,000 to about 80,000, and in the range of about 80,000 to about 2,000,000. A peak molecular weight of particular interest, notably in the case of dextrans as polymeric carriers, is a peak molecular weight of about 500,000.  
     [0232] The term “peak molecular weight” (also denoted “peak average molecular weight”) as employed herein denotes the molecular weight of greatest abundance, i.e. that molecular weight (among a distribution of molecular weights) which is possessed by the greatest number of molecules in a given sample or batch of the polymer. It is quite normal to characterize numerous types of polymers in this manner, owing to the difficulty (particularly for the highest molecular weights) of obtaining or preparing polymer fractions of very narrow molecular weight distribution. In the case of numerous commercially available polymers which are of interest in the context of the invention, for example dextrans, the manufacturer or distributor will be able to provide reliable peak molecular weight data (determined, for example, by gel-permeation chromatography) which can provide a basis for the selection of a polymer fraction suitable for the preparation of a particular type of reagent or conjugate.  
     [0233] Peak molecular weight values cited herein refer to the peak molecular weight of the free polymer in question, and take no account of, for example, the possible formation of cross-linked polymer units, e.g. as a result of cross-linking of two or more polymer molecules by reaction with e.g. divinyl sulfone during a process according to the invention for the preparation of a reagent or conjugate of the invention; such cross-linked units will, on average, have higher molecular weights than the individual free polymer molecules from which they are formed.  
     [0234] Conjugates according to the present invention may be tailored to meet a very wide range of requirements with regard to peak molecular weight of the polymer and the content of free, reactive vinyl groups. A further aspect of the invention relates to conjugates comprising a polymeric carrier molecule having a peak molecular weight of about 500,000 or about 2,000,000, or having a peak molecular weight in any one of the following ranges: From about 1,000 to about 20,000; from about 20,000 to about 80,000; from about 80,000 to about 500,000; from about 500,000 to about 5,000,000; and from about 5,000,000 to about 40,000,000;  
     [0235] The polymeric carrier molecules preferably have a content of free, reactive vinyl groups in the range of about 1 to about 5,000 μmoles of vinyl groups per gram of polymeric carrier, such as in any of the following sub-ranges (expressed in μmoles of vinyl groups per gram of polymeric carrier): From about 1 to about 50; from about 50 to about 300; from about 300 to about 1,000; and from about 1,000 to about 5,000.  
     [0236] In one further embodiment of the present invention there is provided a kit comprising a conjugate comprising a polymeric carrier having  
     [0237] i) a peak molecular weight of about 500,000 or about 2,000,000, or having a peak molecular weight in any one of the following ranges: From about 1,000 to about 20,000; about 20,000 to about 80,000; about 80,000 to about 500,000; about 500,000 to about 5,000,000; or about 5,000,000 to about 40,000,000; and  
     [0238] ii) a total content of molecular species and, where relevant, free vinyl groups in the range of about 1 to about 5,000 μmoles of a) molecular species and, where relevant, b) vinyl groups per gram of polymeric carrier, such as in any of the following subranges (expressed in μmoles of molecular species plus, where relevant, μmoles of vinyl groups per gram of polymeric carrier): From about 1 to about 50; from about 50 to about 300; from about 300 to about 1,000; or from about 1,000 to about 5,000.  
     [0239] The samples according to the present invention are suitably conjunctival fluid, nasal secretion, pharyngeal secretion, sputum, mouth wash, bronchial wash, cervical and vaginal secretion, urine, blood, faeces, synovia, cerebrospinal fluid, ascites, vesicles, lesion exudate, and swabs from for example ulcers or conjunctiva.  
     [0240] Inflammatory indicators including inflammatory mediators according to the invention are selected from, but not limited to, the group consisting of cytokines and autoantibodies, including cytokines belonging to inflammatoric systems such as e.g. the IL-1 system; including IL-1α and IL-1β IL-1ra, and autoantibodies against IL-1α, sIL1-RI and sIL1-RII, the TNFα system; including, but not limited to TNFα antagonists sTNFR p55 and p75, and IL-6 and autoantibodies against IL-6, cytokines belonging to immunoregulatory systems such as mediators related to the Th1/Th2 balance: IL-12, sIL-4R, Th1 cytokines: TNFβ(LT), INFγ, Th2 cytokines: IL-4, IL-10, and additional mediators such as e.g. IL-2, RANTES, IL-8, sIL-2R, IL-18, IFNα and eosinofil cationic protein.  
