US20120020954A1 - Methods of predicting clinical course and treating multiple sclerosis - Google Patents

Methods of predicting clinical course and treating multiple sclerosis Download PDF

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US20120020954A1
US20120020954A1 US13/260,573 US201013260573A US2012020954A1 US 20120020954 A1 US20120020954 A1 US 20120020954A1 US 201013260573 A US201013260573 A US 201013260573A US 2012020954 A1 US2012020954 A1 US 2012020954A1
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Anat Achiron
Michael Gurevich
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Tel HaShomer Medical Research Infrastructure and Services Ltd
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    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
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    • C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • C12Q2600/00—Oligonucleotides characterized by their use
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    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/136—Screening for pharmacological compounds
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    • C12Q2600/00—Oligonucleotides characterized by their use
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    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/166—Oligonucleotides used as internal standards, controls or normalisation probes

Definitions

  • the present invention in some embodiments thereof, relates to methods of classifying a subject as having benign multiple sclerosis or typical relapsing remitting multiple sclerosis and, more particularly, but not exclusively, to methods of treating multiple sclerosis based on same.
  • MS Multiple sclerosis
  • CNS central nervous system
  • the disease is characterized by destruction of myelin, associated with death of oligodendrocytes and axonal loss.
  • the main pathologic finding in MS is the presence of infiltrating mononuclear cells, predominantly T lymphocytes and macrophages, which surpass the blood brain barrier and induce an active inflammation within the brain and spinal cord.
  • the neurological symptoms that characterize MS include complete or partial vision loss, diplopia, sensory symptoms, motor weakness that can worsen to complete paralysis, bladder dysfunction and cognitive deficits, which eventually may lead to a significant disability.
  • the associated multiple inflammatory foci lead to myelin destruction, plaques of demyelination, gliosis and axonal loss within the brain and spinal cord and are the reasons contribute to the clinical manifestations of neurological disability.
  • MS The etiology of MS is not fully understood.
  • the disease develops in genetically predisposed subjects exposed to yet undefined environmental factors and the pathogenesis involves autoimmune mechanisms associated with autoreactive T cells against myelin antigens. It is well established that not one dominant gene determines genetic susceptibility to develop MS, but rather many genes, each with different influence, are involved.
  • RRMS relapsing-remitting course
  • PPMS primary progressive course
  • Benign MS is a clinical variant of RRMS in which the patients develop low neurological disability if at all after a disease duration of at least 10 years. Accordingly, this group of MS patients do not experience devastating accumulating disability over-time and when these patients are examined neurologically and scored by the Expanded Disability Status Scale (EDSS) they receive a score that is equal to or lower than 3.0. This low EDSS score signifies mild disability and when this low disability occurs more than 10 years after disease onset, the course of MS is defined as benign (Pittock S J and Rodriguez M, 2008; Costelloe, L., et al., 2008). Prediction of patients that will have BMS is currently impossible and the definition of these patients is retrospective. The molecular events accountable for the BMS variant of disease are not understood.
  • EDSS Expanded Disability Status Scale
  • TPT Diterpenoid triepoxide Triptolide
  • the Chinese herb Tripterygium wilfordii (Leuenroth S J and Crews C M. Triptolide-induced transcriptional arrest is associated with changes in nuclear substructure. Cancer Res. 2008; 68:5257-5266) has various anti-inflammatory effects (Liu Y, et al. Triptolide, a component of Chinese herbal medicine, modulates the functional phenotype of dendritic cells. Transplantation. 2007; 84:1517-1526), it modulates T-cell inflammatory responses and ameliorates Experimental Autoimmune Encephalomyelitis (Wang Y, et al.
  • Triptolide modulates T-cell inflammatory responses and ameliorates experimental autoimmune encephalomyelitis. J Neurosci Res. 2008; 86:2441-2449). Derivatives of TPT were suggested for treating autoimmune diseases (EP 0983256, PCT/US1998/008562; WO9852933A1).
  • Cycloheximide inhibits the phosphorylation of RRN3 and causes its dissociation from RNA polymerase I.
