Cancer Patent

February 2, 2009

Urine cancer test

Filed under: Issued Patent — admin @ 3:36 am

Abstract
A urine test for cancer is disclosed for the detection of a broad spectrum of cancers in which the specimen of urine from the subject to be tested is placed into a test tube, a concentrated acid is added to the specimen and the resulting mixture is heated to the boiling point. The mixture is then cooled to ambient temperature, ethyl ether is added and mixed well into the mixture and the mixture is left to stand. The change in color of the mixture of from pink to purple indicates the presence of cancer in the subject and no change in color indicates the absence of cancer.

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Inventors: Rogers; Sam S. (Chicago, IL)
Appl. No.: 09/329,164
Filed: June 9, 1999
Claims

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I claim:

1. A method for detecting the presence of cancer in a mammal comprising:

depositing a specimen of urine from the subject mammal to be tested into a container;

adding a concentrated acid to the specimen of urine in the container;

heating the specimen of urine with the acid therein to its boiling point;

cooling the heated specimen of urine with the acid therein to ambient temperature;

adding ethyl ether to the ambient temperature specimen of urine with the acid therein, and mixing the resulting liquid thoroughly; and

allowing the mixed liquid to stand and then determining the presence or absence of cancer in the subject mammal by observing the color of the liquid after standing.

2. The method of claim 1, wherein the concentrated acid is hydrochloric acid.

3. The method of claim 1, wherein the volume ratio of the concentrated acid to the specimen of urine is about 0.1:1 to 0.6:1.

4. The method of claim 3, wherein the volume ratio of the ethyl ether to the specimen of urine is about 0.04:1 to 0.2:1.

5. The method of claim 1, wherein the volume ratio of the ethyl ether to the specimen of urine is about 0.04:1 to 0.2:1.

6. The method of claim 1, wherein the mixing of the resulting liquid is by shaking.

7. The method of claim 1, wherein the purity of the concentrated acid and the ethyl ether is at least of USP grade.

8. The method of claim 1, wherein the concentrated acid is hydrochloric acid, the volume ratio of the acid to the specimen of urine is about 0.1:1 to 0.6:1; the volume ratio of the ethyl ether to the specimen of urine is about 0.04:1 to 0.2:1, and wherein the purity of the acid and the ethyl ether is at least of USP grade.

9. The method of claim 8, wherein the mixing of the resulting liquid is by shaking.

10. The method of claim 8, wherein the presence of cancer is exhibited by the mixed liquid in the container changing color to a color of pink to purple, and the absence of cancer is exhibited by the color of the mixed liquid in the container remaining unchanged.

11. The method of claim 1, wherein the presence of cancer is exhibited by the mixed liquid in the container changing color to a color of pink to purple, and the absence of cancer is exhibited by the color of the mixed liquid in the container remaining unchanged.
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Description

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BACKGROUND AND SUMMARY OF THE INVENTION

The present invention is directed to a test for the detection of a broad spectrum of cancers and, more specifically, to a method of testing for the presence or absence of cancer in mammals by analyzing a urine specimen from the subject mammal.

Although some test procedures have been conducted on urine to determine the presence of bladder cancer, no test is known to the inventor in which a urine specimen may be analyzed to detect a broad spectrum of diverse forms of cancer in the mammalian subject from which the urine specimen was obtained.

It would be highly advantageous if a simple diagnostic test was available in which a urine specimen provided by the subject to be tested could be simply, inexpensively and non-invasively tested to determine whether the individual might have any one of a broad spectrum of different cancers, or whether the subject was cancer free of any such cancers at the time of the test. The purpose of the present invention is to realize these advantages.

In the present invention, a urine specimen from the mammalian subject to be tested may be simply, inexpensively, non-invasively and quickly and reliably tested to determine whether or not the individual does or does not have any one of a wide and diverse spectrum of cancers at the time of testing.

In one principal aspect of the present invention, a method for detecting the presence of cancer in a mammal comprises depositing a specimen of urine from the subject mammal to be tested into a container and adding a concentrated acid to the specimen of urine in the container. The specimen of urine with the acid therein is heated to its boiling point and then allowed to cool to ambient temperature. After cooling, ethyl ether is added to the ambient temperature specimen of urine with the acid therein, and mixed thoroughly therewith. The resulting mixed liquid is permitted to stand and then the presence or absence of cancer in the subject mammal is determined by observing the color of the liquid after standing.

In another principal aspect of the present invention, the concentrated acid is hydrochloric acid.

In still another principal aspect of the present invention, the volume ratio of the acid to the specimen of urine is about 0.1:1 to 0.6:1.

In still another principal aspect of the present invention, the volume ratio of the ethyl ether to the specimen of urine is about 0.04:1 to 0.2:1.

In still another principal aspect of the present invention, the mixing of the liquid following the addition of the ethyl ether is by shaking.

In still another principal aspect of the present invention, the purity of the acid and the ethyl ether is at least USP grade.

In another principal aspect of the present invention, the presence of cancer is exhibited by the mixed liquid in the container changing color to a color of pink to purple, and the absence of cancer is exhibited by the color of the mixed liquid in the container remaining unchanged.

These and other objects, features and advantages of the present invention will be more clearly understood through a consideration of the following detailed description.

DESCRIPTION OF THE PREFERRED EMBODIMENT

In the preferred method of the present invention, a specimen of urine from the subject to be tested is placed in a container. The container may, for example, be a test tube of about 1/2 inch in diameter and about 5 inches in length, and the specimen may fill about 1/2 to 3/4 of the test tube.

A concentrated acid, preferably of at least USP grade, is added to the specimen of urine in the container. The acid is preferably hydrochloric acid and is added in the amount of about 1.5-4.5 cc to the specimen of urine in the container which is at room temperature. The volume ratio of concentrated acid to the specimen of urine is preferably between about 0.1:1 to 0.6:1.

The specimen of urine with the acid therein is then heated from ambient room temperature to its boiling point by suitable heating means, for example a Bunsen burner. Once the boiling point is reached, the heating is ceased and the heated urine and acid mixture is then allowed to again cool to ambient room temperature.

Upon reaching ambient room temperature, ethyl ether, also preferably of at least USP grade, is added to the urine and acid mixture and is mixed thoroughly therewith, for example, by shaking.

This mixed liquid is then allowed to stand for a sufficient period of time for a color change to develop, if a change is to develop. If no change in color develops within the first 10-15 minutes of standing, the mixed liquid is permitted to stand for preferably up to about one hour total to insure that no color change will develop.

In the present invention it has been discovered, that if the mixed liquid comprising the heated and then cooled mixture of urine and acid, together with the subsequently added ethyl ether, changes in color to pink to purple, the subject mammal from which the specimen has been obtained has cancer somewhere within its body. This cancer may be any one of a wide range of spectrum of diverse cancers including, for example lung, liver, uterine and pancreatic cancers and leukemia. The color change may be confined to a narrow band of from 1/8-1/4 inches in the center of the specimen, the remainder of which is substantially clear in color, or it may consist of an overall color change of the entire specimen of urine which may be cloudy, but of a pink to purple color. In either event, the subject from which the specimen was taken will have cancer somewhere within its body. Conversely, if no color change is observed at the conclusion of the test, the subject is cancer free.

EXAMPLE

Urine specimens were obtained from 50 persons at a hospital. Unknown to the individual conducting the test according to the present invention, 20 of the persons who provided specimens to be analyzed had previously been diagnosed with any one of several forms of cancer, including colon, lung, liver and uterine cancers and leukemia. The remaining 30 specimens were from persons who had either never previously been diagnosed for cancer and/or may have had observed conditions which may or may not be cancerous, e.g. colon polyps, lung spots, etc.

The specimens of urine obtained from each of these 50 persons were individually analyzed according to the invention. Each specimen was added to a test tube approximately 5 inches long and 1/2 inch in diameter in an amount sufficient to fill the test tube approximately 3/4 full. To this specimen was added 1.5 cc of concentrated hydrochloric acid, and the urine and acid mixture was then heated over a Bunsen burner to bring it up to the boiling point of the mixture. This heated mixture was then cooled to ambient room temperature, at which point 0.5 cc of ethyl ether was added and the mixture was shaken well.

Within 10-15 minutes, 40 of the 50 specimens tested had changed colors to anywhere from various tones of pink to, in one instance, a very dark pink/purple. The remaining 10 specimens remained unchanged in color after standing for at least one hour.

Up to this point, the analyses of the specimens which had been conducted by the person performing the analyses had been blind tests, i.e. the person had not been given any information with respect to the gender, age or condition of the 50 subjects from whom the specimens were obtained. At the conclusion of the 50 tests, the results were compared to the individual subject’s medical history at which time the following observations were made.

Of the 40 specimens in which a color change to pink was observed, 20 of the subjects who provided the specimens had previously been diagnosed with any one of several different forms of cancer, including colon, lung, liver or uterine cancer or leukemia. In fact, the single specimen which turned dark pink/purple was from a leukemia patient who was terminal at the time of the test, and who passed away soon after the analyses were performed.

Of the remaining 20 test specimens that showed a color change, the subjects who provided the specimens had not previously been specifically diagnosed with cancer. However, several of these subjects had been observed to have conditions which may or may not be cancerous, e.g. colon polyps, lung spots, etc. It is significant that in a follow-up of these 20 patients one year after the analyses were performed, each of the 20 had subsequently been diagnosed with cancer, including colon, lung, liver and pancreatic cancer. At least some of these determinations were subsequently made by biopsy of the conditions which had previously been observed, e.g. the colon polyps or lung spots.

Also of significance, the subjects who provided the 10 remaining specimens that showed no color change during the tests neither had previously been diagnosed with cancer, had exhibited any evidence of any condition that might be cancerous, e.g. colon polyps or lung spots, and after the one year follow-up, were not reported to have developed cancer or any condition that might be determined upon further testing to be cancerous.

It will be understood that the preferred embodiment of the present invention which has been described is merely illustrative of the principles of the present invention. Modifications may be made by those skilled in the art without departing from the true spirit and scope of the invention.

Method for the detection of malignant and premalignant stages of cervical cancer

Filed under: Issued Patent — admin @ 3:35 am

Abstract
This invention discloses a method to identify premalignant and malignant stages of cervical cancer from an infrared (IR) spectrum of exfoliated cervical cells which are dried on an infrared transparent matrix and scanned at the frequency range from 3000-950 cm.sup.-1. The identification of samples is based on establishing a calibration using a representative set of spectra of normal, dysplastic and malignant specimens. During the calibration process, multivariate techniques such as Principal Component Analysis (PCA) and/or Partial Least Squares (PLS) are used. PCA and PLS reduce the data based on maximum variations between the spectra, and generate clusters in a multidimensional space representing the different populations. The utilization of Mahalinobis distances, or linear regression (e.g., Principle Component Regression on the reduced data from PCA) form the basis for the discrimination. This method is simple to use and achieves statistically reliable distinction between the following groups of cervical smears: normal (individuals with no prior history of dysplasia), dysplasia and malignant samples. Lastly, this invention discloses a method to obtain the IR spectrum of individual cervical cells fixed on an infrared transparent matrix.

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Inventors: Cohenford; Menashi A. (West Warwick, RI), Bhandare; Prashant S. (Arlington, MA), Cahn; Frederick R. (Princeton, NJ), Krishnan; Krishnaswamy (Norwell, MA), Rigas; Basil (White Plains, NY)
Assignee: Bio-Rad Laboratories, Inc. (Hercules, CA)

Appl. No.: 08/558,130
Filed: November 13, 1995
Claims

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What is claimed is:

1. A method for the identification of a malignant or premalignant condition in an exfoliated cervical cell sample, said method comprising:

(a) drying said exfoliated cervical cell sample on an infrared transparent matrix to produce a dried cell sample;

(b) directing a beam of mid-infrared light at said dried cell sample, said beam of mid-infrared light having a frequency of from about 3000 to about 950 cm.sup.-1 to produce absorption data for said dried cell sample; and

(c) comparing said absorption data for said dried cell sample with a calibration/reference set of infrared absorption data to determine whether variation in infrared absorption occurs in said dried cell sample, at at least one range of frequencies, due to the said variation being characteristic of said malignant or premalignant condition, said comparing utilizing a partial least squares or principal component analysis statistical method and said absorption data being underivatized and unsmoothed, whereby said identification of said malignant or premalignant condition is made.

2. A method in accordance with claim 1 wherein said calibration/reference set of infrared absorption data is from a representative set of normal, dysplastic and malignant cervical cells.

3. A method in accordance with claim 2, wherein said calibration/reference set is prepared from about 100 to about 1000 reference cell samples.

4. A method in accordance with claim 2, wherein said calibration/reference set of infrared absorption data is prepared from about 100 to about 500 reference cell samples.

5. A method in accordance with claim 1, wherein said comparing utilizes principal component regression which is carried out using principal component analysis.

6. A method in accordance with claim 1, wherein said infrared transparent matrix is a matrix prepared from a member selected from the group consisting of BaF.sub.2, ZnS, polyethylene film, CsI, KCl, KBr, CaF.sub.2, NaCl and ZnSe.

7. A method in accordance with claim 1, wherein prior to step (a) said exfoliated cervical cell sample is dispersed, thereby separating said cervical cells from nondiagnostic debris in said sample to provide a substantially uniform suspension of cells for drying.

8. A method in accordance with claim 7, wherein said exfoliated cervical cell sample is dispersed in a preservative solution.

9. A method in accordance with claim 1, wherein said comparing utilizes principal component analysis and is confined to the frequency region of about 1200 cm.sup.-1 to about 1000 cm.sup.-1.

10. A method in accordance with claim 1, wherein said comparing utilizes principal component analysis and is carried out by concurrent analysis of the frequency regions of about 1250 to 1000 cm.sup.-1, about 1420 to 1330 cm.sup.-1 and about 3000 to 2800 cm.sup.-1.

11. A method in accordance with claim 1, wherein said beam of mid-infrared light is directed through an aperture of individual cell size and said absorption data for said dried cell sample is produced for single cells.

12. A method in accordance with claim 1, wherein prior to step (a) said exfoliated cervical cell sample is dispersed in a preservative solution, thereby separating said cervical cells from nondiagnostic debris in said sample to provide a substantially uniform suspension of cells for drying and wherein said beam of mid-infrared light is directed through an aperture of individual cell size and said absorption data for said dried cell sample is produced for single cells.
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Description

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BACKGROUND OF THE INVENTION

The detection of premalignant and malignant cells by the Papanicolaou smear (Pap smear) has greatly reduced the high mortality rate due to cervical cancer. Nevertheless, the Pap screening process is labor intensive and has remained essentially unchanged since it was first described by Papanicolaou almost 50 years ago. To perform the test, exfoliated cells from a patient’s cervix are first scraped using a spatula or brush. The scraping is then smeared on a slide, and the slide is stained and microscopically examined. The microscopic examination is a tedious process, and requires a cytotechnologist to visually scrutinize all the fields within a slide to detect the often few aberrant cells in a specimen. Consequently, the rate in the detection of abnormal specimens depends on the level of a cytotechnologist’s experience, quality of the smear preparation, and the work load. As a result of these concerns, attempts have been made both to automate the Pap screening process, and develop other objective alternatives.

A number of methods have been explored to detect cytological anomalies, including those using molecular and immunological techniques. One impetus behind the development of new molecular and immunological methods is the detection of the human papilloma virus (HPV). Certain subtypes of HPV have been linked to a high incidence of abnormal lesions, and are implicated in the etiology of cervical cancer. Although these techniques are specific and detect cervical specimens at high risk, they are currently cost prohibitive and too labor intensive.

Recently, differences have been reported in the Fourier Transform Infrared (FT-IR) spectra of 156 cervical samples, of which, by cytological screening, 136 were normal, 12 had cancer, and 8 had dysplasia (see, Wong et al., Proc. Natl. Acad. Sci. USA, 87:8140-8145 (1991)). This study relied on features of the Mid-IR region (3000-950 cm.sup.-1) to discriminate between the samples. The spectra of normal samples exhibited a prominent peak at 1025 cm.sup.-1 which appears to be due to glycogen, and other less pronounced bands at 1047 cm.sup.-1, 1082 cm.sup.-1, 1155 cm.sup.-1 and 1244 cm.sup.-1. The spectra of specimens diagnosed with cancer exhibited significant changes in the intensity of the bands at 1025 cm.sup.-1 and 1047 cm.sup.-1, and demonstrated a peak at 970 cm.sup.-1 which was absent in normal specimens. Samples with cancer also showed a significant shift in the normally appearing peaks at 1082 cm.sup.-1, 1155 cm.sup.-1 and 1244 cm.sup.-1. The cervical specimens diagnosed cytologically as dysplasia exhibited spectra intermediate in appearance between normal and malignant. Based on these observations, Wong et al. concluded that FT-IR spectroscopy may provide a reliable and cost effective alternative for screening cervical specimens.

More recently, others have reported a greater diversity in the spectra of specimens with dysplasia than previously reported by Wong et al. (see Morris, et al., Gynecologic Oncology 56:245-249 (1995)). Out of the 25 specimens that were evaluated, the spectra of 9/13 specimens with low grade dysplasia (CIN I) appeared essentially similar to the spectra of normal specimens. However, as dysplasia progressed from low to high (CIN I to CIN III), the magnitude of spectral differences between normal and dysplastic samples intensified. This difference was most apparent in specimens with high grade dysplasia (CIN III) which exhibited a characteristic peak at 972 cm.sup.-1, and changes in intensity of bands at 1026 cm.sup.-1 (decreased), 1081 cm.sup.-1 (increased and shifted to higher frequency), 1156 cm.sup.-1 (decreased and flattened), and 1240 cm.sup.-1 (increased).

The FT-IR spectroscopic studies of Wong, et al. (1991) focused primarily on the differences between normal and malignant samples, and utilized only a few dysplastic specimens. More importantly, discrimination between specimens was achieved by inspection of spectra, and by overt changes in peak intensity ratios at specified frequencies. Visual inspection as a basis of discrimination is not an ideal method of analysis. This approach lends itself to subjective bias and is frequently insensitive to small variations between spectra. In the case of malignant specimens, the spectral patterns are markedly altered compared to those of normal samples. However, as indicated earlier, the spectra of a great majority of specimens with low grade dysplasia (e.g. CIN I–cervical intraepithelial neoplasia) appear similar to spectra from normal samples and are difficult to distinguish. As a result, this method is unreliable and unsuited for the analysis of cervical specimens.

The method of selecting peak intensity ratios to discriminate between spectra has its problems too. This technique identifies general shapes and patterns, and like the previous approach lacks acuity in the detection of subtle differences between spectra. Other disadvantages of this method include its inability to model for interferences that may be caused by nondiagnostic debris, and/or errors that may result from sample preparation and handling techniques. Aside from the latter, this method also fails to adequately model for baseline shifts, spectral fringes, batch to batch variations in samples and/or to account for the nonlinearities that may arise from spectroscopic instrumentation and refractive dispersion of light.

Robinson, et al. in U.S. Pat. No. 4,975,581 issued Dec. 4, 1990 describe a quantitative method to determine the similarities of a biological analyte in known biological fluids using multivariate analysis. Although reliable, the method focuses on the in vivo evaluation of analytes in fluids, and uses noninvasive techniques. No accommodations are made to discriminate between solid biological material such as mammalian cells or to address the issues that may arise while discriminating the IR spectra of solid biological materials with varied path lengths outside the body.

From a clinical point of view, it is desirable to detect all specimens with dysplasia. The progression of dysplastic cells to cancer is not only well documented, but is also of fundamental importance in the Pap screening process. The present invention provides methods of detecting both malignant and premalignant stages of cervical cancer.

SUMMARY OF THE INVENTION

The present invention provides methods for the identification of a malignant or premalignant condition in an exfoliated cervical cell sample. The methods involve,

(a) drying an exfoliated cervical cell sample on an infrared transparent matrix to produce a dried cell sample;

(b) directing a beam of mid-infrared light at the dried cell sample, the beam of mid-infrared light having a frequency of from about 3000 to about 950 cm.sup.-1 to produce absorption data for the dried cell sample;

(c) comparing the absorption data for the dried cell sample with a calibration/reference set of infrared absorption data to determine whether variation in infrared absorption occurs in the dried cell sample, at at least one range of frequencies, due to the variation being characteristic of a malignant or premalignant condition. The method of comparison utilizes a partial least squares or principal component analysis statistical method and is based on absorption data which is underivatized and unsmoothed. In particularly preferred embodiments, the calibration/reference set of infrared absorption data is obtained from a representative set of normal, dysplastic and malignant cervical cells which were dried on an infrared transparent matrix.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows the mid-infrared spectrum (from 950 cm.sup.-1 -1300 cm.sup.-1) of a normal cervical scraping.

FIG. 2 shows the mid-infrared spectrum (from 950 cm.sup.-1 -1300 cm.sup.-1) of a malignant cervical scraping.

FIG. 3 is a histogram showing the prediction of scores of normal samples.

FIG. 4 is a histogram showing the prediction of scores of malignant samples.

FIG. 5 shows the mid-infrared spectrum (from 950 cm.sup.-1 -1300 cm.sup.-1) of two populations of squamous epithelial cells.

FIG. 6 shows a comparison of the mid-infrared spectra (from 950 cm.sup.-1 -1300 cm.sup.-1) from parabasal cells and endocervical cells.

FIG. 7 shows a comparison of the mid-infrared spectra (from 950 cm.sup.-1 -1300 cm.sup.-1) from a dysplastic cell and a squamous cancer cell.

DETAILED DESCRIPTION OF THE INVENTION

Abbreviations and Definitions

Abbreviations used herein have the following meanings: PCA, principal component analysis; PCR, principal component regression; PLS, partial least squares analysis.

As used herein, the terms “underivatized” and “unsmoothed” are used to refer to a process whereby no arithmetic manipulations have been applied to 1) enhance the slope or changes in the slope of spectra, and 2) reduce the random noise in spectra, respectively.

Description of the Embodiments

Discrimination between spectra of cervical specimens that have subtle variations requires the use of robust and sensitive methods of analysis. These methods must model for the nonlinearities that may arise due to various causes as well as account for the day to day drifts in instrument settings. Sample handling errors, spectral fringes, baseline shifts, batch to batch variations, the presence of nondiagnostic debris and all other factors that adversely affect discrimination must be also accounted adequately and modeled for. Water absorbs strongly in mid-infrared region and contributes to changes in intensity at several frequencies. Thus, the method of analysis must also consider the varying amounts of moisture in cervical specimens. Lastly, for a method to prove robust it must distinguish between good and poor quality spectra, and exclude or model for outlier samples. An outlier sample is a sample that is statistically different from all other samples in the calibration set. In the case of cervical scrapings, an outlier spectrum may result from samples with less than an optimal number of cells, and/or specimens that are rich in blood, mucus and/or nondiagnostic debris.

In one aspect, the present invention provides a method for the identification of a malignant or premalignant condition in an exfoliated cervical cell sample. This method comprises:

(a) drying the exfoliated cervical cell sample on an infrared transparent matrix to produce a dried cell sample;

(b) directing a beam of mid-infrared light at the dried cell sample, the beam of mid-infrared light having a frequency of from about 3000 cm.sup.-1 to about 950 cm.sup.-1 to produce absorption data for the dried cell sample; and

(c) comparing the infrared absorption data for the dried cell sample with a calibration/reference set of infrared absorption data to determine whether variation in infrared absorption occurs in the dried cell sample, at least one range of frequencies, due to the variation being characteristic of the malignant or premalignant condition. The method of comparing utilizes a partial least squares (PLS) or principal component analysis (PCA) statistical method. Additionally, the absorption data is underivatized and unsmoothed.

In this method, the calibration/reference set of infrared absorption data is obtained from cell samples which have previously been identified as normal, dysplastic or malignant samples. Identification of these cell types is typically made by cytological examination such as the one performed on smears. The infrared absorption spectra for each of the identified cell types is obtained for the mid-infrared region from about 3000 cm.sup.-1 to about 950 cm.sup.-1. Typically, the calibration/reference set of infrared absorption data is prepared from about 100 to about 1000 reference cell samples, preferably from about 100 to about 500 reference cell samples.

In general, the calibration set should be representative of all expected variations in the spectra. The infrared absorption data of all samples is then processed with a computer utilizing PCA or PLS algorithms to extract information relating to each of the variations within the calibration spectra. The resulting information is used, thereafter, to distinguish between different groups of cervical specimens (e.g. normal, dysplastic or malignant).

The exfoliated cervical cell sample is collected by standard methods such as those used in collecting samples for Pap screening and applied to an infrared transparent matrix. A variety of matrices are available for use in the present invention. Preferred matrices are BaF.sub.2, ZnS, polyethylene film, CsI, KCl, KBr, CaF.sub.2, NaCl and ZnSe. A particularly preferred matrix is ZnS. Once the sample is applied to the matrix, the sample is dried to remove moisture which interferes with the infrared spectra. The methods used for drying will typically involve air-drying at ambient temperatures. Alternatively, the sample can be dried with controlled gentle heating, and by passing a stream of air or inert gas over the sample. For example, matrices with applied samples can be placed at 30.degree. C. to 35.degree. C. (e.g., a hot plate with temperature control knob to about 30-35.degree. C.) and an atmosphere of, for example, air, nitrogen or argon can be passed over the samples to expedite their drying.

Others have relied on the utilization of a sample holder described in U.S. Pat. No. 4,980,551. Briefly, that device is made to accommodate a set of IR transparent windows in face to face contact, and contains the means to secure the windows in the path of an infrared light beam transmitting passage. The exterior of at least one of the windows has a surface portion contoured to provide between the windows a space for the sample. This sample space being shaped to provide adjacent light beam paths of different length minimizes optical interference fringes, and enhances the quality of spectra. To utilize the holder, contents from cervical scraping are first deposited in the sample space of one of the windows. With the other window carefully positioned over the specimen, the holder is tightened to secure the windows. An infrared light beam is passed through the sample space and the absorption of the cervical sample is recorded. Acquisition of spectra of cervical specimens by this technique is a difficult and time consuming process. For example, it is not only required that special windows be made, but also the biological specimen must remain undisturbed while being compressed between two windows. Compression frequently causes the leakage of tissue fluids, and ultimately the spilling of cervical specimens beyond the confines of the windows. Moreover, because cervical specimens may be contaminated with infectious agents such as the AIDS, Herpes and/or the various Hepatitis viruses, any leakage creates serious biological safety concerns. Still further, tissue fluids also absorb strongly in the mid-infrared region and contribute to changes in intensity at several frequencies.

In contrast, the methods of the present invention result in samples that are easy to manipulate and which provide high quality spectra. More importantly, drying eliminates the problems associated with tissue fluids, and reduces the risk of contamination by infectious agents. In a study of more than 100 cervical scrapings processed by this method, the direct deposition and drying of specimens was found to provide spectra with minimal or no fringes.

Another complication to the screening of cervical samples by infrared spectroscopy is the fact that only a few aberrant cells are generally recovered from the cervical scrapings of patients with dysplasia and cancer. For these cells to be detected by FT-IR spectroscopy, they must be present in the path of the infrared beam before analysis. One approach to ensure that the IR transparent windows contain a representative population of cells is to disperse the cervical scrapings prior to their deposit on the IR transparent windows. A thorough dispersion of the cervical scraping causes the separation of cells from surrounding nondiagnostic debris and mucus, provides a relatively uniform suspension of cells for spectral acquisition, and enhances the possibility of detecting the abnormal cells.

Thus, in some embodiments, the samples will be dispersed prior to their application to the infrared matrix. Dispersion of the cell sample is preferably carried out in a preservative solution which maintains the integrity of the exfoliated cells. The selection criteria for a preservative solution also necessitate that the preservative solution evaporates readily, and upon evaporation, leaves no residues that create interference in the infrared spectra of cervical scrapings. An example of one such preservative solution is PRESERV CYT.RTM. (CYTYC Corporation, Marlborough, Mass., U.S.A.). Following dispersion of the cell sample, the mixture is filtered to remove the nondiagnostic debris and the solution of cells is applied in a uniform layer to an infrared matrix, as described above, and dried.

Once the sample has been prepared (and dried) on the infrared matrix, a beam of mid-infrared light is directed at the sample and the absorption of the sample is monitored using any of a number of commercially available infrared spectrophotometers. Preferably, the spectrometer is a Bio-Rad Digilab FTS 165 spectrometer equipped with a DTGS detector. Other suitable spectrometers are known to those of skill in the art. Spectra are collected at a resolution of from about 2 cm.sup.-1 to about 10 cm.sup.-1, preferably from about 4 cm.sup.-1 to about 8 cm.sup.-1. Additionally, a number of scans are taken and co-added. Preferably about 50-500 scans are co-added, more preferably about 100-300 scans are co-added. In preferred embodiments, the spectra are normalized by setting the minimum absorbance at 0.0 and the maximum absorbance at 1.0 in the frequency regions between 3000 cm.sup.-1 to 1000 cm.sup.-1.

After collection of the infrared absorption data for the dried cell sample, the data is compared to the calibration/reference set to determine if variations exist in the sample which are characteristic of a malignant or premalignant condition. This comparison is typically carried out by a partial least squares (PLS) or principal component analysis (PCA) statistical method on absorption data for the sample which is preferentially unsmoothed and underivatized. Preferably, comparisons using principle component regression (PCR) are carried out using PCA. A number of computer programs are available which carry out these statistical methods, including PCR-32.RTM. (from Bio-Rad, Cambridge, Mass., U.S.A.) and PLS-PLUS.RTM. and DISCRIMINATE.RTM. (from Galactic Industries, Salem, N.H., U.S.A. ). Discussions of the underlying theory and calculations can be found in, for example, Haaland, et al., Anal. Chem. 60:1193-1202 (1988); Cahn, et al., Applied Spectroscopy, 42:865-872 (1988); and Martens, et al., MULTIVARIATE CALIBRATION, John Wiley and Sons, New York, N.Y. (1989).

Principal Component Analysis (PCA) and discriminate analysis has recently been employed to distinguish between normal and abnormal cervical scrapings. See, Zhengfang, et al., Applied Spectroscopy 49:432-436 (1995). However, the methods described therein did not focus on the detection of premalignant stages of cervical cancer and also relied on preprocessing algorithms that smoothed the spectra. Smoothing of spectra can obscure the subtle differences which exist between spectral patterns, and consequently can affect the discriminate analysis.

Although PCR and PLS have been used in various fields of science and in many types of applications, these techniques have never been used to discriminate in the mid-infrared region of the spectra, cervical scrapings from normal patients and patients with dysplasia or cervical cancer. Both PCR and PLS can reduce massive amounts of data into sets that can be readily managed for analysis. More importantly, when these methods are used to evaluate the spectra of mammalian cells, the techniques analyze entire regions of a spectrum and allow discrimination between the spectra of different groups of specimens.

Both PCR and PLS use a library of spectra from known materials with known concentrations to create a reference (calibration set). These spectra are acquired under the same experimental conditions. These techniques consist of spectral data compression (in the case of PCR, this step is known as PCA), and linear regression. Using a linear combination of factors or principal components, a reconstructed spectrum is derived. This reconstructed spectrum is compared with the spectra of unknown specimens which serves as the basis for classification.

Prior to the analysis of unknown samples, another set of spectra of the same materials are typically used to validate and optimize the calibration. This second set of spectra enhance the prediction accuracy of the PCR or PLS model by determining the rank of the model. The optimal rank is determined from a range of ranks by comparing the PCR or PLS predictions with known diagnoses. Increasing or decreasing the rank from what was determined optimal may adversely affect the PLS or PCR predictions. For example, as the rank is gradually decreased from optimal to suboptimal, PCR or PLS would account for less and less variations in the calibration spectra. In contrast, a gradual increase in the rank beyond what was determined optimal would cause the PCR or PLS methodologies to model random variation rather than significant information in the calibration spectra.

Generally, the more spectra a reference set includes, the better is the model, and the better are the chances to account for batch to batch variations, baseline shifts and the nonlinearities that may arise due to instrument drifts and changes in the refractive index. Errors due to poor sample handling and preparation, sample impurities, and operator mistakes can also be accounted for so long as the reference data render a true representation of the unknown samples.

Another major advantage to using PCR and PLS analysis is that these methods measure the spectral noise level of unknown samples relative to the calibration spectra. Biological samples are subject to numerous sources of perturbations. Some of these perturbations drastically affect the quality of spectra, and adversely influence the results of a “diagnosis”. Consequently, it is imperative to distinguish between spectra that conform with the calibration spectra, and those that do not (e.g. the outlier samples). The F-ratio is a powerful tool in detecting conformity or a lack of fit of a spectrum (sample) to the calibration spectra. In general F-ratios considerably greater than those of the calibration indicate “lack of fit” and should be excluded from the analysis. The ability to exclude outlier samples adds to the robustness and reliability of PCR and PLS as it avoids the creation of a “diagnosis” from inferior and corrupted spectra. F-ratios can be calculated by the methods described in Haaland, et al., Anal. Chem. 60:1193-1202 (1988), and Cahn, et al., Applied Spectroscopy 42:865-872 (1988).

When discriminating between samples of different cervical scrapings, the biological materials no longer have known concentrations of constituents, and/or a constant path length. As a result, the calibration spectra must determine the range of variation allowed for a sample to be classified as a member of that calibration, and should also include preprocessing algorithms to account for diversities in path length. One normalization approach that aids in the discrimination of cervical specimens is locating the maximum and minimum points in a spectral region, and rescaling the spectrum so that the minimum remains at 0.0, and the maximum at 1.0 absorbance (e.g. in the frequency region between 3000 cm.sup.-1 to 1000 cm.sup.-1). Another normalization procedure is to select a specific peak(s) at a certain frequency(ies) of the IR spectra, and relate all other peaks to the selected peak(s). A third type of normalization is to normalize the magnitude of the absorbance vector before processing.

In preferred embodiments, comparison of the infrared absorption data for the sample and the data for the calibration/reference set utilizes principal component analysis in the frequency region 1200 cm.sup.-1 to 1000 cm.sup.-1, more preferably in the frequency regions of about 1250 to 1000 cm.sup.-1, about 1420 to 1330 cm.sup.-1 and about 3000 to 2800 cm.sup.-1.

The Pap screening process renders a diagnosis based on the microscopic examination of each of the cells in a cervical scraping. Nevertheless, present spectroscopic techniques have used a bulk analysis of cervical scrapings. The use of Fourier Transform IR (FT-IR) spectroscopy, while capable of examining objects with sizes approaching 10 .mu.m, is complicated by the presence of blood, mucus, and nondiagnostic debris in cervical scrapings. These materials may not only contribute to the clumping of the cells, but also create interferences that mask the actual spectra of cells in general. Nevertheless, it remains important to conclusively identify those cells that contribute to the changes in the spectra between normal and abnormal specimens. Thus, in one group of embodiments, the present method is carried out using a beam of mid-infrared light which is directed through an aperture of individual cell size, thereby providing absorption data for single cells. In this group of embodiments, the sample is dispersed and filtered, as described above, to create a uniform suspension of cells which can be applied to an infrared matrix and dried.

In another aspect, the present invention provides a method for the in vivo identification of a malignant or premalignant cervical condition in a host, comprising;

(a) directing a beam of infrared light through an optic fiber at the cervical cells in the host, at a range of frequencies to produce absorption data for the host;

(b) performing the analysis in mid or near infrared regions; and

(c) comparing the absorption data for the cervical cells with a calibration/reference set of infrared absorption data to determine whether variation in infrared absorption occurs in the cervical cells, at at least one range of frequencies, due to the variation being characteristic of a malignant or premalignant condition, the comparing utilizing a partial least squares or principal component analysis statistical method and the absorption data being underivatized and unsmoothed, whereby an identification of a malignant or premalignant condition is made.

In preferred embodiments, the calibration/reference set of infrared absorption data from cervical cells is obtained from a representative population of normal, dysplastic and malignant hosts.

In the mid infrared region, use of the frequencies between 3000 cm.sup.-1 to 950 cm.sup.-1 is preferred. In the near IR, use of the frequencies between 12,500 cm.sup.-1 to 4000 cm.sup.-1 is preferred.

The techniques used in this aspect of the invention are generally the same as those described above. Differences are in the fundamental approach of in vivo collection of data and in the use of an optic fiber to direct the beam of mid or near infrared light. Typical optic fibers used for mid-Infrared include Chalcogenide, and Silver Halide. A typical optic fiber for near IR is the Quartz fiber. One advantage to in vivo analysis of cervical cells is that the method directs the physician to the site of anomalous tissue, and also minimizes the size of specimens for biopsy. Moreover, this method can provide a rapid objective screening of patients, while patients are being examined in a doctor’s office. The current procedures necessitate that a physician sends Pap smears to a laboratory, where they are stained and evaluated by a cytotechnologist. Other benefits to the in vivo technique include the on-site treatment of suspicious tissues after localization by infrared spectroscopy.