     [0241] The below listed cytokines represent one preferred group of inflammatory indicators according to the present invention.  
                                       Cytokine   Produced by for example   Most important effects                  IL-1α/IL-1β   Monocytes, macrophages, NK-cells,   Activates T-, B- and NK-cells, endothelial           T- and B-cells, neutrophil granolocytes,   cells, osteoclasts and bone marrow cells.           keratinocytes, endothelial cells,   Numerous effects on inflammatory cells,           astrocytes, fibroblasts, synovial cells,   mediates fever           smooth muscle cells, mesangial cells       IL-1ra   Monocytes, macrophages   Antagonizes effects of IL-1α/β on receptor               levels       IcIL-1ra   Neutrophil granulocytes, keratinocytes   Is being utilised on a trial basis in patients               with sepsis, chronic arthritis       IL-2   Th1-cells   Enhances growth of T-, B- and NK-cells       IL-3   Th2-cells, keratinocytes, mastcells   Stimulates basophilic granulocytes       IL-4   Th2-cells, basophilic granulocytes and   Enhances growth of T- and B-cells.           mastcells, monocytes/macrophages,   Suppresses macrophage functions.           B-cells   Induces shift of isotype in B-cells (IgE- and               IgG4-production)       IL-5   Th2-cells, mastcells   Stimulates eosinophil granulocytes       IL-6   Monocytes, macrophages, Th2-cells,   As IL-1 with certain exceptions.           fibroblasts, endothelial cells, certain   Most important activator of acut-phase           cancer cells   protein production from hepatocytes.               Growth factor for myeloma cells       IL-7   Stroma cells in bone marrow, foetal   Growth- and maturation of pre-T and pre-           liver cells, cells in intestinal epithelium   B-cells. Coactivates T- and NK-cells       IL-8   α-chemokine   α-chemokine       IL-9   Th2-cells   Growth factor for mastcells (with IL-3), T               cells, megakaryocytes, pre-erythrocytes               (with erythropoietin). Coactivates mast-               cells, T-cells and B-cells (IgE-production)       IL-10   Monocytes, macrophages, Th0-, Th2-   Coactivates certain T- and B-cell sub-           cells, B-cells (especially EBV in-   populations and mastcells.           fected), mastcells, keratinocytes, epi-   Suppresses Th1-cells (IFNγ-production)           dermal cells   and certain monocyte/macrophage- and               NK-cell functions       IL-11   Fibroblasts, stroma cells in bone mar-   As IL-6           row, foetal lung cells, trophoblasts       IL-12   Monocytes, macrophages, B-cells,   Activates Th1-cells (IFNγ-production) and           dendritic cells, Langerhan cells,   NK-cells           keratinocytes, neutrophil granulocytes       IL-13   T-cells   Stimulates B-cell growth (induces IgE,               IgG4)       IL-14   T-cells   Coactivates B-cells (prolifera-               tion/differentiation), but inhibits Ig-secretion       IL-15   Monocytes, macrophages, certain T-   As IL-2           cells, fibroblasts, endothelial and           epithelial cells, myocytes, stroma cells           in bone marrow, placenta cells       IL-16   T-cells, eosinophil granulocytes   Chemotactic for CD4 T-cells. Activates               CD4 T-cells and monocytes       IL-17   Th-cells   Activates T-cells, fibroblasts (ICAM-1 ex-               pression). Induces IL-6 and IL-8       IL-18   Monocytes, macrophages, Kupffer   Activates Th1- and NK-cells (induces IFNγ)           cells, osteoblasts       LIF   Monocytes, macrophages, T-cells,   As IL-6           stroma cells in bone marrow, fibro-           blasts, astrocytes       PDGF   Thrombocytes, monocytes, macro-   Activates vascular smooth muscle cells,           phages, endothelial cells, smooth   endothelial- and epithelial cells, gliacells,           muscle cells, fibroblasts, neurons   chondrocytes, fibroblasts, neutrophilocytes               and monocytes.               Chemotactic for the above mentioned cells       NGF   Macrophages, astrocytes, nerve cells,   Activates B-cells, basophilic granulocytes           smooth muscle cells, fibroblasts   and sympathetic and sensory neurons       TGFβ (sev-   Megakaryocytes, thrombocytes,   Activates B-cells (induces IgA), osteo-       eral forms)   monocytes, macrophages, T-cells,   blasts, fibroblasts and other cells.           