  • RRN3 interacts with the rpa43 subunit of RNA polymerase I, and treatment with cycloheximide inhibits the formation of a RRN3/rpa43 complex in vivo (Alice H. Cavanaugh, et al., 2002.
  • Rrn3 Phosphorylation is a regulatory checkpoint for ribosome biogenesis J. Biol. Chem., 2002; 277: 27423-27432).
  • PCT Application No. PCT/IL2007/32856 discloses methods and kits for predicting prognosis of multiple sclerosis.
  • PCT Application No. PCT/IL2007/001617 discloses methods and kits for predicting the prognosis of a subject diagnosed with multiple sclerosis and methods of selecting a treatment regimen of a subject diagnosed with multiple sclerosis.
  • Achiron A et al., 2007 (Clinical and Experimental Immunology, 149: 235-242) describe genes of the zinc-ion binding and cytokine activity regulation pathways which predict outcome in relapsing-remitting multiple sclerosis.
  • a method of classifying a subject as being more likely to have benign multiple sclerosis (BMS) or as being more likely to have typical relapsing remitting multiple sclerosis (RRMS), the method comprising comparing a level of expression of at least one gene involved in the RNA polymerase I pathway in a cell of the subject to a reference expression data of the at least one gene obtained from a cell of at least one subject pre-diagnosed as having BMS and/or from a cell of at least one subject pre-diagnosed as having typical RRMS, thereby classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS.
  • BMS benign multiple sclerosis
  • RRMS typical relapsing remitting multiple sclerosis
  • a subject pre-diagnosed with multiple sclerosis as having benign multiple sclerosis (BMS) or typical relapsing remitting multiple sclerosis (RRMS)
  • BMS benign multiple sclerosis
  • RRMS typical relapsing remitting multiple sclerosis
  • a method of monitoring an efficiency of an anti multiple sclerosis (MS) drug in treating a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS) course comprising:
  • a method of treating a subject diagnosed with multiple sclerosis comprising
  • step (b) selecting a treatment regimen based on classification results of step (a); thereby treating the subject diagnosed with multiple sclerosis.
  • a method of treating a subject diagnosed with multiple sclerosis comprising:
  • TPT diterpenoid triepoxide Triptolide
  • a probeset comprising a plurality of oligonucleotides and no more than 50 oligonucleotides, wherein an oligonucleotide of the plurality of oligonucleotides specifically recognizes a polynucleotide of at least one gene involved in the RNA polymerase pathway.
  • kits for classifying a disease course in a subject diagnosed with multiple sclerosis comprising the probeset of claim 7 .
  • a method of selecting a drug for treating a typical relapsing remitting multiple sclerosis (RRMS) in a subject comprising:
  • the at least one drug molecule is suitable for treating the typical RRMS in the subject,
  • a decrease above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from the at least one subject having the typical RRMS classifies the subject as being more likely to have the BMS.
  • an increase above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from the at least one subject having the BMS classifies the subject as being more likely to have the typical RRMS.
  • a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from the at least one subject having the BMS, then the subject is classified as being more likely to have the BMS.
  • a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from the at least one subject having the typical RRMS, then the subject is classified as being more likely to have the typical RRMS.
  • the treatment regimen comprises administering to the subject an agent which downregulates the level of expression of the at least one gene involved in the RNA polymerase I pathway.
  • the at least one gene involved in the RNA polymerase 1 pathway is selected from the group consisting of POLR1D, LRPPRC, RRN3 and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises the POLR1D, LRPPRC, RRN3 and NCL genes.
  • the agent is selected from the group consisting of an siRNA, an antisense, an antibody and a small molecule.
  • the small molecule is Cycloheximide.
  • the at least one gene is RRN3, and whereas the downregulating is effected using diterpenoid triepoxide Triptolide (TPT) or a derivative thereof.
  • TPT diterpenoid triepoxide Triptolide
  • the at least one gene is RRN3, and whereas the downregulating is effected using Cycloheximide.
  • the kit further comprising a positive control for an expression level of the at least one gene involved in the RNA polymerase pathway.
  • each of the plurality of oligonucleotides is bound to a solid support.