In yet another aspect, the present invention provides a method for identifying a patient who is at high risk for dysplasia. In this method, a reference set of cervical cell samples is created from women having no history of dysplasia, each of the samples having a balance of two cell types. A mean and standard distribution for the balances from the reference samples is established and a cervical cell sample population from the patient is compared with the mean and standard distribution to determine if the balance of cell types from the patient is outside the mean and standard distribution from the reference set. In this manner, one can determine if the patient is at high risk for dysplasia.

In preferred embodiments, the two cell types are mature squamous cells and intermediate squamous epithelial cells. In other preferred embodiments, the balance of cells in the reference set and in the patient sample are identified by spectroscopic means (e.g., flow cytometry, infrared, ultraviolet, nuclear magnetic resonance). In other embodiments, the balance is determined visually with the aid of a microscope.

The following examples are offered solely for the purposes of illustration, and are intended neither to limit nor to define the invention.

EXAMPLES

Example 1

This example illustrates the detection of malignant and premalignant cervical cancer conditions using infrared spectroscopy with principal component analysis.

1.1 Materials and Methods

Four hundred thirty-six spectra were obtained from cervical scrapings collected by the method described in Wong, et al., Proc. Natl. Acad. Sci. USA, 88:10988-10992 (1991). The spectra and Pap smear diagnosis were analyzed for the feasibility of predicting Pap smear diagnosis by principle component analysis of the infrared spectra. Unless otherwise indicated, analysis was confined to the frequency region of 1200 cm.sup.-1 to 1000 cm.sup.-1. All spectra were normalized in the frequency region of 1200 cm.sup.-1 to 1000 cm.sup.-1 so that the minimum absorbance was set at 0.0 absorbance and the maximum at 1.0 absorbance.

1.2 Results

Inspection of the spectra after normalization revealed two basic patterns. One pattern exhibited a prominent peak around 1025 cm.sup.-1 (see FIG. 1), and had spectral features typical of those observed with normal cervical scrapings (see Wong, et al., ibid.). The second basic pattern manifested no peaks at or around the 1025 cm.sup.-1 region (FIG. 2), and appeared `typical` of the spectra which were reported for malignant specimens (Wong, et al., ibid.). In some cases, spectra appeared to be a mixture of the two patterns, and/or appeared atypical, or showed fringing. The initial analysis focused on samples that exhibited the `typical` normal and malignant spectra, and excluded all other specimens with anomalous spectral features (e.g. with a mixed, or an atypical or fringed pattern).

A calibration set was then created on a subset of these preselected spectra as follows: one reference included the normal specimens with spectra `typical` of normal cervical scrapings (FIG. 1), and the other of malignant samples with spectra typical of cancer. Spectra from normal cervical scrapings were assigned a dummy variable value of 0, and those from malignant scrapings were assigned a value of 1. Every 4th spectrum of the remaining subset of selected spectra was then used as a validation sample.

Table 1 summarizes the Sum of Squares (SS) of the spectra after mean centering as elucidated by each principal component. Calculation of these values was carried out by the methods described in Haaland, et al., Anal. Chem. 60:1193-1202 (1988), and in Cahn, et al., Applied Spectroscopy 42:865-872 (1988). Tabulated results show that over 99% of the variation in the spectra are accountable by the first 7 principal components.

TABLE 1 ______________________________________ PCA ANALYSIS OF CALIBRATION DATA SET Rank SS Cumulative SS ______________________________________ 1 70.03% 70.03% 2 15.07% 85.11% 3 7.76% 92.86% 4 3.77% 96.63% 5 1.50% 98.13% 6 0.72% 98.85% 7 0.40% 99.25% 8 0.24% 99.49% 9 0.18% 99.68% 10 0.12% 99.80% ______________________________________

A rank of 7 was selected as providing the best discrimination on a cross validation analysis of the few randomly selected validation samples that were omitted from the calibration. This rank was selected on the basis of tabulating the minimum prediction of the malignant samples and the maximum prediction for the normal samples vs. PCR model rank (Table 2).

TABLE 2 ______________________________________ PREDICTED DUMMY VARIABLES VS. PCR MODEL RANK Minimum malignant Maximum normal Rank prediction prediction ______________________________________ 1 0.93 0.14 2 0.95 0.10 3 0.92 0.16 4 0.92 0.19 5 0.90 0.09 6 0.94 0.09 7 0.95 0.08 8 0.95 0.08 9 0.95 0.12 10 0.94 0.11 ______________________________________

At rank 7, the minimum prediction of the dummy variable among malignant validation samples was 0.95 (closest to 1.0), and the highest prediction of the dummy variable among normal validation samples was 0.08. Rank 7 was thereafter used to analyze the entire set of the 436 spectra. Histograms were then computed for the predicted dummy variable using 162 normal and 19 malignant samples. A break point (BP) of 0.5 provided a reasonable discrimination between the normal and malignant spectra (see FIGS. 3 and 4).

1.3 PCA Analysis of All Spectra

F-ratios were calculated for all spectra from the sample set. These values were calculated according to the methods described in Haaland, et al., Anal. Chem. 60:1193-1202 (1988). The F-ratios provide an indication of how similar a sample spectrum is to the calibration set. High F ratios, for examples, can result when a sample is not similar to the calibration spectra being analyzed. In this study, all spectra with F ratios.gtoreq.25 were by visual inspection found to be either corrupt or significantly distinct from the calibration spectra.

A F-ratio.gtoreq.25 was, thus, arbitrarily selected as the rejection threshold for exclusion of outlier spectra. This selection provides a consistency (which cannot be obtained by purely visual inspection) to the set of spectra which are then used for diagnosis. Based on this criterion, 40/436 samples were flagged out as specimens with a “poor” spectrum. The following table summarizes the diagnosis code, and the number of specimens that remained in each diagnosis class after exclusion by the F ratio criterion.

TABLE 3 ______________________________________ Diagnosis Total Code Specimens Pap smear report ______________________________________ 0 174 Normal a 52 Atypical ab 4 Atypical with a bloody smear abi 4 Bloody smear with atypical cells and inflammatory signs ai 27 Atypical with evidence of inflammation air 5 Atypical (reactive) with evidence of inflammation ar 19 Atypica1 (reactive) at 2 Atypical with atrophic pattern b 6 Bloody smear bi 2 Bloody smear with evidence of inflammation br 2 Bloody smear with reactive cells bx 2 Bloody and an aceffular smear d 8 Dysplasia i 30 Inflammatory ib 1 Inflammatory and bloody smear ir 7 Inflammatory with reactive cells it 4 Inflammatory with atrophic pattern m 19 Malignant or carcinoma in situ r 4 Reactive rt 1 Reactive with atrophic pattern t 19 Atrophic pattern tx 3 Acellular with atrophic pattern x 1 Acellular Total 396 ______________________________________

Based on a 0.5 breakpoint, the 396 samples having F-ratios below 25 were classified as normal or malignant according to this linear discriminate function on the spectra. The following contingency table summarizes the results:

TABLE 4 ______________________________________ CONTINGENCY TABLE BASED ON 0.5 BREAKPOINT Observed Expected Diagnosis Total 0 m 0 m .chi..sup.2 p ______________________________________ 0 174 148 26 132 42 a 52 39 13 39.4 12.6 2.18 0.140 ab 4 1 3 3.03 0.97 6.41 0.011 abi 4 2 2 3.03 0.97 1.46 0.226 ai 27 21 6 20.5 6.52 0.46 0.497 air 5 3 2 3.79 1.21 0.80 0.370 ar 19 16 3 14.4 4.59 0.06 0.810 at 2 0 2 1.52 0.48 5.28 0.022 b 6 3 3 4.55 1.45 3.00 0.083 bi 2 1 1 1.52 0.48 0.15 0.703 br 2 2 0 1.52 0.48 0.17 0.682 bx 2 1 1 1.52 0.48 0.l5 0.703 d 8 4 4 6.07 1.93 4.52 0.034 i 30 21 9 22.8 7.24 3.09 0.079 ib 1 1 0 0.76 0.24 0.98 0.322 ir 7 6 1 5.31 1.69 0.24 0.622 it 4 3 1 3.03 0.97 0.02 0.880 m 19 4 15 — – 38.2 0.000* r 4 2 2 3.03 0.97 1.46 0.226 rt 1 0 1 0.76 0.24 0.92 0.337 t 19 9 10 14.4 4.59 13.65 0.000* tx 3 2 1 2.28 0.72 0.00 0.945 x 1 1 0 0.76 0.24 0.98 0.322 Totals: 396 290 106 Totals 377 286 91 ______________________________________ *denotes that a rounding of the number resulted in a p = 0.000. denotes that totals were subtracted from the samples with diagnosis malignant (code m) denotes that the method used to calculate the .chi..sup.2 values necessitates the exercise of caution when interpreting the p values havin a zero in one of the “observed” cells.

The above contingency table was based on the null hypothesis that with the exclusion of the malignant specimens (e.g., code m), there was no difference in the predicted distribution of each individual diagnosed category. A Chi Square test of the null hypothesis yielded a value of 44.9 at 21 degrees of freedom. The null hypothesis is rejected at the p=0.002 significance level, suggesting that at least some of the diagnoses are associated with a different frequency than being predicted as normal by spectroscopy. The computation of the Chi Square value (.chi..sup.2) was performed by standard statistical methods, by excluding the malignant samples (code m) as follows: First, the sum of the numbers in column O and column m were calculated. These numbers were found to be 286 and 91, respectively. Next, for each of the “observed” values, an expected value was calculated. These expected values in column O were calculated on the basis of multiplying (the total sum of each row) by (the total sum of the observed numbers in column O divided by 377). The number 377 represents the total of all rows. For example, the “expected” value of 39.4 in column O for diagnosis atypical (code a) resulted from taking the number 52 (e.g., the total sum of the row).times.(286.div.377). The “expected” values in column m were calculated by the same method except for multiplying (the total sum of each row) by (the total sum of the observed numbers in column m.div.377). Once again, using the atypical diagnosed samples (code a) as an example, the “expected” value of 12.6 in column m was calculated by taking the number 52 (e.g., the total sum of the row).times.(91.div.377). Table 5 uses the first 4 rows of the contingency table to illustrate the overall mathematical manipulations that were employed in arriving at the .chi..sup.2 value.

TABLE 5 __________________________________________________________________________ Observed Expected (O) (E) (O-E).sup.2 (O-E).sup.2 /E Diagnosis 0 m 0 m 0 m 0 m __________________________________________________________________________ o 148 26 132 42 (148-132).sup.2 (26-42).sup.2 1.94 6.09 a 39 13 39.4 12.6 (39-39.4).sup.2 (13-12.6).sup.2 .004 .013 ab 1 3 3.03 0.97 (1-3.03).sup.2 (3-0.97).sup.2 1.36 4.25 abi 2 2 3.03 0.97 (2-3.03).sup.2 (2-0.97).sup.2 0.35 1.09 __________________________________________________________________________ .chi..sup.2 = .SIGMA.(OE).sup.2 /E = Sum of the numbers in column A + Sum of the numbers in column B for all diagnoses (with the exclusion of the malignant samples) = 44.9 (a .chi..sup.2 value of 44.9 at 21 degrees of freedom yields p = 0.002 from a .chi..sup.2 distribution table)

With such a significant probability (e.g. p=0.002) for the contingency table as a whole, attempts were then made to find out which diagnosis class had a predicted distribution different than the normal samples. Accordingly, Chi Square tests (with Yates correction) were, once again, computed but this time for individual 2.times.2 subtables, each taken with the first row (normal diagnosis). If a, b, c, and d were to represent the numbers in the cells of the 2.times.2 tables as shown.

______________________________________ Diagnosis Observed ______________________________________ a b c d ______________________________________

.chi..sup.2 was calculated as follows: ##EQU1## Thus, with the malignant samples, as an example:

______________________________________ Observed Diagnosis 0 m ______________________________________ 0 148 26 m 4 15 ______________________________________ ##EQU2## A diagnosis category with a high probability value (p) indicates that samples within that category have a distribution similar to the normal specimens. While those with low probability are distributed differently. Thus, as shown in Table 4, highly significant frequencies of being predicted “malignant” were associated with samples which were diagnosed malignant, as expected (p<0.001). Also highly significant was the prediction for samples diagnosed with “atrophic pattern” (p<0.001). In addition, prediction frequencies were significantly higher than expected (p.ltoreq.0.05) for specimens diagnosed as atypical with bloody smear, atypical with atrophic pattern and dysplasia (e.g., diagnosis codes ab, at, and d, respectively).

There are other ways to analyze such a contingency table (table 4) that may be advantageous for statistical accuracy. For example, the routine “PROC FREQ” in the SAS library of statistical routines (The SAS Institute Inc., Cary, N.C.) can be used to compute the probability of the null hypothesis of this entire table as well as the 2.times.2 contingency tables. This routine can also compute “Fisher’s Exact” test, which may be preferred when some of the cells in the table are zero. Another approach that could be used to compute the probability that the distribution of the samples in one or more of the diagnosis subgroups differ from that of the sample with normal diagnosis would be to aggregate the date for all the different diagnoses (preferably excluding diagnosis of 0, d, and m, for which there is an expectation of such a difference) before constructing a 2.times.2 table of normal vs. all other diagnoses, which can be analyzed by the Chi Square test.

Example 2

This example provides a comparison of diagnosis with a mid-infrared technique using partial least squares analysis, and Pap smears applying conventional microscopy.

2.1 Specimen Collection

Cervical scrapings were collected by the standard brushing procedure. Exfoliated cells from each brush were harvested in separate vials which contained normal saline. The cell suspensions in each vial were dispersed with a Pasteur pipette and divided into two equal portions. One portion of the cell suspension was centrifuged and the pellet was stored frozen in liquid nitrogen until spectroscopic analysis. The other portion was spread on a microscope slide, fixed and stained by Papanicolaou stain and was examined by at least one pathologist. Out of 302 cervical scrapings that were analyzed, 206 samples were obtained from a dysplasia clinic and 96 specimens were obtained from an outpatient gynecology clinic. Three types of diagnosis were assigned to the specimens. Specimens which showed no evidence of cytological abnormality and which were obtained from individuals who had no history of cervical anomaly were classified as “normal-normal”. Specimens which had normal cytology, and which were obtained from individuals who had a prior history of dysplasia were labeled as “normal-dysplasia”. Specimens which exhibited evidence of dysplasia were classified according to the extent of disease using standard nomenclature. Samples which were found to have the human papilloma virus were designated with the letters “HPV”, and were included in the samples diagnosed as “dysplasia”.

The following table summarizes the number and the diagnosis of each type of specimen.

TABLE 6 ______________________________________ Specimen Type Number ______________________________________ Normal-Normal 96 Normal-Dysplasia 152 Type of Dysplasia CIN I 30 CIN II 5 CIN III 3 CIN I-II 8 CIN II-III 1 CIN I-HPV 4 CIN II-HPV 1 HPV 2 Total no. of specimens 302 ______________________________________

2.2 Spectroscopic Analysis

The thawed pellets of cervical scrapings were analyzed spectroscopically, as follows: cervical scrapings were mixed with a Pasteur pipette in a syringing action, and the cell suspensions were then smeared and dried on Cleartran windows (ZnS). Mid-infrared spectra were obtained at room temperature on a Bio-Rad, Digilab FTS 165 spectrometer equipped with a DTGS detector. Spectra were collected at a resolution of 4 cm.sup.-1 and 100 scans were co-added. A single-beam spectrum of Cleartran window was used for a background reference with each spectrum. Each spectrum was also normalized by setting the minimum absorbance at 0.0 and the maximum absorbance at 1.0. Drying of the samples resulted in specimens which were easy to manipulate and which yielded high quality spectra.

2.3 Partial Least Squares Analysis

Out of the 302 spectra that were selected for PLS analysis, 54 spectra were from specimens that had the diagnosis of dysplasia, 152 spectra were from specimens with diagnosis `normal-dysplasia`, and 96 spectra were from samples with diagnosis `normal-normal`. A subset of the dysplastic and the `normal-normal` spectra was then used to create a calibration set. Unless otherwise indicated, the `normal-normal` specimens that were included in the calibration (reference) set all had spectra that appeared similar or identical to the spectrum in FIG. 1 (e.g. the spectrum reported by Wong and co-workers to characterize normal cervical scrapings). The reference specimens with dysplasia were assigned a dummy variable value of 1, and the `normal-normal` references were assigned a value of 0. Spectra that were not included in the calibration set were used as validation samples. A break point (BP) of 0.5 was used to discriminate between the samples. All specimens with a predictive break point value<0.5 were classified as normal, and those with a predictive value.gtoreq.0.5 were classified as abnormal.

2.4 Results

Three spectral regions were utilized in the analysis of the data. These regions included the zones between 1250-1000 cm.sup.-1, 1420-1330 cm.sup.-1, and 3000-2800 cm.sup.-1. Rank 8 was selected as providing the best discrimination between the samples. A F-ratio.gtoreq.17 was arbitrarily selected as the rejection threshold for exclusion of outlier spectra. Table 7 summarizes the results of PLS with the validation samples (e.g. 27 dysplasia, 44 “normal-normal” and 152 “normal-dysplasia” specimens).

TABLE 7 __________________________________________________________________________ Total Total Samples Observed Diagnosis Number with F ratios < 17 N D .chi..sup.2 __________________________________________________________________________ Normal-Normal 44 40 31 9 Normal-Dysplasia 152 146 49 97 23 p < 0.001 Dysplasia 27 27 3 24 25.8 p < 0.001 Total 223 213 __________________________________________________________________________ N and D denote samples which were predicted as “NormalNormal”, and “Dysplasia”, respectively.

As shown in Table 7, a total of 10 samples (e.g., 4 “normal-normal”, and 6 “normal-dysplasia”) were excluded from the study. Each of the excluded samples had a F ratio.gtoreq.17. A Chi Square analysis of 2.times.2 subtables each taken with the first row (“normal-normal” diagnosis) based on the null hypothesis that there was no difference in the predicted distribution of specimens identified as “normal-normal”, and specimens with “normal-dysplasia” or “dysplasia” yielded .chi..sup.2 values of 23, and 25.83, respectively. The null hypothesis is rejected for both the “normal-dysplasia”, and the “dysplasia” specimens at the p<0.001 significance level. As shown in Table 7, highly significant frequencies of predicting samples with dysplasia were associated with dysplasia samples. Also highly significantly was the difference in the distribution of specimens classified as “normal-dysplasia” relative to the “normal-normal” samples.

These results demonstrate the potential of PLS in discriminating between “normal-normal” specimens, and specimens with existing or with a prior history of dysplasia.

Example 3

This example illustrates that there are close similarities between the spectra of cervical scrapings with dysplasia, and cervical scrapings which are diagnosed as normal, but which have a prior history of dysplasia (e.g. specimens with diagnosis “normal-dysplasia”).

A calibration set consisting of spectra from samples with known dysplasia, and from samples with “normal-dysplasia” using the prior data was constructed. The purpose of this analysis was to determine whether the spectra of cervical scrapings with dysplasia appeared different than the spectra of cervical scrapings with `normal-dysplasia`. Using PCA and discriminate analysis, no significant discrimination between the two populations was observed. In the absence of observable differences, this analysis suggests that regardless of the cytological appearance of the Pap smear, in a majority of patients who have had a prior history of dysplasia the method applied to the IR spectra detects abnormal findings. Hence, IR spectroscopy, as practiced here, provides additional diagnostic information, not available by the standard cytological examination of cervical smears. Bearing in mind that the genesis of a majority of cervical dysplasias is believed to be caused by the human papilloma virus, these abnormal spectral features may directly relate to the presence of the HPV virus in the cervical scrapings of patients classified with `normal-dysplasia`.

The IR methods of this invention can thus discriminate between a population of women having no history of dysplasia or malignancy, and one of women who are either diagnosed with dysplasia or malignancy (as detected by Pap cytology) or who have a history of dysplasia in the absence of a current diagnosis for dysplasia by Pap cytology (e.g., patients who are clinically at a high risk for dysplasia).

Example 4

This example illustrates the use of single cell infrared spectroscopy for the detection of malignant and premalignant conditions in cells.

Recent infrared spectroscopic studies of bulk cervical scrapings have revealed marked differences in the spectra of normal and malignant samples. Despite the presence of these differences, their precise origin is unknown. Although it appears intuitive that changes in the malignant cell per se give rise to the spectral abnormalities associated with cancer, no confirmation of this exists. Still further, it has been observed that in some malignant cervical samples, the cancerous cells constitute no more than 10% of the total number of epithelial cells; yet, their infrared spectra are no different from those with far greater percentages of malignant cells. Four possible explanations that may account for such an observation, include: 1) the changes in the cancer cell are so strong that they dominate the spectral contribution of the remaining 90.sup.+ % of the cells, 2) the spectral changes originate from another type of cell, 3) cells not identifiable morphologically as malignant by Pap smear may have already undergone the same or similar chemical changes as the malignant cell and therefore, together with the bone fide malignant cells constitute the majority of abnormal cells, and/or 4) cancer cells secrete chemicals that absorb strongly in the mid-infrared region and it is these chemicals that contribute to the spectral changes.

To address some of these issues, the present invention provides a novel method for the acquisition of spectra from cervical scrapings on a cell by cell basis.

4.1 Materials and Methods

Cells were fixed on a custom made ZnS (Cleartran) microscope slide and examined unstained under a Bio-Rad FT-IR UMA-500 microscope linked to a FTS 165 spectrometer. The aperture was adjusted to the size of individual cells and 500 spectra were co-added at a resolution of 8 cm.sup.-1. Spectra were analyzed in the mid-IR range (950-3000 cm.sup.-1). Zinc sulfide was chosen as the matrix for the support of the cells for three reasons. It provided a clear support for viewing the cells under a conventional microscope and an IR microscope. Second, the material was resistant to a number of chemicals including the stains used in Pap smears. Third, the material was well suited for the acquisition of spectra in the IR regions of interest.

(a) Preprocessing of Cervical Specimens

Cervical scrapings were collected by the standard brushing procedure. Exfoliated cells from each brush were gently shaken in vials which contained preservative solution (Preserv Cyt, CYTYC Corporation, Marlborough, Mass.). The preservative solution maintained the integrity of the exfoliated cells during transport and storage, and also served to lyse the red blood cells in the cervical scrapings. Vials containing the exfoliated cells were then treated with a CYTYC THIN PREP PROCESSOR.RTM.. The processor filtered out the mucus and non-diagnostic debris, and spread the cells in a uniform layer on the ZnS slides. In this manner, it is possible to selectively remove the majority of interfering materials from cervical scraping and obtain a uniform layer of cells while preserving the diagnostically important features of the cells. Infrared microspectroscopy was performed on unstained exfoliated cells which were recorded for their position by a cellfinder. Thereafter the slides were stained by the Papanicolaou stain, and were cytologically examined. The results of spectroscopy were then correlated with the cytological findings.

4.2 Results

In the normal cervical scrapings four types of morphologically distinguishable cells were studied. These cells included the mature squamous epithelial cells, the intermediate squamous epithelial cells, parabasal cells and endocervical cells. Two different spectra were typically observed for the normal squamous epithelial cells. One spectrum appeared identical to the spectra for the normal cervical scrapings (FIG. 1), and the other appeared with a significantly diminished band at 1025 cm.sup.-1. FIG. 5 shows the spectra of the two squamous cells. Squamous cells that had the typical spectrum of normal cells are referred to as Population 1, and those that lacked the 1025 cm.sup.-1 band characteristic for glycogen are referred to as Population 2. The parabasal cells which are normally found in abundance in the cervical scrapings of menopausal patients with estrogen deficiency (e.g. a condition referred to as atrophic) exhibited spectra resembling the spectrum observed in malignant scrapings (FIG. 2, see also Wong, et al, Proc. Natl. Acad. Sci. USA 87:8140-8145 (1991)). This finding supported the PCA analysis in EXAMPLE 1 which found that highly significant frequencies of prediction as malignant are associated with Pap smears identified with “atrophic pattern” (e.g., contingency table 4 code t.chi..sup.2 =13.7 p<0.001). While the spectra of endocervical cells also exhibited a diminished peak at 1025 cm.sup.-1, a strong band at the 1076 cm.sup.-1 region was also observed. FIG. 6 provides a comparison of the spectra of parabasal cells and endocervical cells.

The examination of malignant cells from patients with adenocarcinoma and squamous carcinoma of the cervix confirmed the spectral features reported by Wong, et al., ibid. All the malignant cells exhibited 1) a prominent band at 970 cm.sup.-1 ; and a shift in the 1082 cm.sup.-1 band to 1086 cm.sup.-1. The loss in the band at 1025 cm.sup.-1 was one of the main spectral features of the cancer cells. Microspectroscopic studies also confirmed that cells diagnosed cytologically as dysplasia (CIN III) exhibited spectra intermediate in appearance between normal and malignant. FIG. 7 exemplifies the spectral differences between a malignant cell and a dysplastic cell with CIN III characteristics.

The microscopic data clearly indicates that some cells have unique spectral features, and that differences in spectra are likely to happen if certain type of cells constitute the majority in a cervical scraping. Henceforth, in view of the fact that the Population 1 spectrum prevails as the predominant spectrum in most of the normal patients (e.g., as demonstrated by the bulk IR technique), suggests that there exists a balance between different types of cells in cervical scrapings. The mature squamous and intermediate squamous epithelial cells (e.g., Populations 1 and 2) constitute a majority in a normal cervical scraping. Thus, for the Population 1 spectrum to dominate, a balance must be maintained between these two cell types. Consequently, any method capable of detecting a shift in the number of cells corresponding to Populations 1 and 2 should also be capable of detecting the same differences in cell populations that are observed by the IR methods of this invention between women having no evidence or history of dysplasia or malignancy, and those women who are either diagnosed as having dysplasia or malignancy (as detected by Pap cytology) or who have a history of dysplasia in the absence of current diagnosis for dysplasia by Pap cytology. A shift in the balance in Populations 1 and 2, as detected by IR or another method, can thus be used to identify clinically the members of a population of women who are at high risk for dysplasia.

All publications, patents and patent applications mentioned in this specification are herein incorporated by reference into the specification to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference.

Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it will be obvious that certain changes and modifications may be practiced within the scope of the appended claims.

Method and apparatus for testing a progression of neoplasia including cancer chemoprevention testing

Filed under: Issued Patent — admin @ 3:35 am

Abstract
A system is provided for analysis of neoplasia in tissue at a very early stage as well as later stages of its progression and for reporting the progression or regression of the neoplasia. The system performs multi-parametric measurements of the morphological structure and texture of the tissue structure and correlates these measurements on a common morphological grading scale. The system performs certain tissue measurements which are more highly discriminating for one kind of neoplasia and performs other tissue measurement, which are more highly discriminating, for another kind of neoplasia. Diverse tissue measurements may be made on diverse tissue types such as breast, colon, or cervix tissue, etc. from animals or humans which tissue has subjected to different carcinogens or chemopreventive agents. The measurements are made in different units and on different scales; and then these measurements are combined and reported on a valid, objective, common, universal scale. Microscopic images of stained neoplastic tissue sections are optically and microscopically scanned to provide electronic tissue sample images that are electronically recorded. Then, morphometric features of tissue sample images are measured in first unit vales and texture measurements of the tissue samples, such as a Markovian texture measurement. Usually, normal tissue samples and abnormal cancerous tissue samples are analyzed using the same morphometric and texture measurements and their respective results are reported onto a grading common scale so that progression of the cancer can be ascertained relative to the normal tissue.

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Inventors: Bacus; James W. (Oakbrook, IL), Bacus; James V. (Downers Grove, IL)
Assignee: Bacus Research Laboratories, Inc. (Lombard, IL)

Appl. No.: 08/701,974
Filed: August 23, 1996
Claims

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What is claimed is:

1. A method of analyzing a tissue sample having a layer of adjacent, connected tissue cells for pre-invasive neoplasia, comprising:

optically and microscopically scanning the tissue sample having adjacent, connected tissue cells to provide, multiple image fields and electronically recording these image fields to provide spatially adjacent multiple image fields of the tissue sample larger than a single view of the adjacent, connected tissue cells;

forming a reconstituted image of the suspected neoplasia tissue from the multiple, electronically recorded, spatially adjacent image fields larger than a single field of view and having adjacent connected tissue cells in the reconstituted image;

displaying to the viewer the reconstituted tissue image comprised of multiple, spatially adjacent image fields larger than a single field of view;

determining and selecting from the reconstituted, tissue image a region of adjacent connected tissue cells for analysis at a resolution; and

analyzing tissue sample images of the selected region at the resolution for the analysis of pre-invasive neoplasia.

2. A method in accordance with claim 1 wherein the step of analyzing the selected region includes:

measuring morphometric features of tissue sample images in first unit values;

measuring texture features of tissue sample images in other units or scale values; and

combining the measured units and scale values into a common scale.

3. A method in accordance with claim 1 wherein the step of analyzing the selected region includes:

optically and microscopically scanning normal tissue samples and analyzing these normal tissue samples using a combination of morphometric and texture measurements; and

optically and microscopically scanning abnormal tissue samples and analyzing these abnormal tissue samples using the same combination of morphometric and texture measurements as used for the normal tissue.

4. A method in accordance with claim 3 including the steps of:

determining the mean and standard deviation for the measurements of the normal tissue; and

subtracting the mean for normal tissue measurements from the abnormal tissue measurements and dividing by the normal tissue’s standard deviation to provide a morphometric score.

5. A method in accordance with claim 4 including wherein the recording step comprises recording the morphometric scores on a graph with a morphometric scale on the ordinate and a time scale on the abscissa to illustrate any progression of neoplasia.

6. A method in accordance with claim 1 wherein the tissue includes a basal layer of tissue cells and the analysis is for neoplasia, said method including the steps of:

addressing a plurality of the tissue sample images adjacent the basal layer;

orienting the addressed tissue sample images to form a tiled, combined, reconstituted image of a portion of the scanned tissue sample; and

the determining and selecting step comprises editing the reconstituted image of the basal layer to delete portions thereof from the subsequent analysis.

7. A method in accordance with claim 6 including the steps of:

scanning the tissue sample at a first magnification resolution; and

decreasing the resolution for the reconstituted image.

8. A method in accordance with claim 7 including the steps of:

interactively viewing the recorded tissue sample images; and

interactively editing to leave substantially only the basal layer of cells and cells evolving therefrom.

9. A method in accordance with claim 6 wherein the editing step comprises:

displaying a tissue sample image selected from the reconstituted image at a higher resolution than the reconstituted image; and

erasing from the displayed tissue sample image, one or more portions thereof having limited analysis value.

10. A method in accordance with claim 9 comprising replacing the selected image of the reconstituted image with the edited version of the selected tissue sample image.

11. A method in accordance with claim 1 including the step of selecting, from a menu of measurements, a first set of morphometric and texture measurements which are highly discriminating for a first kind of tissue sample; and

selecting a second set of different morphometric and texture measurements which are highly discriminating for a second kind of tissue sample.

12. A method in accordance with claim 1 wherein the analyzing step comprises analyzing a tissue sample image for a predetermined texture feature and the method comprises:

identifying a mean value of the result of analyzing normal tissue images for the texture feature;

determining the mean value of the result of analyzing the tissue sample image for the predetermined texture feature;

subtracting the mean value identified for the particular texture feature of normal tissue from the mean value determined for the particular texture feature of the analyzed tissue sample image; and

recording the result of the subtracting step.

13. A method in accordance with claim 12 comprising identifying the standard deviation of the results of analyzing normal tissue images for the predetermined texture feature and dividing the result of the subtraction step by the identified standard deviation.

14. A method of claim 1 comprising presenting the recorded results in a manner which normalizes the results of different analyses.

15. A method of analysis of a tissue sample having adjacent, connected tissue cells comprising the steps of:

optically and mircroscopically scanning the tissue sample to provide multiple tissue sample images having adjacent, connected tissue cells therein, and electronically recording the tissue sample images to provide multiple tissue sample images of the tissue sample;

reassembling the recorded tissue sample images to form a reconstituted, tissue sample image comprised of multiple spatially adjacent, microscopic, tissue sample images from the tissue sample;

measuring sections of the reconstituted tissue sample image with respect to area;

measuring sections of the reconstituted tissue sample image with respect to optical density;

measuring the morphological texture of adjacent, connected tissue cells of sections of the reconstituted tissue sample image;

analyzing the results of the measured area, optical densities and morphological texture of adjacent, connected tissue cells of the selected sections of the reconstituted tissue sample image of adjacent, connected tissue cells to provide morphological data; and

providing the morphological data for an analysis of the reconstituted tissue sample image of adjacent, connected tissue cells.

16. A method of analysis in accordance with claim 15 wherein the step of analyzing the texture of the tissue sample image comprises the step of measuring run length which includes an analysis of neighboring cells in the tissue sample image for optical densities above a predetermined threshold.

17. A method of analysis in accordance with claim 16 wherein the tissue sample has a basal layer extending in a given direction; and

making the run length configurable by analyzing neighboring cells in the given direction of the basal layer.

18. A method in accordance with claim 15 wherein the texture measuring step comprises making at least one of a valley, slope or peak measurement.

19. A method in accordance with claim 18 wherein a coarseness measurement of the texture is obtained by subtracting from the slope measurements, the peak and valley measurements.

20. A method in accordance with claim 15 wherein the texture measuring step comprises the making of a Markovian Texture measurement.

21. A method in accordance with claim 20 including the steps of analysis of human cervix tissue sample images wherein the step of measuring morphological texture includes the making of Markovian Texture measurements.

22. A method of analyzing a basal layer sample of tissue having adjacent, connected tissue cells evolving from the basal layer for neoplasia, said method comprising the steps of:

optically and microscopically scanning the adjacent, connected tissue cells along the basal layer over a plurality of tissue sample fields to provide microscopic, multiple spatially adjacent, image fields of the tissue sample;

recording these image fields and reassembling these image fields to form a reconstituted, magnified image comprised of multiple image fields of the tissue and having the basal layer thereon;

tracing the basal layer for analysis;

analyzing the traced basal layer of the reconstituted tissue sample image with respect to area and optical density;

analyzing the traced basal layer of the reconstituted tissue sample image with respect to texture by making measurements including the step of an analysis of texture by examining adjacent, neighboring cell images with respect to values above or below a predetermined threshold; and

providing the texture analysis of adjacent, connected tissue cells for use in evaluation of neoplasia.

23. A method in accordance with claim 22 including the step of configuring the run length to extend in the direction that the basal layer extends.

24. A method in accordance with claim 22 including the step of analyzing adjacent tissue cells to provide at least one of valley, slope and peak measurements.

25. A method in accordance with claim 22 including the step of measuring the tissue cell images using a Markovian Texture analysis.

26. A method in accordance with claim 22 for analysis of human cervix tissue including the steps of:

measuring the summed optical densities from the cervix tissue cell images; and

measuring the slope between adjacent human cervix cell images.

27. A method in accordance with claim 22 including the steps of:

analyzing an animal tissue to provide discriminating data comprising the steps of:

measuring the average optical densities of the animal tissue cell images;

measuring the valley and slope from adjacent cell images of the animal tissue; and

measuring Markovian Textures of the animal cell images.

28. A method in accordance with claim 22 wherein the texture measurements of animal tissue includes using at least one of the following steps:

measuring the run length of adjacent animal tissue cell images;

measuring the run length which is configured in direction and the spacing between analyzed cell images;

measuring the valley, slope and peak between adjacent cell images;

measuring the coarseness which includes the step of subtracting the peak and valley from the slope; and

measuring Markovian Textures of the analyzed cell images.

29. A method in accordance with claim 22 including the step of recording the results of the respective measurements in a manner which normalizes the results of the morphometric and texture analyses.

30. A method of analyzing histological tissue samples of different kinds of tissues having adjacent connected tissue cells having inherent variabilities for pre-invasive cancer comprising the steps of:

for each of the histological tissue samples, optically scanning the tissue sample at a plurality of non-overlapping tissue sample fields and electronically recording a high resolution tissue sample image representing selected fields for each of the different kinds of tissues;

analyzing each of the respective tissue sample images using a combination of morphometric and texture analyses of histological tissue predetermined to be indicative of the progression of cancer development for each of the kinds of tissues;

normalizing results of selected analyses performed in the analyzing step for the respective kinds of tissues to a common standard; and

deriving values for the respective kinds of tissues so that a comparison can be made indicative of the progression of their respective cancer developments from the normalized results.

31. A method in accordance with claim 30 including the step of editing the recorded tissue sample images to delete portions of the image not representing the basal layer and the evolving tissue cells to create edited tissue sample images and wherein the analyzing step comprises analyzing the edited tissue sample images.

