Patent Description:
Circulating miRNAs offer many features to make them an attractive class of biomarkers. They are stable, their sequences are evolutionarily conserved, miRNA expression is often tissue or pathology specific, and because they can be detected by real-time PCR, assays can be highly sensitive and specific. However, there are also challenges associated with the detection of circulating miRNAs that still need to be addressed. One of the challenges relates to the low amount of total RNA in blood, which makes it difficult to measure the concentration and quality of the isolated RNA. As a consequence, it is of crucial importance to i) have calibrated and precise positive controls of miRNAs of interest and ii) precisely normalize detected miRNA values for variances based on the amount of starting material and miRNA extraction. Normalization has been tried by seeking a "housekeeping" circulating RNA. Some reports use U6 or other miRNAs (e.g., miR-<NUM>) as a housekeeping RNA. However, the levels of these RNAs often change under pathological conditions. Others have reported a spiked-in normalization approach in which <NUM> synthetic Caenorhabditis elegans miRNAs (without homology to human miRNAs) were added during the purification procedure and used for data normalization. However, while miRNAs are relatively stable in biological fluids, being associated to proteins and lipids, and packaged into macrovesicles, synthetic miRNAs are easily hydrolyzed by RNases and are thus difficult to handle or use. This is a major concern because a spiked-in approach should use a miRNA standard of known concentration, a requirement for absolute or relative quantification of a miRNA level from a biological fluid.

<CIT> describes that synthesized miRNAs are mixed with LipoFectamine before spiked in plasma to be protected from degradation. <NPL>) describe the use of lipofectamine as a lipofecting agent to transfect cells with miRNA.

The present invention provides compositions and methods solving this issue.

The inventors herein show that synthetic miRNAs can advantageously be introduced into kits useful for the diagnosis, prognosis or monitoring of a disease when complexed with a lipid vector.

Accordingly, a first aspect of the invention relates to a diagnostic kit comprising more than one container comprising a synthetic miRNA and a lipid vector, wherein said synthetic miRNA is at a defined concentration, wherein the lipid vector is selected from lipids conjugated to PEG.

In a particular aspect of the invention relates to a diagnostic kit comprising more than one container comprising a synthetic miRNA, a lipid vector and a matrix (for example synthetic serum, plasma depleted in nucleic acid, blood derived sample), wherein said synthetic miRNA is at a defined concentration.

The kit can further comprise at least one other container or at least one other set of containers comprising an additional synthetic miRNA (e.g. a third or more than third synthetic miRNA). The additional synthetic miRNA can be different from the first synthetic miRNA, from the second synthetic miRNA and from any other miRNA of a lower order included into the kit. For example, in case of a third synthetic miRNA, said third synthetic miRNA is different from the first synthetic miRNA and from the second synthetic miRNA. In the embodiment comprising another set of containers, the additional synthetic miRNA (e.g. the third synthetic miRNA) can be at a different concentration in each container of the additional (e.g. third) set of containers.

The synthetic miRNA(s) included in the kit of the invention can be any synthetic miRNA that can be used for quality control or for internal control, diagnostic, prognostic or monitoring value. For example, the synthetic miRNA(s) included in the kit can have the sequence of a miRNA whose level, absence or presence in a biological fluid is correlated to a disease or disease stage, or is potentially correlated to a disease or disease stage, or is correlated to a potential disease or potential disease stage. Illustrative diseases whose diagnosis can comprise the assessment of the level, presence or absence of at least one miRNA include, without limitation, non-alcoholic fatty liver disease (NAFLD), NASH, cancers, fibrosis, viral infections, nervous system disorders, cardiovascular disorders and diabetes.

In a particular embodiment, the synthetic miRNA(s) is a miRNA whose level, absence or presence is associated to NAFLD, NASH or fibrosis, in particular to NASH with fibrosis.

In a particular embodiment, at least one of the more than one container(s) comprises synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p), hsa-miR-<NUM> (more particularly hsa-miR-<NUM>-5p) or synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p).