  • the plurality of oligonucleotides are bound to the solid support in an addressable location.
  • the level of expression is determined using an RNA detection method.
  • the level of expression is determined using a protein detection method.
  • the cell is a blood cell.
  • the method further comprising administering to the subject a therapeutically effective amount of an anti MS agent.
  • a method of predicting a benign multiple sclerosis course in a subject diagnosed with multiple sclerosis comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IP
  • a method of predicting a benign multiple sclerosis course in a subject diagnosed with multiple sclerosis comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036, TUBB2, PDCL, CCL5, CDS
  • a method of monitoring treatment with an anti MS drug in a subject in need thereof comprising: (a) treating the subject with the anti MS drug; and (b) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036, TUBB2, PD
  • step (b) is effected also prior to step (a) and wherein the upregulation is with respect to a level of the at least one polynucleotide prior to the treating.
  • a method of monitoring treatment with an anti MS drug in a subject in need thereof comprising: (a) treating the subject with the anti MS drug; and (b) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NR
  • step (b) is effected also prior to step (a) and wherein the downregulation is with respect to a level of the at least one polynucleotide prior to the treating.
  • a method of predicting a typical relapsing-remitting multiple sclerosis (RRMS) course in a subject diagnosed with multiple sclerosis comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036,
  • a method of predicting a typical relapsing-remitting multiple sclerosis (RRMS) course in a subject diagnosed with multiple sclerosis comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF
  • a method of treating a subject diagnosed with multiple sclerosis comprising: (a) determining if the subject is predicted to have a relapsing-remitting multiple sclerosis course according to the method of the invention, (b) selecting a treatment regimen based on the prediction of the relapsing-remitting multiple sclerosis course; thereby treating the subject diagnosed with multiple sclerosis.
  • a method of treating a subject diagnosed with multiple sclerosis comprising: (a) determining in a biological sample of the subject a level of expression of RRN3, wherein upregulation above a predetermined threshold in the level of expression relative to a level of expression of the RRN3 in a biological sample of a subject diagnosed with benign multiple sclerosis (BMS) is indicative of the prediction of the relapsing-remitting multiple sclerosis course of the subject; (b) administering to the subject a therapeutically effective amount of diterpenoid triepoxide Triptolide (TPT) or a derivative thereof, thereby treating the subject.
  • BMS benign multiple sclerosis
  • a method of treating a subject diagnosed with multiple sclerosis comprising: administering to the subject an agent which downregulates the expression level and/or activity of at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway, with the proviso that the agent is not diterpenoid triepoxide Triptolide (TPT), thereby treating the subject.
  • an agent which downregulates the expression level and/or activity of at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway, with the proviso that the agent is not diterpenoid triepoxide Triptolide (TPT), thereby treating the subject.
  • TPT diterpenoid triepoxide Triptolide
  • a probeset comprising a plurality of oligonucleotides and no more than 500 oligonucleotides, the plurality of oligonucleotides specifically recognizing the polynucleotides of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IPW, FLJ20152, SIRPB
  • kits for predicting a benign or relapsing-remitting course in a subject diagnosed with multiple sclerosis comprising the probeset of the invention.
  • the kit further comprising a positive control for an expression level of at least one of the polynucleotides.
  • the at least one polynucleotide comprises the polynucleotides of RRN3, POLR1D and LRPPRC.
  • the treatment regimen comprises administering to the subject an agent which downregulates the expression level and/or activity of at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway, thereby treating the subject.
  • the at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway comprises RRN3.
  • the at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway further comprises POLR1D and LRPPRC.
  • the method further comprising determining in the biological sample of the subject the level of expression of POLR1D and/or LRPPRC, wherein upregulation above a predetermined threshold in the level of expression relative to a level of expression of the POLR1D and/or LRPPRC in a biological sample of a subject diagnosed with benign multiple sclerosis (BMS) is indicative of the prediction of the relapsing-remitting multiple sclerosis course of the subject.
  • BMS benign multiple sclerosis
  • Implementation of the method and/or system of embodiments of the invention can involve performing or completing selected tasks manually, automatically, or a combination thereof. Moreover, according to actual instrumentation and equipment of embodiments of the method and/or system of the invention, several selected tasks could be implemented by hardware, by software or by firmware or by a combination thereof using an operating system.