32. A method of analyzing the efficacy of a chemopreventive agent on first and second precancerous tissues of adjacent, connected tissue cells, said method comprising the steps of:

optically and microscopically scanning the first precancerous tissue to provide image fields and electronically recording the image fields to provide multiple image fields of the first precancerous tissue; integrating the recorded image fields into a reconstituted, first tissue sample image comprised of multiple image fields representing the first tissue;

analyzing tissue regions of the first reconstituted tissue sample image using a first set of morphometric and texture features highly discriminating for the first precancerous tissue;

optically and microscopically scanning the second precancerous tissue to provide image fields and electronically recording the image fields to provide multiple image fields of the second precancerous tissue; integrating the recorded image fields into a reconstituted, second tissue sample image comprised of multiple image fields representing the second tissue;

analyzing tissue regions of the second reconstituted tissue sample image using a second set of morphometric and texture features highly discriminating for the second precancerous tissue;

combining the morphometric and texture feature measurements of the tissue regions from the first precancerous tissue to a common scale; and

combining the morphometric and texture feature measurements of the tissue regions from the second precancerous tissue to the same common scale so that progression of cancer of the first and second tissues can be compared on the same basis.

33. A method in accordance with claim 32 wherein there is provided as first precancerous tissue a cervical tissue sample and wherein there is provided as the second precancerous tissue an esophageal tissue.

34. A method in accordance with claim 32 including the step of taking sequentially in time the first and second precancerous tissue samples from the same part of the body and using thereon the first and second sets of morphometric and texture features for analysis.

35. A method in accordance with claim 32 wherein the first and second precancerous tissues are taken from first and second parts of a body.

36. A method in accordance with claim 32 wherein the first and second precancerous tissues are taken from different animals.

37. A method in accordance with claim 32 including the steps of analyzing the first and second precancerous tissue over a plurality of tissue fields.

38. A method in accordance with claim 32 including the step of normalizing the measurements recording the scores on a scale that has plus and minus numbers below twenty (20).

39. A method in accordance with claim 32 including the step of measuring at least some of the first morphometric or texture features with scales or units different from the scales or units used to measure the second morphometric or texture features.

40. Apparatus for analyzing a tissue sample having a layer of adjacent, connected tissue cells for pre-invasive neoplasia, comprising:

a scanning device for optically and microscopically scanning the tissue sample to provide magnified multiple image fields of the tissue sample;

a recorder for electronically recording the magnified, multiple image fields;

apparatus for forming a reconstituted, low magnification image comprised of the multiple image fields of the suspected neoplasia tissue;

a display for displaying to a viewer a reconstituted, low magnification tissue image comprised of multiple image fields;

a selector allowing the viewer to select a region from the reconstituted, low magnification image for analyses at a higher resolution; and

an analyzer for analyzing the selected tissue sample image fields of the selected region using at least one morphometric and texture measurement for adjacent, connected tissue cells predetermined to be indicative of the progression of pre-invasive neoplasia development in the tissue sample.

41. Apparatus in accordance with claim 40 wherein the analyzer for analyzing the texture of the selected tissue sample image fields comprises a means for measuring texture which includes an analysis of neighboring cells for optical densities above a predetermined threshold.

42. Apparatus in accordance with claim 41 wherein the cells are part of a tissue sample having a basal layer extending in a given direction; and the means for measuring the run length is configurable to analyzing neighboring cells in the given direction of the basal layer.

43. Apparatus in accordance with claim 40 wherein the analyzer for measuring texture comprises means for making at least one of a valley, slope or peak measurement.

44. Apparatus in accordance with claim 43 comprising means for measuring a coarseness of the texture by subtracting from the slope measurements, the peak and valley measurements.

45. Apparatus in accordance with claim 40 wherein the analyzer for measuring texture comprises means for making a Markovian Texture measurement.

46. Apparatus in accordance with claim 45 wherein the analyzed cells are human cervix tissue cells images and the means for measuring morphological texture includes means for the making of Markovian Texture measurements.
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Description

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BACKGROUND OF THE INVENTION

This invention relates to a method and apparatus for analysis of neoplasia in tissue and for pre-invasive cancer and for analysis of the effect of chemopreventive agents with respect to neoplasia.

Currently, there are on-going chemoprevention programs that involve the routine testing of chemopreventive agents with the aims of using such agents to reduce the incidence of cancer by stopping the cancer progression or to regress the cancer. These programs desire to test a very large number of chemopreventive agents which occur naturally in foods or drinks or synthesized drugs for their efficacy. Currently, there are a number of centers that are testing chemopreventive agents and that use pathologists to visually examine tissue and quantify the efficacy of these agents administered to animals or humans. These visual assessments are quite broad and are subjective and usually result in assessments such as nuclear grade, carcinoma in situ, preneoplastic intraepithelial neoplasia, etc. It will be appreciated that the limited ability of the human eye to make visual assessments often requires the neoplasia to reach an advanced state in its evolution before it can be assessed. However, it is preferred to quantitatively evaluate the evolution of neoplasia in its early stage of evolution. The earlier the effective evaluation, the better chance of halting the progression of premalignant cells to the malignant state and the earlier that the effectiveness of possible chemopreventive agents can be determined.

A number of benefits are obtained by an earlier evaluation of the effectiveness of a chemopreventive agent. First, a very substantial cost benefit results from the ability to quantitatively evaluate premalignant tissue if done after an animal or person has been treated for ten to twenty weeks rather than to wait for the current thirty to forty weeks, which is often the case for visual evaluation by a pathologist. Further, if the apparatus and methodology used are more sensitive or precise than those used by the pathologist, fewer subjects need to be tested. This reduces the cost of analysis with respect to a particular chemopreventive agent or subject, and allows for more analyses to be done at any given testing facility in a given time frame. Of course, obvious health benefits accrue from earlier detection of a precancerous condition and the ability to monitor more quickly and more precisely the effectiveness of chemopreventive treatment for a given patient.

An article by Boone and Kelloff, entitled “Development of Surrogate Endpoint Biomarkers for Clinical Trials of Cancer Chemopreventive Agents: Relationships to Fundamental Properties of Preinvasive (Intraepithelial) Neoplasia”, describes chemoprevention as the prevention of clinical cancer by the administration of drugs or dietary constituents prior to or during the early phases of precancerous neoplasia, i.e., while the neoplastic process is still confined to the intraepithelial compartment and has not yet become invasive. Boone and Kelloff describe tissue and cell changes and the need for the development of surrogate endpoint biomarkers (SEBs), and divide the evolution of neoplasia as a continuum divided for convenience into five phases. In Phase I, genomic instability is present in an otherwise normal-appearing epithelium. In Phase II, clonal expansion of a mutated cell occurs. The individual cells are normal in appearance but crowded and disorganized in pattern, with compression of the surrounding normal cells. This is the classic benign epithelioma (aberrant crypt foci of the colon are an example). In Phase III, the cells develop abnormal morphology (described in detail below). Phase IV is marked by invasion, the classic criterion by which pathologists make the diagnosis of cancer; and in Phase V, there is wide-spread dissemination. The ideal SEB should detect early changes during the intraepithelial neoplastic period and should monotonically increase in magnitude with neoplastic growth. The present invention is directed to providing a method and apparatus to assay cellular or tissue changes associated with the early neoplastic process, i.e., Stages I, II or III, prior to invasiveness and to be useful for many different tissue types, e.g. breast tissue, colon tissue, prostate tissue, esophageal tissue, skin tissue, cervix tissue, etc. for animals as well as for humans.

One problem with assaying such a variety of tissues is a determination of what measurements or features are most relevant or robust for each given neoplasia in that tissue. The measurements that provide the highest discrimination will vary from one neoplastic tissue to another type of neoplastic tissue. It will be appreciated that the various tissue types described above, such as breast tissue, colon tissue, prostate tissue, esophageal tissue, skin tissue, and cervix tissue have different morphologies, and they undergo different neoplasias usually resulting from a cellular mutation rate as may be enhanced by a carcinogen or resulting from a cellular proliferation rate enhanced by sex hormones, irritant chemicals or inducers from chronic infection. Currently, there are no good objective biomarkers for such diverse neoplasias that can be done using equipment. There is a need to develop highly discriminating tests or measurements. Additionally, the tests or measurements for neoplasia will be done on different types of animals and on humans and at different clinical sites. Further, the measurements are often made when the change in the neoplasia is quite small, such as when the neoplasia is incipient or because sequential tests are performed at close time intervals to ascertain if the progression of neoplasia has been slowed, stopped or regressed. The neoplasias may have distinct appearances as do their respective tissues. To be highly discriminating for such diverse tissues and diverse neoplasias, there is a need for a system which performs highly discriminating measurements for each particular neoplastic tissue. It has been found that some measurements are very discriminating for some tissues neoplasias but not very discriminating for other neoplasias.

Assuming that appropriate discriminating measuring techniques and data are found, there still is a problem of how to grade or report these diverse test results which are so disparate in form. That is, linear measurements, area measurements, density measurements, surface roughness or texture measurements are made in diverse units, scales and magnitudes; and there exists the problem of how to coherently combine these results into a common scale that will be meaningful, easily understood and easily interpreted by pathologists or clinicians. For example, it would be best if the common scale would be valid and useful for evaluating, for example, thirty (30) different agents for skin precancerous tissue, twenty (20) different agents for esophageal precancerous tissue, and fifty (50) precancerous agents for precancerous colon cancer. Thus, there is a need for a system where the results of the measurements are standardized and objective and are easily conveyed to clinicians and others and will provide them with an understanding of a chronology of the effects of small treatment doses of one or more chemopreventive agents on precancerous tissue.

SUMMARY OF THE INVENTION

In accordance with the present invention, a method and apparatus are provided for analysis of neoplasia in tissue at a very early stage as well as later stages of its progression and includes an easily understood reporting of the progression or regression of the neoplasia. The present invention provides a fast and cost-effective analysis of the efficacy of or lack of efficacy of chemopreventive agents with respect to neoplasia. This has been achieved by an objective analysis system that performs multi-parametric measurements of the morphological structure and texture of the tissue structure itself and correlates them to a simple morphological grading scale. Further, this analysis has been achieved by the determination of and the selective measurement of those features or attributes which are most discriminating for a given kind of neoplastic tissue to show the progression of neoplasia in the tissue. It has been determined that certain tissue texture measurements are more highly discriminating for certain neoplasias and that other tissue measurements are more discriminating for other neoplasias. The present invention has determined which measurements are most highly discriminating for certain neoplasias in certain tissues and allows a selection from a large menu of multi-parametric measurements for the respective different ones of the neoplastic tissues. Further, this invention provides a method of and apparatus for rapidly and automatically performing scanning and data acquisition for these assays in a cost-effective manner.

The present invention also relates to a method and apparatus for combining several diverse measurements results in different units and on different scales into a valid, objective and common universal scale which is useful not only in grading a particular neoplasia in tissue but is also useful for grading other neoplasias in tissues analyzed with other discriminating measurement. This common scale is relative to and self-adjusts to the respective normal morphology characteristics and differing heterogeneity of different tissue structures. In accordance with the present invention, a sound and universal morphological grading system has been devised to combine onto a common scale the various test results made of diverse tissue types, such as breast tissue, colon tissue, cervix tissue, etc. and on different types of animals and humans as well as with different carcinogens or chemopreventive agents. That is, the present invention allows one to analyze and measure the texture of a particular tissue having neoplasia, with a number of test results in different units and one different scales and combine them into a common score on a common scale. Also, the present invention provides a common scale and score for various neoplasias in different tissues and relates them to a common scale wherein their relationship to an invasive score can be easily understood. Stated differently, different test measurements on different neoplasias may be plotted on the same score or scale so that each neoplasia’s progression or regression relative to a preinvasive state is easily understood. Such a common scale allows an objective comparison of one chemopreventive agent versus another chemopreventive agent, and between the efficacy of such agents on animal or human neoplastic tissue.

In the preferred apparatus and embodiment of the invention, a field of tissue is scanned by a microscope, and the scanned images are digitized, displayed and stored electronically. The stored tissue images are then optionally edited to isolate for analysis the basal layer and tissues evolving therefrom. The edited images are then measured for morphometric and texture features that are preselected as being highly discriminating for the kind of neoplastic tissue being analyzed. The measurements may be performed on entire microscope fields of imaged cell objects or on individual cell objects of the fields.

In accordance with another aspect of the invention, the preferred analysis is achieved by performing texture and morphometry measurements on normal tissue of the kind under consideration and then performing the same morphometry and texture measurements on a second tissue which is usually known to be a neoplastic tissue or suspected to be a neoplastic tissue. Then, the mean and standard deviation for each normal tissue measurement are determined. The mean for the second tissue is subtracted and divided by the standard deviation of the normal tissue to provide an individual Z-scale morphometric score. Individual Z-scale scores are averaged to provide a final score for the second tissue that is hereinafter is called a “Morphometric Z-scale Score”. By way of example only, the morphometric Z-scale score for invasive neoplasia would be about a 7 or a 8 relative to zero or about zero score for a normal tissue so that there is sufficient breath of scale to distinguish on the scale incipient neoplasias close to zero and to distinguish small incremental changes in neoplasia as may occur subsequently to an application of an effective chemopreventive agent for a short period of time. On the other hand, the application of a highly carcinogenic or neoplastic enhancing agent may provide a widely differentiating morphometric Z-scale score over a short period of time.

In the present invention, each of the various suspected neoplastic tissues from the skin, cervix, colon, breast, etc. may be examined using different morphometric and texture features which are more powerful or discriminating for that kind of tissue. Even though different features are measured for these diverse neoplastic tissues, the above-described normalizing allows the results of each assay to be scored on the same morphometric Z-scale, and automatically compensates for normal heterogeneity of different tissues.

Referring now in greater detail to the illustrated embodiment of the invention, neoplastic tissue sections are cut on edge and stained; and a step of editing is done interactively by a person who views visually and edits 100 to 400 digitized tissue images. The magnification used by the microscope allows the detection of features that are not seen by the human eye without magnification; and the analysis is done using these magnified features. Because 100 to 400 high resolution images of a neoplastic tissue is too large for an ordinary monitor, it is preferred to decrease the magnification of the displayed image so that a large segment of suspected neoplastic tissue comprising many images can be seen at once by the operator. The operator may then edit the tissue image on the monitor to exclude muscle, debris and other cell images leaving the basal layer image and those tissue cell images evolving from the basal layer for the morphometric and texture analysis at the higher resolution.

It has been found that the measurements and tests used and needed are those that discriminate more texture and more granules which appear in neoplastic tissue than appear in normal tissue. That is, the malignant cells have more dark granules and a more “clump-like” or clumpy appearance and also a more “coarse” appearance. By way of analogy, the coarseness may be thought of as a serrated edge of a saw blade that has teeth defined by a number of uniform size peaks and valleys with occasional larger teeth projecting above the uniformly-sized teeth. The measure of the number of such oversized peaks, the distance therebetween, the length of teeth slope, the depth of the valleys, and the height of the peaks provide data as to the abnormal morphology of the neoplasia. The present invention may use some conventional tests and measurements, such as area measurements and summed optical densities, but a number of other specialized tests have been developed to quantify texture. Some known “Markovian Texture” measurements may also be used. For the most part, the selection of which particular measurements will result in highly discriminating Z-scores is one of trial and error.

The preferred texture measurements are usually taken in orientation to the basal layer and will have adjustable thresholds set for a particular tissue. Typically, the test measurements used are selected from a menu of as many as one hundred (100) test measurements; but usually include ten (10) or less test measurements which are defined hereinafter) selected from a group comprising area; summed optical densities; run length; configurable run length; valley, slope or peak; and Markovian Textures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an apparatus for assaying biological specimens embodying the present invention;

FIG. 1A is a perspective view, having portions broken away, of an automatic optical input subsystem of the apparatus for assaying biological specimens shown in FIG. 1;

FIG. 2 is a block diagram of the apparatus shown in FIG. 1;

FIG. 3 shows a slide holder and associated control equipment of the apparatus shown in FIG. 1;

FIG. 4 is a block diagram view of focus and light control portions of the apparatus shown in FIG. 1;

FIG. 5 is a plan view of a microscope slide with a tissue section placed thereon for use with the apparatus of FIG. 1;

FIG. 6 shows a plurality of abutting image fields acquired for analysis;

FIG. 7 shows a monitor screen on which is presented a mosaic of field images at reduced magnification and one field image in the present acquisition magnification;

FIGS. 8A and 8B illustrate an edit mode of operation for working with displayed image frames;

FIG. 9 shows a menu display for the selection of assays to be performed on digitized tissue samples;

FIG. 10 shows a plurality of adjacent pixels to illustrate a run length assay;

FIG. 11 shows a run length configuration setup screen with which run length analysis can be configured;

FIG. 12 shows a valley-slope-peak setup screen;

FIG. 13 shows a Markovian Texture analysis setup screen;

FIG. 14 shows the set of analyses used to evaluate human cervix tissue samples;

FIG. 15 is a graph of average Z-scores measured from tissue sections taken from experimental animals over a period of 30 weeks;

FIG. 16 is a graph of the correlation of Z-scores of human cervical tissue sections having known levels of neoplasia, compared to normal;

FIG. 17 is a flow diagram of the function performed by the scanning and analysis apparatus;

FIG. 18 shows the Z-scores of tissue sections from experimental animals given different levels of chemopreventive agents;

FIGS. 19A-B show a before and after distribution of one group of the experimental animal tissues of FIG. 18;

FIGS. 20A-D illustrate the raster method of image frame capture, editing and presentation;

FIG. 21 shows the raster method applied to human cervix tissue;

FIGS. 22A-B illustrate an analysis example performed on rat esophagus tissue sections; and

FIG. 23 illustrates an analysis example performed on rat colon tissue sections.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The present embodiment assays tissue samples to identify a progression of neoplasia therein and is used with laboratory animals, such as rats, to test possible chemopreventive agents for efficacy. The embodiment is also used to identify early neoplasia in other populations, including humans, to provide early disease detection which can prompt early treatment.

The neoplasia identification of the embodiment begins with a tissue sample which is stained or otherwise prepared for microscopic examination. The tissue samples are prepared so that a basal layer and cells evolving therefrom are presented to the microscope objective. The microscopic examination is performed by automated apparatus such as that described in U.S. Pat. No. 5,473,706 issued Dec. 5, 1995.

The automated apparatus acquires optical density data from the stained tissue sample in a plurality of image frames, each about 90 .times.150 microns. The image frames of most interest are acquired along the basal layer of the tissue sample. Accordingly, when the basal layer is relatively linear, the image frames are acquired in abutting fashion along the basal layer. When the basal layer is more irregular, abutting image frames are acquired in successive raster-like rows to cover the area of the sample. The acquired data is digitized and stored for editing and analysis. In an editing process, image frames which do not contain information helpful to the analyses are excluded in their entirety. Further, cell objects in selected image frames are erased and the remainder of the image frame is stored for later use.

After image frame acquisition and editing the analysis of the data they contain begins. A plurality of morphometric and texture analyses, such as cell object area, optical density, optical density per unit area, run length, configurable run length, valley-slope-peak and Markovian, may be performed on the image frames. The particular analyses to be performed for each type of tissue are selected for that type of tissue to be indicative of neoplasia. As described in greater detail below, the selection of analyses may result in a different set of analyses being performed for different tissue samples.

The analyses are performed on a per-image frame resulting in a mesaured quantity being stored for each analyzed image frame for each analysis performed. The analysis on a per-image frame basis has been found to provide results which identify neoplastic growth more readily than measuring only selected cell objects.

Image Acquisition Apparatus

With the multitude of different tests being performed with many having different units of measurement, analyzing the results is difficult. The present embodiment includes a data normalizing method for use in producing a morphological Z-score which uses a single number to represent the analysis of a tissue sample. Examples are provided herein which show the efficacy of the present embodiment to detect neoplasia.

The preferred embodiment disclosed herein is used for the assay of tissue sections for neoplasia. The tissue samples to be analyzed in the preferred embodiment are stained using the Feulgen technique for DNA which is described in detail in U.S. Pat. No. 4,998,284, issued Mar. 5, 1991 to Bacus which is hereby incorporated by reference. Other types of staining such as Hematoxylin and Eosin or Papanicolaou may be used within the scope of the present invention, as can any stain that enhances histological structure for images. The apparatus shown and described with regard to FIGS. 1-4 is used in the preferred embodiment to acquire image frames of tissue sample data. This apparatus includes a two-color optical system to enhance the optical characteristics of stained tissue samples; although, analysis by a single color is used primarily herein to determine optical densities.

An apparatus for assaying biological specimens, and embodying the present invention and generally identified by numeral 10 is shown in perspective view in FIG. 1 and in block diagram form in FIG. 2. An interactive optical system 11a comprises an optical microscope 12, which may be of any conventional type, but in this embodiment, is a Riechart Diastar. An optical conversion module 14 is mounted on the microscope 12 to enhance the optically magnified image of cell samples viewed with the microscope 12. The optical conversion module 14, as may best be seen in FIG. 2, includes a beam-splitting prism 80 which conveys approximately 90% of the light into optical conversion module 14 and passes the remaining 10% to a microscope eyepiece 76. The light transmitted into module 14 is fed to a dichroic beam-splitter 82 which reflects a portion of the light to a television camera 20 via a red filter 18 and a mirror 81. The remaining portion of the light is filtered by a dichroic beam-splitter 82 and fed to a television camera 26 through a green filter 24. The dichroic beam-splitter 82 selectively passes light having wavelengths greater than approximately 560 nanometers to the filter 18 and having a wavelength of less than 560 nanometers to the filter 24. Thus, the dichroic beam-splitter 82 acts as a first color filter before the light reaches the color filters 18 and 24. Red filter 18 is a 620.+-.20 nanometer bandpass optical transmission filter which provides a high contrast image to the camera 20. As shown in FIG. 2, the camera 20 generates an NTSC image signal which is fed through an optical signal switch 90a to an image processor 90 of an image processor module 28 (FIG. 2). Green filter 24 is a 500.+-.20 nanometer narrow bandpass optical transmission filter which provides a high contrast image to a camera 26. The camera 26 then feeds an NTSC image signal through the optical signal switch 90a to an image processor 92. Both of the image processors 90 and 92 contain analog to digital converters for converting the analog NTSC signals to a digitized 384 by 485 array pixel image. The center 256 by 256 array of pixels from this digitized image is then stored within frame buffers internal to the image processors 90 and 92. The visual image represented by the 256 by 256 array of pixels is referred to as an image field. In the present embodiment a pixel has a height of approximately 0.34 micron and width of approximately 0.5725 micron, so that an image field represents approximately an 87.04 by 146.54 micron portion of the tissue section.

Each of the image processors 90 and 92 is a Model AT428 from the Data Cube Corporation, and includes six internal frame buffers. The image processors 90 and 92 are connected to a system bus 34 of a computer 32. The frame buffers of image processors 90 and 92 are mapped into the address space of a microprocessor 36 in computer 32 to provide easy access for image processing. Additionally, an image monitor 30 is connected to image processor 92 and displays a cell sample image field stored in a predetermined one of the frame buffers. The storage of an image field representation into the predetermined frame buffer is described later herein.

The automatic optical conversion module 11b, as may best be seen in FIG. 2, includes a prism 80a which conveys the light into optical conversion module 14a. The light transmitted into module 14a is fed to a dichroic beam-splitter 82a which reflects a portion of the light to a television camera 20a via a red filter 18a and a mirror 81a. The remaining portion of the light is filtered by a dichroic beam-splitter 82a and fed to a television camera 26a through a green filter 24a. The dichroic beam-splitter 82a selectively passes light having wavelengths greater than approximately 560 nanometers to the filter 18a and having a wavelength of less than 560 nanometers to the filter 24a. Thus, the dichroic beam-splitter 82a acts as a first color filter before the light reaches the color filters 18a and 24a. Red filter 18a is a 620.+-.20 nanometer bandpass optical transmission filter which provides a high contrast image to the camera 20a. As shown in FIG. 2, the camera 20a then generates an NTSC image signal which is fed through the optical signal switch 90 to the image processor 90 of the image processor module 28 (FIG. 2). Green filter 24a is a 500.+-.20 nanometer narrow bandpass optical transmission filter which provides a high contrast image to a camera 26a. The camera 26a then feeds an NTSC image signal through the optical signal switch 90a to the image processor 92.

The above-described apparatus accumulates image information at cameras 20 and 20a from red filters 18 and 18a and at cameras 26 and 26a from green filters 24 and 24a. The analysis performed herein uses primarily the image produced by the red filters 18 and 18a and converted by cameras 20 and 20a. As a result, a data acquisition having only the filters 18 and 18a with associated cameras 20 and 20a is sufficient for performing analyses herein described.

The microprocessor 36 of computer 32 is an Intel 80486 microprocessor which is connected to the system bus 34. The optical switch 90a, under control of the microprocessor 36, selects the signal from interactive unit 11a or automatic unit 11b to be fed to the image processors 90 and 92. A random access memory 38 and a read only memory 40 are also connected to the system bus 34 for storage of program and data. A disk controller 42 is connected by a local bus 44 to a Winchester disk drive 46 and to a floppy disk drive 48 for secondary information storage. Advantageously, local bus 44 is connected to a moveable media bulk data drive 45 such as an optical write once read many times (WORM) drive for image field recording and retrieval.

A video conversion board 50, in this embodiment a VGA board, is connected to the system bus 34 to control an instruction monitor 52 connected to the VGA board 50. Operational information such as selection menus and reports of analysis are displayed on instruction monitor 52. A keyboard processor 54 is connected to the system bus 34 to interpret signals from a keyboard 56 connected to the keyboard processor 54. Input signals to microprocessor 36 are also generated by a hand control drive (mouse) 13 having a control button 15. Signals from mouse 13 and its button 15 are conveyed to bus 34 via a mouse interface 17. A printer 58 is connected to the system bus 34 for communication with microprocessor 36. The apparatus 10 also includes a joystick control device 13a of a type well known in the art. Signals from the joystick 13a are conveyed to bus 34 via a joystick interface 17a.

The automated image input subsystem 11b of apparatus 10 performs automated X-Y slide positioning, image focusing, light intensity adjustment and light color balancing functions. The X-Y slide position controlling apparatus is shown in FIGS. 1, 1A, 3 and 4, and includes a slide holder 62a capable of holding eight microscope slides 101 through 108 in side-by-side relationship such that the upper surfaces of the slides are substantially coplanar. Slide holder 62a, which is sometimes referred to as a flat bed carrier, is movably attached to the stage 65a of microscope objective 64a by means of a slide holder base 63a. The portion of slide holder 62a positionable with respect to microscope objective 64a is controlled by an X position stepper motor 110 and a Y position stepper motor 111 which are mechanically attached to base 63a. The stepper motors 110 and 111 are of the type known in the art which respond to pulse signals from a slide holder position controller 60. The actual X and Y positions of the slide holder 62a are sensed by an X position sensor 68 and a Y position sensor 66, respectively, which substantially continuously report position information to slide holder controller 60. In the present embodiment the slide holder 62a, base 63a, and position sensors 66 and 68 including limit switches and numbered 110 and 111 comprise a commercially available unit from Marzhauser Wetzlar GmbH Model EK8B-S4 with Model MCL-3 control units.

Responsive to appropriate stepper motor control signals, the slide holder base 63a is capable of placing substantially all of each of slides 101 through 108 under the objective 64a. Slide holder position controller 60 is connected to system bus 34 by means of a communication path 61. Microprocessor 36, as discussed later herein, transmits commands to slide holder position controller 60 specifying an X and Y position to place under the microscope objective 64a. Slide holder position controller 60 responds to such commands by transmitting to the X and Y stepper motors 110 and 111 the appropriate sets of pulse signals to move the slide holder 62a to the desired X-Y position. The actual position of slide holder 62a is checked by slide holder position controller 60 during and at the completion of movement. The slide holder position controller 60 also maintains an internal record of the X and Y position of the slide holder 62a which internal record can be read by microprocessor 36 via bus 34 and communication path 61.

The apparatus 10 also includes a focus and light controller 73 which controls the light intensity and color balance from the light source 84a, as well as the focus of the image field presented to microscope 12. Microprocessor 36 communicates with focus and light controller 73, via the system bus 34 and a communication path 74, to control the focus and light properties. FIG. 4 is a functional block diagram of focus and light controller 73 and its connection to objective 64a and to bus 34. The objective 64a includes a focus stepper motor 75a, which is controlled by focus and light controller 73 through the stepper motor controller 73a to raise and lower the stage 62a, and thereby raise and lower the microscope slides 101 through 108 carried by slide holder 62a. Microprocessor 36 includes a focus routine which is periodically performed during tissue analysis. When the focus routine is entered, microprocessor 36 reviews a digital representation of an image field from the image processors 90 and 92, and issues a command to focus and light controller 73, to raise or lower the stage by a specified amount. Focus and light controller 73 responsively transmits to focus stepper motor 75a electrical signals to implement the requested stage movement. By continued checking of the quality of the image field and adjustment of the up and down position of the slide holder 62a, microprocessor 36 brings the upper surface of the slide under the objective 64a into focus.

Microprocessor 36 also stores a target value for the light intensity which is to be maintained during tissue sample analysis. This stored light intensity value is used by microprocessor 36 in conjunction with an intensity function to regulate the intensity of light from light source 84a. When the intensity function of microprocessor 36 is enabled, the light intensity as represented by image fields from image processors 90 and 92 is determine. Any departure from the stored target light intensity value is corrected by sending intensity control commands to focus and light controller 73 which responds thereto by controlling a voltage regulator to increase or decrease the voltage applied to light source 84a. Voltage regulator 83 may be, for example, a standard rotatable voltage regulator which is rotated by a stepper motor operating under the control of electrical signals from focus and light controller 73.

Acquisition of Image Frames

FIG. 5 shows a microscope slide 400 prepared for the evaluation of rat esophageal tissue for neoplasia. Tissue sections 401, 403, and 405 of the entire rat esophagus are taken and placed on the slide 400. Also placed on the slide 400 is a control tissue sample 407 of, for example, rat liver cells about which the properties are well known and which can be used to calibrate the apparatus and the tests performed as is known. The tissue sections 401, 403 and 405 are taken and placed on the slide in such a manner that the basal layer of cells is substantially continuously observable. FIG. 6 shows a magnified portion of an esophageal tissue section such as section 401. The tissue section 401 is an epithelial section having a basement membrane 411 whith the basal layer of cells on one side 413 and supportive tissue cells on the other side 414. The basal layer of cells forms the inner layer of the esophagus and it is in this layer in which cells evolve to maintain the outer surface of the esophagus. After the tissue samples 401, 403, 405 and 407 are placed on slide 400 (FIG. 5), they are prepared with normal DNA Feulgen staining techniques in a manner in which all cell samples including the control cells 407 are stained by the same process. After staining, the tissue section is covered with a cover glass and made ready for testing.

The slide 400 is mounted in one of the slide positions, e.g. 102, of slide holder 62a which is, in turn, attached to base 63a so that slide 400 can be positioned under the objective 64a. The joystick 13a is used to control the position of slide 400 by controlling control unit 32 to energize motors 100 and 111 as previously discussed. The magnification of the microscope is set to 40X, corresponding to approximately the previously discussed 0.34 by 0.5725 micron pixel size, resulting in an image frame (256.times.256 pixels ) of about 87.04 microns by 146.54 microns. In the manner previously described, the instrument is focused and light intensity is adjusted automatically to predetermined standards. The position of slide 400 is then adjusted to bring one of the esophageal tissue samples, e.g. 401, under the objective 64a and focus is again performed by the apparatus.

The primary interest in the present analysis is the basal layer on side 413 of the basement membrane 411 and the cells evolving from the basal layer. In tissue samples such as the rat esophagus of FIG. 6, the basal layer is somewhat continuous and linear and a plurality of abutting optical frames, e.g. 417-422, are imaged and a digital representation of the optical density of each image frame is generated and stored. In an analysis, between 100 and 400 such frame images along the basal layer are imaged and digitized. The digitized images represent the intensity of the light at each pixel on a linear scale represented by 8 bits. Thus, the stored image records the optical density of each of the 256.times.256 pixels in the image frame. After an image is digitized, it is stored in an addressable location in the system memory for later recall. The set of stored digital images make up the data used for later analysis. Also stored is a physical address of each optical frame on the tissue sample so that the whole image can later be reconstructed from the set of stored frame images. The individual digital values representing each pixel within each frame are also stored at individually addressable locations.

The selection of frames for imaging and storage may be done manually by an operator or automatically by the apparatus. In a completely manual operations, the human operator selects, by controlling the joystick 13a, each of the fields and marks them for digitizing. In a completely automatic system, the apparatus will image adjacent fields in an area identified as containing the basal layer or the apparatus could automatically follow the line of increased density (darkness) which represents the basal layer, producing a series of images as shown in FIG. 6. In a preferred image acquisition method, an operator first identifies generally the position of the basal layer by tracing it using the joystick. The apparatus records the X and Y coordinates of the traced line and after tracing, returns to digitize and store abutting frames along the recorded line.

The image acquisition phase of the procedure may continue with an optional editing phase. In other cases, the editing phase is omitted and the analysis process continues on all of the acquired images. At the beginning of the editing phase, a mosaic of tiles representing the images from the data acquisition is presented to an operator on the video display 30. The mosaic is presented with accurate image frame alignment so that the image, although reduced in magnification, appears substantially the same as the original tissue samples. FIG. 7 shows a mosaic 431 of frame images of rat esophagus tissue as displayed on monitor 30. A particular frame, as indicated by rectangle 433 of the mosaic 431, has been selected for a magnified view. The magnified view of frame 433 is presented in a field 435 of the display screen 30. When a magnified field 435 is presented, the operator can click on an eraser icon 436 and enter an edit mode in which the displayed individual image frame can be modified. The selected frame can be deleted entirely from the analysis, in which case it is marked with an X on the mosaic as shown at 437 and 439 in FIG. 7. The deleted frame may, for example, be one in which the tissue sample is broken or distorted or which contains some other flaw to cause it to have limited analysis value. In the edit mode the operator can also delete selected cell objects from the stored digital image. When the edit mode is optionally entered, an erasing cursor 426 is presented on the magnified image as shown in FIG. 8A, which erasing cursor can be moved by the computer mouse 13. As the erasing cursor 426 is moved on the image, the digital value of any pixel displayed at a position crossed by the erasing cursor 426, is set to “0″ and remains “0″ after the cursor moves on. Any object can be removed from the image field by the use of the erasing cursor. FIG. 8B shows the image field of FIG. 8A after the erasing cursor has been moved across the pixels of cell objects 423, 424 and 425 to remove them. The edited image 8B replaces the image 8A in the mosaic 431 and for later analysis.

the preceding example of mouse esophageal tissue (FIGS. 6-8) demonstrated the capture and editing of image frames by an operator identifying the relatively linear basal layer and the apparatus producing a series of abutting images along the identified layer. The present apparatus can also be used to capture and edit images in cases where a relatively linear basal layer is not present. The preferred embodiment can, at the operator’s request, scan and image tissue samples in a raster manner as shown in FIG. 20A mouse colon cross sections. In the raster type scan the operator identifies the outer perimeter of the object to be scanned. The apparatus records the X and Y coordinate of the perimeter and then begins the image capture and digitizing at the upper left and proceeds across the object, within the identified perimeter with abutting image fields. When the right-most perimeter is reached the apparatus drops down one row of images and proceeds to capture and digitize abutting image fields from right to left and so on until the area within the identified perimeter is filled with abutting image fields.

After the area of image fields has been captured and digitized, the editing process begins on a per-image frame basis. As shown with X’s in FIG. 20A, some image frames, e.g. 485, 486, are completely removed from analysis by deleting them. After all unwanted image frames have been deleted, the remaining image frames can be individually selected and edited as described with regard to FIGS. 8A and B to remove unwanted cell objects. The selection of an image field 488 for display at an increased magnification (FIG. 20D) and editing with the erasing cursor 426 is shown in FIG. 20C. After all unwanted image frames have been deleted and unwanted cell objects removed from the remaining image frames, the individual image frames are presented on the display as an edited sample mosaic as shown in FIG. 20B. After editing, analysis proceeds image frame by image frame. The raster scan technique for image capture and analysis is also useful for human cervix tissue samples as represented at FIG. 21.

Image Frame Analysis

After editing the displayed tissue sample, if selected, and storage of the edited image frames, analysis begins by selecting measurement from the displayed menu field 441 (FOG. 7). When measurement begins, an image field morphology page (FIG. 9) is displayed for operator interaction.

The particular analyses to be used for analysis of a given type tissue sample are selected to provide results which accurately and efficiently identify neoplastic growth. The selection of analyses is done by acquiring and analyzing many tissue samples of a given type with varying known degrees of neoplasia. The acquired image frames are then analyzed using various combinations of the tests discussed below and an assessment is made of which of the performed tests best identify neoplasia. After such “best” tests are identified for a particular tissue type, they become the standards for the identification of neoplasia in that tissue type.