In a further particular embodiment, at least one of the more than one container(s) comprises synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p). In yet another embodiment, the kit comprises a set of containers each comprising synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) at a different concentration. In a particular variant, said kit comprises one, at least two or at least three containers each comprising synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) at a different concentration. In another particular variant, said kit comprises one, two or three containers each comprising synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) at a different concentration. A further variant relates to a kit comprising one container comprising synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) at a defined concentration. Another variant relates to a kit comprising two containers comprising synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) at a defined concentration, wherein the concentration of synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) in the first container is different from the concentration of synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) in the second container. In yet a further variant, the kit comprises three containers comprising synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) at a defined concentration, wherein the concentration of synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) in the first container is different from the concentration of synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) in the second container, and wherein the concentration of synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) in the third container is different from the concentration of synthetic hsa-miR-34a (more particularly hsa-miR-34a-5p) in the first container and in the second container.

In a further particular embodiment, at least one of the more than one container(s) comprises synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p). In yet another embodiment, the kit comprises a set of containers each comprising synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) at a different concentration. In a particular variant, said kit comprises one, at least two or at least three containers each comprising synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) at a different concentration. In another particular variant, said kit comprises one, two or three containers each comprising synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) at a different concentration. A further variant relates to a kit comprising one container comprising synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) at a defined concentration. Another variant relates to a kit comprising two containers comprising synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) at a defined concentration, wherein the concentration of synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) in the first container is different from the concentration of synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) in the second container. In yet a further variant, the kit comprises three containers comprising synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) at a defined concentration, wherein the concentration of synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) in the first container is different from the concentration of synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) in the second container, and wherein the concentration of synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) in the third container is different from the concentration of synthetic hsa-miR-<NUM> (more particularly hsa-miR-193b-3p) in the first container and in the second container.

In a particular embodiment, at least one of the more than one container(s) comprises synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p). In yet another embodiment, the kit comprises a set of containers each comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a different concentration. In a particular variant, said kit comprises one, at least two or at least three containers each comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a different concentration. In another particular variant, said kit comprises one, two or three containers each comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a different concentration. A further variant relates to a kit comprising one container comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a defined concentration. Another variant relates to a kit comprising two containers comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a defined concentration, wherein the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the first container is different from the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the second container. In yet a further variant, the kit comprises three containers comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a defined concentration, wherein the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the first container is different from the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the second container, and wherein the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the third container is different from the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the first container and in the second container.

In another particular embodiment, at least one of the more than one container(s) comprises synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p). In yet another embodiment, the kit comprises a set of containers each comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a different concentration. In a particular variant, said kit comprises one, at least two or at least three containers each comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a different concentration. In another particular variant, said kit comprises one, two or three containers each comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a different concentration. A further variant relates to a kit comprising one container comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a defined concentration. Another variant relates to a kit comprising two containers comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a defined concentration, wherein the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the first container is different from the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the second container. In yet a further variant, the kit comprises three containers comprising synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) at a defined concentration, wherein the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the first container is different from the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the second container, and wherein the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the third container is different from the concentration of synthetic cel-miR-<NUM> (more particularly cel-miR-<NUM>-3p) in the first container and in the second container.

In a further particular embodiment, at least one of the more than one container(s) comprises synthetic ath-miR-159a, cel-lin-<NUM>, cel-miR-<NUM>, cel-miR-<NUM>, cel-miR-<NUM> or cel-miR-<NUM>, more particularly ath-miR-1549a, cel-lin4-5p, cel-miR2-3p, cel-miR-<NUM>-3p, cel-miR-<NUM>-3p or cel-miR-<NUM>-3p respectively.