  • a data processor such as a computing platform for executing a plurality of instructions.
  • the data processor includes a volatile memory for storing instructions and/or data and/or a non-volatile storage, for example, a magnetic hard-disk and/or removable media, for storing instructions and/or data.
  • a network connection is provided as well.
  • a display and/or a user input device such as a keyboard or mouse are optionally provided as well.
  • FIG. 1 is a schematic illustration depicting the design of the study for identification of genes which predict benign multiple sclerosis
  • FIG. 2 depicts Principal Component Analysis (PCA) based on 406 most informative genes (MIGs);
  • the present invention in some embodiments thereof, relates to methods of classifying a subject as being more likely to have BMS or to be more likely to have typical RRMS and, more particularly, but not exclusively, to methods of diagnosing typical RRMS or BMS and treating a subject based on the diagnosis.
  • the present inventors have applied a high throughput gene expression technology to identify biomarkers for the diagnosis of benign multiple sclerosis (BMS) and for potential targets for therapeutic interventions in order switch RRMS course of disease to a BMS course of disease.
  • BMS benign multiple sclerosis
  • Example 1 of the Examples section which follows the present inventors have identified 406 genes which are differentially expressed between multiple sclerosis subjects having a benign MS course or an RRMS course (typical RRMS) (Tables 1 and 2). These genes can be used for classification of MS disease course, diagnosis of a typical RRMS course and selecting a suitable treatment regimen for a subject diagnosed with MS which will prevent deterioration in the subject's state while avoiding unnecessary side effects.
  • Example 3 Example 1
  • Tables 4A-C Example 2
  • the present inventors have uncovered that the expression level of genes which are involved in the RNA polymerase I pathway such as POLR1D, LRPPRC, RRN3 and NCL is downregulated in subjects having a BMS course of MS as compared to the expression level of these genes in subjects having an RRMS course of MS.
  • Tables 5 and 6 Example 2 the present inventors identified MIGs (most informative genes) discriminating between BMS and typical RRMS and genes which can classify subjects as having a BMS or a typical RRMS.
  • a method of classifying a subject as being more likely to have benign multiple sclerosis (BMS) or as being more likely to have typical relapsing remitting multiple sclerosis (RRMS), the method comprising comparing a level of expression of at least one gene involved in the RNA polymerase I pathway in a cell of the subject to a reference expression data of the at least one gene obtained from a cell of at least one subject pre-diagnosed as having BMS and/or from a cell of at least one subject pre-diagnosed as having typical RRMS, thereby classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS.
  • BMS benign multiple sclerosis
  • RRMS typical relapsing remitting multiple sclerosis
  • subject refers to mammal, preferably a human being.
  • the subject is diagnosed with multiple sclerosis.
  • the phrase “diagnosed with multiple sclerosis” refers to a subject who experienced at least one neurological attack affecting the central nervous system (CNS) accompanied by demyelinating lesions within the brain or spinal cord, which may have, but not necessarily confirmed by magnetic resonance imaging (MRI).
  • the neurological attack can involve acute or sub-acute neurological symptomatology (attack) manifested by various clinical presentations like unilateral loss of vision, vertigo, ataxia, incoordination, gait difficulties, sensory impairment characterized by paresthesia, dysesthesia, sensory loss, urinary disturbances until incontinence, diplopia, dysarthria, various degrees of motor weakness until paralysis, cognitive decline either as a monosymptomatic or in combination.
  • the symptoms usually remain for several days to few weeks, and then partially or completely resolve.
  • the subject is suspected of having multiple sclerosis.
  • the subject has probable multiple sclerosis.
  • the subject does not have a primary progressive course (PPMS).
  • PPMS primary progressive course
  • the subject does not have a secondary progressive MS course (SPMS).
  • SPMS secondary progressive MS course
  • classifying refers to determining if the subject is more likely to have benign multiple sclerosis (BMS) or typical relapsing remitting multiple sclerosis (RRMS).