At the beginning of frame analysis, the previously stored frames are individually evaluated and each pixel of the frame is compared to a predetermined threshold indicative of a meaningful value of optical density. The current value of any pixel more optically dense than the threshold is restored for that pixel and the stored optical density of any pixel which is less dense than the threshold is set to “0″, representing no optical density. The comparison to the optical density threshold and setting of pixels to “0″ removes potentially meaningless “clutter” from the image. Such comparison with a threshold to remove clutter may alternatively be performed prior to the image analysis operation and may be performed on the original digitized image before storage.

The particular analyses which have been identified and are used for particular tissue type analyses are discussed below, after description of the individual analyses available to the operator. The user can select at a point 443 of field 441 the measurement of the area in square microns which is a measurement of the area of non “0″ optical density pixels in the recorded image. The operator can select at a point 444, the sum optical density which is the total of the density values of all pixels of the selected image frame. The average optical density can also be selected at a point 445. The average optical density is the sum optical density of all pixels in the image frame, divided by the above identified area of non-zero pixels in the frame. For each of the above analyses used, a value representing each measured quantity is stored in association with each measured image frame.

Image texture measurements are also used for analysis. For example, the measurement of run length can be selected at point 447. In the run length measurement, each non-removed frame of data, e.g. 433, is analyzed by comparing the optical density of each pixel (called the center pixel) with the optical density of both its immediate left pixel neighbor and its immediate right pixel neighbor. When the value of the center pixel is different from both neighbor pixels, the center pixel is counted and the analysis moves to the same comparison using the next pixel to the right as the center pixel. Alternatively, when the optical density of one or both of the pixels to the immediate left and right of the center pixel is the same as the center pixel, the center pixel is not counted and analysis proceeds using the pixel to the immediate right of the center pixel as a new center pixel. The analysis proceeds in raster-like rows across the frame, then down one pixel and across again until all pixels have been compared. After an entire frame of 256.times.256 pixels has been analyzed, the total number of counted center pixels is recorded for the frame and the process proceeds to the next image frame upon which run length is performed again. The result of the run length analysis is the total count of pixels as above counted for each frame stored for the tissue sample. Thus, if 500 frames are un length analyzed 500 counts will be stored, one being associated with each image frame.

FIG. 10, which is used to demonstrate run length analysis, represents 6 pixels 447-452 arranged in a scanned row. In the example, pixels 447, 448 and 449 are of equal optical density, pixel 450 has an optical density different from pixels 447, 448 and 449 and pixels 451 and 452 are all of an equal optical density, which is different from the optical density of pixels 447, 448, 449 and 450. When pixel 448 is the center pixel, its optical density will be compared with that of pixels 447 and 449 in the run length test. Since the optical density is the same, no count is made and pixel 449 will be next chosen as the center pixel. Since pixel 449 is of different optical density from its left and right neighbors 448 and 450, the pixel is counted and pixel 450 is next selected as the center pixel. Again, a pixel will be counted when 450 is the center pixel since its optical density is different from pixels 449 and 451; thereafter, pixel 451 becomes the center pixel. Pixel 451 is of different optical density from pixel 450, its left neighbor, but it is equal to pixel 452, its right neighbor. Accordingly, no count is made for pixel 451. As can be seen, many comparisons and pixel selections are employed to analyze an entire 256.times.256 pixel field.

A configurable run length analysis is another available analysis option. Configurable run length is similar to run length, but the operator has more control over the comparison of pixels and the direction of center pixel selection and comparison with other pixels. Upon selecting configurable run length from the FIG. 9 menu, a new menu shown in FIG. 11 is presented to allow the user to set parameters for the analysis. Entry of a sample size value at a variable entry field 454 allows the lengthening of the comparison distance from the center pixel. For example, entering the number 2 at field 454 results in the comparison of the center pixel with its two left side neighbors and its two right side neighbors. Counting of a pixel takes place only when the conditions exist among the center pixel and the defined neighbor pixels as defined by the preset variables. A variable entry field 456 permits an operator to identify either a positive or a negative optical density difference threshold. The optical density difference threshold is the amount of optical density difference between the center pixel and a neighbor pixel which is considered the same density. When this number is positive, e.g., 0.02 OD, a center pixel will be counted when it is greater than its left and right neighbors (defined by the sample size) by an optical density of 0.02 OD or more. Similarly, when the difference threshold is negative, e.g., -0.02 OD, a center pixel is counted when it is less than its neighbors by 0.02 OD or greater.

The previously described run length analysis compares pixels in a horizontal scan row, then drops down to perform the same comparison on the next row, always comparing in a horizontal direction. The textures of various tissue types yield differing results depending on the orientation of the comparison direction. This is due in part to the shapes of the cell object of the image frame and the orientation of those cell objects. In the case of rat esophagus tissue it has been found that comparing along the general direction of the basal layer provides best results. For analysis of a tissue sample as shown in FIG. 6, top-to-bottom projection is preferred. Configurable run length permits the operator to select the comparison direction to be horizontal, vertical or at a 45.degree. angle from upper left or upper right to provide maximum advantage. The particular direction is selected by setting one or more projection variables by selecting from four input boxes 458. After adjusting variable entry fields 454 and 456 and selecting one or more projections at 458, the operator selects an OK button 556 and returns to screen 446 of FIG. 9. The configurable run length is then performed and center pixels are counted, which compare to their neighbors in the manner defined by the variables set using the screen of FIG. 11. At the conclusion of the configurable run length analysis, a count is stored for each analyzed image frame which is the sum of all center pixels meeting the tests established by the variables. When more than one projection is selected, the result of configurable run length analysis is the sum of all counted pixels for all projections.

Another texture analysis called valley-slope-peak can be selected to analyze the image frames of tissue samples. As with the preceding analyses, variables are adjusted to define this analysis. Upon selection of valley-slope-peak a variable setting menu 461 (FIG. 12) is presented to the operator to define the analysis variables. In valley-slope-peak, a center pixel is compared with its immediate neighbor pixels in a direction selected at projection configuration 463. The available directions are left to right, upper left to lower right, top to bottom and upper right to lower left. When a center pixel is less than both of its adjacent neighbor pixels by an amount equal to or greater than a valley difference threshold set at point 465, the center pixel is counted as a valley pixel. When a center pixel is less than the neighbor pixel to one side and greater than the neighbor pixel on the other side, by an amount selected at a slope difference threshold 467, the center pixel is counted as a slope pixel. Lastly, when the optical density of a center pixel is greater than both neighbor pixels by a peak difference threshold set at 469, the center pixel is counted as a peak pixel. As with the run length measurement, all pixels of a field are selected in the predetermined direction for the valley-slope-peak tests and the various valley-slope-peak pixel counts are retained on a per-image frame basis as indicative of the texture of the image field. After a frame is analyzed, the process proceeds to valley-slope-peak analysis of another image frame until all image frames of the sample are analyzed and all valley, slopes and peaks have been counted and results recorded.

The valley-slope-peak counts are also used to define a result called coarseness which is defined as the slope count minus two times the peak count-valley count [Consensus=slope-2 (peak-valley)]. When the operator selects the coarseness results, valley-slope-peak analysis is performed and at the conclusion of each image frame analysis, the coarseness is calculated from the valley, slope and peak counts from that image frame. A coarseness results is stored in association with each analyzed iamge frame.

Markovian texture analysis can be also selected as an image field texture analysis of the tissue selection. The selection of Markovian textures on screen 446 causes a variable setting screen 473 (FIG. 13) to be presented to the operator. Screen 446 permits the operator to select up to 21 of the known Markovian texture analyses and to set variables to refine the selected analyses. The performance of the individual Markovian analyses is described in detail in the literature, such as Pressman, NJ: “Markovian analysis of cervical cell images”, J. Histochem Cytochem 24:138-144, 1976. In Markovian analysis, a histogram of 8 grey ranges is created to count the optical density of pixels. The common technique for identifying the 8 grey level ranges, as described in the above Pressman article, is called floating equalization in which the pixels having the least and most optical density are first identified and the range between them is divided into 8 equal grey level ranges. The floating equalization brings out the texture of the analyzed sample but the actual optical density information is lost. The present Markovian analysis allows the operator to select a fixed equalization process and to define the upper and lower boundaries of the fixed equalization range. As before, the fixed range is divided into 8 equal sized grey level ranges for an optical density counting histogram. The fixed equalization provides the usual results from Markovian analyses but the actual optical density information is preserved. Additionally, the operator can adjust the step size of the performed Markovian analysis.

EXAMPLES

The preceding has described the apparatus used to acquire and digitize image frames of tissue samples, how image frames are edited and stored, and the types of analyses available to identify neoplasia. The following sets forth examples for the use of these tools in identifying neoplasia and using such identification to test possible chemopreventive agents and diagnosing possible cancers.

One manner of testing chemopreventive agents uses rats which are treated with a carcinogen to develop a particular neoplastic growth and ultimately a carcinoma. A first group of the rats is treated with a carcinogen, and a second group is then treated with the same carcinogen and also with an expected chemopreventive agent while a third control group is not treated in any way. The effectiveness of the administered chemopreventive agents can then be evaluated by comparing the progression of neoplasia in the two treated groups versus the control group. The experiment is designed to sacrifice groups of animals at various time periods to assess neoplastic development. The present analysis permits early detection of the pre-cancerous conditions, which greatly shortens the time required to assess the effectiveness of chemopreventive agents. Shortening the times is important because there are many compounds to test and shorter, more precise testing saves testing costs and identifies chemopreventive agents for possible use earlier than other analysis methods, such as human visual tissue inspection or time to death from cancer or survival rates.

The present analysis is also used to evaluate tissue samples of animals, including humans, for possible neoplasia, which can result in an early diagnosis of pre-cancerous conditions and can thus greatly increase patient survival rates over later detection, possibly after metastasis. The present analysis has been used to analyze human cervix tissue samples to identify the extent of progression of early pre-cancerous conditions.

The first example relates to the analysis of rat esophagus tissue for the growth of neoplasia and the use of detected neoplasia in the identification of chemopreventive agents.

FIGS. 22A and 22B comprise a diagrammatic representation of the analysis of rat esophagus tissue. FIG. 22A includes a representation of a plurality of image frames K.sub.1 through K.sub.N acquired from a normal rat esophagus tissue sample 501. A dotted line box 503 labeled analyses is shown connected by illustrative arrows 502 to receive image data from image frame K.sub.2. In the example, the analyses 503 are sequentially connected to receive stored image frame data from all image frames K.sub.1 through K.sub.N. The particular analyses shown in box 503 and discussed herein have been selected after detailed study to have significant value in the detection of neoplasia in rat esophagus tissue. After the analyses have been selected for use on a particular tissue type, such as rat esophagus, they become the standard for testing that tissue type.

As previously described, the best results from the varied analyses performed are achieved when they are reported as a morphometric Z-score. The morphometric Z-score is a normalizing of the results which uses a mean and standard deviation of analyses performed on normal tissue. The analysis of normal tissue should be done using the same analyses as are to be used for the analysis of neoplasia in suspected tissue. Determining the mean and standard deviation from normal tissue is not a sequential step of each analysis but it is to be performed before the results of the analysis of suspected tissue are normalized. Accordingly, for a given set of analyses the evaluation of normal tissue can occur once and the result stored as a library for later use in normalizing results of suspected tissue.

Each image frame, e.g., K.sub.2, is evaluated by each of the 10 analyses 505-517 shown within the analyses box 503, then the evaluation proceeds to perform the analyses on the next image frame. Each analysis, such as area analysis 505, of an image frame results in a result X.sub.1,K.sub.2 for that analysis and that image frame.

The tests performed on each image frame of the tissue sample begin with Area 503, sum optical density 507 and run length 509 which are performed as previously described. A configurable run length 511 is also performed on each image frame. The configurable run length analysis for rat esophagus tissue has a step size of 1 pixel, a difference threshold of -0.60 OD and a projection from top to bottom. A valley-slope-peak analysis 513 is also performed and 3 analysis results X.sub.5,K.sub.2 ; X.sub.6,K.sub.2 and X.sub.7,K.sub.2 for the valley count, slope count and peak count, respectively. For the valley-slope-peak analysis the difference threshold is set to 0.01 OD and the projection is from left to right for all tests. In addition, an overall threshold of low=0.08 OD to high=0.229 OD is set. The results of the valley-slope-peak analysis are separately stored for later use and are also combined into a coarseness measurement by analysis 515. Finally, the Markovian texture analyses of difference entropy X.sub.9,K.sub.2 and triangular symmetry X.sub.10,K.sub.2 are performed. Both Markovian analyses use a step size of 8 pixels and a fixed equalization between 0.08 OD and 0.4 OD

At the conclusion of the analyses 503 of the normal tissue sample, a set of 10 test results X.sub.1,K.sub.N through X.sub.10,K.sub.N exists for each of the N image frames analyzed. When, for example, 300 image frames are analyzed, this yields 300 results for each of the tests 505-517.

After all analyses have been completed on the normal tissue section 501 image frames, the mean M and standard deviation S must be calculated for each analysis for later use in normalizing the results gained from analysis of suspected neoplastic tissue. In FIG. 22A the normal tissue mean and standard deviation for the area analysis are shown as M.sub.1 and S.sub.1, respectively, and the mean and standard deviation for the triangular symmetry Markovian analysis are shown as M.sub.10 and S.sub.10, respectively.

FIG. 22B represents the analysis of a suspected neoplastic rate esophagus tissue section represented at 527 and having a plurality of acquired image frames L.sub.1 through L.sub.M. As previously described, the image frames are acquired and digitized and they are then analyzed using the same 10 analyses 505-517 shown in FIG. 22A and having the same variable settings. The results of these analyses are shown as Y.sub.1,L.sub.2 through Y.sub.10,L.sub.2 for the second image frame L.sub.2. When the results of all 10 analyses Y.sub.1,L.sub.2 through Y.sub.10,L.sub.2 have been computed and are stored in association with a respective image frame, they are normalized using the mean M and standard deviation S computed for corresponding analysis of the normal tissue sample 501. More specifically, the results of the area analysis 505 for suspected neoplastic tissue yields a result Y.sub.1,L.sub.2 for the second image frame L.sub.2. The result is converted to a preliminary Z-score (Z’.sub.1) by subtracting Y.sub.1,L.sub.2 from the mean M.sub.1 identified for normal tissue and dividing the result by the standard deviation S.sub.1 of the normal sample. Similarly, each test result is subtracted from the corresponding mean M.sub.1 through M.sub.10 and the result divided by the respective standard deviation S.sub.1 through S.sub.10 of normal tissue. Preliminary normalizing creates 10 values, Z’ through Z’.sub.10, one for each different test performed on the same image frame. The 10 Z’ values are averaged to result in the Z-score Z.sub.i for the image frame. After a value Z.sub.i has been determined for each image frame, all of the image frame Z-scores Z.sub.i are averaged to yield an overall Z-score for the tissue sample. This resulting Z-score can be accurately compared with the Z-scores of other tests, whether or not the tests were performed on the same tissue type.

FIG. 15 is a graph comparing the increasing Z-scores over time of esophagus tissue of rats induced by treatment with N-Nitrosomethylbenzlamine (NMBA) which causes neoplasia compared to a control population which was not treated with NMBA. At ten weeks into the trial the Z-score of the normal population ranges from +0.5 to -1.5, while the Z-score of the esophagus tissue in NMBD-treated animals exhibiting neoplasia ranges from +1.0 to +4.5. At 20 weeks the control population exhibits a Z-score between 0 and 1, while the tissue from the esophagus of treated animals exhibits a Z-score from +3.5 to +6. At 30 weeks the control tissue exhibits a Z-score from 0 to -1.5, while the tested tissues exhibit a Z-score of +3.5 to +10.5. From FIG. 15 it is apparent that the tests performed show a substantial departure from the control group as early as 10 weeks into the trial, which departure increases markedly at 20 and 30 weeks.

FIG. 14 represents the analyses performed to detect neoplasia in human cervix tissue samples represented at 530. As discussed with regard to rat esophagus tissue, a set of analyses 503 useful in detecting neoplasia is performed on normal tissue samples and on suspected neoplastic tissue sections. For human cervix tissue a sum optical density 531 analysis and the slope test 533 make up the set. The slope analysis is performed with a difference threshold of 0.06 OD and projections in the direction of all 8 pixel neighbors. Both analyses are performed on normal tissue and a mean M and a standard deviation S is computed for each test. The same set of analyses are then performed on tissue suspected to exhibit neoplasia. The analysis results of the suspected tissue are then normalized in the manner of the rat esophagus tissue and the resulting Z-score is used to represent the tissue sample.

FIG. 16 is a graph of Z-scores obtained by analysis, in accordance with the preferred embodiment, of human cervix tissue sections identified by pathology experts to be in progressive stages of neoplasia ranging from normal tissue through cervical intraepithelial neoplasia grade III (CIN III). In FIG. 16, the Z-scores of normal tissue range from -1 to +1. The Z-scores of tissue of CIN I range from +1 to +2; the Z-scores of tissue of CIN II range from 0 to +6 and; the Z-scores of tissue of CIN III range from +5.5 to +10. Clearly the apparatus and methods of the present embodiment shown increasing Z-scores for increasing neoplasia.

FIG. 23 represents the analyses performed to detect neoplasia in mouse colon tissue sections represented at 540. The analyses 503 performed on mouse colon tissue consist of average optical density, valley and slope and the Markovian textures of sum average, sum variance, difference variance and product moment. The valley and slope analyses are each performed with a difference threshold of 0.01 OD and in all projections. The Markovian textures analyses are all performed with a step size of 1 pixel and a fixed equalization between the values 0.08 OD and 0.70 OD.

The efficacy of the present embodiment in identifying chemopreventive agents is shown in the graph of FIG. 18. The results of testing three groups of rats for neoplasia in accordance with the present embodiment show differences in the group results based on dosage of phenethylisothiocyate (PEITC), a likely chemopreventive agent. All groups were treated with NMSA in a manner to produce a likelihood of neoplasia, similarly to the groups shown in FIG. 15. The first group, shown by line 479, received no PEITC during the test and the result is a nearly straight projected line for an average Z-score of 0 at the inception of the test to an average Z-score of almost 7 at 20 weeks into the test. The second group (line 481) which received low doses of PEITC, exhibit an average Z-score of approximately +2.5 at 10 weeks and an average S-score of approximately +3.25 at 20 weeks. The third group (line 483) which received a high dosage of PEITC exhibits an average Z-score of approximately +1.5 at 10 weeks and a reduction in Z-score to approximately +0.75 at 20 weeks.

The test results can also be presented in a manner referred to an “with and without treatment” or “before and after” as shown in FIGS. 19A-B. FIG. 19A shows the “without” or “before” image of test results measured at 10 weeks after administration of a high dosage of NMBA without PEITC (line 479 of FIG. 18) and FIG. 19B shows the “with” or “after” image of test results measured at 10 weeks after administration of a high dosage of PEITC. The movement of the measured distribution closer to the mean as is already demonstrated by FIGS. 19A-B shows the improvements achieved by the use of the chemopreventive agent PEITC.

In the above described embodiments, the analysis and computation of the Z-scores are performed by the computer 32 (FIG. 2) of the image analysis equipment. It should be mentioned that the accumulated image frame data may be stored on removable media or made available on a network, and the analysis and computation of the Z-scores may be performed on another computer system. That is, the analysis need not be performed by the data acquisition computer system. As an example, the image frame data may be collected on a first computer and interactively analyzed by an operator at a second computer. The operator may select fields individually, rather than by a scanning method. This may be desirable for small, hard to locate, neoplasia lesions such as prostate interephithelial neoplasia (PIN) lesions, where accumulation of results may occur at many distinct sites.

FIG. 17 shows the functions of the analysis apparatus. In a block 601 the analysis data is received by the apparatus. The analysis data includes the digitized image frames as well as the results of the analysis of “normal” tissue samples. The digitized image frame may be already be stored in the apparatus when the analysis apparatus is also the scanning apparatus, or the digitized images may be received from movable storage media or downloaded from a network. The analysis results from normal tissue may be entered from movable media or the keyboard 56.

Block 603 represents the selection of analyses by an operator, as represented in display screens 9, 11, 12 and 13 ad discussed above. After the selections of analyses, the apparatus, block 605, performs the requested analyses in the manner discussed above and the results are stored in the apparatus. At the conclusion of measurements and analyses, the apparatus reads the stored results and the results for normal tissue and computes the Z-scores in block 607, as discussed with regard to FIGS. 14, 22A, 22B and 23. The results of measurements and analyses, including the Z-scores computed by the apparatus, are then presented to the operator in block 609. Examples of such presented results are shown, for example, in FIGS. 15, 16 and 18. The results can also be stored for digital presentation on movable media or via a network. The preceding description sets forth analysis apparatus and methods for use in identifying the development of preinvasive neoplasia. Also described are methods for evaluating possible chemopreventive agents and the use of the disclosed methods and apparatus in such evaluating. The present invention is not limited to the above embodiments but extends to cover other embodiments, not shown or described, but falling within the ambit of the appended claims.

Method of treating cancer with a tumor cell line having modified cytokine expression

Filed under: Issued Patent — admin @ 3:33 am

Abstract
The present invention provides a method of treating cancer comprising (a) obtaining a tumor cell line, (b) modifying the tumor cell line to render it capable of producing an increased level of a cytokine relative to the unmodified tumor cell line, and (c) administering the tumor cell line to a mammalian host having at least one tumor that is the same type of tumor as that from which the tumor cell line was obtained, wherein the tumor cell line is allogeneic and is not MHC-matched to the host. The present invention also provides a pancreatic tumor cell line, a method and medium for obtaining such a tumor cell line, and a composition comprised of cells of a purified pancreatic tumor cell line.

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Inventors: Jaffee; Elizabeth M. (Lutherville, MD), Pardoll; Drew M. (Brookville, MD), Levitsky; Hyam I. (Owings Mills, MD)
Assignee: Johns Hopkins University School of Medicine (Baltimore, MD)

Appl. No.: 08/773,367
Filed: December 26, 1996
Government Interests

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This invention was made with Government support under Grant Number CA62924 awarded by the National Institutes of Health, and under Grant Number CA57842 awarded jointly by the National Institutes of Health and National Cancer Institute. The Government may have certain rights in this invention .
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Parent Case Text

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This application claims priority to U.S. patent application Ser. No. 60/032,801, which was filed on Dec. 28, 1995, and which has since lapsed.
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Claims

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What is claimed is:

1. A method of stimulating an antitumor immune response to a pancreatic tumor in a mammalian host that has pancreatic cancer, which method comprises:

administering to said mammalian host a pancreatic tumor cell line, which (i) has been derived from a primary pancreatic tumor, (ii) is purified from stromal and noncancerous epithelial cells, (iii) is allogeneic and not major histocompatibility-matched to said mammalian host, and (iv) has been modified so that it produces an increased level relative to the unmodified pancreatic tumor cell line of a cytokine, which stimulates an antitumor immune response,

wherein the administration of said pancreatic tumor cell line to said mammalian host stimulates an antitumor immune response to said pancreatic tumor in said mammalian host.

2. The method of claim 1, wherein said pancreatic tumor cell line is administered to said mammalian host in vivo in close proximity to said pancreatic tumor.

3. The method of claim 1, wherein said pancreatic tumor cell line is irradiated prior to administration to said mammalian host.

4. The method of claim 1, wherein said pancreatic tumor cell line is treated to enhance its immunogenicity prior to administration to said mammalian hose.

5. The method of claim 4, wherein said pancreatic tumor cell line is treated by admixture with an adjuvant.

6. The method of claim 1, wherein said pancreatic tumor cell line has been derived from a primary pancreatic tumor by:

(a) obtaining a sample of tumor cells from a primary pancreatic tumor from a mammalian host,

(b) forming a single cell suspension from said sample of tumor cells,

(c) pelleting tumor cells from said single cell suspension,

(d) plating the pelleted tumor cells in a growth medium comprising fetal serum, insulin at a concentration of from about 0.1 to about 1.0 U/ml, and insulin-like growth factor 1 at a concentration of from about 0.005 to about 0.05 .mu.g/ml, and insulin-like growtn factor 2 at a concentration of from about 0.005 to about 0.05 .mu.g/ml, and

(e) purifying said tumor cells.

7. The method of claim 1, wherein said pancreatic tumor cell line comprises a mutation in an oncogene or a tumor suppressor gene that allows confirmation of the oncogenic nature of the pancreatic tumor cell line and its derivation from a host tumor.

8. The method of claim 7, wherein said mutation is in a ras gene.

9. The method of claim 1, wherein said cytokine is granulocyte-macrophage colony stimulating factor (GM-CSF).

10. The method of claim 8, wherein said pancreatic tumor cell line comprises a mutation in codon 12, 13 or 61 of H-ras, K-ras or N-ras and expresses cell-surface cytokeratins and high levels of MHC class I antigens.

11. The method of claim 6, wherein said pancreatic tumor cell line is administered to said mammalian host in vivo in close proximity to said pancreatic tumor.

12. The method of claim 6, wherein said pancreatic tumor cell line is irradiated prior to administration to said mammalian host.

13. The method of claim 6, wherein said pancreatic tumor cell line is treated to enhance its immunogenicity prior to administration to said mammalian host.

14. The method of claim 13, wherein said pancreatic tumor cell line is treated by admixture with an adjuvant.

15. The method of claim 6, wherein said pancreatic tumor cell line comprises a mutation in an oncogene or a tumor suppressor gene that allows confirmation of the oncogenic nature of the pancreatic tumor cell line and its derivation from a host tumor.

16. The method of claim 15, wherein said mutation is in a ras gene.

17. The method of claim 6, wherein said cytokine is GM-CSF.
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Description

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TECHNICAL FIELD OF THE INVENTION

The present invention pertains to a method of treating cancer using allogeneic tumor cell lines, i.e., tumor cell lines that are genetically dissimilar to those of the host. In particular, the invention pertains to a method of treating pancreatic cancer using an allogeneic pancreatic tumor cell line. The present invention also pertains to a pancreatic tumor cell line, a method and medium for obtaining such a cell line, and a composition comprised of cells of a purified pancreatic tumor cell line.

BACKGROUND OF THE INVENTION

It is generally accepted that human tumor cells contain multiple specific alterations in the cellular genome responsible for their malignant phenotype. These alterations affect the expression or function of genes that control cell growth and differentiation. For instance, typically these mutations are observed in oncogenes, or positive effectors of cellular transformation, such as ras, and in tumor suppressor genes (or recessive oncogenes) encoding negative growth regulators, the loss of function of which results in expression of a transformed phenotype, such as p53, Rb1, DCC, MCC, NF1, and WT1.

Mutations have been detected in all of the common human tumors including pancreatic and colorectal carcinomas. To date, a transforming ras gene (i.e., a mutated version of H-ras, K-ras, or N-ras encoding a protein having an altered amino acid at one of the critical positions 12, 13 and 61) is the oncogene most frequently identified in human cancer. As reviewed by Barbacid, Ann. Rev. Biochem., 56, 779-827 (1987), a ras oncogene has been observed in carcinoma of the bladder, breast, colon, kidney, liver, lung, ovary, pancreas, rectum, and stomach; in hematopoietic tumors of lymphoid and myeloid lineage; in tumors of mesenchymal origin such as fibrosarcomas and rhabdomyosarcomas; and in other tumors, including melanomas, teratocarcinomas, neuroblastomas, and gliomas. In particular, a ras mutation has been identified in greater than 90% of patients with adenocarcinoma of the pancreas, as described by Bos, Cancer Research, 49, 4682-4689 (1989).

Tumors of the pancreas are highly malignant and generally result in death. In fact, cancer of the pancreas is the fifth leading cause of cancer-related death in the United States. The presently available treatment modalities have shown little or no benefit for patients with tumors that are unresectable (i.e., regionally advanced or metastatic cancers). Similarly, for patients with localized disease that can be resected, state-of-the-art adjuvant therapy with radiation and chemotherapy has shown only modest benefits–and that at the expense of significant treatment toxicity. Over 71% of cancer patients undergoing adjuvant therapy will eventually die of recurrent disease. For these reasons, more effective treatments are currently needed for cancer, and, in particular, both for advanced as well as limited-stage pancreatic cancer.

Immunotherapy is a potentially therapeutic approach for the treatment of cancer. Immunotherapy is based on the premise that the failure of the immune system to reject spontaneously arising tumors is related to the failure of the immune system to respond appropriately to tumor antigens. In a functioning immune system, tumor antigens are processed and expressed on the cell surface in the context of major histocompatibility complex (MHC) class I and II molecules, which, in humans, also are termed “human-leukocyte associated” (HLA) molecules. When complexed to antigens, the MHC class I and II molecules are recognized by CD8.sup.+ and CD4.sup.+ T cells, respectively. This recognition generates a set of secondary cellular signals and the paracrine release of specific cytokines, or soluble so-called “biological response modifiers”, that mediate interactions between cells and stimulate host defenses to fight off disease. The release of cytokines then results in the proliferation of antigen-specific T cells.

Thus, active immunotherapy involves the injection of is tumor cells, typically in the vicinity of a tumor, to generate either a novel or an enhanced systemic immune response. The ability of this immunotherapeutic approach to augment a systemic T cell response against a tumor has been previously disclosed, e.g., amongst others, see International Application WO 92/05262, Fearon et al., Cell, 60, 397-403 (1990), and Dranoff et al., Proc. Natl. Acad. Sci., 90, 3539-3543 (1993). The injected tumor cells are usually altered to enhance their immunogenicity, such as by admixture with non-specific adjuvants, or by genetic modification of the cells to express cytokines, or other immune co-stimulatory molecules. The tumor cells employed can be autologous, i.e., derived from the same host as is being treated. Alternately, the tumor cells can be MHC-matched, or derived from another host having the same, or at least some of the same, MHC complex molecules.

Clinical researchers prefer the use of autologous over MHC-matched tumor cells, and vice versa, for different reasons. Namely, autologous cells are preferred since each patient’s tumor expresses a unique set of tumor antigens that can differ from those found on histologically-similar, MHC-matched tumor cells from another patient, see, e.g., Kawakami et al., J. Immunol., 148, 638-643 (1992); Darrow et al., J. Immunol., 142, 3329-3335 (1989); and Hom et al., J. Immunother., 10, 153-164 (1991). Studies evaluating human melanoma antigens confirm that all the human tumor antigens identified to date are shared among at least 50% of patients’ tumors–regardless of whether or not the same MHC-type is similarly shared. Use of cells from a patient’s own tumor circumvents any need for matching of tumor or MHC antigens.

In comparison, MHC-matched tumor cells are preferred since the use of autologous tumor cell vaccines require that each patient be taken to surgery to obtain a sample of their tumor for vaccine production. The in vitro expansion of fresh human tumor explants necessary for the production of autologous tumor cell vaccines is labor-intensive, technically demanding, and frequently impossible for most histologic types of human tumors, even with highly specialized research facilities. Moreover, the production of a vaccine from each patient’s tumor is quite expensive. There also is a substantial likelihood that after extended passage of autologous cells in culture, the antigenic composition of such cells will change relative to the primary tumor from which the cell line originated, making the cells ineffective as a vaccine. While such change is inevitable with all established cell lines, as regarding the use of autologous cells as a tumor vaccine, it will require the maintenance of freezer stocks of each initially-isolated cell line for each patient being treated using this approach.

Based on these shortcomings associated with use of autologous and MHC-matched cells as tumor vaccines, other researchers have sought alternative tumor vaccines, as reviewed by Jaffee et al., Seminars in Oncology, 22, 81-91 (1995). The recent results of Huang et al., Science, 264, 961-965 (1994), are relevant to this proposal. Namely, prior to this study, tumor vaccine strategies were based on the understanding that the vaccinating tumor cells function as the antigen presenting cells (APCs) that present the tumor antigens on their MHC class I and II molecules, and directly activate the T cell arm of the immune response. In contrast, the results of Huang et al. indicate that the professional APCs of the host rather than the vaccinating tumor cells prime the T cell arm of the immune response. The tumor vaccine cells secrete a cytokine such as GM-CSF and recruit to the region of the tumor bone marrow-derived APCs. The bone marrow-derived APCs take up the whole cellular protein of the tumor for processing, and then present the antigenic peptide(s) on their MHC class I and II molecules. In this fashion, the APCs prime both the CD4.sup.+ and the CD8.sup.+ T cell arms of the immune system, resulting in the generation of a systemic antitumor immune response that is specific for the antigenic epitopes of the host tumor. These results suggest that it may not be necessary to use autologous or MHC-matched tumor cells in cancer treatment.

Other results suggest that the transfer of allogeneic MHC genes (i.e., genes from a genetically dissimilar individual of the same species) can enhance tumor immunogenicity. Specifically, in certain cases, the rejection of tumors expressing allogeneic MHC class I molecules resulted in enhanced systemic immune responses against subsequent challenge with the unmodified parental tumor, as reviewed in Jaffee et al., supra, and Huang et al., supra. This appears to represent an example of the general phenomenon described as “xenogenization” by Itaya et al., Cancer Res., 47, 3136-3140 (1987), wherein tumor vaccine potency is enhanced by introducing genes into the tumor cell that code for foreign antigens.

Thus, there remains a need for a method of treating cancer, in particular, a method of treating pancreatic cancer, which does not rely on use of autologous or MHC-matched tumor cells, and that avoids the difficulties and shortcomings associated with such use. The present invention provides such a method, as well as components necessary for effectuating the method. These and other objects and advantages of the present invention, as well as additional inventive features, will be apparent from the description of the invention set forth herein.

BRIEF SUMMARY OF THE INVENTION

The present invention provides a method of treating cancer comprising the steps of (a) obtaining a tumor cell line, (b) modifying the tumor cell line to render it capable of producing an increased level of a cytokine relative to the unmodified tumor cell line, and (c) administering the tumor cell line to a mammalian host having at least one tumor that is the same type of tumor as that from which the tumor cell line was obtained. The tumor cell line is allogeneic and is not MHC-matched to the host. In particular, the present invention provides a method of treating pancreatic cancer using an allogeneic pancreatic tumor cell line. The present invention also provides a pancreatic tumor cell line, a method and medium for obtaining such a tumor cell line, and a composition comprised of cells of a purified pancreatic tumor cell line.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The method of the present invention of treating cancer comprises the steps of (a) obtaining a tumor cell line, (b) modifying the tumor cell line to render it capable of producing an increased level of a cytokine relative to the unmodified tumor cell line, and (c) administering the tumor cell line to a mammalian host having at least one tumor that is the same type of tumor as that from which the tumor cell line was obtained. The administered tumor cell line is allogeneic and is not MHC-matched to the host.

Cancer

The method of the invention can be employed to treat cancer. “Treating cancer” according to the invention comprises administering to a host the tumor cell lines set forth herein for the purpose of effecting a therapeutic response. In particular, a therapeutic response is a systemic immune response (i.e., a T cell response) to tumor antigens. Such a response can be assessed by monitoring the attenuation of tumor growth and/or tumor regression. “Tumor growth” includes an increase in tumor size and/or the number of tumors. “Tumor regression” includes a reduction in tumor mass.

“Cancer” according to the invention includes cancers, in particular those of epithelial origin, characterized by abnormal cellular proliferation and the absence of contact inhibition, which can be evidenced by tumor formation. The term encompasses cancer localized in tumors, as well as cancer not localized in tumors, such as, for instance, cancer cells which expand from a tumor locally by invasion. Thus, any type of cancer can be targeted for treatment according to the invention. For example, the approach preferably can be applied in several clinical scenarios including, but not limited to, local adjuvant therapy for resected cancers, and local control of tumor growth, such as carcinomas of the bladder, breast, colon, kidney, liver, lung, ovary, pancreas, rectum, and stomach. The method also preferably can be used for treatment when the tumor is a sarcoma (e.g., a fibrosarcoma or rhabdosarcoma), a hematopoietic tumor of lymphoid or myeloid lineage, or another tumor, including, but not limited to, a melanoma, teratocarcinoma, neuroblastoma, or glioma.

Preferably the method of the invention can be employed to treat pancreatic cancer. Thus, the present invention also provides a method of treating pancreatic cancer comprising the steps of (a) obtaining a pancreatic tumor cell line, (b) modifying the tumor cell line to render it capable of producing an increased level of a cytokine relative to the unmodified tumor cell line, and (c) administering the tumor cell line to a mammalian host having at least one pancreatic tumor, wherein the tumor cell line is allogeneic and is not MHC-matched to the host.

The method of treating cancer can be effectively carried out using a wide variety of different hosts. For instance, the method can be employed with various eukaryotic hosts, but preferably is employed with mammalian hosts including but not limited to rodent, ape, chimpanzee, feline, canine, ungulate (such as ruminant or swine), as well as, in particular, human hosts.

Tumor Cell Line

As described herein, a “tumor cell line” comprises cells that initially derived from a tumor. Such cells typically have undergone some change in vivo such that they theoretically have indefinite growth in culture; i.e., unlike primary cells, which can be cultured only for a finite period of time. Moreover, such cells preferably can form tumors after they are injected into susceptible animals.