endothelial cells, fibroblasts, osteo-   Inhibits growth of endothelial and epithelial           blasts, chondrocytes, smooth muscle   cells, osteoclasts, T-cells and NK-cells           cells       TNF   Monocytes, macrophages incl. tissue   Activates T-, B- and NK-cells, neutro- and           macrophages, Th1- and Tc-cells, B-   eosinophil granulocytes, endothelial cells,           cells, NK-cells, neutrophilocytes,   osteoclasts.           keratinocytes, smooth muscle cells   Cytotoxic for transformed and virus in-               fected cells. Mediates fever       LTα-/LTβ   Th1-cells, (B-cells)   As TNF       FasL   Th1- and Tc-cells, NK-cells   Cytotoxic for virus infected cells, incl. HIV-               infected cells                   IFNα (&gt;16   Virus infected leukocytes, T- and B-   Antiviral activity.       subtypes)   cells, monocytes, macrophages   Antiproliferative and antitumour effects.               Activates macrophages, NK-cells and B-               cells       IFNβ   Many virus infected cell types, fibro-   Antiviral activity. Activates NK-cells           blasts       IFNγ   Th-1- and Tc-cells, endothelial cells,   Activates fibroblasts, monocytes/macro-           smooth muscle cells   phages, T-, B- and NK-cells (induces IgG).               Induces MHC II (many cell types).               Suppresses cell growth in general       SCF   Stroma cells in bone marrow, endo-   Activates and differentiates marrow stem-           thelial cells, fibroblasts, Sertoli cells   cells, mastcells       GM-CSF   Th2- cells, fibroblasts, endothelial   Activates, differentiates precursors of T-           cells, macrophages, mastcells,   cells, monocytes, neutrophil granulocytes           neutrophil granulocytes, eosinophil           granulocytes       G-CSF   Monocytes, macrophages, fibroblasts,   Activates, differentiates precursors of           endothelial cells, T-cells, neutrophil   neutrophil granulocytes           granulocytes       M-CSF   Monocytes, macrophages, fibroblasts,   Activates, differentiates precursors of           endothelial cells   monocytes       α-   Monocytes, macrophages, T-cells,   Chemotactic for neutrophil granulocytes, T-       chemokines   endothelial cells, several other cells   cells, basophilic granulocytes,       (CXC)       keratinocytes       β-   Monocytes, macrophages, T- and B-   Chemotactic for monocytes/macrophages,       chemokines   cells, thrombocytes, endothelial cells,   NK-cells, eosinophil and basophilic       (CC)   smooth muscle cells, mastcells, fibro-   granulocytes.           blasts   Inhibits infection of CD4-positive mono-               cytes/macrophages with HIV (that uses β-               chemokine receptors as co-activators by               the infection)       Lymfotactin   T-cells   Chemotactic for T-cells       VIP/PACAP   Nerve cells (in for example thymus,   Immunosuppressive by inhibition of IL-2       and other   spleen and lymphnodes), T- and B-   and IL-4 production.       neuropeptides   cells, eosinophilocytes, mastcells,   Indirect immunostimulation by inhibition of           neutrophilocytes   IL-10                  
 
     [0242] Abbreviations and Definitions  
                                      CC:   β-chemokines (for example macrophage inflammatory protein           (MIP)-1, monocyte chemoattractant protein (MCP)-1-4,           regulated on activation, normal T expressed and secreted           (RANTES)       CXC:   α-chemokines (for example IL-8)       CSF:   colony-stimulating factor       FasL:   Fas-ligand       G-CSF:   granolocyte-CSF       GM-CSF:   granolocyte-macrophage-CSF       icIL-1ra:   intracellular IL-1ra       IFN:   interferon       IL:   interleukine       LT:   lymphotoxin       M-CSF:   macrophage-CSF       MHC:   major histocompatibility complex       NGF:   nerve growth factor       NK-cells:   natural killer cells       PACAP:   pituitary adenylyl cyclase-activating peptide       SCF:   stem-cell factor       TGF:   transforming growth factor       TNF:   tumour necrosis factor       VIP:   vasoactive intestinal peptide                  
 
     [0243] In particular the present invention may be used for providing a cytokine profile, i.e. a measurement of at least two cytokines, such as for example at least four cytokines, whereby the presence and relative concentration of each cytokine may be indicative of a disease or of the prognosis of a disease.  