  • BMS benign multiple sclerosis
  • RRMS typical relapsing remitting multiple sclerosis
  • being more likely to have refers to having increased probability to have a certain disease course (classification of disease) than another disease course.
  • the phrase “being more likely to have” refers to a probability of at least about 51%, at least about 52%, at least about 53%, at least about 54%, at least about 55%, at least about 56%, at least about 57%, at least about 58%, at least about 59%, at least about 60%, at least about 61%, at least about 62%, at least about 63%, at least about 64%, at least about 65%, at least about 66%, at least about 67%, at least about 68%, at least about 69%, at least about 70%, at least about 71%, at least about 72%, at least about 73%, at least about 74%, at least about 75%, at least about 76%, at least about 77%, at least about 78%, at least about 79%, at least about 80%, at least about 81%, at least about 82%, at least about 83%, at least about 84%, at least about 85%, at least about 86%, at least about 87%, at least about 88%, at least about 8
  • the phrase “benign multiple sclerosis” refers to a subject having MS and exhibiting an Expanded Disability Status Scale (EDSS) of less than 3.0 following at least 10 years from onset and/or diagnosis of MS.
  • EDSS Expanded Disability Status Scale
  • the phrase “typical RRMS” or a “relapsing-remitting multiple sclerosis course”, which is interchangeably used herein, refers to a subject having MS and exhibiting an Expanded Disability Status Scale (EDSS) higher than 3.0 within less than 10 years of disease onset and/or diagnosis.
  • EDSS Expanded Disability Status Scale
  • onset of multiple sclerosis refers to the time of occurrence of the first clinical neurological symptomatology suggestive of MS.
  • the Kurtzke EDSS is a method scale of quantifying disability in MS by scoring eight Functional Systems (FS) (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, cerebral, and other) and allows neurologists to assign a Functional System Score (FSS) in each and to combine the FSS scores into the EDSS score as follows:
  • FS Functional Systems
  • EDSS 0.0 Normal neurological examination
  • EDSS 1.0 No disability, minimal signs in one FS
  • EDSS 1.5 No disability, minimal signs in more than one FS;
  • EDSS 2.0 Minimal disability in one FS
  • EDSS 2.5 Mild disability in one FS or minimal disability in two FS;
  • EDSS 3.0 Modemaize disability in one FS, or mild disability in three or four FS. Fully ambulatory;
  • EDSS 3.5 Fluorous ambulatory but with moderate disability in one FS and more than minimal disability in several others;
  • EDSS 4.0 Full ambulatory without aid, self-sufficient, up and about some 12 hours a day despite relatively severe disability; able to walk without aid or rest some 500 meters;
  • EDSS 4.5 Full ambulatory without aid, up and about much of the day, able to work a full day, may otherwise have some limitation of full activity or require minimal assistance; characterized by relatively severe disability; able to walk without aid or rest some 300 meters;
  • EDSS 5.0 Ambulatory without aid or rest for about 200 meters; disability severe enough to impair full daily activities (work a full day without special provisions);
  • EDSS 5.5 Ambulatory without aid or rest for about 100 meters; disability severe enough to preclude full daily activities;
  • EDSS 6.0 Intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about 100 meters with or without resting;
  • EDSS 6.5 Constant bilateral assistance (canes, crutches, braces) required to walk about 20 meters without resting;
  • EDSS 7.0 Unable to walk beyond approximately five meters even with aid, essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about in wheelchair some 12 hours a day;
  • EDSS 7.5 Unable to take more than a few steps; restricted to wheelchair; may need aid in transfer; wheels self but cannot carry on in standard wheelchair a full day, May require motorized wheelchair;
  • EDSS 8.0 Essentially restricted to bed or chair or perambulated in wheelchair, but may be out of bed itself much of the day; retains many self-care functions; generally has effective use of arms;
  • EDSS 8.5 Essentially restricted to bed much of day, has some effective use of arms retains some self care functions
  • EDSS 9.0 Consclosed to bed; can still communicate and eat;
  • EDSS 9.5 totally helpless bed patient; unable to communicate effectively or eat/swallow;
  • EDSS 10.0 Death due to MS
  • MS is performed by clinical neurological symptoms and/or findings such as laboratory tests involving evaluation of IgG synthesis and oligoclonal bands (immunoglobulins) in the cerebrospinal fluid (CSF) which provide evidence of chronic inflammation of the central nervous system, and brain or spinal cord MRI according to the McDonald criteria [McDonald W I, Compston A, Edan G, et al., 2001, “Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis”. Ann. Neurol.