According to the invention, a tumor cell line can be derived from any tumor, e.g., a carcinoma of the bladder, breast, colon, kidney, liver, lung, ovary, pancreas, rectum, and stomach; a hematopoietic tumor of lymphoid or myeloid lineage; a tumor of mesenchymal origin such as a fibrosarcoma or rhabdomyosarcoma; or another tumor, including a melanoma, teratocarcinoma, neuroblastoma, or glioma. Preferably the tumor cell line is derived from a pancreatic tumor.

A tumor cell line employed in a method of treating cancer can be obtained by any suitable means but preferably is obtained in a general method involving the steps of (a) obtaining a sample of a tumor from a mammalian host, (b) forming a single cell suspension from the tumor sample, (c) pelleting the tumor cells, and (d) plating the tumor cells.

More specifically, a sample of a tumor typically can be obtained at the time of surgery. The tumor sample subsequently can be handled and manipulated using sterile technique and in such a fashion so as to minimize tissue damage. The tissue sample can be placed on ice in a sterile container and moved to a laboratory laminar flow hood. The portion of the tumor to be employed for isolation of tumor cell lines can be minced into small pieces; the remainder of the tumor can be stored at -70.degree. C. The slices of tumor then can be digested into single cell suspensions using a solution of Collagenase I. This digestion can be carried out at room or at elevated temperature. Preferably the digestion is carried out at 37.degree. C., while shaking the mixture, e.g., in a shaking incubator.

The single cell suspension is then pelleted, and the pellets can be resuspended in a small volume of tissue culture medium. The resuspended cells can be inoculated into tissue culture medium appropriate for the growth of the cells in culture at a density of about 2.times.10.sup.5 tumor cells/ml. Preferably the medium is one that has wide applicability for supporting growth of many types of cell cultures, such as a medium that utilizes a bicarbonate buffering system and various amino acids and vitamins. Optimally the medium is RPMI-1640 medium. The medium can contain various additional factors as necessary, e.g., when required for the growth of tumor cells, or for maintenance of the tumor cells in an undifferentiated state.

The cultures can be maintained at about 35-40.degree. C. in the presence of about 5-7% CO.sub.2. The tumor cell cultures can be fed and recultured as necessary, i.e., typically every 1 to 10 days. The tumor cells also can be subjected to differential trypsinization to remove other cells (e.g. stromal cells) that can overgrow the primary tumor cultures. Preferably, such differential trypsinization is done about every 5 to 10 days.

When it appears that a substantially pure culture of the tumor cells has been obtained, various tests can be carried out as necessary to determine the relative purity of the cultures, and to characterize the resultant tumor cell lines. For instance, the existence of certain genetic sequences in the cell line, or certain phenotypic traits, as further described herein, can be explored.

The method of isolating a tumor cell line preferably can be employed for the isolation of a pancreatic tumor cell line. Such a pancreatic tumor cell line similarly can be employed in a method of treating pancreatic cancer and can be obtained by (a) obtaining a sample of a pancreatic tumor from a mammalian host, (b) forming a single cell suspension from the tumor sample, (c) pelleting the tumor cells, and (d) plating the tumor cells. Thus, the present invention provides a substantially purified tumor cell line, particularly a substantially purified pancreatic tumor cell line.

Desirably, as part of the isolation process, the pancreatic tumor cells are plated in a growth medium optimized for culturing pancreatic tumor cells. Preferably this medium is RPMI-1640 medium. Optimally, this medium further comprises fetal serum, insulin, and insulin-like growth factors 1 and 2. Preferably fetal serum is fetal bovine serum and is included at a concentration of about 5 to about 30%, even more preferably, about 10 to about 25%, and optimally, about 20%. Also, preferably insulin is human insulin, and is included in the medium at a concentration of from about 0.02 to about 2.0 U/ml, even more preferably, from about 0.1 to about 1.0 U/ml, and optimally, about 0.2 U/ml. Insulin-like growth factors 1 and 2 can each preferably be included in the medium at a concentration of from about 0.001 to about 0.1 .mu.g/ml, even more preferably, from about 0.005 to about 0.05 .mu.g/ml, and optimally, about 0.01 .mu.g/ml.

The medium and medium components are readily available, and can be obtained, for instance, from commercial suppliers. Such commercial suppliers include, but are not limited to, JRH Biosciences (Lenexa, Kans.), Gibco BRL (Gaithersberg, Md.), Hyclone Labs. (Logan, Utah), Sigma Biosciences (St. Louis, Mo.), Cell Sys. Corp. (Kirkland, Wash.), Intergen Co. (Purchase, N.Y.), Eli Lilly and Co. (Indianapolis, Ind.), Biofluids, Inc. (Rockville, Md.), and other suppliers manufacturing similar products.

Preferably the tumor cell line (which desirably is a pancreatic tumor cell line) comprises a mutation in an oncogene or tumor suppressor gene such that the oncogenic nature of the tumor cell line, and its derivation from a host tumor, can be confirmed. The mutation can occur in any oncogene or tumor suppressor gene, including, but not limited to, trk, ks3, hst, ras, myc, p53, mas, Rb1, DCC, MCC, NF1, and WT1. Optimally the tumor cell line comprises a ras mutation. Preferably the mutation is present in codon 12, 13, or 61 of one of the ras genes H-ras, K-ras, and N-ras. Optimally the mutation is in codon 12 of a ras gene, preferably codon 12 of a K-ras gene.

The use of a tumor cell line characterized by a ras mutation is advantageous inasmuch as the mutations which render a ras gene oncogenic have been characterized, e.g., as reviewed by Bos, supra, and Barbacid, supra. This means that peptides that incorporate amino acid changes known to result in a ras oncoprotein can be synthesized easily, and can be evaluated as targets of cytotoxic T lymphocytes (CTLs). Host immune responses to these peptides can be assessed both before and after vaccination.

The tumor cell line, which preferably is a pancreatic cell line, also can be characterized by a further trait which distinguishes the tumor cells from other cells and can be employed, for instance, for monitoring cell survival either in vittro or in vivo. Examples of such a trait include antibody staining for a particular protein, which, desirably is a cell surface protein. Preferably, the pancreatic tumor cell lines of the present invention demonstrate cytokeratin staining upon histochemical staining using an antibody directed against cytokeratin. Accordingly, the present invention provides preferred pancreatic tumor cell lines including, but not limited to Panc 4.14.93, Panc 1.28.94, Panc 6.3.94, Panc 8.13.94, Panc 9.6.94, Panc 12.1.94, Panc 2.3.95, Panc 4.3.95, Panc 4.21.95, Panc 5.4.95, and, in particular, Panc 10.5.92.

Cytokine

In the method of treating cancer of the invention, preferably the tumor cell line (e.g., the pancreatic tumor cell line) has been modified to render the tumor cell line capable of producing an increased level of a cytokine relative to the unmodified tumor cell line, or the parental tumor cell line from which the modified tumor cell line derives. A “cytokine” is, as that term is understood by one skilled in the art, any immunopotentiating protein (including a modified protein such as a glycoprotein) that enhances responsiveness of a host immune system to a tumor present in the host. Preferably the cytokine is not itself immunogenic to the host, and potentiates immunity by activating or enhancing the activity of cells of the immune system.

As used herein, a cytokine includes such proteins as interferons (e.g., IFN.sub..alpha., IFN.sub..beta., and IFN.sub..gamma.), interleukins (e.g., IL-1 to IL-11), tumor necrosis factors (e.g., TNF.sub..alpha. and TNF.sub..beta.), erythropoietin (EPO), macrophage colony stimulating factor (M-CSF), granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF). Preferably the cytokine is GM-CSF from any source, optimally the cytokine is murine or human GM-CSF.

“Modifying” a tumor cell line according to the invention comprises providing to the tumor cell line a vector capable of imparting increased expression of a cytokine of interest. A “vector” encompasses a DNA molecule such as a plasmid, virus or other vehicle, which contains one or more heterologous or recombinant DNA sequences, e.g., a cytokine gene or cytokine coding sequence of interest under the control of a functional promoter and possibly also an enhancer, and that is capable of functioning as a vector as that term is understood by those of ordinary skill in the art. Appropriate viral vectors include, but are not limited to simian virus 40, bovine papilloma virus, Epstein-Barr virus, adenovirus, herpes virus, vaccinia virus, Moloney murine leukemia virus, Harvey murine sarcoma virus, murine mammary tumor virus, and Rous sarcoma virus.

Reference to a vector or other DNA sequences as “recombinant” merely acknowledges the linkage of DNA sequences which are not typically conjoined as isolated from nature. A “gene” is any nucleic acid sequence coding for a protein or a nascent mRNA molecule. Whereas a gene comprises coding sequences plus any non-coding (e.g., regulatory sequences), a “coding sequence” does not include any non-coding DNA. A “promoter” is a DNA sequence that directs the binding of RNA polymerase and thereby promotes RNA synthesis. “Enhancers” are cis-acting elements of DNA that stimulate or inhibit transcription of adjacent genes. An enhancer that inhibits transcription also is termed a “silencer”. Enhancers differ from DNA-binding sites for sequence-specific DNA binding proteins found only in the promoter (which also are termed “promoter elements”) in that enhancers can function in either orientation, and over distances of up to several kilobase pairs (kb), even from a position downstream of a transcribed region.

Any suitable vector can be employed that is appropriate for introduction of nucleic acids into eukaryotic tumor cells, or more particularly animal tumor cells, such as mammalian, e.g., human, tumor cells. Preferably the vector is compatible with the tumor cell, e.g., is capable of imparting expression of the cytokine gene or coding sequence, and is stably maintained or relatively stably maintained in the tumor cell. Desirably the vector comprises an origin of replication. Preferably the vector also comprises a so-called “marker” function by which the vector can be identified and selected (e.g., an antibiotic resistance gene). When a cytokine coding sequence is transferred (i.e., as opposed to a cytokine gene having its own promoter), optimally the vector also contains a promoter that is capable of driving expression of the coding sequence and that is operably linked to the coding sequence. A coding sequence is “operably linked” to a promoter (e.g., when both the coding sequence and the promoter together constitute a native or recombinant cytokine gene) when the promoter is capable of directing transcription of the coding sequence.

As used herein, cytokine “gene” or “coding sequence” includes cytokine genomic or cDNA sequences, greater and lesser sequences and mutations thereof, whether isolated from nature or synthesized in whole or in part, as long as the gene or coding sequence is capable of expressing or capable of being expressed into a protein having the characteristic function of the cytokine, i.e., the ability to stimulate the host immune response. The means of modifying genes or coding sequences are well known in the art, and can also be accomplished by means of commercially available kits (e.g., New England Biolabs, Inc., Beverly, Md.; Clontech, Palo Alto, Calif.). The cytokine gene or coding sequence can be of any suitable source, for example, isolated from any mammalian species such as human. Preferably, however, the cytokine gene or coding sequence comprises a GM-CSF sequence, particularly a human or murine GM-CSF gene or coding sequence including a human or murine GM-CSF cDNA sequence (e.g., as described by Cantrell et al., Proc. Natl. Acad. Sci., 82, 6250-6254 (1985)).

In the recombinant vectors of the present invention, preferably all proper transcription, translation and processing signals (e.g., splicing and polyadenylation signals) are correctly arranged on the vector such that the cytokine gene or coding sequence will be appropriately transcribed and translated in the tumor cells into which it is introduced. The manipulation of such signals to ensure appropriate expression in host cells is well within the knowledge and expertise of the ordinary skilled artisan.

Whereas a cytokine gene is controlled by (i.e., operably linked to) its own promoter, another promoter, including a constitutive promoter, such as, for instance the adenoviral type 2 (Ad2) or type 5 (Ad5) major late promoter (MLP) and tripartite leader, the cytomegalovirus (CMV) immediate early promoter/enhancer, the Rous sarcoma virus long terminal repeat (RSV-LTR), and others, can be employed to command expression of the cytokine coding sequence.

Alternately, a tissue-specific promoter (i.e., a promoter that is preferentially activated in a given tissue and results in expression of a gene product in the tissue where activated) can be used in the vector. Such promoters include but are not limited to the elastase I gene control region which is active in pancreatic acinar cells as described by Swift et al., Cell, 38, 639-646 (1984) and MacDonald, Hepatology, 7, 425-515 (1987); the insulin gene control region which is active in pancreatic beta cells as described by Hanahan, Nature, 315, 115-122 (1985); the hepatocyte-specific promoter for albumin or .alpha..sub.1 -antitrypsin described by Frain et al., Mol. Cell. Biol., 10, 991-999 (1990) and Ciliberto et al., Cell, 41, 531-540 (1985); and the albumin and alpha.sub.1 -antitrypsin gene control regions which are both active in liver as described by Pinkert et al., Genes and Devel., 1, 268-276 (1987) and Kelsey et al, Genes and Devel., 1, 161-171 (1987).

Similarly, a tumor-specific promoter, such as the carcinoembryonic antigen for colon carcinoma described by Schrewe et al., Mol. Cell Biol., 10, 2738-2748 (1990), can be used in the vector. Along the same lines, promoters that are selectively activated at different developmental stages (e.g., globin genes are differentially transcribed in embryos and adults) can be employed for gene therapy of certain types of cancer.

Another option is to use an inducible promoter, such as the IL-8 promoter, which is responsive to TNF, or the 6-16 promoter, which is responsive to interferons, or to use other similar promoters responsive to other cytokines or other factors present in a host or that can be administered exogenously. Use of a cytokine-inducible promoter has the added advantage of allowing for auto-inducible expression of a cytokine gene. According to the invention, any promoter can be altered by mutagenesis, so long as it has the desired binding capability and promoter strength.

Accordingly, the present invention provides a vector that comprises a nucleic acid sequence encoding a cytokine as defined above, and that can be employed in the method of the present invention of treating cancer. In particular, the present invention provides a recombinant vector comprising a nucleic acid sequence encoding GM-CSF. Thus, preferably, the present invention provides the vector designated as pcDNA 1/Neo, which is further described herein.

In the method of the present invention, the recombinant vector can be employed to transfer a cytokine gene or coding sequence to a cell in vitro, which preferably is a cell of an established tumor cell line, particularly, a pancreatic tumor cell line. Various methods can be employed for delivering a vector to cells in vitro. For instance, such methods include electroporation, membrane fusion with liposomes, high velocity bombardment with DNA-coated microprojectiles, incubation with calcium phosphate-DNA precipitate, DEAE-dextran mediated transfection, infection with modified viral nucleic acids, direct microinjection into single cells, and the like. Other methods are available and are known to those skilled in the art. Thus, the present invention provides a substantially purified tumor cell line wherein the cell line has been modified to render it capable of producing an increased level of a cytokine (preferably GM-CSF) relative to the unmodified tumor cell line.

The level of cytokine produced by the modified tumor cell is important in the context of the present invention for the purpose of obtaining an immunostimulatory response. Preferably the modified (e.g., transfected or transformed) tumor cell line produces a level of cytokine that is increased over that observed for the unmodified (i.e., parental) tumor cell line. Even more preferably, the modified cell line produces a level of cytokine that results in cytokine secretion greater than 35 ng/10.sup.6 cells/24 hours.

Administering the Modified Tumor Cell Line

“Administering” modified cells of the tumor cell line to a mammalian host refers to the actual physical introduction of the modified (i.e., cytokine-producing) tumor cells into the host. Any and all methods of introducing the modified tumor cells into the host are contemplated according to the invention; the method is not dependent on any particular means of introduction and is not to be so construed. Means of introduction are well known to those skilled in the art, and also are exemplified herein.

Preferably, the modified tumor cell line is administered to a host having at least one tumor (i.e., the host can have more than one tumor) that is of the same type as that from which the cell line was obtained. “Same type of tumor” encompasses tumors that are histologically similar, i.e., similar in terms of the structure and property of the tissue/organ being treated. While it is anticipated that the administered tumor cell line can have some antigens (e.g., tumor antigens or MHC antigens) in common with the host tumor, for the purpose of this invention, it is not necessary that the administered tumor cell and the host tumor have any MHC antigens in common. Similarly, even though tumor antigens can differ between the administered tumor cell line and the host tumor, it is preferred that there is enough commonality such that administration of the tumor cell line can effect a systemic (i.e., a T cell-mediated) response against the host tumor. Accordingly, the present invention encompasses the administration of a tumor cell line, which is allogeneic (i.e., genetically dissimilar) to the host, and which is not MHC-matched to the host. According to this invention a tumor cell line is “not MHC-matched” to a host when it doesn’t share any MHC antigens in common with the host, or when it doesn’t share any of the MHC antigens with the host which are typically MHC-matched when using tumor cell vaccines (e.g., MHC class I antigens, especially HLA-A2).

Inasmuch as the present invention provides for paracrine delivery of cytokines to tumors in vivo, preferably the genetically modified tumor cell line (e.g., the modified pancreatic tumor cell line) is administered in close proximity to the tumor to be treated. By “close proximity” is meant a distance such that the cytokine released by the modified tumor cell is able to exert its therapeutic effect upon a host cell tumor. Optimally, the modified tumor cell line is not injected directly into the tumor itself.

Also, preferably the modified tumor cell line (e.g., the modified pancreatic tumor cell line) is irradiated prior to administration to prevent cell replication, and possible tumor formation in vivo. For irradiation of tumor cells, the tumor cells typically are plated in a tissue culture plate and irradiated at room temperature using a .sup.137 Cs source. Preferably, the cells are irradiated at a dose rate of from about 50 to about 200 rads/min, even more preferably, from about 120 to about 140 rads/min. Preferably, the cells are irradiated with a total dose sufficient to inhibit the majority of cells, i.e., preferably about 100% of the cells, from proliferating in vitro. Thus, desirably the cells are irradiated with a total dose of from about 10,000 to 20,000 rads, optimally, with about 15,000 rads.

Moreover, the modified tumor cell line (e.g., the transfected pancreatic tumor cell line) optimally is treated prior to administration to enhance its immunogenicity. Preferably, this treatment comprises, as described herein, further genetic manipulation, such as, for instance, introduction of other cytokine or immune co-stimulatory functions, or, for example, admixture with nonspecific adjuvants including but not limited to Freund’s complete or incomplete adjuvant, emulsions comprised of bacterial and mycobacterial cell wall components, and the like.

Methods of Use

The allogeneic tumor cell lines, particularly the allogeneic pancreatic tumor cell lines, can be used to vaccinate patients with histologically similar tumors for the purpose of generating a systemic antitumor immune response against the patient’s own tumor.

To facilitate administration, a modified allogeneic tumor cell line (i.e, a modified allogeneic pancreatic tumor cell line) can be made into a pharmaceutical composition or implant appropriate for administration in vivo, with appropriate carriers or diluents, which further can be pharmaceutically acceptable. The means of making such a composition or an implant have been described in the art (see for instance, Remington’s Pharmaceutical Sciences, 16th Ed., Mack, ed. (1980)). Where appropriate, a tumor cell line can be formulated into a preparation in solid, semisolid, liquid or gaseous form, such as a tablet, capsule, powder, granule, ointment, solution, suppository, injection, inhalant, or aerosol, in the usual ways for their respective route of administration. Means known in the art can be utilized to prevent or minimize release and absorption of the composition until it reaches the target tissue or organ, or to ensure timed-release of the composition. Preferably, however, a pharmaceutically acceptable form is employed which does not ineffectuate the compositions of the present invention. Thus, desirably a modified allogeneic tumor cell line (i.e., a modified allogeneic pancreatic tumor cell line) can be made into a pharmaceutical composition comprising a balanced salt solution, preferably Hanks’ balanced salt solution.

Thus, the present invention provides a pharmaceutical composition comprising a pharmaceutically acceptable carrier and a tumor cell line. Preferably, the invention provides a pharmaceutical composition comprising a pharmaceutically acceptable carrier and a pancreatic tumor cell line, particularly wherein the tumor cell line is Panc 10.5.92, and especially wherein the tumor cell line, such as Panc 10.5.92, has been modified to produce an increased level of a cytokine, optimally GM-CSF.

In pharmaceutical dosage form, a composition can be used alone or in appropriate association, as well as in combination, with other pharmaceutically active compounds and methods of treatment. For example, in applying a method of the present invention for the treatment of cancer, in particular, for the treatment of pancreatic cancer, such treatment can be employed in conjunction with other means of treatment of cancer, particularly pancreatic cancer, e.g., surgical ablation, irradiation, chemotherapy, and the like.

A pharmaceutical composition of the present invention can be delivered via various routes and to various sites in a mammalian, particularly human, body to achieve a particular effect. One skilled in the art will recognize that, although more than one route can be used for administration, a particular route can provide a more immediate and more effective reaction than another route. Local or systemic delivery can be accomplished by administration comprising application or instillation of the formulation into body cavities, inhalation or insufflation of an aerosol, or by parenteral introduction, comprising intramuscular, intravenous, intraportal, intrahepatic, peritoneal, subcutaneous, or intradermal administration. Preferably, delivery can be accomplished by intradermal administration.

A composition of the present invention can be provided in unit dosage form, wherein each dosage unit, e.g., a teaspoonful, tablet, solution, or suppository, contains a predetermined amount of the composition, alone or in appropriate combination with other active agents. The term “unit dosage form” as used herein refers to physically discrete units suitable as unitary dosages for human and animal subjects, each unit containing a predetermined quantity of the compositions of the present invention, alone or in combination with other active agents, calculated in an amount sufficient to produce the desired effect, in association with a pharmaceutically acceptable diluent, carrier, or vehicle, where appropriate. The specifications for the novel unit dosage forms of the present invention depend on the particular pharmacodynamics associated with the pharmaceutical composition in the particular host.

Preferably, a sufficient number of the modified tumor cells are present in the composition and introduced into the host, such that expression of cytokine by the host cell and subsequent recruitment of APCs to the tumor site result in a greater immune response to the extant host tumor than would otherwise result in the absence of such treatment, as further discussed herein. Accordingly, the amount of host cells administered should take into account the route of administration and should be such that a sufficient number of the tumor cells will be introduced so as to achieve the desired therapeutic (i.e., immunopotentiating) response. Furthermore, the amounts of each active agent included in the compositions described herein (e.g., the amount per each cell to be contacted or the amount per certain body weight) can vary in different applications. In general, the concentration of modified tumor cells preferably should be sufficient to provide at least from about 1.times.10.sup.6 to about 1.times.10.sup.9 tumor cells, even more preferably, from about 1.times.10.sup.7 to about 5.times.10.sup.8 tumor cells, although any suitable amount can be utilized either above, e.g., greater than 5.times.10.sup.8 cells, or below, e.g., less than 1.times.10.sup.7 cells.

These values provide general guidance of the range of each component to be utilized by the practitioner upon optimizing the method of the present invention for practice of the invention. The recitation herein of such ranges by no means precludes the use of a higher or lower amount of a component, as might be warranted in a particular application. For example, the actual dose and schedule can vary depending on whether the compositions are administered in combination with other pharmaceutical compositions, or depending on interindividual differences in pharmacokinetics, drug disposition, and metabolism. One skilled in the art readily can make any necessary adjustments in accordance with the exigencies of the particular situation. Moreover, the effective amount of the compositions can be further approximated through analogy to other compounds known to inhibit the growth of cancer cells, in particular, pancreatic cancer cells.

One skilled in the art also is aware of means to monitor a therapeutic (i.e., systemic immune) response upon administering a composition of the present invention. In particular, the therapeutic response can be assessed by monitoring attenuation of tumor growth, and/or tumor regression. The attenuation of tumor growth or tumor regression in response to treatment can be monitored using several end-points known to those skilled in the art including, for instance, number of tumors, tumor mass or size, or reduction/prevention of metastasis. These described methods are by no means all-inclusive, and further methods to suit the specific application will be apparent to the ordinary skilled artisan.

EXAMPLES

The following examples further illustrate the present invention but, of course, should not be construed as in any way limiting its scope.

Example 1

This example illustrates the method of obtaining and culturing the allogeneic tumor cell lines of the present invention.

Eleven allogeneic pancreatic tumor cell lines were developed from patients undergoing pancreaticoduodenectomy at Johns Hopkins Hospital. These cell lines were generated from fresh human pancreatic tumor explants obtained at the time of surgical resection. Namely, immediately upon tumor resection, the specimen was placed on ice in a sterile container and moved to a laminar flow tissue culture hood in a laboratory. All subsequent manipulations were performed using standard sterile tissue culture technique, and using media and reagents from various commercial suppliers (e.g. JRH Biosciences (Lenexa, Kans.), Gibco BRL (Gaithersberg, Md.), Hyclone Labs. (Logan, Utah), Sigma Biosciences (St. Louis, Mo.), Cell Sys. Corp. (Kirkland, Wash.), Intergen Co. (Purchase, N.Y.), Eli Lilly and Co. (Indianapolis, Ind.), Biofluids, Inc. (Rockville, Md.), and other suppliers manufacturing similar products).

The portion of the tumor to be employed for isolation of tumor cell lines was minced into small pieces measuring about a few millimeters in diameter. The pieces were placed in a solution containing about 15 mg of Collagenase I, and were digested at 37.degree. C. in a shaking incubator into single cell suspensions. The pancreatic tumor cell suspensions were then subjected to gravity centrifugation for five minutes to pellet the cells. The pellets were resuspended and plated by inoculating into a 25 cm.sup.2 tissue culture flask with about 1-2.times.10.sup.6 viable cells in RPMI 1640 medium containing 20% fetal bovine serum, 100 units (U) of human insulin per 500 ml of medium, and 5 .mu.g per 500 ml of medium of each of the insulin-like growth factors 1 and 2. The cultures were placed in 25 cm.sup.2 tissue culture flasks and were incubated at about 37.degree. C. in humidified incubators with about 5-7% CO.sub.2.

Primary cell cultures were subjected every 5 to 10 days to differential trypsinization to remove the majority of stromal cells that routinely overgrow primary pancreatic tumor cultures. Several tests were used to characterize the resultant tumor cell lines and to assess the presence of the malignant epithelial cells as compared with stromal cells and nonmalignant epithelial cells. Namely, histochemical staining was performed using antibodies directed against cytokeratin to distinguish cells of epithelial origin from cells of mesenchymal origin. All of the obtained eleven tumor cell lines were characterized by cytokeratin staining as comprised primarily or exclusively of epithelial cells, as set out in Table 1.

TABLE 1 ______________________________________ Cytokeratin Staining of Pancreatic Cell Lines % Cytokeratin positive* raw Mutation ______________________________________ Panc 10.5.92 100% codon 12 Panc 4.14.93 100% codon 13 Panc 1.28.94 100% codon 12 Panc 6.3.94 100% codon 12 Panc 8.13.94 100% codon 12 Panc 9.6.94 100% codon 12 Panc 12.1.94 100% codon 12 Panc 2.3.95 100% codon 12 Panc 4.3.95 100% codon 12 Panc 4.21.95 100% codon 12 Panc 5.4.95 100% codon 12 ______________________________________ *Cytokeratins 7 and 18

Also, all generated tumor cell lines were evaluated for maintenance of the same ras mutation that was observed in the original tumor specimen prior to in vitro culture to validate the malignant origin of the cell line, as well as the genetic stability of the cell line in culture. As illustrated in Table 1, all of these lines were confirmed to have a ras mutation identical to that of the original tumor from which the tumor cell line derived. Codon 12 mutations present in the tumor cell lines resulted in a Asp.fwdarw.Gly conversion, and codon 13 modifications resulted in a Ser.fwdarw.Gly conversion in the encoded Ras oncoprotein. In addition, all tumor cell lines were observed to express high levels of MHC class I antigens. Two of the four lines (i.e., Panc 10.5.92 and Panc 9.6.94) also express elevated levels of MHC class II antigens. The pancreatic tumor cell lines are easily expanded in culture and have doubling times of about 72 hours.

The methods employed in this example for derivation of allogeneic pancreatic tumor cell lines similarly can be employed for the generation and isolation of other kinds of allogeneic tumor cell lines.

Example 2

This example illustrates the method of modifying the allogeneic tumor cell lines of the present invention to produce an increased amount of a cytokine. Inasmuch as the cytokine granulocyte-macrophage colony stimulating factor (GM-CSF) is potentially more potent than other cytokines in generating a systemic antitumor response in preclinical tumor models (Dranoff et al., Proc. Natl. Acad. Sci., 90, 3539-3542 (1993), the Panc cell line 10.5.92 described in Example 1 was employed as representative of the allogeneic tumor cell lines, and was modified to secrete GM-CSF.

To accomplish this, a recombinant human GM-CSF gene was cloned into pcDNA 1/Neo. All cloning reactions and DNA manipulations were carried out using methods well known to the ordinary skilled artisan, and which have been described in the art, e.g., Maniatis et al., Molecular Cloning: A Laboratory Manual, 2nd ed. (Cold Spring Harbor Laboratory, NY, (1982)). Enzymes employed in these reactions were obtained from commercial suppliers (e.g., New England Biolabs, Inc., Beverly, Mass.; Clontech, Palo Alto, Calif.; Boehringer Mannheim, Inc., Indianapolis, Ind.; etc.) and were used according to the manufacturers’ recommendations.

The plasmid pcDNA 1/Neo contains the human GM-CSF cytokine coding sequence under the control of the cytomegalovirus (CMV) promoter, and the neomycin resistance gene also controlled by a separate CMV promoter. The CMV promoter was employed since it is able to drive a relatively high level of gene expression in most eukaryotic cells (Boshart et al., Cell, 41, 521-530 (1985)). Initial studies using this vector for gene transfer to a human melanoma cell line confirm that, following selection for neomycin resistance, secreted levels of GM-CSF greater than 35 ng/10.sup.6 cells/24 hours were achieved. These initial studies indicate that the pcDNA 1/Neo plasmid is functional. Moreover, this is the dose of GM-CSF that is required to generate adequate antitumor immune responses in mouse models. Namely, dilution experiments using varying concentrations of tumor cells that either were or were not transduced with a retroviral vector carrying a GM-CSF gene confirm that in the B16-F10 tumor system, GM-CSF secretion below 35 ng/10.sup.6 cells/24 hours fails to generate the potent antitumor immunity seen at levels of secretion above this threshold. These findings underscore the importance of delivering high and sustained levels of GM-CSF directly at the site of the vaccinating tumor cells that are the source of the relevant tumor antigen.

The Panc line 10.5.92 was transfected with pcDNA 1/Neo by electroporation, and was subsequently cloned by limiting dilution. GM-CSF levels were determined by ELISA and confirmed by bioassay using GM-CSF dependent TF-1 cells (Kitamura et al., Blood, 73, 375-380 (1989)). The GM-CSF secretion level observed for the resultant transfected pancreatic tumor cell line is about 90 ng/10.sup.6 tumor cells/24 hours. Irradiation of the transfected tumor cells prevents their replication, but allows the cells to secrete GM-CSF and to remain metabolically active for up to one week in culture. Irradiation was carried out using a .sup.137 Cs source at a dose rate of about 120-140 rads/min to deliver a total dose of about 15,000 rads.

The methods employed in this example also can be used to generate other tumor cell lines capable of producing increased amounts of cytokine, and which similarly can be employed as vaccines.

Example 3

This example illustrates further studies regarding GM-CSF administration to a host.

Further studies confirm that GM-CSF secretion needs to parallel the known paracrine physiology of this cytokine. In particular, secretion must be at the site of the relevant antigens (i.e., the tumor cells), as described in the previous example, and high levels must be sustained for several days (Dranoff et al., supra; Golumbek et al., Cancer Research, 53, 1-4 (1993)). However, it appears that the tumor cell, itself, need not be the source of GM-CSF secretion (Golumbek et al., supra). Immunologic protection and histologic infiltrates similar to those seen with retrovirally transduced cytokine-expressing tumor cells can be generated when GM-CSF is slowly released from biodegradable polymers co-injected with the tumor cell. In addition, if a second non-cross-reacting tumor is co-injected with a GM-CSF-secreting tumor, immunologic protection against both tumors can be generated. Simple injection of soluble GM-CSF along with tumor cells, however, does not provide sustained local levels of this cytokine and does not generate systemic immunity (Golumbek et al., supra). Thus, the effectiveness of using an allogeneic tumor cell that was not MHC-matched to the host cell for delivery of cytokine in vivo was explored.

In murine models, it was demonstrated that the antitumor immunity generated with the delivery of GM-CSF by bystander allogeneic tumor cells is comparable to that achieved when GM-CSF is delivered by the target tumor cell itself. Specifically, in these experiments, BALB/c mice were subcutaneously vaccinated with irradiated CT26 colon carcinoma cells, with GM-CSF delivered either by retrovirally transduced CT26 cells, or by retrovirally transduced B16-F10 cells. Two weeks later, mice were rechallenged with injections of wild-type strain CT26. The CT26 tumor cell line possesses some intrinsic immunogenicity; however, a greater degree of protection was seen when GM-CSF was secreted at the vaccination site, whether by the syngeneic or the allogeneic tumors. While it is unclear to what degree, or by what mechanism, the allogeneic tumor cells can augment antitumor immunity, these data strongly suggest that allogeneic delivery of GM-CSF is likely to be at least as effective as autologous tumor delivery.

Example 4

This example illustrates the method of treating cancer by administering to a host the genetically modified allogeneic tumor cell lines of the present invention.

Tumor cell lines that secrete levels of GM-CSF greater than 35 ng/10.sup.6 tumor cells/24 hours are obtained and employed. The modified tumor cells are harvested from the tissue culture flasks by trypsinization. The cells are washed using normal saline, pelleted, and resuspended in Hanks’ balanced salt solution, or some other salt solution appropriate for introduction in vivo. The cells are resuspended at a concentration of from about 1.times.10.sup.7 to about 1.times.10.sup.10 tumor cells/ml, and optimally, at a concentration of from about 1.times.10.sup.8 to about 5.times.10.sup.9 tumor cells/ml. About 0.1 ml of this resuspension mixture is employed as a vaccine. Thus, preferably from about 1.times.10.sup.6 to about 1.times.10.sup.9 tumor cells are injected, and optimally, from about 1.times.10.sup.7 to about 5.times.10.sup.8 tumor cells are injected in toto. Whereas the modified tumor cells are injected subcutaneously in the mouse, the cells preferably are injected intradermally in humans. Injections preferably are made in the vicinity of the tumor; optimally, the vaccines are not injected directly into the tumor, itself. Also, the amounts of tumor cells employed for vaccination in humans are roughly about ten times greater than the amounts employed for vaccination in the mouse.

Prior to injection, the modified tumor cells can be irradiated e.g., using a .sup.137 Cs source as described in Example 2, to prevent replication of the modified tumor cells in vivo. The modified tumor cells also can be altered to enhance their immunogenicity. For instance, the cells can be further genetically manipulated (e.g., through insertion of other cytokine or immune stimulatory nucleic acid sequences), or can be admixed with non-specific adjuvants (e.g., Freund’s complete or incomplete adjuvant, emulsions comprised of bacterial and mycobacterial cell wall components, etc.).

The invention can be used in mammals, particularly humans, having various tumors, for instance, a carcinoma of the bladder, breast, colon, kidney, liver, lung, ovary, pancreas, rectum, or stomach; a hematopoietic tumor of lymphoid or myeloid lineage; a tumor of mesenchymal origin such as a fibrosarcoma or rhabdomyosarcoma; or another tumor, including a melanoma, teratocarcinoma, neuroblastoma, or glioma. Preferably, the invention can be used in the treatment of pancreatic cancer. It also is anticipated that the patient can be treated prior to, or in addition to (i.e., concurrently or immediately following) immunotherapy as described herein with any number of methods as are employed to treat cancer, for instance, surgical resection, irradiation, chemotherapy, and the like.

All of the references cited herein, including patents, patent applications, and publications, are hereby incorporated in their entireties by reference.

While this invention has been described with an emphasis upon preferred embodiments, it will be obvious to those of ordinary skill in the art that variations of the preferred embodiments can be used and that it is intended that the invention can be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications encompassed within the spirit and scope of the invention as defined by the following claims.

Prevention of ovarian cancer by administration of a Vitamin D compound

Filed under: Issued Patent — admin @ 3:31 am

Abstract
The present invention relates to methods for preventing the development of epithelial ovarian cancer by administering a Vitamin D compound in an amount capable of increasing apoptosis in non-neoplastic ovarian epithelial cells of the female subject.

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Inventors: Rodriguez; Gustavo C. (Durham, NC), Whitaker; Regina Salas (Hillsborough, NC)
Assignee: New Life Pharmaceuticals Inc. (Chicago, IL)

Appl. No.: 08/873,010
Filed: June 11, 1997
Parent Case Text

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This application is a continuation-in-part of U.S. Ser. No. 08/713,834 filed Sep. 13, 1996.
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Claims

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What is claimed is:

1. A method of increasing apoptosis in non-neoplastic ovarian epithelial cells of a female subject in need thereof comprising administering to a female subject a Vitamin D compound sensitive to induce apoptosis in an amount effective to induce apoptosis in non-neoplastic ovarian epithelial cells of the female subject.