     [0244] Furthermore, the inflammatory indicators may include immune system indicators, such as autoantibodies. By the present invention it is possible to detect and quantify autoantibodies related to immune diseases or conditions related to immune diseases.  
     [0245] In a preferred embodiment the autoantibodies are selected from, but not limited to, the autoantibodies mentioned below in relation to the disease to be diagnosed for.  
                                       Recommended       Tentative diagnosis   test for autoantibody                                            Addisons disease   1:   anti-adrenocortical       Acute reno-pulmonal syndrome   1:   reno-pulmonal pack       Antiphospholipid syndrome*   1:   ANA screening, IgG and IgM               anti-cardiolipin, anti-beta2-GPI.           2:   anti-dsDNA.           3:   ANA titration, anti-ENA, IB               screening, anti-SSA/SSB.       Celiac disease   1:   EMA, anti-gliadin, anti-               retikulin.       Colitis ulcerosa   1:   ANCA IIF.       Cystic fibrosis   1:   BPI-ANCA.       Diabetes mellitus   1:   anti-GAD-65, ICA.       Febris rheumatica   1:   anti-sarcolemma.       Fibrosing alveolitis   1:   ANA screening.           2:   anti-ENA, anti-Jo-1, anti-Scl-70.           3:   ANA titration, IB screening.       Glomerulonephritis (RPGN)   1:   ANCA IIF, anti-GBM.           2:   MPO-ANCA, Pr3-ANCA.           3:   ANA screening, anti-dsDNA,               anti-entaktin, IgA-FN.       Goodpastures syndrome   1:   anti-GBM.           2:   MPO-ANCA.       Hypergammaglobulinemic purpura   1:   ANA screening.           2:   ANA titration, anti-SSA/SSB,               IgM-RF.           3:   IB screening.       Hyper/hypothyreosis   1:   anti-TPO, anti-TG.           2:   PCA.       IgA nephritis   1:   IgA-FN.       Infection related vasculitis   1:   BPI-ANCA.       Juvenile rheumatoid arthritis*   1:   ANA screening, ANCA IIF.           2:   IgM-RF.           3:   ANA titration, IB screening.       Chronic active hepatitis   1:   SMA, anti-LKM.           2:   ANA screening.           3:   ANA titration, ANCA IIF, anti-               dsDNA, AMA, IgM-RF.       Drug-related LE*   1:   ANCA IIF.           2:   ANA screening, anti-histoner,               EL-ANCA, MPO-ANCA.           3:   ANA titration, anti-dsDNA, IB               screening, Pr3-ANCA.       Microscopic polyangiitis/   1:   ANCA IIF.       Churg-Strauss&#39; syndrome   2:   MPO-ANCA, Pr3-ANCA.       Mixed connective tissue disease*   1:   ANA screening.           2:   ANA titration, anti-ENA,               IgM-RF.           3:   IB screening.       Morbus Crohn   1:   ASCA       Myasthenia gravis   1:   TVMA.       Pernicious anaemia   1:   PCA.       Poly-dermatomyositis*   1:   ANA screening.           2:   anti-ENA, anti-Jo-1, myositis               pack.       Primary biliary cirrosis   1:   ANA screening, AMA.           2:   anti-PDH.           3:   ANA titration, SMA, IB               screening.       Primary sclerosing cholangitis   1:   ANCA IIF.       Primary Raynauds syndrome   1:   ANA screening.           2:   anti-ENA.           3:   ANA titration, IB screening,               anti-Scl-70.       Propylthiouracil-induced vasculitis   1:   ANCA IIF.           2:   EL-ANCA, MPO-ANCA.       Reumatoid arthritis*   1:   anti-keratin, IgM-RF, ANCA               IIF.           2:   ANA screening, IgA-RF.           3:   ANA titration, anti-histoner,               IB screening, anti-SSA/SSB.       Reumatoid vasculitis   1:   ANCA IIF.           2:   LF-ANCA.       Sjögrens syndrome*   1:   ANA screening.           2:   ANA titration, anti-SSA/SSB,               IgA-RF, IgM-RF.           3:   AMA, IB screening.       