The container(s) of the kit of the disclosure comprises a complex of a miRNA and of a lipid vector. Illustrative lipid vectors can comprise, without limitation, cationic lipids, non-cationic lipids (such as neutral or anionic lipids) and conjugated lipids, such as lipids conjugated to amino-acids, lipids conjugated to peptides, or lipids conjugated to PEG. In an embodiment, lipid vectors for practice of the invention comprise non-cationic lipids (such as neutral or anionic lipids) and lipids conjugated to PEG. In a particular embodiment, the lipid vector comprises at least one cationic lipid. In a further particular embodiment, the at least one cationic lipid is mixed with at least one neutral lipid and/ or to at least one conjugated lipid. In a further particular embodiment, a cationic lipid can be mixed with PEG, such as C12-C20, in particular C14-C18, PEG with <NUM> - <NUM> molecular weight.

The lipid vector for practice of the invention is selected from lipids conjugated to PEG. In a particular embodiment, the lipid vector is a glycerophospholipid conjugated to PEG. In yet another embodiment, the lipid vector is a monoglycerophosphoethanolamine conjugated to PEG or a diacylglycerophosphoethanolamine conjugated to PEG, or a salt thereof. In a further embodiment, the lipid vector is a diacylglycerophosphoethanolamine conjugated to PEG, or a salt thereof. In another particular embodiment, the lipid vector is a di(C<NUM>-C<NUM>)acylglycerophosphoethanolamine conjugated to PEG, or a salt thereof, such as a diC<NUM>acylglycerophosphoethanolamine conjugated to PEG, or a salt thereof. In each of the embodiments disclosed in the present paragraph, the PEG moiety may be a PEG having a molecular weight from <NUM> to <NUM>, in particular from <NUM> to <NUM>, such as from <NUM> to <NUM>. In particular embodiment, the PEG moiety of the lipid vectors described in the present paragraph may be of <NUM>, <NUM>, <NUM> or <NUM>, in particular <NUM>. In a further particular embodiment, the lipid vector is <NUM>,<NUM>-dipalmitoyl-sn-glycero-<NUM>-phosphoethanolamine-N-[methoxy(polyethylene glycol)-<NUM>] (C16 PEG2000 PE), or a salt thereof such as its ammonium salt.

In a particular embodiment, the cationic lipid is a monovalent or polyvalent cationic lipid. Among monovalent cationic lipids, one can cite, without limitation, DOTMA, DOTAP, DMRIE, and DDAB. Illustrative polyvalent cationic lipids include, without limitation, DOSPA, DOSPER, DOGS, TMTPS, TMTOS, TMTLS, TMTMS, and TMDOS. Among neutral lipids, one can cite, without limitation, DOPE, DPhPE, and cholesterol.

For example, illustrative lipid vectors include, without limitation, those disclosed in <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT> and <CIT>.

In a particular embodiment of the disclosure, the lipid vector is selected from:.

In a particular embodiment of the disclosure, the lipid vector is N,N,N',N'-tetramethyltetrapalmylsperminetetrammonium iodide, more particularly a mixture <NUM>:<NUM> mixture of N,N,N',N'-tetramethyltetrapalmylsperminetetrammonium iodide and DOPE;.

In a particular embodiment, the lipid-based vector comprises <NUM>,<NUM>-dioleyloxy-N-[<NUM>(sperminecarboxamido)ethyl]-N,N-dimethyl-<NUM>-propanaminium trifluoroacetate. In a further embodiment, <NUM>,<NUM>-dioleyloxy-N-[<NUM>(sperminecarboxamido)ethyl]-N,N-dimethyl-<NUM>-propanaminium trifluoroacetate is mixed to a neutral lipid such as dioleoylphosphatidylethanolamine.

In another particular embodiment, the lipid-based vector comprises:.

In a further embodiment, the lipid-based vector comprises:.

In another embodiment, the lipid-based vector comprises an amine-containing lipid such as:.

In a further particular embodiment, the lipid vector comprises at least one of compounds <NUM> to <NUM> of <CIT>. In a further particular embodiment, the lipid vector comprises at least one lipid selected in the group consisting of:.

In another specific embodiment, the lipid vector can be a lipid formulation as disclosed in tables <NUM>, <NUM> and <NUM> of <CIT>, which are reproduced below:.