2. The method of claim 1 wherein Vitamin D compound is administered at a dosage equivalent of from 0.0001 to 1.0 mg 1,25-dihydroxyvitamin D.sub.3 /kg of body weight.

3. The method of claim 2 wherein Vitamin D compound is administered at a dosage equivalent of from 0.005 to 0.1 mg/kg 1,25-dihydroxyvitamin D.sub.3 of body weight.

4. The method of claim 1 wherein the Vitamin D compound is 1,25-dihydroxyvitamin D.sub.3.

5. The method of claim 1 wherein the female subject is at high risk of developing ovarian cancer.

6. The method of claim 1 wherein said non-neoplastic cells are dysplastic cells.
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Description

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FIELD OF THE INVENTION

The present invention relates generally to methods of preventing the development of ovarian cancer by administering Vitamin D compounds including Vitamin D, and biologically active analogues and derivatives thereof.

BACKGROUND OF THE INVENTION

Ovarian cancer is the fourth leading cause of cancer deaths among women in the United States and causes more deaths than all other gynecologic malignancies combined. In the United States, a woman’s lifetime risk of developing ovarian cancer is 1 in 70. In 1992, about 21,000 cases of ovarian cancer were reported, and about 13,000 women died from the disease. Chapter 321, Ovarian Cancer, Harrison’s Principles of Internal Medicine, 13th ed., Isselbacher et al., eds., McGraw-Hill, New York (1994), pages 1853-1858; American Cancer Society Stativtics, Cancer J. Clinicians, 45:30 (1995). Epithelial ovarian cancer, the most common ovarian cancer, has a distinctive pattern of spread: cancer cells may migrate through the peritoneum to produce multiple metastatic nodules in the visceral and parietal peritoneum and the hemidiaphragms. In addition cancer cells metastasize through the lymphatic and blood vessels to areas such as the liver, lung and brain. Early stage ovarian cancer is often asymptomatic and is detected coincidentally by palpating an ovarian mass on pelvic examination. In premenopausal patients, about 95% of these masses are benign. Even after menopause, 70% of masses are benign but detection of any enlargement requires exploratory surgery. In postmenopausal women with a pelvic mass, a markedly elevated serum CA-125 level of greater than 65 U/ml indicates malignancy with a 96% positive predictive value. Chapter 321, Ovarian Cancer, Harrison’s Principles of Internal Medicine, supra.

Epithelial ovarian cancer is seldom encountered in women less than 35 years of age. Its incidence increases sharply with advancing age and peaks at ages 75 to 80, with the median age being 60 years. The single most important risk factor for this cancer is a strong family history of breast or ovarian cancer. In families in which ovarian, breast, endometrial or colon cancer can be tracked as an apparent autosomal dominant trait, the risk of this cancer can be as high as 50%. Having a single first-degree relative with ovarian cancer increases a woman’s risk by at least three-fold, and having a personal history of breast or colorectal cancer increases the risk of subsequently developing ovarian cancer by two-fold. Chapter 321, Ovarian Cancer, Harrison’s Principles of Internal Medicine, supra. In addition, those with identifiable genetic mutations in genes such as BRCA1 also have an increased risk. Baker et al., Etiology, Biology, and Epidemiology of Ovarian Cancer, Seminars in Surgical Oncology 10: 242-248, 1994; Amus et al., Genietic Epidentiology of Epitlielial Ovarian Cancer, Cancer 71: 566-72, 1993; Whitmore, Characteristics Relating To Ovarian Cancer Risk: Implications for Preventing and Detection, Gynecologie Oncology 55, 515-19, 1994. Oncogenes associated with ovarian cancers include the HER-2/neu (c-erbB-2) gene, which is overexpressed in a third of ovarian cancers, the fms oncogene, and abnormalities in the p53 gene, which are seen in about half of ovarian cancers. A number of environmental factors have also been associated with a higher risk of epithelial ovarian cancer, including a high fat diet and intake of lactose in subjects with relatively low tissue levels of galactose-1-phosphate uridyl transferase.

Previously, there has existed no established pharmaceutical approach to the prevention of ovarian cancer. For all women, especially those at high risk of developing this disease, the only available option has been surgical removal of the ovaries, with all of the attendant risks and subsequent adverse health consequences due to resulting estrogen deficiency.

Of interest to the present invention is the disclosure of co-owned and copending U.S. patent application Ser. No. 08/713,834 filed Sep. 13, 1996 entitled “Prevention of Ovarian Cancer by Administration of Progestin Products” the disclosure of which is hereby incorporated by reference. This application discloses a method for preventing the development of epithelial ovarian cancer by administering progestin products, either alone or in combination with other agents, such as estrogen products. Specifically, a method is described for preventing ovarian cancer comprising administering to a female subject an amount of progestin product effective to increase apoptosis in ovarian epithelial cells of the female subject. Apoptosis is one of the most important mechanisms used for the elimination of cells that have sustained DNA damage and which are thus prone to transformation into malignant neoplasms. Thus, increasing apoptosis of ovarial epithelial cells will prevent the transformation of non-neoplastic, including normal and dysplastic, cells into neoplastic cells.

Vitamin D is a fat soluble vitamin which is essential as a positive regulator of calcium homeostasis. In the skin 7-Dehydrocholesterol (pro-Vitamin D.sub.3) is photolyzed by ultraviolet light to pre-Vitamin D.sub.3, which spontaneously isomerizes to Vitamin D.sub.3. Vitamin D.sub.3 (cholecalciferol), the structure of which is set out below, is converted into an active hormone by hydroxylation reactions occurring in the liver to produce 25-hydroxyvitamin D.sub.3 which is then converted in the kidneys to produce 1,25-dihydroxyvitamin D.sub.3 (1,25-dihydroxycholecalciferol, calcitriol, 1,25(OH).sub.2 D.sub.3) which is transported via the blood to its classic target organs, namely, the intestine, kidney, and bones. Vitamin D.sub.3 and 1,25-dihydroxy vitamin D.sub.3 are shown below: ##STR1## Vitamin D deficiency in childhood produces rickets, which is characterized by inadequate calcification of cartilage and bone. In adults, Vitamin D deficiency leads to softening and weakening of bones, known as osteomalacia. The major therapeutic uses of Vitamin D are divided into four categories: (1) prophylaxis and cure of nutritional rickets, (2) treatment of metabolic rickets and osteomalacia, particularly in the setting of chronic renal failure, (3) treatment of hypoparathyroidism, and (4) prevention and treatment of osteoporosis. Recommended daily dietary allowances of Vitamin D by the Food and Nutrition Board of the United states National Research Council (1989) were 10 mg cholecalciferol (400 IU Vitamin D) daily for females age 11-24 and 5 mg cholecalciferol (200 IU Vitamin D) daily for females age 25 and older. Normal serum levels of 25-hydroxyvitamin D.sub.3 are not closely regulated and it has a biological half-life of several weeks with blood levels typically ranging from 15 to 80 ng/mL. Serum levels of 1,25-dihydroxyvitamin D.sub.3 are more closely regulated and typically range from 15-60 pg/mL. Serum 1,25-dihydroxyvitamin D.sub.3 has a half-life of 6-8 hours. 1,25-dihydroxyvitamin D.sub.3 partitions into cells by virtue of its lipophilicity, binds to intracellular receptors, and translocates to the nucleus where the complex controls the transcription of a number of genes, many of which relate to calcium metabolism. Corder et al., Cancer Epideiniology, Biomarkers & Prevention 2:467-472 (1993).

Certain compounds are known to upregulate the functional human Vitamin D receptor (“VDR”). For example, Santiso-Mere et al., Molecular Endocritiology Vol. 7, No. 7, pp.833-839 (1993) teach the expression of functional human vitamin D receptor (VDR) in Saccharomyces cerevisiae. This reference further teaches up-regulation of the VDR by 1,25-dihydroxyvitamin D.sub.3. Davoodi et al., J. Steroid Biochem. Molec. Biol. 54: No. 3/4, pp. 147-153 (1995) relates to the effect of 1,25-dihydroxyvitamin D.sub.3 on upregulation of the VDR. Davoodi et al. teach that progestins and transretinoic acid may also upregulate the VDR. Davoodi et al., at pp. 149-50.

Vitamin D and its analogues and derivatives are taught to have possible utility in the treatment, rather than prevention, of cancers by retarding tumor growth and in stimulating the differentiation of malignant cells to normal cells. For example, 1,25-dihydroxyvitamin D.sub.3 possesses potent antileukemic activity by virtue of inducing the differentiation of leukemia cells to non-malignant macrophages.

Colston et al., Endocrinology Vol. 108, No. 3, 1083-1086 (1981) may have been the first to report antitumor effects of Vitamin D. This study reported the presence of specific, high-affinity receptors for 1,25-dihydroxy-vitamin D.sub.3 in malignant melanoma and that iti vitro administration of 1,25-dihydroxy-vitamin D.sub.3 produced a marked increase in cell doubling time. Sato et al., Tohoku J. exp. Med. 138:445-446 (1982) reported the utility of 1a-Hydroxyvitamin D.sub.3 in in vivo experiments relating to treatment of Sarcoma 180 and Lewis lung carcinoma implanted into mice. In these experiments the Vitamin D suppressed tumor growth or inhibited pulmonary metastases. Disman et al., Cancer Research 47: 21-25 (1987) disclose the utility of 1,25-dihydroxyvitamin D.sub.3 in inhibiting the growth of human colonic cancer xenografts in mice. Dokoh et al., Cancer Research 44: 2103-2109 (1984) disclose the utility of 1,25-dihydroxyvitamin D.sub.3 on cultured osteogenic sarcoma cells. The utility of 1,25-dihydroxyvitamin D.sub.3 for inducing differentiation of leukemic cells is also known. See Mangelsdorf et al., J. Cell Biol. Vol. 98, 391-398 (1984).

Chida et al., Cancer Research 45: 5426-5430 (1985) describe the inhibition of the promotional phase of 7,12-dimethylbenz[a]anthracene-induced skin carcinogenesis in mice by 1,25-dihydroxyvitamin D.sub.3. Oikawa et al., Anti-Cancer Drugs 2: 475-480 (1991) disclose the antitumor effect of 22-oxa-1a,25-dihydroxyvitamin D.sub.3 on rat mammary tumors induced by 7,12-dimethylbenz[a]anthracene.

Vitamin D and its metabolic products while potentially useful in retarding tumor growth have the disadvantage that they are very potent calcemic agents that cause elevated blood calcium levels by stimulating intestinal calcium absorption and bone calcium resorption. Accordingly, there has been a desire in the art for Vitamin D analogues and derivatives having variant activities such that, for example, antileukemic activity is enhanced without concomitant enhancement of calcemic activity. Frampton et al., Cancer Research 43: 4443-4447 (1983) disclose the inhibition of human breast cancer cell growth in vitro. The vitamin D.sub.3 metabolites 1,24,25-(OH).sub.3 D.sub.3 and 1,25,26-(OH).sub.3 D.sub.3 were identified as analogues which would be effective in inhibiting tumor cell growth without exhibiting unacceptable bone resorption and hypercalcemia. Sporn et al., Proc. Am. Assn. Cancer Res. No. 34 Abstracts p. 622 (March 1993) report the utility of the vitamin D analogue 1,25-dihydroxy-16-ene-23-yne-26, 27-hexafluorocholecalciferol having greater potency than 1,25-dihydroxycholecalciferol in differentiating HL-60 leukemic cells but which is less active in its hypercalcemic effects.

There also exists a large patent literature relating to the use of Vitamin D analogues for retarding tumor growth and treatment of leukemias. Partridge et al., U.S. Pat. No. 4,594,340 teaches the syntheses of the Vitamin D analogues 25,26-dehydro-1a,24R-dihydroxycholecalciferol and 25,26-dehydro-1a,24S-dihydroxycholecalciferol as differentiation inducing agents and anti-proliferation agents useful in treating osteoporosis, tumors and leukemia. DeLuca et al., U.S. Pat. No. 4,800,198 discloses the use of secosterol compounds sharing structural similarity with Vitamin D for inducing differentiation of malignant cells in methods of treatment of leukemic disorders.

Binderup et al., U.S. Pat. No. 5,190,935 disclose Vitamin D analogues having antiproliferative effects on cancer cells. Calverly et al., U.S. Pat. No. 5,206,229 disclose Vitamin D analogues exhibiting antiinflammatory and immunomodulating effects which also exhibit strong activity in inducing differentiation and inhibiting undesirable proliferation of certain cells. DeLuca et al., U.S. Pat. No. 5,246,925 disclose 1a-hydroxy-19-nor-vitamin D analogues which exhibit activity in arresting the proliferation of undifferentiated cells, including malignant cells, and in inducing their differentiation. Ikekawa et al., U.S. Pat. No. 5,278,155 disclose Fluorine-containing vitamin DI analogues which showed in vitro activity in inducing differentiation of human colonic cancer cells. DeLuca et al., U.S. Pat. No. 5,373,004 disclose 26,28-methylene-1a,25-dihydroxyvitamin D.sub.2, compounds having unique preferential calcemic activity. Calverley et al., U.S. Pat. No. 5,374,629 disclose Vitamin D analogues having antiinflammatory and immunomodulating effects as well as strong activity in inducing differentiation and inhibiting proliferation of cancer cells. DeLuca et al., U.S. Pat. No. 5,380,720 disclose 1a-hydroxy-22-iodinated vitamin D.sub.3 compounds capable of inducing relatively high differentiation of malignant cells. Hansen et al., U.S. Pat. No. 5,387,582 disclose Vitamin D analogues having activity in inducing differentiation of cancer cells and skin cells. Posner et al., U.S. Pat. No. 5,389,622 disclose a Vitamin D.sub.3 analogue having growth inhibition activities against murine kerotinocyte cells. Calverley et al., U.S. Pat. No. 5,401,731 disclose Vitamin D analogues having activity in the prophylaxis of autoimmune diseases.

Neef et al., U.S. Pat. No. 5,411,949 disclose 23-Oxa-derivatives of Vitamin D having proliferation inhibiting and cell-differentiation effects. Doran et al., U.S. Pat. No. 5,428,029 disclose Vitamin D.sub.3 fluorinated analogues as agents for the treatment of tumors such as breast cancer, as agents for the treatment of neoplastic diseases such as leukemia, and as agents for the treatment of sebaceous gland diseases. Neef et al., U.S. Pat. No. 5,446,035 disclose 20-methyl-substituted Vitamin D derivatives exhibiting improved induction of cell differentiation as compared to calcitriol in an HL-60 cell line. Baggiolini et al., U.S. Pat. No. 5,451,574 and No. 5,512,554 disclose Vitamin D.sub.3 fluoridated analogues as agents for treatment of cancer, such as leukemia and or hyperproliferative skin diseases such as psoriasis. DeLuca et al., U.S. Pat. No. 5,484,782 disclose (E)-20(22)-dehydrovitamin D compounds having relatively high HL-60 cell differentiation activity. Neef et al., U.S. Pat. No. 5,532,228 disclose Vitamin D derivatives having cell proliferation-inhibiting and cell-differentiating activity. DeLuca et al., U.S. Pat. No. 5,536,713 disclose 19-nor-Vitamin D.sub.3 compounds with substituents at the 2-position which exhibit activity in inducing differentiation of malignant cells with little or no bone calcification activity. Dore et al., U.S. Pat. No. 5,547,947 disclose methods of inducing inhibition or loss of cell proliferation in solid tumors utilizing a Vitamin D.sub.3 analogue alone or in combination with a trans retinoic acid. Grue-Sorensen et al., U.S. Pat. No. 5,554,599 disclose 22-thio Vitamin D derivatives exhibiting antiinflammatory and immunomodulating effects which also exhibit strong activity in inducing differentiation and inhibiting undesirable proliferation of certain cells.

The use of 1,25-dihydroxyvitamin D.sub.3 for treatment of gynecologic neoplasms including ovarian carcinomas is proposed in various references, but its efficacy against ovarian cancer cells is unclear. Moreover, there is no suggestion that Vitamin D will inhibit conversion of non-neoplastic ovarian cells to neoplastic ovarian cells or will promote apoptosis in non-neoplastic ovarian cells. Specifically, Christopherson et al., Am. J. Obstet Gynecol. Vol 155, No. 6. 1293-1296 (1986) report that 1,25-dihydroxhcholecalciferol is useful in inhibiting the replication of various malignant human cells but that administration of 1,25-dihydroxhcholecalciferol in ovarian adenocarcinoma cells was associated with an increase in the rate of cancer cell growth when treated at a concentration of 10 nmol/L. In contrast, Saunders et al., Gynecologic Oncology 44: 131-136 (1992); and Saunders et al., Gynecologic Oncology 51: 155-159 (1993) report the in vitro inhibition of endometrial carcinoma cell growth by the combination of 1,25-dihydroxyvitamin D.sub.3 with the antineoplastic agent carboplatin; and Saunders et al., AntiCancer Drugs 6 562-569 (1995) report inhibition of growth in breast and ovarian carcinoma cells by 1,25-dihydroxyvitamin D.sub.3, when combined with retinoic acid and dexamethasone. Thus, based on the results of these studies, it is unclear whether Vitamin D is itself useful for the inhibition of ovarian cancer cell growth. More significantly, none of these studies describe the effect, or suggest any effect, of Vitamin D on growth or apoptosis of non-neoplastic ovarian epithelial cells.

Similarly, while references suggest that Vitamin D may be effective to induce apoptosis in breast cancer cells, those references do not suggest that Vitamin D may effect the growth or apoptosis of non-neoplastic breast cells. For example, Welsh, Biochem. Cell Biol. 72: 537-545 (1994) discloses the in vitro use of 1,25-dihydroxyvitamin D.sub.3 in combination with the antiestrogen 4-hydroxytamoxifen to induce apoptosis in the breast cancer cell line MCF-7. However, Welsh makes no suggestion that Vitamin D.sub.3 can induce apoptosis in normal or non-malignant cells.

The teachings of Narvaez et al., Endocrinology Vol. 137, No. 2 pp 400-409 (1996) are in accord with the references discussed above. Narvaez et al. teach (1) that Vitamin D can have effects on malignant cells, but the effects are cell type specific and unpredictable and (2) that, to the extent tested, Vitamin D did not have any effect on non-malignant cells. Specifically, Narvaez et al., teach that 1,25-dihydroxyvitamin D.sub.3 is a negative growth regulator of breast cancer epithelial cells and that its effects are mediated via the nuclear vitamin D receptor (VDR). The reference also suggests that the reduction in the in vitro growth of the MCF-7 breast cancer cell line in response to 1,25-dihydroxyvitamin D.sub.3 is associated with morphological and biochemical evidence of cancer cell death by apoptosis. Narvaez et al. disclose selection of a variant line of MCF-7 cells resistant to the growth inhibitory effects of 1,25-(OH).sub.2 D.sub.3. The MCF-7.sup.D3Res cells express the VDR but are resistant to induction of apoptosis in response to 1,25-(OH).sub.2 D.sub.3 and structurally related compounds. Despite vitamin D.sub.3 resistance, the MCF-7.sup.D3Res cells are sensitive to induction of apoptosis in response to antiestrogens.

Narvaez et al. further teach that Vitamin D had no apoptotic effect on the normal cells which they studied. Specifically, the reference teaches that doses of the vitamin D analog EB 1089 which cause breast tumor regression in rats have no growth or apoptotic effects in vivo on normal intestine and kidney cells of rats treated with the analog. Narvaez et al. further investigated the possibility that 1,25-dihydroxyvitamin D.sub.3 might be able to induce apoptosis in cell lines of normal tissues such as intestinal crypt cells and normal renal epithelial cells which express high levels of the VDR and known vitamin D.sub.3 -regulated proteins. Although the 1,25-dihydroxy vitamin D.sub.3 induced vitamin D dependent proteins in both cell lines, no evidence of apoptosis was observed even when the cells were treated with 500 nM 1,25-dihydroxy vitamin D.sub.3. In addition, no inhibitory effects on growth nor induction of apoptosis were observed in the intestine or kidney cells of rats treated with a vitamin D analogue (EB1089) in doses previously shown to cause breast tumor regression.

Narvaez et al. state that these and other data “suggest that although a functional VDR may be necessary for the growth regulatory effects of 1,25-(OH).sub.2 D.sub.3, its activation is not sufficient for triggering these effects. Thus, we hypothesize that induction of apoptosis by the 1,25-(OH).sub.2 D.sub.3 –VDR complex is cell type specific.” Accordingly, although the effects of Vitamin D are mediated by the VDR, the expression of the receptor by cells does not determine how they will respond to Vitamin D. For example, Vitamin D has potent effects on kidney cells and intestinal cells relating to calcium homeostasis, but does not cause apoptosis. On the other hand, Vitamin D might inhibit the growth of certain malignant cell lines or cause apoptosis of such cell lines. The only specific cell types for which Narvaez et al. were able to establish apoptosis through administration of Vitamin D were certain malignant cells. Narvaez et al. observed no apoptotic effect on any non-malignant cells studied. Accordingly, although ovarian epithelial cells express the VDR it would not have been expected by those skilled in the art that Vitamin D would have apoptotic effects on normal ovarian epithelial cells.

Also of interest to the present invention is the epidemiologic study of Lefkowitz et al., International Journal of Epidemiology vol 23, No. 6 pp 1133-1136 (1994) reporting that sunlight exposure may reduce the risk of ovarian cancer mortality. Using population based data regarding ovarian cancer mortality in large cities across the United States, as well as geographically based long-term sunlight data reported by the National Oceanic and Atmospheric Administration, the authors found an inverse correlation between regional sunlight exposure and ovarian cancer mortality risk. The publication refers to the antineoplastic effect of vitamin D against cancer lines and tumors as demonstrated in in vivo and in vitro studies and suggests that this antineoplastic effect may be reducing the ovarian cancer mortality rates for the regions with more sunlight. Thus, this study teaches that Vitamin D may have an effect on malignant cells. There is no teaching or suggestion that sunlight may have any effect on non-neoplastic cells or that the protective effect of sunlight may be mediated by an effect of enhanced levels of Vitamin D on non-neoplastic ovarian epithelial cells in vivo.

Studzinski et al., Cancer Research 55:4012-4022 (1995) also discuss the potential effect of Vitamin D from sunlight on retarding neoplastic progression of various cancers. Studzinski et al. refer to evidence that Vitamin D retards growth of cancer cells in vivo and in vitro, induces differentiation of cancer cells, and induces apoptosis in cancer cells, and that these effects may prevent cancer progression. Studzinski et al. do not suggest or imply that Vitamin D may have a preventative benefit through effect on non-malignant cells.

Thus, while the art reports various therapeutic activities of Vitamin D and its analogues and derivatives in retarding tumor growth, the effect of Vitamin D on ovarian carcinoma cells is unclear. Moreover there exists no suggestion that Vitamin D has activity in causing apoptosis in non-ineoplastic cells or in inhibiting the conversion of non-neoplastic cells to neoplastic cells in any manner. Accordingly, there remains a need in the art for methods and compositions which will prevent cancers such as ovarian epithelial cancer by inhibiting the conversion of normal and dysplastic ovarian epithelial cells to neoplastic cells.

SUMMARY OF THE INVENTION

The present invention provides a method for preventing the development of epithelial ovarian cancer by administering an effective amount of Vitamin D compounds including Vitamin D and biologically active analogues and derivatives thereof to a female subject.

While the inventors do not wish to be bound by any particular theory, the present invention is based on the discovery that administration of Vitamin D compounds results in an accelerated rate of apoptosis in vitro in non-neoplastic human ovarian epithelial cells including benign and dysplastic ovarian epithelial cells. Apoptosis is one of the most important mechanisms used for the elimination of cells that have sustained DNA damage and which are thus prone to transformation into malignant neoplasms. By augmenting the apoptosis pathway, Vitamin D compounds including Vitamin D and biologically active analogues and derivatives thereof may thus enhance the efficient removal of pre-neoplastic ovarian epithelial cells, thereby decreasing the risk of developing epithelial ovarian carcinoma.

Thus, the invention provides methods of inhibiting conversion of non-neoplastic ovarian epithelial cells to neoplastic cells comprising administering to a female subject an amount of Vitamin D or a biologically active analogue or derivative thereof effective to increase apoptosis in non-neoplastic ovarian epithelial cells of a female subject. The invention further provides methods of increasing apoptosis of non-neoplastic ovarian epithelial cells of a female subject comprising administering to a female subject an amount of Vitamin D or a biologically active analogue or derivative thereof effective to increase apoptosis in ovarian epithelial cells of the subject.

DETAILED DESCRIPTION OF THE INVENTION

The present invention generally relates to methods for preventing the development of epithelial ovarian cancer by administering Vitamin D compounds in an amount effective to increase apoptosis of ovarian epithelial cells. The invention also provides a method of increasing apoptosis in ovarian epithelial cells of a female subject comprising administering to a female subject an amount of a Vitamin D compound including Vitamin D or an analogue or derivative thereof effective to increase apoptosis in ovarian epithelial cells of the female subject.

The present invention is related to the discovery that administration of 1,25-dihydroxyvitamin D.sub.3 and 24,25-dihydroxyvitamin D.sub.3 each induced an accelerated rate of apoptosis in vitro in human ovarian epithelial cells. Apoptosis is a process whereby a genetic program within the cell is activated to trigger a specific series of events within the cell eventually leading to the death and efficient disposal of the cell. Richard Lockshin, Zahra Zakeri, The Biology of Cell Death and Its Relationship to Aging in Cellular Aging and Cell Death, pp. 167-180, 1996. Wiley-Liss Inc., Editors: N. J. Holbrook, G. Martin, R. Lockshin. C. Miligan, L. Schwartz, Programmed Cell Death During Development of Animals in Cellular Aging and Cell Death, pp. 181-208, 1996. Wiley-Liss Inc. P53-Dependent Apoptosis in Tumor Progression and in Cancer Therapy, Scott W. Lowe, H. Earl Ruley in Cellular Aging and Cell Death, pp. 209-234, 1996. Wiley-Liss, Inc.

For cells that have sustained DNA damage, apoptosis is one of the most important mechanisms used for the elimination of these cells, the preservation of which could otherwise lead to the development of malignant neoplasms. Canman et al., DNA Damage Responses: P-53 Induction, Cell Cycle Pertubations, and Apoptosis, Cold Spring Harbor Symp. Quant. Biol., 59:277-286 (1994). Thus, the apoptosis pathway is a virtually universal safeguard to prevent the persistence and proliferation of damaged cells that can be lethal to the organism. For normal tissues, the processes of cell proliferation and cell death are usually in a steady-state balance, and the apoptosis mechanism not only serves to prevent overgrowth of tissue, but also to eliminate those cells that are aberrant and therefore prone to resist normal growth regulatory controls.

An accelerated rate of apoptosis would facilitate the destruction and thereby removal of ovarian surface epithelial cells which have defective DNA and which have the potential to transform into malignant neoplasms. Given the importance of the apoptotic pathway for removal of abnormal cells from tissues, and thus the protection of normal tissues from neoplastic transformation, it is possible that the induction of apoptosis by Vitamin D is one mechanism underlying the effect of exposure to sunlight in reducing the risk of ovarian cancer.

The term “Vitamin D compound” including “Vitamin D” “Vitamin D analogue” or “Vitamin D derivative” as used herein includes any compound which activates the Vitamin D Receptor, by binding or otherwise, either in its form of administration or in a form to which it is converted by processing by the human body. This definition thus includes each of Vitamins D.sub.1, D.sub.2, D.sub.3, D.sub.4 and D.sub.5 and the various known analogues and derivatives thereof and any other agent that has Vitamin D activity or is an agonist thereof and that thereby increases the rate of apoptosis in ovarian epithelial cells. It is contemplated that not only presently available Vitamin D analogues and derivatives but also Vitamin D analogues and derivatives introduced in the future will be useful according to the present invention. Given the ability to produce the VDR recombinantly as described by Santiso-Mere et al., supra and models for determining VDR activation efficiency those of ordinary skill would be capable of identifying suitable Vitamin D compounds useful for practice of the present invention. Suitable analogues and derivatives are expected to include but are not limited to the following: 1.alpha.(x-hydroxyvitamin D.sub.3 ; 25-hydroxyvitamin D.sub.3 ; 1,24,25-(OH).sub.3 D.sub.3 ; 24,25-(OH).sub.2 D.sub.3 ; 1,25,26-(OH).sub.3 D.sub.3 ; 24,25-(OH).sub.2 D.sub.3 ; 1,25-dihydroxy-16-ene-23-yne-26, 27-hexafluorocholecalciferol; 25,26-dehydro-1a,24R-dihydroxycholecalciferol and 25,26-dehydro-1a,24S-dihydroxycholecalciferol; 1a-hydroxy-19-nor-vitamin D analogues; 26,28-methylene-1a,25-dihydroxyvitamin D, compounds; 1a-hydroxy-22-iodinated vitamin D.sub.3 compounds; 23-Oxa-derivatives of Vitamin D; and fluorinated Vitamin D analogues; 20-methyl-substituted Vitamin D derivatives; (E)-20(22)-Dehydrovitamin D compounds; 19-nor-Vitamin D.sub.3 compounds with substituents at the 2-position; and 22-thio Vitamin D derivatives.

Appropriate dosages to increase the induction of apoptosis of non-neoplastic ovarian epithelial cells may be determined by those of skill in the art depending upon the identity of the Vitamin D compound and its method of administration. For example, preferred dosages of the Vitamin D compound effective to increase apoptosis of non-neoplastic ovarial epithelial cells range from 0.0001 to 1.0 mg/kg of body weight (based upon the apoptotic potency of 1,25-dihydroxyvitamin D.sub.3) with dosages ranging from about 0.005 to 0.75 mg/kg being more preferred and dosages of about 0.05 to 0.5 mg/kg being particularly preferred. It is hypothesized that even higher dosages of 1,25-dihydroxyvitamin D.sub.3 may be more effective in inducing apoptosis. A Vitamin D analogue that has greater potency than 1,25-dihydroxyvitamin D.sub.3 in inducing apoptosis and/or which does not have the deleterious side effects of 1,25-dihydroxyvitamin D.sub.3, such as hypercalcemia, could be administered at a dosage equivalent much higher than 1.0 mg/kg of 1,25-dihydroxyvitamin D.sub.3. While the potency and bioavailability of other Vitamin D compounds and analogues may vary, those of skill in the art can determine their apoptotic potency in relation to 1,25-dihydroxyvitamin D.sub.3 and appropriate dosages and regimens of administration through use of in vitro testing methods such as disclosed in the accompanying example.

Prophylactic regimens for administration of Vitamin D compounds for normal female individuals and for those at increased risk of ovarian epithelial cancer can include daily or other periodic administration of Vitamin D compounds. It is contemplated that preferred regimens for prevention of ovarian cancer may comprise periodic administration of relatively larger dosages of Vitamin D compounds on a monthly or less than monthly basis rather than more frequent administration. The larger dosage would preferably range from a dosage equivalent to at least 400 I.U., more preferably a dosage equivalent to at least 2000 I.U., or still more preferably a dosage equivalent to 4000 I.U. According to such a regimen, a larger dosage of a Vitamin D compound might induce apoptosis in a large cohort of normal or dysplastic epithelial cells which over a period of time have become available for apoptosis. The treatment is then repeated some time later when another cohort of epithelial cells is capable of being induced for apoptosis. It is contemplated that one mode of administration may be administering the Vitamin D compound for a brief period sufficient to produce apoptotic turnover of damaged ovarian cells, followed by repeated dosing periods at intervals, for example 1, 3, 6, or 9 months or 1, 3, 5, or 10 years, selected to provide apoptotic turnover adequate to prevent malignant transformations. The most preferable mode for administration would be one that maximizes the apoptotic turnover of ovarian epithelial cells and minimizes any side effects. The advantage of a technique of using large doses of Vitamin D on an infrequent basis is that it may minimize the adverse calcemic effects of a more frequent administration of Vitamin D compounds. The efficacy of such a technique is supported by the recognition that 1,25-dihydroxyvitamin D.sub.3, the active metabolite of Vitamin D, has a relatively short serum half-life and that its apoptotic effect may be based on transient surges in serum levels. It is also possible that the apoptotic effect may not result entirely from the interaction of 1,25-dihydroxyvitamin D.sub.3 (or its analogues) with the Vitamin D receptor but result from the effects of other Vitamin D compounds such as 25 hydroxyvitamin D.sub.3 on the VDR. Furthermore, the inventors do not wish to be bound by the theory presented above for the efficacy of Vitamin D in preventing epithelial ovarian cancer. While it is believed that increased apoptosis is the responsible mechanism, it may be that other mechanisms are responsible.

In one mode of practicing this invention, it is first determined that a patient does not display any signs of ovarian cancer. The patient may in the alternative or addition be determined to be a female at high risk of developing ovarian cancer. A regimen of Vitamin D product, alone or in combination with other compounds, is then prescribed for the female patient.

As a further aspect of the invention it is contemplated that Vitamin D and analogues and derivatives thereof may be co-administered with other agents which promote apoptosis of non-neoplastic ovarian epithelial cells. One particularly preferred class of agents are the progestins as disclosed in co-owned and copending U.S. patent application Ser. No. 08/713,834 filed Sep. 13, 1996, the disclosure of which is incorporated herein by reference. According to one preferred aspect of the invention, Vitamin D compounds may be administered in combination with a progestin product in amounts which will induce apoptosis of non-neoplastic epithelial cells. It is contemplated that combinations of Vitamin D compounds and progestins will exhibit not only additive but synergistic effects in the induction of apoptosis of non-neoplastic ovarian epithelial cells. In this manner the adverse physiological effects of administering larger quantities of Vitamin D compounds and of progestin products can be minimized.

The term “progestin product” as used herein includes any drug which binds to the progestin receptor and induces a progestational effect. This definition thus includes all of the known progestins, derivatives of progesterone or testosterone that have progestin activity, and progestin agonists. It is contemplated that not only presently available progestins but also progestins introduced in the future will be useful according to the present invention. The known synthetic progestins are mainly derivatives of 17-alpha-hydroxy-progesterone or 19-nortestosterone. These progestins can be classified into three groups: the pregnane, estrane, and gonane derivatives. Progestin products may be administered at a variety of dosages including at a dose less than or equal to a dose equivalent to 10 mg daily of norethindrone, more preferably less than or equal to 1 mg daily, or less than or equal to 0.2 mg daily, and possibly as low as 0.05 mg daily of a norethindrone equivalent dose. According to a preferred aspect of the invention, a vitamin D compound and a progestin may be coadministered as a pharmaceutical composition preferably in a single unit dosage, such as a tablet, for inhibiting the conversion of non-neoplastic ovarian epithelial cells to neoplastic cells. The pharmaceutical composition comprises a Vitamin D compound and a progestin product in amounts which are together effective to increase apoptosis in non-neoplastic ovarian epithelial cells. Preferred pharmaceutical compositions include those wherein the Vitamin D compound is present at a dosage equivalent of from 0.0001 to 1.0 mg 1,25-dihydroxyvitamin D.sub.3 /kg of body weight and wherein the progestin product is present at a dosage less than, or equal to, a dosage equivalent to 10 mg of norethindrone or 1 mg of norethindrone. More preferred compositions comprise those wherein the Vitamin D compound is present at a dosage equivalent of from 0.005 to 0.1 mg 1,25-dihydroxyvitamin D.sub.3 /kg of body weight and wherein the progestin product is present at a dosage less than or equal to a dosage equivalent to 1 mg of norethindrone.

According to another dosage regimen a progestin product may be administered at a dose higher than 10 mg daily of a norethindrone equivalent dose. The oral preparations currently on the market are: norgestrel 0.075 mg, medroxyprogesterone acetate 2.5 mg, 5.0 mg, and 10.0 mg, norethindrone 0.35 mg, and norethindrone acetate 0.50 mg but it is contemplated that any of the progestins would be useful for combination with Vitamin D.

It is hypothesized that the combination of Vitamin D and progestins would have a synergistic effect, with reduced adverse side effects, based at least in part on the ability of the progestin compounds to upregulate the VDR. For that reason, it is contemplated in another aspect of the present invention that other compounds known to upregulate the VDR may be co-administered with the Vitamin D compounds. Such compounds include Vitamin A derivatives, such as retinoic acid, and also include dexamethasone.

Another aspect of the present invention involves the use of Vitamin D in combination with hormones at levels sufficient to provide the dual benefits of contraceptive protection and prevention of ovarian cancer. As discussed above, Vitamin D can be co-administered with progestins. Similarly, Vitamin D can be co-administered with estrogens and progestins at levels sufficient to provide contraceptive protection. The levels of estrogen and/or progestin for contraceptive protection are well known in the art. (See Speroff et al., Clinical Gynecologic Endocrinology and Infertility (Chap. 15), 4th Ed. 1989, incorporated herein by reference).