Sclerodermia*   1:   ANA screening.           2:   ANA titration, anti-ENA,               anti-Scl-70.           3:   anti-histoner, IB screening, anti-               SSA/SSB, anti-RNA.       Systemic lupus erythematosus*   1:   ANA screening.           2:   ANA titration, anti-cardiolipin,               anti-dsDNA, anti-ENA, anti-               rRNP.           3:   anti-histoner, IB screening,               AMA, anti-SSA/SSB, IgM-RF.       Tubulo-interstitiel nephritis   1:   anti-TBM.       Suspected connective tissue dis-   1:   ANA screening, ANCA IIF,       ease       anti-cardiolipin, IgM-RF.           2:   anti-Jo-1, AMA, anti-SSA/SSB.           3:   ANA titration, anti-ENA, IB               screening, anti-Scl-70, anti-TPO,               MPO-ANCA, Pr3-ANCA.       Wegener&#39;s granulomatosis   1:   ANCA IIF.           2:   MPO-ANCA, Pr3-ANCA                  
 
     [0246] Numbering Relates to Choice of Priority  
     [0247] Detection of autoantibodies may be used for diagnosing a condition relating to the immune system, such as a auto-immune disease, or an indication of the risk of acquiring an auto-immune disease. The correlation between selected autoantibodies and diseases is listed in schematic form in FIG. 1. The list should not be regarded as limiting the invention to the stated autoantibodies and diseases.  
     [0248] In one embodiment of the present invention the inflammatory indicators are proteinaceous infectious particles, such as prions. The term prion include PrP-Sc proteins. PrP-Sc proteins are insoluble, protease-resistant glycoproteins resulting from post translational modification of the normal mammalian sialoglycoproteins PrP-C. Both PrP-Sc and PrP-C are encoded by a PrP gene.  
     [0249] The proteinaceous infectious particles within the scope of the present invention can be indicative of a heterogeneous group of fatal neurodegenerative disorders, commonly designated transmissible spongiform encephalopathies (TSEs). TSEs are characterized by deposition of prion proteins, the infectious form of PrP-C proteins, in the central nervous system of affected individuals.  
     [0250] Transmissible spongiform encephalopathies within the meaning of the present invention include, but are not limited to scrapie in sheep and goats, bovine spongiform encephalopathy (BSE) in cattle, chronic wasting disease (CWD) in mule deer and elk, transmissible mink encephalopathy (TME) in mink, feline spongiform encephalopathy (FSE) in cats, Creutzfeldt-Jakob Disease (CJD) in humans, Gerstmann-Straussler-Scheinker Syndrome (GSS) in humans, Fatal Familial Insomnia (FFI) in humans or Kuru in humans.  
     [0251] Detection of transmissible spongiform encephalopathies can be done in samples derived from a variety of animals including humans, cattle, mink, cats, goat, mule deer, elk and sheep. Such samples may be tissue sample, such as samples from brain or the central nervous system or body fluid samples.  
     [0252] Monoclonal antibodies that specifically recognise PrP-Sc of various species are known to the person skilled in the art. For example U.S. Pat. No. 6,165,784 describes monoclonal antibodies that specifically bind a conserved epitope on PrP-Sc proteins from sheep, cattle, mule deer, and elk.  
     [0253] Furthermore, the kit according to the invention may be suitable for detecting autoantibodies in combination with relevant cytokines.  
     [0254] Thus, by the present invention it is possible to qualitatively and quantitatively detecting inflammatory indicators, and provide profiles of the inflammatory indicators, as a tool for rapidly diagnosing a wide variety of diseases and conditions.  