In a further particular embodiment of the disclosure, the lipid vector is a mixture of DHDMS, HDMS, DOPE and cholesterol. In another embodiment, the lipid vector is a lipid formulation as disclosed in table <NUM> of <CIT>:.

In a further particular embodiment, the lipid vector comprises a lipid nanoparticle formulation as disclosed in <CIT>, comprising PEG of <NUM>, <NUM> or <NUM> molecular weight, with a chain length of <NUM> or <NUM>, DHDMS, HDMS, DOPE, and cholesterol. More particularly, the formulation is one of the formulations of table <NUM> of <CIT>:.

In a particular embodiment of the disclosure, the lipid vector is a lipid-based transfection reagent, such as a lipid-based transfection selected from:.

In a particular embodiment of the invention, the lipid vector is invivofectamine® <NUM> or invivofectamine® <NUM>, in particular invivofectamine® <NUM>.

The invention also relates to uses of the diagnostic kit of the invention.

In a particular embodiment, the diagnostic kit of the invention is used in a method for the diagnosis of a disease. In particular, the kit is used to provide a calibration standard for the miRNA(s) contained in the kit.

In the context of the present invention, the expression "method for the diagnosis" denotes a method for the diagnosis, prognosis or monitoring of a disease, but also a method for evaluating the efficacy of a treatment against the disease.

The invention thus relates to the use of the diagnostic kit of the invention, in a method for the diagnosis, prognosis or monitoring of a disease. The kit of the invention may be a method for the diagnosis of non-alcoholic steatohepatitis (NASH), and for classifying a subject as a potential receiver of a treatment for NASH as described in the <CIT>.

The invention further relates to a method for the diagnosis of a disease, comprising the determination of the level of miRNA in a biological sample of a subject, wherein the level of said miRNA is compared to the level of the same miRNA in the standard or positive control from the kit of the present invention.

In a particular embodiment, the uses and methods of the invention comprise the comparison of the level of the miRNA determined from the biological sample to the level of the synthetic miRNA used as a standard or positive control in the kit.

In another embodiment, the uses and methods of the invention comprise the normalization of the level of the miRNA determined from the biological sample to the level of the synthetic miRNA used as an internal control in the kit.

In a further embodiment, the uses and methods of the invention comprise the normalization of the level of the miRNA determined from the biological sample with the extraction yield of the synthetic miRNA used as a standard or positive control in the kit.

The uses and methods of the invention are useful for the quantification of miRNA in a biological fluid sample of a subject, such as blood derived samples, for example whole blood, serum or plasma, in particular serum.

In a further embodiment, the uses and methods of the invention comprise the spike in of a defined amount of the synthetic miRNA in the kit of the invention into the biological sample into which a miRNA level is to be determined. In a particular embodiment, the spike-in synthetic miRNA is a non-human miRNA, an exogenous miRNA absent in the subject sample. For example, the non-human synthetic or exogenous miRNA can be derived from Caenorhabditis elegans (cel) or Arabidopsis thaliana (ath). In a particular embodiment, the spiked-in miRNA is cel-miR39 (in particular cel-miR-<NUM>-3p). Other non-human miRNA for use as synthetic miRNA in the context of the present invention include, without limitation, ath-miR-159a and cel-miR-<NUM>-3p.

The kit of the invention can thus be used to provide an internal control measured simultaneously to the miRNA to be tested in the biological fluid sample. It can be used to calculate the level of miRNA in the sample using the following formula, which is given for an illustrative purpose with respect to the measurement of hsa-miR-34a-5p as the miRNA to be tested in the sample, and cel-miR-<NUM>-3p as the internal control and spiked synthetic miRNA: <MAT> Where: <MAT> <MAT> <MAT>.

Highly purified miRNAs oligoribonucleotides are custom synthesized from IDT (Integrated DNA Technologies Skokie, Illinois USA).