Yet another aspect of the present motion involves the co-administration of Vitamin D with hormones at levels sufficient for hormone replacement therapy. Estrogen is the primary agent in hormone replacement therapy. Postmenopausal women are generally given estrogen alone, or with low doses of progestins. The hormones may be administered continuously or cyclically. Continuous administration is typically 0.625 mg Premarin.RTM. (a conjugated equine estrogen) daily or its equivalent, with a 2.5 mg Provera.RTM. (medroxyprogesterone acetate) daily. Cyclical administration is typically 25 consecutive days of 0.625 mg Premarin.RTM. daily, with 10 mg Provera.RTM. daily on days 16 through 25, followed by 5 days of no hormone treatment (during which time these women will menstruate). (See Danforth’s Obstetrics and Gynecology, Chapter 42, 7th Ed. 1994, incorporated herein by reference). Exemplary regimens according to this aspect of the present invention include doses of Vitamin D compounds with estrogen (with or without other compounds such as progestins) at levels sufficient for hormone replacement therapy.

Estrogen is believed to be possibly linked to ovarian cancer. For that reason, the combination of Vitamin D with estrogen would provide a pharmaceutical composition which would reduce the risk of developing ovarian cancer.

“Concurrent administration” or “co-administration” as used herein includes administration of the agents together, or before or after each other. The agents may be administered by different routes. For example, one agent may be administered intravenously while the second agent is administered intramuscularly, intravenously or orally. They may be administered simultaneously or sequentially, as long as they are given in a manner sufficient to allow both agents to achieve effective concentrations in the body. The preferred manner of co-administration for all the combinations described above is a single unit dosage, such as a single tablet.

All doses given herein are appropriate for a female subject of about 60 kg weight; the dosages naturally will vary more or less depending on the weight of the subject. The doses may be increased or decreased, and the duration of treatment may be shortened or lengthened as determined by the treating physician. The frequency of dosing will depend on the pharmacokinetics parameters of the agents and the route of administration. The optimal pharmaceutical formulation will be determined by one skilled in the art depending upon the route of administration and desired dosage. See for example, Remington’s Pharmaceutical Sciences, 18th Ed. (1990, Mack Publishing Co., Easton, Pa. 18042) pages 1435-1712, the disclosure of which is hereby incorporated by reference. Such formulations may influence the physical state, stability, rate of in vivo release, and rate of in vivo clearance of the administered agents.

Those of ordinary skill in the art will readily optimize effective dosages and concurrent administration regimens as determined by good medical practice and the clinical condition of the individual patient. Regardless of the manner of administration, the specific dose may be calculated according to body weight, body surface area or organ size. Further refinement of the calculations necessary to determine the appropriate dosage for treatment involving each of the above mentioned formulations is routinely made by those of ordinary skill in the art and is within the ability of tasks routinely performed by them without undue experimentation, especially in light of the dosage information and assays disclosed herein. Appropriate dosages may be ascertained through use of established assays for determining dosages in conjunction with appropriate dose-response data. The final dosage regimen will be determined by the attending physician, considering various factors which modify the action of drugs, e.g. the drug’s specific activity, the responsiveness of the subject, the age, condition, body weight, diet and sunlight exposure of the patient, the severity of any infection, time of administration and other clinical factors. Given the teachings herein those of ordinary skill would be able to determine appropriate dosage levels of Vitamin D compounds for inducing apoptosis of non-neoplastic ovarian epithelial cells.

It is contemplated that the routes of delivery of Vitamin D compounds including Vitamin D and biologically active analogues and derivatives thereof (either alone or in combination with other pharmaceuticals) could include oral, sublingual, injectable (including short-acting, depot, implant and pellet forms injected subcutaneously or intramuscularly), vaginal creams, suppositories, pessaries, rings, rectal suppositories, intrauterine devices, and transdermal forms such as patches and creams.

The term “females at high risk of developing ovarian cancer” includes females with a family history of breast or ovarian cancer, females with a prior history of breast or ovarian cancer, or females with a mutation in the BRCA1 gene or any other mutation shown to be associated with a high risk of developing ovarian cancer.

Other aspects and advantages of the present invention will be understood upon consideration of the following illustrative examples.

EXAMPLE 1

Example 1 addresses the effect of administration of Vitamin D on human ovarian epithelial cells. According to this example, a cell culture derived from normal ovarian epithelial cells was plated in 24 well plates at a concentration of 100,000 cells per well. After 24 hours, the wells were treated with 1,25-dihydroxyvitamin D.sub.3 at a 100 nM concentration or control medium, and allowed to incubate for 96 hours. All experiments were carried out in triplicate. After 96 hours, cell Iysates were extracted from each of the wells, and the cytoplasmic fraction was normalized for cell number and analyzed for DNA-histone complexes indicative of apoptosis using a cell death ELISA (Boehringer Mannheim). A significant (300%) increase in apoptosis (p=0.01) was measured in the human ovarian epithelial cells treated with Vitamin D as compared with the controls.

EXAMPLE 2

A spontaneously transformed yet non-malignant epithelial cell culture derived from normal human ovarian epithelial cells was plated in pronectin coated 6-well dishes at a concentration of 250,000 cells per well. The cells were allowed to plate and then grow to 70% confluence. The wells were then washed, and the medium was replaced with phenol red free, dextran charcoal treated medium containing 2% fetal calf serum, and treated with 500 ng/ml of 24,25 (OH).sub.2 D.sub.3 for 72 hours. The cells were harvested, centrifuged, and the resultant cell pellets were resuspended in lysis buffer. DNA was precipitated using the Puregene DNA Isolation Kit (Gentra Systems, Minneapolis, Minn.). Equal amounts of DNA were then subjected to electrophoresis on a horizontal 1.5% agarose gel containing ethidium bromide and visualized under UV illumination. On electrophoresis, DNA laddering (the hallmark of apoptosis) was observed in cells treated with 24,25 Vitamin D.sub.3, but not in the control, untreated cells.

While the above studies relate to non-neoplastic ovarian epithelial cells, it is further hypothesized that administration of Vitamin D can prevent breast cancer by causing apoptosis of non-neoplastic breast cells. Prevention of breast cancer could be achieved by administration of Vitamin D, alone or in combination with other agents and/or VDR upregulators, in an amount sufficient to cause apopotosis of non-neoplastic breast cells.

Numerous modifications and variations in the practice of the invention are expected to occur to those skilled in the art upon consideration of the foregoing description on the presently preferred embodiments thereof. Consequently the only limitations which should be placed upon the scope of the present invention are those that appear in the appended claims.

Compounds and methods for immunotherapy and immunodiagnosis of prostate cancer

Filed under: Issued Patent — admin @ 3:30 am

Abstract
Compounds and methods for treating and diagnosing prostate cancer are provided. The inventive compounds include polypeptides containing at least a portion of a prostate protein. Vaccines and pharmaceutical compositions for immunotherapy of prostate cancer comprising such polypeptides or DNA molecules encoding such polypeptides are also provided. The inventive polypeptides may also be used to generate antibodies useful for the diagnosis and monitoring of prostate cancer. Nucleic acid sequences for preparing probes, primers, and polypeptides are also provided.

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Inventors: Reed; Steven G. (Bellevue, WA), Dillon; Davin C. (Redmond, WA), Twardzik; Daniel R. (Bainbridge Island, WA), Mitcham; Jennifer L. (Redmond, WA)
Assignee: Corixa Corporation (Seattle, WA)

Appl. No.: 08/946,026
Filed: October 7, 1997
Parent Case Text

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CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No. 08/633,840, filed Apr. 11, 1996, now abandoned which is a continuation-in-part of U.S. application Ser. No. 08/616,745, filed Mar. 15, 1996, now abandoned.
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Claims

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We claim:

1. A composition for eliciting an immune response, comprising an isolated polypeptide and a physiologically acceptable carrier, the isolated polypeptide comprising an immunogenic portion of a prostate protein having a sequence of SEQ ID NO:3.

2. A composition for eliciting an immune response, comprising an isolated polypeptide and a non-specific immune response enhancer, the isolated polypeptide comprising an immunogenic portion of a prostate protein having a sequence of SEQ ID NO:3.

3. The composition of claim 2 wherein the non-specific immune response enhancer is an adjuvant.
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Description

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TECHNICAL FIELD

The present invention relates generally to the treatment, diagnosis and monitoring of prostate cancer. The invention is more particularly related to polypeptides comprising at least a portion of a prostate protein. Such polypeptides may be used in vaccines and pharmaceutical compositions for treatment of prostate cancer. The polypeptides may also be used for the production of compounds, such as antibodies, useful for diagnosing and monitoring the progression of prostate cancer, and possibly other tumor types, in a patient.

BACKGROUND OF THE INVENTION

Prostate cancer is the most common form of cancer among males, with an estimated incidence of 30% in men over the age of 50. Overwhelming clinical evidence shows that human prostate cancer has the propensity to metastasize to bone, and the disease appears to progress inevitably from androgen dependent to androgen refractory status, leading to increased patient mortality. This prevalent disease is currently the second leading cause of cancer death among men in the U.S.

In spite of considerable research into therapies for the disease, prostate cancer remains difficult to treat. Commonly, treatment is based on surgery and/or radiation therapy, but these methods are ineffective in a significant percentage of cases. Three prostate specific proteins–prostate specific antigen (PSA) and prostatic acid phosphatase (PAP)–have limited diagnostic and therapeutic potential. PSA levels do not always correlate well with the presence of prostate cancer, being positive in a percentage of non-prostate cancer cases, including benign prostatic hyperplasia (BPH). furthermore, PSA measurements correlate with prostate volume, and do not indicate the level of metastasis.

Accordingly, there remains a need in the art for improved vaccines and diagnostic methods for prostrate cancer.

SUMMARY OF THE INVENTION

The present invention provides compounds and methods for immunotherapy and diagnosis of prostate cancer. In one aspect, polypeptides are provided comprising at least an immunogenic portion of a prostate protein having a partial sequence as provided in SEQ ID NOS: 2 and 4-8, or a variant of such a protein that differs only in conservative substitutions and/or modifications, together with polypeptides comprising an immunogenic portion of a prostate protein, or a variant thereof, wherein the protein comprises an amino acid sequence encoded by a DNA sequence selected from the group consisting of sequences recited in SEQ ID NOS: 11, 13-19, 58 and 59, the complements of said sequences, and DNA sequences that hybridize to a sequence recited in SEQ ID NOS: 11, 13-19, 58 and 59, or a complement thereof under moderately stringent conditions.

In related aspects, DNA molecules encoding the above polypeptides, expression vectors comprising such DNA molecules and host cells transformed or transfected with such expression vectors are also provided. In preferred embodiments, the host cells are selected from the group consisting of E. coli, yeast and mammalian cells.

The present invention also provides pharmaceutical compositions comprising one or more of the polypeptides of SEQ ID NOS: 1-8, 20, 21, 25-31, 44-57, 60 or 61, or DNA molecules of SEQ ID NOS: 9-19, 22-24, 32-43, 58 or 59 and a physiologically acceptable carrier. The invention further provides vaccines comprising one or more of such polypeptides or DNA molecules in combination with a non-specific immune response enhancer.

In yet another aspect, methods are provided for inhibiting the development of prostate cancer in a patient, comprising administering an effective amount of one or more of the polypeptides of SEQ ID NOS: 1-8, 20, 21, 25-31, 44-57, 60 or 61, or DNA molecules of SEQ ID NOS: 9-19, 22-24, 32-43, 58 or 59 to a patient in need thereof.

In further aspects, methods are provided for detecting prostate cancer in a patient, comprising: (a) contacting a biological sample obtained from a patient with a binding agent that is capable of binding to a polypeptide of SEQ ID NOS: 1-8, 20, 21, 25-31, 44-57, 60 or 61; and (b) detecting in the sample a protein or polypeptide that binds to the binding agent.

In related aspects, methods are provided for monitoring the progression of prostate cancer in a patient, comprising: (a) contacting a biological sample obtained from a patient with a binding agent that is capable of binding to a polypeptide of SEQ ID NOS: 1-8, 20, 21, 25-31, 44-57, 60 or 61; (b) determining in the sample an amount of a protein or polypeptide that binds to the binding agent; (c) repeating steps (a) and (b); and comparing the amounts of polypeptide detected in steps (b) and (c).

Within related aspects, the present invention provides antibodies, preferably monoclonal antibodies, that bind to the polypeptides described above, as well as diagnostic kits comprising such antibodies, and methods of using such antibodies to inhibit the development of prostate cancer.

The present invention also provides methods for detecting prostate cancer comprising: (a) obtaining a biological sample from a patient; (b) contacting the sample with at least two oligonucleotide primers in a polymerase chain reaction, at least one of the oligonucleotide primers being specific for a DNA sequence selected from the group consisting of SEQ ID NOS: 9-19, 22-24, 32-43, 58 and 59; and (c) detecting in the sample a DNA sequence that amplifies in the presence of the oligonucleotide primer. In one embodiment, the oligonucleotide primer comprises at least about 10 contiguous nucleotides of a DNA sequence selected from the group consisting of SEQ ID NOS: 9-19, 22-24, 32-43, 58 and 59.

In a further aspect, the present invention provides a method for detecting prostate cancer in a patient comprising: (a) obtaining a biological sample from the patient; (b) contacting the sample with an oligonucleotide probe specific for a DNA sequence selected from the group consisting of SEQ ID NOS: 9-19, 22-24, 32-43, 58 and 59; and (c) detecting in the sample a DNA sequence that hybridizes to the oligonucleotide probe. In one embodiment, the oligonucleotide probe comprises at least about 15 contiguous nucleotides of a DNA sequence selected from the group consisting of SEQ ID NOS: 9-19, 22-24, 32-43, 58 and 59.

These and other aspects of the present invention will become apparent upon reference to the following detailed description and attached drawings. All references disclosed herein are hereby incorporated by reference in their entirety as if each was incorporated individually.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a Western blot analysis of sera obtained form rats immunized with rate prostate extract.

FIG. 2 illustrates a non-reduced SDS PAGE of the rat immunizing preparation of FIG. 1.

FIG. 3 illustrates the binding of a putative human homologue of rat steroid binding protein to progesterone and to estramustine.

DETAILED DESCRIPTION OF THE INVENTION

As noted above, the present invention is generally directed to compositions and methods for the immunotherapy, diagnosis and monitoring of prostate cancer. The inventive compositions are generally polypeptides that comprise at least a portion of a human prostate protein, the protein demonstrating immunoreactivity with human prostate sera. Also included within the present invention are molecules (such as an antibody or fragment thereof) that bind to the inventive polypeptides. Such molecules are referred to herein as “binding agents.”

In particular, the subject invention discloses polypeptides comprising at least a portion of a human prostate protein provided in SEQ ID NOS: 2 and 4-8, or a variant of such a protein that differs only in conservative substitutions and/or modifications. As used herein, the term “polypeptide” encompasses amino acid chains of any length, including full length proteins, wherein the amino acid residues are linked by covalent peptide bonds. Thus, a polypeptide comprising a portion of one of the above prostate proteins may consist entirely of the portion, or the portion may be present within a larger polypeptide that contains additional sequences. The additional sequences may be derived from the native protein or may be heterologous, and such sequences may be immunoreactive and/or antigenic.

As used herein, an “immunogenic portion” of a human prostate protein is a portion that reacts either with sera derived from an individual inflicted with autoimmune prostatitis or with sera derived from a rat model of autoimmune prostatitis. In other words, an immunogenic portion is capable of eliciting an immune response and as such binds to antibodies present within prostatitis sera. Autoimmune prostatitis may occur, for example, following treatment of bladder cancer by administration of Bacillus Calmette-Guerin (BCG), an avirulent strain of Mycobacterium bovis. In the rat model of autoimmune prostatitis, rats are immunized with a detergent extract of rat prostate. Sera from either of these sources may be used to react with the human prostate derived polypeptides described herein. Antibody binding assays may generally be performed using any of a variety of means known to those of ordinary skill in the art, as described, for example, in Harlow and Lane, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y., 1988. For example, a polypeptide may be immobilized on a solid support (as described below) and contacted with patient sera to allow binding of antibodies within the sera to the immobilized polypeptide. Unbound sera may then be removed and bound antibodies detected using, for example, .sup.125 I-labeled Protein A.

A “variant,” as used herein, is a polypeptide that differs from the recited polypeptide only in conservative substitutions and/or modifications, such that the immunotherapeutic, antigenic and/or diagnostic properties of the polypeptide or molecules that bind to the polypeptide, are retained. For prostate proteins with immunoreactive properties, variants may generally be identified by modifying one of the above polypeptide sequences, and evaluating the immunoreactivity of the modified polypeptide. For prostate proteins useful for the generation of diagnostic binding agents, a variant may be identified by evaluating a modified polypeptide for the ability to generate antibodies that detect the presence or absence of prostate cancer. Such modified sequences may be prepared and tested using, for example, the representative procedures described herein.

As used herein, a “conservative substitution” is one in which an amino acid is substituted for another amino acid that has similar properties, such that one skilled in the art of peptide chemistry would expect the secondary structure and hydropathic nature of the polypeptide to be substantially unchanged. In general, the following groups of amino acids represent conservative changes: (1) ala, pro, gly, glu, asp, gln, asn, ser, thr; (2) cys, ser, tyr, thr; (3) val, ile, leu, met, ala, phe; (4) lys, arg, his; and (5) phe, tyr, trp, his.

Variants may also, or alternatively, contain other modifications, including the deletion or addition of amino acids that have minimal influence on the antigenic properties, secondary structure and hydropathic nature of the polypeptide. For example, a polypeptide may be conjugated to a signal (or leader) sequence at the N-terminal end of the protein which co-translationally or post-translationally directs transfer of the protein. The polypeptide may also be conjugated to a linker or other sequence for ease of synthesis, purification or identification of the polypeptide (e.g., poly-His), or to enhance binding of the polypeptide to a solid support. For example, a polypeptide may be conjugated to an immunoglobulin Fc region.

Polypeptides having one of the sequences provided in SEQ ID NOS: 1 to 8, 20, 21 and 25-31 may be isolated from a suitable human prostate adenocarcinoma cell line, such as LnCap.fgc (ATCC No. 1740-CRL). LnCap.fgc is a prostate adenocarcinoma cell line that is a particularly good representation of human prostate cancer. Like the human cancer, LnCap.fgc cells form progressively growing tumors as xenografts in SCID mice, respond to testosterone, secrete PSA and respond to the presence of bone marrow components (e.g., transferrin). In particular, the polypeptides may be isolated by expression screening of a LnCap.fgc cDNA library with human prostatitis sera using techniques described, for example, in Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratories, Cold Spring Harbor, N.Y. (and references cited therein), and as described in detail below. The polypeptides of SEQ ID NOS: 48 and 49 may be isolated from the LnCap/fgc cell line by screening with sera from the rat model of autoimmune prostatitis discussed above. The polypeptides of SEQ ID NOS: 50-56 may be isolated from the LnCap/fgc cell line by screening with human prostatitis sera as described in detail in Example 4. The polypeptides of SEQ ID NOS: 44-47 may be isolated from human seminal fluid as described in detail in Example 2. The polypeptides of SEQ ID NOS: 60 and 61 may be isolated by screenign a prostate tumor cDNA expression library with monkey anti-prostate sera as detailed below in Example 6. Once a DNA sequence encoding a polypeptide is obtained, any of the above modifications may be readily introduced using standard mutagenesis techniques, such as oligonucleotide-directed site-specific mutagenesis.

The polypeptides disclosed herein may also be generated by synthetic or recombinant means. Synthetic polypeptides having fewer than about 100 amino acids, and generally fewer than about 50 amino acids, may be generated using techniques well known to those of ordinary skill in the art. For example, such polypeptides may be synthesized using any of the commercially available solid-phase techniques, such as the Merrifield solid-phase synthesis method, where amino acids are sequentially added to a growing amino acid chain. See Merrifield, J. Am. Chem. Soc. 85:2149-2146, 1963. Equipment for automated synthesis of polypeptides is commercially available from suppliers such as Applied BioSystems, Inc., (Foster City, Calif.), and may be operated according to the manufacturer’s instructions.

Alternatively, any of the above polypeptides may be produced recombinantly by inserting a DNA sequence that encodes the polypeptide into an expression vector and expressing the protein in an appropriate host. Any of a variety of expression vectors known to those of ordinary skill in the art may be employed to express recombinant polypeptides of this invention. Expression may be achieved in any appropriate host cell that has been transformed or transfected with an expression vector containing a DNA molecule that encodes a recombinant polypeptide. Suitable host cells include prokaryotes, yeast and higher eukaryotic cells. Preferably, the host cells employed are E. coli, yeast or a mammalian cell line, such as CHO cells. The DNA sequences expressed in this manner may encode naturally occurring polypeptides, portions of naturally occurring polypeptides, or other variants thereof.

In general, regardless of the method of preparation, the polypeptides disclosed herein are prepared in substantially pure form (i.e., the polypeptides are homogenous as determined by amino acid composition and primary sequence analysis). Preferably, the polypeptides are at least about 90% pure, more preferably at least about 95% pure and most preferably at least about 99% pure. In certain preferred embodiments, described in more detail below, the substantially pure polypeptides are incorporated into pharmaceutical compositions or vaccines for use in one or more of the methods disclosed herein.

Polypeptides of the present invention that comprise an immunogenic portion of a prostate protein may generally be used for immunotherapy of prostate cancer, wherein the polypeptide stimulates the patient’s own immune response to prostate tumor cells. In further aspects, the present invention provides methods for using one or more of the immunoreactive polypeptides of SEQ ID NOS: 1 to 8, 20, 21, 25-31, 44-57, 60 and 61 (or DNA encoding such polypeptides) for immunotherapy of prostate cancer in a patient. As used herein, a “patient” refers to any warm-blooded animal, preferably a human. A patient may be afflicted with a disease, or may be free of detectable disease. Accordingly, the above immunoreactive polypeptides may be used to treat prostate cancer or to inhibit the development of prostate cancer. The polypeptides may be administered either prior to or following surgical removal of primary tumors and/or treatment by administration of radiotherapy and conventional chemotherapeutic drugs.

In these aspects, the polypeptide is generally present within a pharmaceutical composition and/or a vaccine. Pharmaceutical compositions may comprise one or more polypeptides, each of which may contain one or more of the above sequences (or variants thereof), and a physiologically acceptable carrier. The vaccines may comprise one or more of such polypeptides and a non-specific immune response enhancer, such as an adjuvant, biodegradable microsphere (e.g., polylactic galactide) or a liposome (into which the polypeptide is incorporated). Pharmaceutical compositions and vaccines may also contain other epitopes of prostate cell antigens, either incorporated into a combination polypeptide (i.e., a single polypeptide that contains multiple epitopes) or present within a separate polypeptide.

Alternatively, a pharmaceutical composition or vaccine may contain DNA encoding one or more of the above polypeptides, such that the polypeptide is generated in situ. In such pharmaceutical compositions and vaccines, the DNA may be present within any of a variety of delivery systems known to those of ordinary skill in the art, including nucleic acid expression systems, bacteria and viral expression systems. Appropriate nucleic acid expression systems contain the necessary DNA sequences for expression in the patient (such as a suitable promoter). Bacterial delivery systems involve the administration of a bacterium (such as Bacillus-Calmette-Guerrin) that expresses an epitope of a prostate cell antigen on its cell surface. In a preferred embodiment, the DNA may be introduced using a viral expression system (e.g., vaccinia or other pox virus, retrovirus, or adenovirus), which may involve the use of a non-pathogenic (defective), replication competent virus. Suitable systems are disclosed, for example, in Fisher-Hoch et al., PNAS 86:317-321, 1989; Flexner et al., Ann. N.Y Acad. Sci. 569:86-103, 1989; Flexner et al., Vaccine 8:17-21, 1990; U.S. Pat. Nos. 4,603,112, 4,769,330, and 5,017,487; WO 89/01973; U.S. Pat. No.4,777,127; GB 2,200,651; EP 0,345,242; WO 91/02805; Berkner, Biotechniques 6:616-627, 1988; Rosenfeld et al., Science 252:431-434, 1991; Kolls et al., PNAS 91:215-219, 1994; Kass-Eisler et al., PNAS 90:11498-11502, 1993; Guzman et al., Circulation 88:2838-2848, 1993; and Guzman et al., Cir. Res. 73:1202-1207, 1993. Techniques for incorporating DNA into such expression systems are well known to those of ordinary skill in the art. The DNA may also be “naked,” as described, for example, in published PCT application WO 90/11092, and Ulmer et al., Science 259:1745-1749, 1993, reviewed by Cohen, Science 259:1691-1692, 1993. The uptake of naked DNA may be increased by coating the DNA onto biodegradable beads, which are efficiently transported into the cells.

Routes and frequency of administration, as well as dosage, will vary from individual to individual and may parallel those currently being used in immunotherapy of other diseases. In general, the pharmaceutical compositions and vaccines may be administered by injection (e.g., intracutaneous, intramuscular, intravenous or subcutaneous), intranasally (e.g., by aspiration) or orally. Between 1 and 10 doses may be administered over a 3-24 week period. Preferably, 4 doses are administered, at an interval of 3 months, and booster administrations may be given periodically thereafter. Alternate protocols may be appropriate for individual patients. A suitable dose is an amount of polypeptide or DNA that is effective to raise an immune response (cellular and/or humoral) against prostate tumor cells in a treated patient. A suitable immune response is at least 10-50% above the basal (i.e., untreated) level. In general, the amount of polypeptide present in a dose (or produced in situ by the DNA in a dose) ranges from about 1 pg to about 100 mg per kg of host, typically from about 10 pg to about 1 mg, and preferably from about 100 pg to about 1 .mu.g. Suitable dose sizes will vary with the size of the patient, but will typically range from about 0.01 mL to about 5 mL.

While any suitable carrier known to those of ordinary skill in the art may be employed in the pharmaceutical compositions of this invention, the type of carrier will vary depending on the mode of administration. For parenteral administration, such as subcutaneous injection, the carrier preferably comprises water, saline, alcohol, a fat, a wax and/or a buffer. For oral administration, any of the above carriers or a solid carrier, such as mannitol, lactose, starch, magnesium stearate, sodium saccharine, talcum, cellulose, glucose, sucrose, and/or magnesium carbonate, may be employed. Biodegradable microspheres (e.g., polylactic glycolide) may also be employed as carriers for the pharmaceutical compositions of this invention. Suitable biodegradable microspheres are disclosed, for example, in U.S. Pat. Nos. 4,897,268 and 5,075,109.

Any of a variety of non-specific immune response enhancers may be employed in the vaccines of this invention. For example, an adjuvant may be included. Most adjuvants contain a substance designed to protect the antigen from rapid catabolism, such as aluminum hydroxide or mineral oil, and a nonspecific stimulator of immune response, such as lipid A, Bordella pertussis or Mycobacterium tuberculosis. Such adjuvants are commercially available as, for example, Freund’s Incomplete Adjuvant and Complete Adjuvant (Difco Laboratories, Detroit, Mich.) and Merck Adjuvant 65 (Merck and Company, Inc., Rahway, N.J.).

Polypeptides disclosed herein may also be employed in ex vivo treatment of prostate cancer. For example, cells of the immune system, such as T cells, may be isolated from the peripheral blood of a patient, using a commercially available cell separation system, such as CellPro Incorporated’s (Bothell, Wash.) CEPRATE.TM. system (see U.S. Pat. No. 5,240,856; U.S. Pat. No. 5,215,926; WO 89/06280; WO 91/16116 and WO 92/07243). The separated cells are stimulated with one or more of the immunoreactive polypeptides contained within a delivery vehicle, such as a microsphere, to provide antigen-specific T cells. The population of tumor antigen-specific T cells is then expanded using standard techniques and the cells are administered back to the patient.

Polypeptides of the present invention may also, or alternatively, be used to generate binding agents, such as antibodies or fragments thereof, that are capable of detecting metastatic human prostate tumors.

Binding agents of the present invention may generally be prepared using methods known to those of ordinary skill in the art, including the representative procedures described herein. Binding agents are capable of differentiating between patients with and without prostate cancer, using the representative assays described herein. In other words, antibodies or other binding agents raised against a prostate protein, or a suitable portion thereof, will generate a signal indicating the presence of primary or metastatic prostate cancer in at least about 20% of patients afflicted with the disease, and will generate a signal indicating the absence of the disease in at least about 90% of individuals without primary or metastatic prostate cancer. Suitable portions of such prostate proteins are portions that are able to generate a binding agent that indicates the presence of primary or metastatic prostate cancer in substantially all (i.e., at least about 80%, and preferably at least about 90%) of the patients for which prostate cancer would be indicated using the full length protein, and that indicate the absence of prostate cancer in substantially all of those samples that would be negative when tested with full length protein. The representative assays described below, such as the two-antibody sandwich assay, may generally be employed for evaluating the ability of a binding agent to detect metastatic human prostate tumors.

The ability of a polypeptide prepared as described herein to generate antibodies capable of detecting primary or metastatic human prostate tumors may generally be evaluated by raising one or more antibodies against the polypeptide (using, for example, a representative method described herein) and determining the ability of such antibodies to detect such tumors in patients. This determination may be made by assaying biological samples from patients with and without primary or metastatic prostate cancer for the presence of a polypeptide that binds to the generated antibodies. Such test assays may be performed, for example, using a representative procedure described below. Polypeptides that generate antibodies capable of detecting at least 20% of primary or metastatic prostate tumors by such procedures are considered to be able to generate antibodies capable of detecting primary or metastatic human prostate tumors. Polypeptide specific antibodies may be used alone or in combination to improve sensitivity.

Polypeptides capable of detecting primary or metastatic human prostate tumors may be used as markers for diagnosing prostate cancer or for monitoring disease progression in patients. In one embodiment, prostate cancer in a patient may be diagnosed by evaluating a biological sample obtained from the patient for the level of one or more of the above polypeptides, relative to a predetermined cut-off value. As used herein, suitable “biological samples” include blood, sera, urine and/or prostate secretions.

The level of one or more of the above polypeptides may be evaluated using any binding agent specific for the polypeptide(s). A “binding agent,” in the context of this invention, is any agent (such as a compound or a cell) that binds to a polypeptide as described above. As used herein, “binding” refers to a noncovalent association between two separate molecules (each of which may be free (i.e., in solution) or present on the surface of a cell or a solid support), such that a “complex” is formed. Such a complex may be free or immobilized (either covalently or noncovalently) on a support material. The ability to bind may generally be evaluated by determining a binding constant for the formation of the complex. The binding constant is the value obtained when the concentration of the complex is divided by the product of the component concentrations. In general, two compounds are said to “bind” in the context of the present invention when the binding constant for complex formation exceeds about 10.sup.3 L/mol. The binding constant may be determined using methods well known to those of ordinary skill in the art.

Any agent that satisfies the above requirements may be a binding agent. For example, a binding agent may be a ribosome with or without a peptide component, an RNA molecule or a peptide. In a preferred embodiment, the binding partner is an antibody, or a fragment thereof. Such antibodies may be polyclonal, or monoclonal. In addition, the antibodies may be single chain, chimeric, CDR-grafted or humanized. Antibodies may be prepared by the methods described herein and by other methods well known to those of skill in the art.

There are a variety of assay formats known to those of ordinary skill in the art for using a binding partner to detect polypeptide markers in a sample. See, e.g., Harlow and Lane, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, 1988. In a preferred embodiment, the assay involves the use of binding partner immobilized on a solid support to bind to and remove the polypeptide from the remainder of the sample. The bound polypeptide may then be detected using a second binding partner that contains a reporter group. Suitable second binding partners include antibodies that bind to the binding partner/polypeptide complex. Alternatively, a competitive assay may be utilized, in which a polypeptide is labeled with a reporter group and allowed to bind to the immobilized binding partner after incubation of the binding partner with the sample. The extent to which components of the sample inhibit the binding of the labeled polypeptide to the binding partner is indicative of the reactivity of the sample with the immobilized binding partner.

The solid support may be any material known to those of ordinary skill in the art to which the antigen may be attached. For example, the solid support may be a test well in a microtiter plate or a nitrocellulose or other suitable membrane. Alternatively, the support may be a bead or disc, such as glass, fiberglass, latex or a plastic material such as polystyrene or polyvinylchloride. The support may also be a magnetic particle or a fiber optic sensor, such as those disclosed, for example, in U.S. Pat. No. 5,359,681. The binding agent may be immobilized on the solid support using a variety of techniques known to those of skill in the art, which are amply described in the patent and scientific literature. In the context of the present invention, the term “immobilization” refers to both noncovalent association, such as adsorption, and covalent attachment (which may be a direct linkage between the antigen and functional groups on the support or may be a linkage by way of a cross-linking agent). Immobilization by adsorption to a well in a microtiter plate or to a membrane is preferred. In such cases, adsorption may be achieved by contacting the binding agent, in a suitable buffer, with the solid support for a suitable amount of time. The contact time varies with temperature, but is typically between about 1 hour and about 1 day. In general, contacting a well of a plastic microtiter plate (such as polystyrene or polyvinylchloride) with an amount of binding agent ranging from about 10 ng to about 10 .mu.g, and preferably about 100 ng to about 1 .mu.g, is sufficient to immobilize an adequate amount of binding agent.

Covalent attachment of binding agent to a solid support may generally be achieved by first reacting the support with a bifunctional reagent that will react with both the support and a functional group, such as a hydroxyl or amino group, on the binding agent. For example, the binding agent may be covalently attached to supports having an appropriate polymer coating using benzoquinone or by condensation of an aldehyde group on the support with an amine and an active hydrogen on the binding partner (see, e.g., Pierce Immunotechnology Catalog and Handbook, 1991, at A12-A13).

In certain embodiments, the assay is a two-antibody sandwich assay. This assay may be performed by first contacting an antibody that has been immobilized on a solid support, commonly the well of a microtiter plate, with the sample, such that polypeptides within the sample are allowed to bind to the immobilized antibody. Unbound sample is then removed from the immobilized polypeptide-antibody complexes and a second antibody (containing a reporter group) capable of binding to a different site on the polypeptide is added. The amount of second antibody that remains bound to the solid support is then determined using a method appropriate for the specific reporter group.

More specifically, once the antibody is immobilized on the support as described above, the remaining protein binding sites on the support are typically blocked. Any suitable blocking agent known to those of ordinary skill in the art, such as bovine serum albumin or Tween 20.TM. (Sigma Chemical Co., St. Louis, Mo.). The immobilized antibody is then incubated with the sample, and polypeptide is allowed to bind to the antibody. The sample may be diluted with a suitable diluent, such as phosphate-buffered saline (PBS) prior to incubation. In general, an appropriate contact time (i.e., incubation time) is that period of time that is sufficient to detect the presence of polypeptide within a sample obtained from an individual with prostate cancer. Preferably, the contact time is sufficient to achieve a level of binding that is at least about 95% of that achieved at equilibrium between bound and unbound polypeptide. Those of ordinary skill in the art will recognize that the time necessary to achieve equilibrium may be readily determined by assaying the level of binding that occurs over a period of time. At room temperature, an incubation time of about 30 minutes is generally sufficient.

Unbound sample may then be removed by washing the solid support with an appropriate buffer, such as PBS containing 0.1% Tween 20.TM.. The second antibody, which contains a reporter group, may then be added to the solid support. Preferred reporter groups include enzymes (such as horseradish peroxidase), substrates, cofactors, inhibitors, dyes, radionuclides, luminescent groups, fluorescent groups and biotin. The conjugation of antibody to reporter group may be achieved using standard methods known to those of ordinary skill in the art.

The second antibody is then incubated with the immobilized antibody-polypeptide complex for an amount of time sufficient to detect the bound polypeptide. An appropriate amount of time may generally be determined by assaying the level of binding that occurs over a period of time. Unbound second antibody is then removed and bound second antibody is detected using the reporter group. The method employed for detecting the reporter group depends upon the nature of the reporter group. For radioactive groups, scintillation counting or autoradiographic methods are generally appropriate. Spectroscopic methods may be used to detect dyes, luminescent groups and fluorescent groups. Biotin may be detected using avidin, coupled to a different reporter group (commonly a radioactive or fluorescent group or an enzyme). Enzyme reporter groups may generally be detected by the addition of substrate (generally for a specific period of time), followed by spectroscopic or other analysis of the reaction products.

To determine the presence or absence of prostate cancer, the signal detected from the reporter group that remains bound to the solid support is generally compared to a signal that corresponds to a predetermined cut-off value. In one preferred embodiment, the cut-off value is the average mean signal obtained when the immobilized antibody is incubated with samples from patients without prostate cancer. In general, a sample generating a signal that is three standard deviations above the predetermined cut-off value is considered positive for prostate cancer. In an alternate preferred embodiment, the cut-off value is determined using a Receiver Operator Curve, according to the method of Sackett et al., Clinical Epidemiology: A Basic Science for Clinical Medicine, Little Brown and Co., 1985, p. 106-7. Briefly, in this embodiment, the cut-off value may be determined from a plot of pairs of true positive rates (i.e., sensitivity) and false positive rates (100%-specificity) that correspond to each possible cut-off value for the diagnostic test result. The cut-off value on the plot that is the closest to the upper left-hand corner (i.e., the value that encloses the largest area) is the most accurate cut-off value, and a sample generating a signal that is higher than the cut-off value determined by this method may be considered positive. Alternatively, the cut-off value may be shifted to the left along the plot, to minimize the false positive rate, or to the right, to minimize the false negative rate. In general, a sample generating a signal that is higher than the cut-off value determined by this method is considered positive for prostate cancer.