     [0255] The method of diagnosis according to the invention in one embodiment includes the use of qualitative and quantitative data obtained by detecting inflammatory indicators. Such data and methods provide profiles of the inflammatory indicators as a tool for rapidly diagnosing and/or identifying individuals suffering from, but not limited to, an infectious condition selected from the group consisting of: Actinomycosis, Adenovirus-infections, Antrax, Bacterial dysentery, Botulisme, Brucellosis (Bang&#39;s disease), caused by e.g.  B. melitensis  and  B. suis,  Candidiasis, Cellulitis, Chancroid, Cholera, Coccidioidomycosis, Acute afebril, Conjunctivitis, Cystitis, Dermatophytosis, Bacteriel Endocarditis, Epiglottitis, Erysipelas, Erysipeloid, Gastroenteritis, Genital herpes, Glandulae, Gonorrhea, Viral Hepatitis, Histoplasmose, Impetigo, Malaria, Mononucleosis, Influenza, Legionaires disease, Leptospirosis, Lyme disease, Melioidosis, Meningitis, Nocardiosis  Nocardia asteroides, Nongonococcal urethritis,  Pinta, Pneumococcal lung disease, Poliomyelitis, Primary lung infection,  Pseudomembranious enterocolitis,  antibiotic-associated  Puerperal sepsis,  Rabies, Relaps-fever, Rheumatic fever, Rocky Mountain spotted-fever, Rubella, Rubeola, Staphylococcal scalded skin syndrome,  Streptococcal pharyngitis  (strep throat), Syphilis, Tetanus, Toxic shock syndrome, Toxoplasmose, Tuberculosis, Tularemia, Typhoid fever, Typhus, Vaginitis, Varicella, Verrucae, Pertussis, Framboesia (Yaws) and Yellow fever.  
     [0256] Also, the method of diagnosis may be able to identify individuals suffering from a condition selected from the group consisting of immune diseases, auto-immune diseases and other inflammatory diseases and syndromes, see for example FIG. 1.  
     EXAMPLE 1  
     [0257] Dipstick for Detecting a Cytokine in a Sample  
     [0258] A dipstick for detecting a cytokine in a sample that could clearly detect the cytokine, by the appearance of a clear visually detectable signal, such as a red spot in a functional lateral flow assay was developed.  
     [0259] The antigen to be tested is a commercially available cytokine (INFx).  
     [0260] A monoclonal antibody directed to INFx as the targeting species coupled to the solid surface on the dipstick, the so-called catching antibody was used.  
     [0261] The reporter species further comprised polydextran polymeric carrier molecules, which were of approximately 500,000 Da, to which the reactive group divinylsulphone were covalently attached. Furthermore, the reporter species comprised rhodamine label molecules, which were also attached via the divinylsulphone groups.  
     [0262] To test the reporter species a 2-layer lateral flow test was employed, following the principles outlined in FIG. 1. FIG. 1 illustrates a schematic dipstick, for use in an assay for testing detecting of INFx cell in a sample. The dipstick comprises an application zone for the sample comprising the reporter species. The term conjugate refers to reporter species. Furthermore, the dipstick comprises one zone whereto the catching antibody is coupled and a second zone whereto the control antibody is coupled. The dipstick is made of nitrocellulose (Sartonius Unisart CN200), and of a microporous membrane of. Whatman FO 75-17 or Millipore Rapid Q24, and an absorbant pad (Whatman 1,5 NF).  
     [0263] A secondary antibody with specificity against the targeting antibody comprised within the reporter species was used as catching antibody. This lateral test gave a positive red spot, which showed that 1) targeting antibody was coupled to polydextran carrier; 2) the polydextran carrier had good flow characteristics. Furthermore, none of them gave rise to background/unspecific binding.  
     [0264] The test was developed so that a visually visible red spot appears when the test is positive. This spot is produced by accumulation of rhodamine linked to the reporter species. The positive result in the test is defined as samples comprising INFx. A negative result, which is visualised by no colour change (no red spot appear), was obtained when substantially no INFx was used.  
     [0265] The test is a 1-step test, where sample is applied directly to the dipstick after which the test results appear. When the test is performed as a 1-step test the first colour reaction appear on the flow test as early as after 1-3 minutes. The test is finished after about 5 minutes.  
     [0266] A control antibody that binds the reporter species independently of the antigen in the urine, was also coupled to the solid surface of the dipstick within the control zone. A red control spot appeared every time in the test regardless whether negative urine or positive urine was used, as an indicator of whether the test was correctly performed. The red colour of this control spot was also produced by accumulation of rhodamine linked to the reporter species.  
     [0267] Furthermore, a dipstick has been developed so that a red test line appears across the membrane instead of a red spot, both for observing the test result and the control (FIG. 2). Often it is observed that the colour intensity is increased on a test line compared to a test spot.  
     EXAMPLE 2  
     [0268] Competetive Dispstick  
     [0269] In this example a dipstick similar to the dipstick described in Example 1 was produced as a competitive dipstick whereby a positive signal is shown as no change of colour, whereas a negative signal is shown as a colour change.  
     [0270] The amount of reporter species was titrated in a way such as a red spot (visible accumulation of rhodamine) only appeared in negative samples.