Invivofectamine® <NUM> reagent (IVF3001-<NUM>, ThermoFisher Scientific, USA) was used for creating complexes with miRNAs according to manufacturer recommendations (Pub. MAN0013651 Rev A. The miRNA/Invivofectamine® (IVF) complex was used without dilution or diluted <NUM>-fold by adding <NUM> PBS (pH <NUM>).

To prepare standards miRNAs or internal controls, <NUM>µL of preparation is added to <NUM>) biological base matrices for standard preparations (i.e. serum or plasma from healthy donors, or other base matrix) or <NUM>) directly to biological samples as internal control.

Standards miRNAs, positive controls and internal controls are prepared with synthetic miRNA oligoribonucleotide (i.e. hsa-miR-34a-5p, cel-miR-<NUM>-3p, cel-miR-<NUM>-3p).

Samples to be tested are thawed on ice. Vortex gently the biological samples and centrifuge at <NUM>,000xg for <NUM> minutes.

Automated extraction with MagMax mirVana™ on KingFisher™ System (KingFisher™ Flex System, catalog nbr <NUM>, ThermoFisher) was carried out according to manufacturers recommendations (KingFisher™_Flex_User_Manual_5400630. pdf, part nbr N07669). MagMax mirVana™ Total RNA Isolation Kit (A27828, ThermoFisher) was used following the user guide (MagMAX mirVana™ Total RNA Isolation Kit (manual extraction) User Guide - Pub. MAN0011131 - Rev.

Reverse transcription reaction was carried using TaqMan® MicroRNA Reverse Transcription Kit, catalog nbr <NUM> following user manual protocol: TaqMan® Small RNA Assays Protocol (PN 4364031E). pdf, part nbr <NUM> Rev E <NUM>/<NUM> and Taqman® MicroRNA assay RT primer [60X], catalog nbr <NUM> (large format). Incubations were performed in a Bio-Rad T100 thermo-cycler according to the manufacturer recommendations (Bio-Rad T100 thermal cycler Cat nbr <NUM>-<NUM>. cDNAs were stored in low binding tubes at -<NUM> until further use.

Expression of mature miRNAs was quantified according to the manufacturer's instructions using the Taqman miRNA RT-qPCR Assay 20X and TaqMan Universal Master Mix II, no Uracil-N-Glycosidase (UNG) 2X (Applied Biosystems, Life Technologies, Carlsbad, CA) in PCR Plate ThermoFisher <NUM>-well, clear well, semi-skirted, catalog nbr AB-<NUM>. A fixed volume of <NUM>µL total RNA was used as a template for the qPCR assay using a CFX96TM Real-Time System- C1000 - IVD certified according to manufacturer guidelines (Bio-Rad CFX96 Touch_Instruction manual. pdf, part nbr <NUM>, Rev E US/EG). The hsa-miR-34a-5p TaqMan assay was used. The RT product from synthetic miRNAs was serially diluted and PCR was performed on all samples (standards and serum-derived RNA). The Cq Determination mode was Regression.

The sequences of mature miRNA and Taq Man assay ID are reported in the following table:.

<FIG>: invivofectamine® protects the synthetic hsa-miR-34a-5p oligoribonucleotide spiked in serum.

hsa-miR-34a-5p expression levels in the absence (A) or the presence (B) of Invivofectamine®. Black box: pool of serum from healthy donors with very low levels of hsa-miR-34a used as a biological base matrix, Grey Box: base matrix spiked with synthetic hsa-miR-34a-5p without invivofectamine® (IVF) before or after denaturation. White box: base matrix spiked with synthetic hsa-miR-34a-5p encapsulated in IVF.

hsa-miR-34a-5p is detected in healthy patients (Matrix) at very low levels (<NUM> Cq). The addition of a synthetic hsa-miR-34a-5p used as spike-in after addition of denaturating buffer in serum results in an induction (<NUM> Cq). The synthetic miRNA is degraded if the addition occurs before the treatment of serum with the denaturating buffer (Matrix + hsa-miR-34a-5p). Interestingly, the combination of invivofectamine® with hsa-miR-34a-5p before the <NUM>:<NUM> dilution restores the miRNA level detected when the spike-in miRNA is added after denaturating buffer. The complex miRNA/invivofectamine® may be used with the <NUM>/<NUM> diluted complex (<FIG>).