In a related embodiment, the assay is performed in a flow-through or strip test format, wherein the antibody is immobilized on a membrane, such as nitrocellulose. In the flow-through test, polypeptides within the sample bind to the immobilized antibody as the sample passes through the membrane. A second, labeled antibody then binds to the antibody-polypeptide complex as a solution containing the second antibody flows through the membrane. The detection of bound second antibody may then be performed as described above. In the strip test format, one end of the membrane to which antibody is bound is immersed in a solution containing the sample. The sample migrates along the membrane through a region containing second antibody and to the area of immobilized antibody. Concentration of second antibody at the area of immobilized antibody indicates the presence of prostate cancer. Typically, the concentration of second antibody at that site generates a pattern, such as a line, that can be read visually. The absence of such a pattern indicates a negative result. In general, the amount of antibody immobilized on the membrane is selected to generate a visually discernible pattern when the biological sample contains a level of polypeptide that would be sufficient to generate a positive signal in the two-antibody sandwich assay, in the format discussed above. Preferably, the amount of antibody immobilized on the membrane ranges from about 25 ng to about 1 .mu.g, and more preferably from about 50 ng to about 500 ng. Such tests can typically be performed with a very small amount of biological sample.

Of course, numerous other assay protocols exist that are suitable for use with the antigens or antibodies of the present invention. The above descriptions are intended to be exemplary only.

In another embodiment, the above polypeptides may be used as markers for the progression of prostate cancer. In this embodiment, assays as described above for the diagnosis of prostate cancer may be performed over time, and the change in the level of reactive polypeptide(s) evaluated. For example, the assays may be performed every 24-72 hours for a period of 6 months to 1 year, and thereafter performed as needed. In general, prostate cancer is progressing in those patients in whom the level of polypeptide detected by the binding agent increases over time. In contrast, prostate cancer is not progressing when the level of reactive polypeptide either remains constant or decreases with time.

Antibodies for use in the above methods may be prepared by any of a variety of techniques known to those of ordinary skill in the art. See, e.g., Harlow and Lane, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, 1988. In one such technique, an immunogen comprising the antigenic polypeptide is initially injected into any of a wide variety of mammals (e.g., mice, rats, rabbits, sheep and goats). In this step, the polypeptides of this invention may serve as the immunogen without modification. Alternatively, particularly for relatively short polypeptides, a superior immune response may be elicited if the polypeptide is joined to a carrier protein, such as bovine serum albumin or keyhole limpet hemocyanin. The immunogen is injected into the animal host, preferably according to a predetermined schedule incorporating one or more booster immunizations, and the animals are bled periodically. Polyclonal antibodies specific for the polypeptide may then be purified from such antisera by, for example, affinity chromatography using the polypeptide coupled to a suitable solid support.

Monoclonal antibodies specific for the antigenic polypeptide of interest may be prepared, for example, using the technique of Kohler and Milstein, Eur. J. Immunol. 6:511-519, 1976, and improvements thereto. Briefly, these methods involve the preparation of immortal cell lines capable of producing antibodies having the desired specificity (i.e., reactivity with the polypeptide of interest). Such cell lines may be produced, for example, from spleen cells obtained from an animal immunized as described above. The spleen cells are then immortalized by, for example, fusion with a myeloma cell fusion partner, preferably one that is syngeneic with the immunized animal. A variety of fusion techniques may be employed. For example, the spleen cells and myeloma cells may be combined with a nonionic detergent for a few minutes and then plated at low density on a selective medium that supports the growth of hybrid cells, but not myeloma cells. A preferred selection technique uses HAT (hypoxanthine, aminopterin, thymidine) selection. After a sufficient time, usually about 1 to 2 weeks, colonies of hybrids are observed. Single colonies are selected and tested for binding activity against the polypeptide. Hybridomas having high reactivity and specificity are preferred.

Monoclonal antibodies may be isolated from the supernatants of growing hybridoma colonies. In addition, various techniques may be employed to enhance the yield, such as injection of the hybridoma cell line into the peritoneal cavity of a suitable vertebrate host, such as a mouse. Monoclonal antibodies may then be harvested from the ascites fluid or the blood. Contaminants may be removed from the antibodies by conventional techniques, such as chromatography, gel filtration, precipitation, and extraction. The polypeptides of this invention may be used in the purification process in, for example, an affinity chromatography step.

Monoclonal antibodies of the present invention may also be used as therapeutic reagents, to diminish or eliminate prostate tumors. The antibodies may be used on their own (for instance, to inhibit metastases) or coupled to one or more therapeutic agents. Suitable agents in this regard include radionuclides, differentiation inducers, drugs, toxins, and derivatives thereof. Preferred radionuclides include .sup.90 Y, .sup.123 I, .sup.125 I, .sup.131 I, .sup.186 Re, .sup.188 Re, .sup.211 At, and .sup.212 Bi. Preferred drugs include methotrexate, and pyrimidine and purine analogs. Preferred differentiation inducers include phorbol esters and butyric acid. Preferred toxins include ricin, abrin, diptheria toxin, cholera toxin, gelonin, Pseudomonas exotoxin, Shigella toxin, and pokeweed antiviral protein.

A therapeutic agent may be coupled (e.g., covalently bonded) to a suitable monoclonal antibody either directly or indirectly (e.g. via a linker group). A direct reaction between an agent and an antibody is possible when each possesses a substituent capable of reacting with the other. For example, a nucleophilic group, such as an amino or sulfhydryl group, on one may be capable of reacting with a carbonyl-containing group, such as an anhydride or an acid halide, or with an alkyl group containing a good leaving group (e.g., a halide) on the other.

Alternatively, it may be desirable to couple a therapeutic agent and an antibody via a linker group. A linker group can function as a spacer to distance an antibody from an agent in order to avoid interference with binding capabilities. A linker group can also serve to increase the chemical reactivity of a substituent on an agent or an antibody, and thus increase the coupling efficiency. An increase in chemical reactivity may also facilitate the use of agents, or functional groups on agents, which otherwise would not be possible.

It will be evident to those skilled in the art that a variety of bifunctional or polyfunctional reagents, both homo- and hetero-functional (such as those described in the catalog of the Pierce Chemical Co., Rockford, Ill.), may be employed as the linker group. Coupling may be effected, for example, through amino groups, carboxyl groups, sulfhydryl groups or oxidized carbohydrate residues. There are numerous references describing such methodology, e.g., U.S. Pat. No. 4,671,958, to Rodwell et al.

Where a therapeutic agent is more potent when free from the antibody portion of the immunoconjugates of the present invention, it may be desirable to use a linker group which is cleavable during or upon internalization into a cell. A number of different cleavable linker groups have been described. The mechanisms for the intracellular release of an agent from these linker groups include cleavage by reduction of a disulfide bond (e.g., U.S. Pat. No. 4,489,710, to Spitler), by irradiation of a photolabile bond (e.g., U.S. Pat. No. 4,625,014, to Senter et al.), by hydrolysis of derivatized amino acid side chains (e.g., U.S. Pat. No. 4,638,045, to Kohn et al.), by serum complement-mediated hydrolysis (e.g., U.S. Pat. No. 4,671,958, to Rodwell et al.), and acid-catalyzed hydrolysis (e.g., U.S. Pat. No. 4,569,789, to Blattler et al.).

It may be desirable to couple more than one agent to an antibody. In one embodiment, multiple molecules of an agent are coupled to one antibody molecule. In another embodiment, more than one type of agent may be coupled to one antibody. Regardless of the particular embodiment, immunoconjugates with more than one agent may be prepared in a variety of ways. For example, more than one agent may be coupled directly to an antibody molecule, or linkers which provide multiple sites for attachment can be used. Alternatively, a carrier can be used.

A carrier may bear the agents in a variety of ways, including covalent bonding either directly or via a linker group. Suitable carriers include proteins such as albumins (e.g., U.S. Pat. No. 4,507,234, to Kato et al.), peptides and polysaccharides such as aminodextran (e.g., U.S. Pat. No. 4,699,784, to Shih et al.). A carrier may also bear an agent by noncovalent bonding or by encapsulation, such as within a liposome vesicle (e.g., U.S. Pat. Nos. 4,429,008 and 4,873,088). Carriers specific for radionuclide agents include radiohalogenated small molecules and chelating compounds. For example, U.S. Pat. No. 4,735,792 discloses representative radiohalogenated small molecules and their synthesis. A radionuclide chelate may be formed from chelating compounds that include those containing nitrogen and sulfur atoms as the donor atoms for binding the metal, or metal oxide, radionuclide. For example, U.S. Pat. No. 4,673,562, to Davison et al. discloses representative chelating compounds and their synthesis.

A variety of routes of administration for the antibodies and immunoconjugates may be used. Typically, administration will be intravenous, intramuscular, subcutaneous or in the bed of a resected tumor. It will be evident that the precise does of the antibody/immunoconjugate will vary depending upon the antibody used, the antigen density on the tumor, and the rate of clearance of the antibody.

Diagnostic reagents of the present invention may also comprise DNA sequences encoding one or more of the above polypeptides, or one or more portions thereof. For example, at least two oligonucleotide primers may be employed in a polymerase chain reaction (PCR) based assay to amplify prostate tumor-specific cDNA derived from a biological sample, wherein at least one of the oligonucleotide primers is specific for a DNA molecule encoding a polypeptide of the present invention. The presence of the amplified cDNA is then detected using techniques well known in the art, such as gel electrophoresis. Similarly, oligonucleotide probes specific for a DNA molecule encoding a polypeptide of the present invention may be used in a hybridization assay to detect the presence of an inventive polypeptide in a biological sample.

As used herein, the term “oligonucleotide primer/probe specific for a DNA molecule” means an oligonucleotide sequence that has at least about 80% identity, preferably at least about 90% and more preferably at least about 95%, identity to the DNA molecule in question. Oligonucleotide primers and/or probes which may be usefully employed in the inventive diagnostic methods preferably have at least about 10-40 nucleotides. In a preferred embodiment, the oligonucleotide primers comprise at least about 10 contiguous nucleotides of a DNA molecule encoding one of the polypeptides disclosed herein. Preferably, oligonucleotide probes for use in the inventive diagnostic methods comprise at least about 15 contiguous oligonucleotides of a DNA molecule encoding one of the polypeptides disclosed herein. Techniques for both PCR based assays and hybridization assays are well known in the art (see, for example, Mullis et al. Ibid; Ehrlich, Ibid). Primers or probes may thus be used to detect prostate and/or prostate tumor sequences in biological samples, preferably blood, semen or prostate and/or prostate tumor tissue.

The following Examples are offered by way of illustration and not by way of limitation.

EXAMPLES

Example 1

A. Isolation of Polypeptides from LnCap.fgc Using Human Prostatitis Sera

Representative polypeptides of the present invention were isolated by screening a human prostate cancer cell line with human prostatitis sera as follows. A human prostate adenocarcinoma cDNA expression library was constructed by reverse transcriptase synthesis from mRNA purified from the human prostate adenocarcinoma cell line LnCap.fgc (ATCC No. 1740-CRL), followed by insertion of the resulting cDNA clones in Lambda ZAP II (Stratagene, La Jolla, Calif.).

Human prostatitis serum was obtained from a patient diagnosed with autoimmune prostatitis following treatment of bladder carcinoma by administration of BCG. This serum was used to screen the LnCap cDNA library as described in Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratories, Cold Spring Harbor, N.Y., 1989. Specifically, LB plates were overlaid with approximately 10.sup.4 pfu of the LnCap cDNA library and incubated at 42.degree. C. for 4 hours prior to obtaining a first plaque lift on isopropylthio-beta-galactoside (IPTG) impregnated nitrocellulose filters. The plates were then incubated for an additional 5 hours at 42.degree. C. and a second plaque lift was prepared by incubation overnight at 37.degree. C. The filters were washed three times with PBS-T, blocked for 1 hours with PBS (containing 1% Tween 20.TM.) and again washed three times with PBS-T, prior to incubation with human prostatitis sera at a dilution of 1:200 with agitation overnight. The filters were then washed three times with PBS-T and incubated with .sup.125 I-labeled Protein A (1 .mu.l/15 ml PBS-T) for 1 hour with agitation. Filters were exposed to film for variable times, ranging from 16 hours to 7 days. Plaques giving signals on duplicate lifts were re-plated on LB plates. Resulting plaques were lifted with duplicate filters and these filters were treated as above. The filters were incubated with human prostatitis sera (1:200 dilution) at 4.degree. C. with agitation overnight. Positive plaques were visualized with .sup.125 I-Protein A as described above with the filters being exposed to film for variable times, ranging from 16 hours to 11 days. In vivo excision of positive human prostatitis antigen cDNA clones was performed according to the manufacturer’s protocol.

B. Characterization of Polypeptides

DNA sequence for positive clones was obtained using forward and reverse primers on an Perkin Elmer/Applied Biosystems Division Automated Sequencer Model 373A (Foster City, Calif.). The cDNA sequences encoding the isolated polypeptides, hereinafter referred to as HPA8, HPA13, HPA15-HPA17, HPA20, HPA25, HPA28, HPA29, HPA32-HPA38 and HPA41 are presented in SEQ ID NOS: 32 and 33, 34 and 35, 36, 9 and 10, 11, 12, 13 and 14, 15, 37 and38, 16, 39, 22 and 23, 17 and 18, 19, 24, 40 and 41, 42 and 43, respectively. The 3′ sequences of HPA16 and HPA20 are identical. HPA13, HPA16, HPA20, HPA29 and HPA33 are believed to be overlapping clones with novel 5′ end points. Two of the positive clones were determined to be identical to HPA15. Also, HPA15, HPA34 and HPA37 were found to be overlapping clones. The expected N-terminal amino acid sequences of the isolated polypeptides HPA16, HPA17, HPA20, HPA25, HPA28, HPA32, HPA35, HPA36, HPA34, HPA37, HPA8, HPA13, HPA15, HPA29, HPA33, HPA38 and HPA41, based on the determined cDNA sequences in frame with the N-terminal portion of .beta.-galactosidase (lacZ) are presented in SEQ ID NOS: 1-8, 20, 21 and 25-31, respectively.

The determined cDNA and expected amino acid sequences for the isolated polypeptides were compared to known sequences in the gene bank using the EMBL and GenBank (Release 91) databases, and also the DNA STAR system. The DNA STAR system is a combination of the Swiss, PIR databases along with translated protein sequences (Release 91). No significant homologies to HPA17, HPA25, HPA28, HPA32, HPA35 and HPA36 were found.

The determined cDNA sequence for HPA8 was found to have approximately 100% identity with the human proto-oncogene BMI-1 (Alkema, M. J. et al., Hum. Mol. Gen. 2:1597-1603, 1993). Search of the DNA database with 5′ and 3′ cDNA sequence encoding HPA 13 revealed 100% identity with a known cDNA sequence from a human immature myeloid cell line (GenBank Acc. No. D63880). Search of the protein database with the deduced amino acid sequence for HPA13 revealed 100% identity with the open reading frame encoded by the same human cDNA sequence. Search of the protein database with the expected amino acid sequence for HPA15, revealed high homology (60% identity) with a Saccharomyces cerevisiae predicted open reading frame (Swiss/PIR Acc. No. S46677), and 100% identity with a human protein from pituitary gland modulating intestinal fluid secretion (Lonnroth, I., J. Biol. Chem. 35:20615-20620, 1995). The deduced amino acid sequence for HPA38 was found to have 100% identity with human heat shock factor protein 2 (Schuetz, T. J. et al., Proc. Natl. Acad. Sci. USA 88:6911-6915, 1991). Search of the DNA database with the 5′ DNA sequence for HPA41 and search of the protein database with the deduced amino acid sequence revealed 100% identity with a human LIM protein (Rearden, A., Biochem. Biophys. Res. Commun. 201:1124-1131, 1994). To the best of the inventors’ knowledge, except for LIM protein, none of the inventive polypeptides have been previously shown to be present in human prostate.

Positive phagemid viral particles were used to infect E. coli XL-1 Blue MRF’, as described in Sambrook et al., supra. Induction of recombinant protein was accomplished by the addition of IPTG. Induced and uninduced lysates were run in duplicate on SDS-PAGE and transferred to nitrocellulose filters. Filters were reacted with human prostatitis sera (1:200 dilution) and a rabbit sera (1:200 or 1:250 dilution) reactive with the N-terminal 4 Kd portion of lacZ. Sera incubations were performed for 2 hours at room temperature. Bound antibody was detected by addition of .sup.125 I-labeled Protein A and subsequent exposure to film for variable times ranging from 16 hours to 11 days. The results of the immunoblots are summarized in Table I, wherein (+) indicates a positive reaction and (-) indicates no reaction.

TABLE I ______________________________________ Human Prostatitis Anti-lacZ Protein Antigen Sera Sera Mass/Kd ______________________________________ HPA8 (-) (-) HPA13 (+) (+) HPA15 (+) (+) 50 HPA16 (+) (+) 40 HPA17 (+) (-) 40 HPA20 (+) (+) 38 HPA25 (-) (+) 32 HPA28 (-) (-) HPA29 (+) (+) HPA32 (-) (-) HPA33 (+) (+) HPA34 not tested (+) 50 HPA35 (-) (-) HPA36 (-) (-) HPA37 not tested (+) 50 HPA38 (-) (-) HPA41 not tested (+) ______________________________________

Positive reaction of the recombinant human prostatitis antigens with both the human prostatitis sera and anti-lacZ sera indicate that reactivity of the human prostatitis sera is directed towards the fusion protein. Cloned antigens showing reactivity to the human prostatitis sera but not to anti-lacZ sera indicate that the reactive protein is likely initiating within the clone. Antigens reactive with the anti-lacZ sera but not with the human prostatitis sera may be the result of the human prostatitis sera recognizing conformational epitopes, or the antigen-antibody binding kinetics may be such that the 2 hour sera exposure in the immunoblot is not sufficient. Antigens not reactive with either sera are not being expressed in E. coli, and reactive epitopes may be within the fusion protein or within an internal open reading frame. Due to the instability of recombinant antigens from HPA13, HPA29 and HPA33, it was not possible to determine the size of the recombinant antigens.

The expression of representative human prostatitis antigens was investigated by RT-PCR in four different human cell lines (including two metastatic prostate tumor lines LNCaP and DU145), normal prostate, breast, colon, kidney, stomach, lung and skeletal muscle tissue, nine different prostate tumor samples and three different breast tumor samples. The results of these studies are shown in Table II.

TABLE II __________________________________________________________________________ Analysis of HPA clone mRNA expression by RT-PCR in human cell lines, normal tissues and tumors Clone LNCaP DU145 MCF-12A HBL-100 Prostate Breast Colon Kidney Stomach Lung Skel. Muscle __________________________________________________________________________ hpa-17 + ++ + + + – .+-. – - + + hpa-20 +++ ++++ NT NT .+-. NT NT – NT + NT hpa-28 + +++ + + + – .+-. + – + .+-. __________________________________________________________________________ Prostate Tumors (n = 9) Breast Tumors (n = 3) Tumor Tumor Tumor Tumor Tumor Tumor Tumor Tumor Tumor Tumor Tumor Tumor Clone 1 2 3 4 5 6 7 8 9 1 2 3 __________________________________________________________________________ hpa-17 + + + – + + .+-. – - + ++ ++ hpa-20 + + NT NT NT NT NT NT NT + + +++ hpa-28 + + .+-. – + + ++ .+-. – ++ +++ + __________________________________________________________________________

mRNA expression of representative antigens in LNCaP and normal prostate, kidney, liver, stomach, lung and pancreas was also investigated by RNase protection. The results of these studies are provided in Table III.

TABLE III __________________________________________________________________________ Analysis of HPA clone mRNA expression by RNase protection in LNCaP and normal human tissues Clone LNCaP Prostate Kidney Liver Stomach Lung Pancreas __________________________________________________________________________ hpa-15 + – ++ ++ + – ++ hpa-20 +++++ + + + + NT NT hpa-25 + + + + ++ ++ NT hpa-32 NT ++ + + NT ++ NT hpa-35 +++ +++ NT + + +++ + hpa-36 + + NT NT + + + __________________________________________________________________________

Example 2

A. Isolation and Characterization of Rat Steroid Binding Protein

Immune sera was obtained from rats immunized with rat prostate extract to generate antibodies to self prostate antigens. Specifically, rats were prebled to obtain control sera prior to being immunized with a detergent extract of rat prostate (in PBS containing 0.1% Triton) in Freunds complete adjuvant. A boost of incomplete Freunds adjuvant was given 3 weeks after the initial immunization and sera was harvested at 6 weeks.

The sera thus obtained was subjected to ECL Western blot analysis (Amersham International, Arlington Heights, Ill.) using the manufacturer’s protocol and a rat prostate protein was identified, as shown in FIG. 1. After reduction, SDS-PAGE revealed a broad silver staining band migrating at 7 kD. Without reduction, a strong band was seen at 24 kD (FIG. 2). This protein was purified by ion exchange chromatography and subjected to gel electrophoresis under reduced conditions. Three bands were seen, indicating the presence of three chains within the protein: a 6-8 kD chain (C1), a 8-10 kD chain (C2) and a 10-12 kD chain (C3). The protein was further purified by reverse phase HPLC on a Delta.TM. C18 300 A.degree. 5 .mu.m column, column size 3.9.times.300 mm (Waters-Millipore, Milford, Mass.). The sample containing 100 .mu.g of protein was dissolved in 0.1% trifluoroacetic acid (TFA), pH 1.9 and polypeptides were eluted with a linear gradient of acetonitrile (0-60%) in 0.1% TFA pH 1.9 at a flow rate of 0.5 mL/min for 1 hour. The eluent was monitored at 214 nm. Two peaks were obtained, a C1-C3 dimer and a C2-C3 dimer. The amino terminus of the C2 chain was found to be blocked. The C1 and C3 chains were sequenced on a Perkin Elmer/Applied Biosystems Inc. Procise Model 494 protein sequencer and found to have the following amino terminal sequences (SEQ ID NOS: 44 and 45, respectively).

(a) Ser-Gln-Ile-Cys-Glu-Leu-Val-Ala-His-Glu-Thr-Ile-Ser-Phe-Leu; and

(b) Xaa-Xaa-Xaa-Xaa-Xaa-Ser-Ile-Leu-asp-Glu-Val-Ile-Arg-Gly-Thr,

wherein Xaa may be any amino acid.

These sequences were compared to known sequences in the gene bank using the databases discussed in Example 1 and were found to be identical to rat steroid binding protein, also known as estramustine-binding protein (EMBP) (Forsgren, B. et al., Prog. Clin. Biol. Res. 75A :391-407, 1981; Forsgren, B. et al., Proc. Natl. Acad. Sci. USA 76:3149-53, 1979). This protein is a major secreted protein in rat seminal fluid and has been shown to bind steroid, cholesterol and proline rich proteins. EMBP has been shown to bind estramustine and estromustine, the active metabolites of estramustine phosphate. Estramustine phosphate has been found to be clinically useful in treating advanced prostate cancer in patients who do not respond to standard hormone ablation therapy (see, for example, Van Poppel, H. et al., Prog. Clin. Biol. Res. 370:323-41, 1991).

B. Isolation of Putative Human Homologue to Rat Steroid Binding Protein

Purified rat steroid binding protein was obtained from freshly excised rat prostate and used to subcutaneously immunize a New Zealand white virgin female rabbit (150 .mu.g purified rat steroid binding protein in 1 ml of PBS and 1 ml of incomplete Freund’s adjuvant containing 100 .mu.g of muramyl dipeptide (adjuvant peptide, Calbiochem, La Jolla, Calif.). Six weeks later the rabbit was boosted subcutaneously with the same protein dose in incomplete Freund’s adjuvant. Finally, the rabbit was boosted intravenously two weeks later with 100 .mu.g protein in PBS and the sera harvested two weeks after the final immunization.

The resulting rabbit antisera was used to screen the LnCap.fgc cell line without success. The rabbit antisera was subsequently used to screen human seminal fluid anion exchange chromatography pools using the protocol detailed below in Example 3. This analysis indicated an approximately 18-22 kD cross-reactive protein. The seminal fluid fraction of interest (Fraction 1) was separated into individual components by SDS-PAGE under non-reducing conditions, blotted onto a PVDF membrane, excised and digested with CNBr in 70% formic acid. The resulting CNBr fragments were resolved on a tricine gel system, again electroblotted to PVDF and excised. The sequence for one peptide was determined as follows:

Val-Val-Lys-Thr-Tyr-Leu-Ile-Ser-Ser-Ile-Pro-Leu-Gln-Gly-Ala-Phe-Asn-Tyr-Lys -Tyr-Thr-Ala (SEQ ID NO: 46).

This sequence was compared to known sequences in the gene bank using the databases identified above and was unexpectedly found to be identical to gross cystic disease fluid protein, a protein whose expression was previously found to correlate with the presence of metastatic breast cancer (Murphy, L. C. et al., J. Biol. Chem. 262:15236-15241, 1987). To the best of the inventors’ knowledge, this protein has not been previously identified in male tissues.

The ability of Fraction 1 as described above, to bind to steroid was investigated as follows. Purified rat steroid binding protein (RSBP) and fraction 1 were subjected to SDS-PAGE and transferred onto nitrocellulose filters. Specifically, 1.5 .mu.g of RSBP/gel lane and 4 .mu.g of fraction 1/gel lane were electrophoresed in parallel on a 4-20% gradient Laemmli gel (BioRad), then electrophoretically transferred to nitrocellulose. After protein transfer, the nitrocellulose was blocked for 1 hour at room temperature in 1% Tween 20 in PBS, rinsed three times for 10 min each in 10 ml 0.1% Tween 20 in PBS plus 0.5 M NaCl, then probed with either 1) 0.87 .mu.M progesterone conjugated to horseradish peroxidase (HRP, Sigma) diluted in the rinse buffer; 2) 0.87 .mu.M progesterone HRP with 200 .mu.M estramustine; or 3) 0.87 .mu.M progesterone HRP plus 400 .mu.M unlabelled progesterone and 200 .mu.M estramustine. Each reaction mixture was incubated for 1 hour at room temperature and washed three times for 10 min each with 0.1% Tween 20 , PBS, and 0.5 M NaCl. The blots were then developed (ECL system, Amersham) to reveal progesterone HRP binding proteins that are also capable of binding estramustine.

With both rat steroid binding protein and Fraction 1, three bands were obtained that bound HRP-progesterone and that were competed out with unlabelled progesterone and estramustine (FIG. 3). These results indicate that the three bands isolated from human seminal fluid as described above bind hormone and correspond in number of polypeptides to the chains C1, C2 and C3 of rat steroid binding protein, although slightly bigger in size, either due to primary sequence or secondary post-translational modifications.

This putative homologue of rat steroid binding protein was also identified in a subsequent screen of human seminal fluid using the rabbit antisera detailed above. Specifically a hydrophobic 22 kD/65 kD aggregate protein was obtained which, following CNBr digestion of the 22 kD band, provided a peptide having the following sequence:

Val-Val-Lys-Thr-Tyr-Leu-Ile-Ser-Ser-Ile-Pro-Leu-Gln-Ala-Phe-Asn-Tyr-Lys-Tyr -Thr-Ala (SEQ ID NO: 47).

This peptide was found to correspond to residues 67 through 87 of gross cystic disease fluid protein and was identified again utilizing human autoimmune prostatitis sera as discussed below in Example 4.

Example 3

Isolation and Characterization of Polypeptides Isolated from LnCaP.fgc Using Rat Prostatitis Sera

A LnCap.fgc cell pellet was homogenized (10 gm cell pellet in 10 ml) by resuspension in PBS, 1% NP-40 and 60 .mu.g/ml phenylmethylsulfonyl fluoride (PMSF) (Sigma, St. Louis, Mo.) then 10 strokes in a Dounce homogenizer. This was followed by a 30 second probe sonication and another 10 strokes in the Dounce homogenizer. The resulting slurry was centrifuged at 10,000.times.G, and the supernatant filtered with a 0.45 .mu.M filter (Amicon, Beverly, Mass.) then applied to a BioRad (Hercules, Calif.) Macro-Prep Q-20 anion exchange resin. Proteins were eluted with a 70 minute 0 to 0.8 M NaCl gradient in 20 mM tris pH 7.5 at a flow rate of 8 ml/min. Fractions were cooled, concentrated with 10 kD MWCO centriprep concentrators (Amicon) and stored at -20.degree. C. in the presence of 60 .mu.g/ml PMSF. The ion exchange pools were then examined by electrophoresis on 4-20% tris glycine Ready-Gels (BioRad) and subsequent transfer to nitrocellulose filters. Ion exchange pools of interest were identified by ECL (Amersham International) Western analysis, using the rat sera described above in Example 2A. This analysis indicated an approximately 65 kD protein eluting at 0.08 to 0.13 M NaCl. The rat sera reactive ion exchange pool was subjected to HPLC and subsequent Western analysis to identify the protein fraction of interest. This protein was then digested for 24 hours at 25.degree. C. in 70% formic acid saturated with CNBr to cleave at methionine residues.

The resulting CNBr fragments were purified by microbore HPLC using a Vydac C18 column (Hesperia, Calif.), column size 1.times.150 mM in a Perkin Elmer/Applied Biosystems Inc. (Foster City, Calif.) Division Model 172 HPLC. Fractions were eluted from the column with a gradient of 0 to 60% of acetonitrile at a flow rate of 40 .mu.l per minute. The eluent was monitored at 214 nm. The resulting fractions were loaded directly onto a Perkin Elmer/Applied Biosystems Inc. Procise 494 protein sequencer and sequenced using standard Edman chemistry from the amino terminal end. Two different peptides having the following sequences were obtained:

(a) Xaa-Ala-Lys-Lys-Phe-Leu-Asp-Ala-Glu-His-Lys-Leu-Asn-Phe-Ala (SEQ ID NO: 48); and

(b) Xaa-Xaa-Xaa-Lys-Ile-Lys-Lys-Phe-Ile-Gln-Glu-Asn-Ile-Phe-Gly,

wherein Xaa may be any amino acid (SEQ ID NO: 49).

These sequences were compared to known sequences in the gene bank using databases identified above, and identified as residues 286 through 300 and 228 through 242, respectively, of probable protein disulfide isomerase ER-60 precursor, hereinafter referred to as ER-60 (Bado, R. J. et al., Endocrinology 123:1264-1273, 1988). This antigen is also known as phospholipase C-alpha (see PCT WO 95/08624). Residues 285 and 227 of ER-60 are methionines, consistent with the above sequences being cyanogen bromide fractions.

ER-60 is a resident endoplasmic protein with multiple biological activities, including disulfide isomerase and restricted cysteine protease activity. In particular, ER-60 has been shown to preferentially degrade calnexin, a protein involved in presentation of antigens via the Class I major histocompatability complex, or MHC, pathway. ER-60 and a related family member, ER-72, have been shown to be over-expressed in colon cancer, with truncated forms of ER-60 exhibiting increased enzymatic activity (Egea, G. et al., J. Cell. Sci. (England) 105:819-30, 1993). However, to the best of the inventors’ knowledge, this polypeptide has not been previously shown to be present or overexpressed in human prostate. Recently, ER-60 gene expression has been correlated with induction of contact inhibition of cell proliferation (Greene, J. J. et al., Cell. Mol. Biol. 41:473-80, 1995). Thus, if ER-60 is also truncated and non-functional in prostate cancer, as it is in colon cancer, the resultant loss of contact inhibition would lead to neoplastic transformation and tumor progression.

Example 4

Isolation and Characterization of Polypeptides Isolated from LnCaP.fgc Using Human Prostatitis Sera

The human prostatitis sera described above in Example 1 was used to screen the LnCaP.fgc cell line using the ion exchange techniques described above in Example 3. Reactive ion exchange pools were purified by reverse phase HPLC as described previously and the polypeptides shown in SEQ ID NOS: 50-56 were isolated utilizing cross-reactivity with said antisera as the selection criteria. Comparison of these sequences with known sequences in the gene bank using the databases described above revealed the homologies shown in Table II. However, none of these polypeptides have been previously associated with human prostate.

TABLE IV ______________________________________ SEQ ID NO: Database Search Identification ______________________________________ 50 glyceraldehyde-3-phosphate- dehydrogenase 51 alpha-human fructose biphosphate aldolase 52 calreticulin 53 calreticulin 54 malate dehydrogenase 55 cystic disease fluid protein 56 cystic disease fluid protein ______________________________________

Example 5

Isolation and Characterization of Polypeptides from Human Seminal Fluid

Polypeptides from human seminal fluid were purified to homogeneity by anion exchange chromatography. Specifically, seminal fluid samples were diluted 1 to 10 with 0.1 mM Bis-Tris propane buffer pH 7 prior to loading on the column. The polypeptides were fractionated into pools utilizing gel profusion chromatography on a Poros (Perseptive Biosystems) 146 II Q/M anion exchange column 4.6 mm.times.100 mm equilibrated in 0.01 mM Bis-Tris propane buffer pH 7.5. Proteins were eluted with a linear 0-0.5 M NaCl gradient in the above buffer. The column eluent was monitored at a wavelength of 220 nm. Individual fractions were further purified by reverse phase HLPC on a Vydac (Hesperia, Calif.) C18 column.

The resulting fractions were sequenced as described above in Example 3. A peptide having the following N-terminal sequence was obtained:

(c) Met-Asp-Ile-Pro-Gln-Thr-Lys-Gln-Asp-Leu-Glu-Leu-Pro-Lys-Leu (SEQ ID NO:57).

Comparison of this sequence with those of known sequences in the gene bank as described above revealed 100% identity with human placental protein 14 (PP14).

Example 6

Isolation of Polypeptides from a Prostate Tumor cDNA Library using Monkey Anti-Prostate Sera

A female cynomologous monkey was immunized with homogenized monkey prostate plus complete Freund’s adjuvant. A booster immunization, using the same immunogen, was given one month later. Sera was taken from this monkey two months after the first immunization. This sera was pre-cleared of E. coli and phage antigens and used at a 1:200 dilution to screen a primary prostate tumor expression library prepared in Lambda ZAP II (Stratagene).

Two positive clones identified in the screen (hereinafter referred to as JF3 and JF5) were found to be non-sister clones from the same gene. The clones were excised and insert size was determined by restriction digest (JF3=1500 bp, JF5=1000 bp). Complete DNA sequencing of these clones with both vector and internal primers indicated that the sequence of JF5 was found within that of JF3. Similarly, the partial open reading frame found in JF5 was found to be contained wholly within JF3. The determined cDNA sequences for JF3 and JF5 are provided in SEQ ID NO: 58 and 59, respectively, with the corresponding predicted amino acid sequences being provided in SEQ ID NO: 60 and 61, respectively. Comparison of these sequences with those in the gene bank as described above revealed no significant homologies.

The expression of these antigens in various tissue types was investigated using RT-PCR. Over-expression was found in 2 out of 5 prostate tumor samples, 3 out of 5 normal prostate samples, 1 out of 2 breast tumor samples, and in a normal kidney sample and a normal brain sample. Northern analysis indicated that these antigens may be expressed both in prostate and testis.

Example 7

Synthesis of Polypeptides

Polypeptides may be synthesized on an Applied Biosystems 430A peptide synthesizer using FMOC chemistry with HPTU (O-Benzotriazole-N,N,N’,N’-tetramethyluronium hexafluorophosphate) activation. A Gly-Cys-Gly sequence may be attached to the amino terminus of the peptide to provide a method of conjugation, binding to an immobilized surface, or labeling of the peptide. Cleavage of the peptides from the solid support may be carried out using the following cleavage mixture: trifluoroacetic acid:ethanedithiol:thioanisole:water:phenol (40:1:2:2:3). After cleaving for 2 hours, the peptides may be precipitated in cold methyl-t-butyl-ether. The peptide pellets may then be dissolved in water containing 0.1% trifluoroacetic acid (TFA) and lyophilized prior to purification by C18 reverse phase HPLC. A gradient of 0%-60% acetonitrile (containing 0.1% TFA) in water (containing 0.1% TFA) may be used to elute the peptides. Following lyophilization of the pure fractions, the peptides may be characterized using electrospray or other types of mass spectrometry and by amino acid analysis.

From the foregoing, it will be appreciated that, although specific embodiments of the invention have been described herein for the purposes of illustration, various modifications may be made without deviating from the spirit and scope of the invention.

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