<FIG>: miRNA/invivofectamine® complex stability at <NUM> up to <NUM> hrs.

Two miRNA/invivofectamine® complex preparation conditions were tested: temperature <NUM> (black boxes) versus room temperature (RT, white boxes) and time between complex preparation and its use (<NUM>, <NUM> and <NUM> hours). Matrix: pool of serum from healthy donors (Etablissement Français du Sang: EFS) with very low levels of hsa-miR-34a-5p.

At room temperature, the hsa-miR-34a-5p levels decrease in matrix and in matrix with spike in hsa-miR-34a-5p. The levels remain constant at <NUM>. This result suggests that spike-in procedure in blood derived samples may be delayed at <NUM> after miRNA/invivofectamine® complex preparation (<FIG>).

<FIG>: Invivofectamine® protects the synthetic hsa-miR-34a-5p oligoribonucleotide spiked in serum at <NUM> up to <NUM> weeks.

The hsa-miR-34a-5p levels are stable in the spiked serum with the hsa-miR-34a-5p/invivofectamine® complex up to <NUM> weeks at <NUM> (<FIG>).

<FIG>: Synthetic miRNA stability in serum when combined with invivofectamine® after repetitive freeze-thaw cycles at -<NUM>.

<NUM> freeze/thaw cycles were tested. Hsa-miR-34a-5p levels are not affected by repetitive freeze/thaw cycles at -<NUM> when the synthetic miRNA is combined with invivofectamine®.

Data are expressed as mean of Cq +/- SD or as fold hsa-miR-34a-p level expression using the following formula: <MAT> Where: <MAT> <MAT> <MAT>.

Positive standards are pooled serum from NASH patients, n=<NUM>.

The spike-in miRNA is a non-human miRNA: cel-miR-<NUM>-3p at Cq=<NUM>. Invivofectamine® is used at ratio of cel-miR-<NUM>-3p/IVF = <NUM>/<NUM>.

After preparation, the complex IVF/cel-miR-<NUM> is incubated at <NUM> for <NUM> or directly freezed at -<NUM>.

CV are not significantly different between conditions. The normalized quantification of hsa-miR-34a-5p remains stable and reproducible between conditions.

The internal control production is robust.

Standard and internal controls were used to evaluate the performances of the hsa-miR-34a-5p assay in NASH patients.

<FIG>: ROC curve of hsa-miR-34a-5p with internal control (A) or without internal control (B) in clinical cohort with NASH diseased patients (n=<NUM> patients, NTBT = <NUM> patients and TBT = <NUM> patients). Target condition to be classified as TBT was NAS≥<NUM> + F≥<NUM>.

The serum of <NUM> patients of the RESOLVE-IT study with corresponding liver biopsy was processed for the validation of the assay with an internal control. Serum samples from all patients were used to evaluate the performances of hsa miR-34a-5p assay using internal control (Cel-miR-<NUM>-3p) complexed to IVF and then compared of the test to the hsa-miR-34a-5p assay without the use of internal control. Patients were divided into <NUM> groups: group#<NUM>: Not To be Treated (NTBT) patients, with NAS score <<NUM> and fibrosis <<NUM> and group#<NUM>: To be Treated Patients (TBT), with NAS score ≥ <NUM> and fibrosis ≥<NUM>. Patients with NAS score <NUM> to <NUM> and fibrosis grade from <NUM> to <NUM> were the more representative of this clinical cohort. Patients with target condition (TBT: NAS≥<NUM> + F≥<NUM>) represent <NUM>% of total cohort population.

The AUROC for hsa-miR-34a-5p assay using the internal control was <NUM> (<NUM>% CI <NUM>-<NUM>) and the AUROC for hsa-miR-34a-5p assay where the internal control was not used represents only <NUM> (<NUM>% CI <NUM>-<NUM>) indicating that hsa-miR-34a-5p assay using the internal control performs significantly better than the assay without internal control (<FIG>). Taken together all these data indicates that the hsa-miR-34a-5p assay is more specific and sensitive when Cel-miR-<NUM>-3p/IVF complex is used to quantify hsa-miR-34a-5p as a marker for the NASH disease.

Highly purified miRs mimic oligoribonucleotides are custom synthesized from IDT (Integrated DNA Technologies Skokie, Illinois USA). For in vitro testing as standards or internal controls, <NUM>µL of miRs mimic solution is prepared by mixing 50µ L miRs in RNase-free water (ref <NUM>-<NUM>, VWR) with <NUM>µL of complexation buffer (Invivofectamine® <NUM> reagent (IVF3001-<NUM>, ThermoFisher Scientific). For example, use miR at <NUM> fmol/ml to prepare Control 28Cqs, miR at <NUM> fmol/ml to prepare Control 30Cqs and miR at <NUM> fmol/ml to prepare 33Cqs. Afterwards, diluted miRs are immediately added to <NUM>µL of invivofectamine® <NUM> or Lipofectamine (life Technologies Carlsbad, CA, USA) previously brought to room temperature. Invivofectamine® (or Lipofectamine) and diluted miRs are then vortexed for <NUM> seconds to ensure miRs-IVF <NUM> (or miRs-Lipofectamine) complex formation. Next, the invivofectamine® (or Lipofectamine)-miRs mixture is incubated for <NUM> at <NUM> and finally, the complex is diluted <NUM>-fold by adding <NUM> PBS (pH <NUM>) to obtain a final concentration respectively of <NUM>,<NUM> fmol/ml, <NUM> amol/and <NUM>,<NUM> amol/ml for Control 28Cqs, 30Cqs and 33Cqs. The preparation is conserved frozen at -<NUM> in aliquots.

To prepare standards miRs or internal controls, <NUM>µL of preparation are added to <NUM>) biological base matrices for standard preparations (i.e. serum or plasma from healthy donors, or commercially available base matrices) or <NUM>) directly to biological samples as internal control.

Comparison Invivofectamine®/Lipofectamine complex conditions.

Several Invivofectamine®/hsa-miR-<NUM>-a-5p or Lipofectamine /hsa-miR-<NUM>-a-5p complex preparation conditions were tested: temperature ; (<NUM> versus room temperature) and time between complex preparation and its use (<NUM>, <NUM> and <NUM> hours). The matrix is a pool of serum from healthy donors with very low levels of hsa-miR-34a-5p. The standard RNA is a pool of RNA with a known hsa-miR-34a-5p levels. All Data are expressed as mean qPCR amplification cycles (Cq) +/- SD with n=<NUM>. ND: Not detectable.

<FIG>: Invivofectamine® (IVF)/hsa-miR-<NUM>-a-5p complex condition preparations.

Temperature ; <NUM> (black boxes), room temperature (RT, white boxes). Time between complex preparation and its use was also tested (<NUM>, <NUM> and <NUM> hours).

NRT: No Reverse Transcriptase control, NTC: No Template Control, Negative Control: PCR blank. All Data are expressed as mean qPCR amplification cycles (Cq) +/- SD with n=<NUM>. ND: Not detectable.

<FIG>: Lipofectamine/hsa-miR-<NUM>-a-5p complex condition preparations.

Temperature ; <NUM> (black boxes), room temperature (RT, Grey boxes). Time between complex preparation and its use (<NUM>, <NUM> and <NUM> hours).

Claim 1:
A diagnostic kit comprising more than one container comprising a complex of a synthetic microRNA (miRNA) and a lipid vector, wherein said synthetic miRNA is at a defined concentration, wherein the lipid vector is selected from lipids conjugated to PEG,
wherein the kit comprises:
- one or more container(s) comprising a first synthetic miRNA; and
- one or more container(s) comprising a second synthetic miRNA different from the first miRNA.