  • level of expression refers to the degree of gene expression and/or gene product activity in a specific cell.
  • up-regulation or down-regulation of various genes can affect the level of the gene product (i.e., RNA and/or protein) in a specific cell.
  • RNA transcripts and polypeptide sequences are sequence information regarding gene products (i.e., RNA transcripts and polypeptide sequences) of the genes of the polynucleotides of the invention such as the genes of RNA polymerase I pathway and of probes which can be used to detect thereof.
  • the level of expression can be determined in arbitrary absolute units, or in normalized units (relative to known expression levels of a control reference). For example, when using DNA chips, the expression levels are normalized according to the chips' internal controls or by using quantile normalization such as RMA.
  • a cell of the subject refers to at least one cell (e.g., an isolated cell), cell culture, cell content and/or cell secreted content which contains RNA and/or proteins of the subject.
  • a blood cell e.g., a cell obtained from any tissue biopsy [e.g., cerebrospinal fluid, (CSF), brain biopsy], a bone marrow cell, body fluids such as plasma, serum, saliva, spinal fluid, lymph fluid, the external sections of the skin, respiratory, intestinal, and genitourinary tracts, tears, saliva, sputum and milk.
  • tissue biopsy e.g., cerebrospinal fluid, (CSF), brain biopsy
  • a bone marrow cell body fluids such as plasma, serum, saliva, spinal fluid, lymph fluid, the external sections of the skin, respiratory, intestinal, and genitourinary tracts, tears, saliva, sputum and milk.
  • the cell is a blood cell (e.g., white blood cells, macrophages, B- and T-lymphocytes, monocytes, neutrophiles, eosinophiles, and basophiles) which can be obtained using a syringe needle from a vein of the subject.
  • a blood cell e.g., white blood cells, macrophages, B- and T-lymphocytes, monocytes, neutrophiles, eosinophiles, and basophiles
  • the cell may be isolated from the subject (e.g., for in vitro detection) or may optionally comprise a cell that has not been physically removed from the subject (e.g., in vivo detection).
  • the white blood cell comprises peripheral blood mononuclear cells (PBMC).
  • PBMCs peripheral blood mononuclear cells
  • PBMCs peripheral blood mononuclear cells
  • PBMCs peripheral blood mononuclear cells
  • PBMCs peripheral blood mononuclear cells
  • Several methods for isolating white blood cells are known in the art.
  • PBMCs can be isolated from whole blood samples using density gradient centrifugation procedures. Typically, anticoagulated whole blood is layered over the separating medium. At the end of the centrifugation step, the following layers are visually observed from top to bottom: plasma/platelets, PBMCs, separating medium and erythrocytes/granulocytes.
  • the PBMC layer is then removed and washed to remove contaminants (e.g., red blood cells) prior to determining the expression level of the polynucleotide(s) therein.
  • the cell or the biological sample comprising same can be obtained from the subject at any time, e.g., immediately after an attack or at any time during remission.
  • the level of expression of the gene(s) of the invention is determined using an RNA and/or a protein detection method.
  • the RNA or protein molecules are extracted from the cell of the subject.
  • RNA or protein molecules from cells of a subject are well known in the art. Once obtained, the RNA or protein molecules can be characterized for the expression and/or activity level of various RNA and/or protein molecules using methods known in the arts.
  • Non-limiting examples of methods of detecting RNA molecules in a cell sample include Northern blot analysis, RT-PCR, RNA in situ hybridization (using e.g., DNA or RNA probes to hybridize RNA molecules present in the cells or tissue sections), in situ RT-PCR (e.g., as described in Nuovo G J, et al. Am J Surg Pathol. 1993, 17: 683-90; Karlinoth P, et al. Pathol Res Pract.
  • oligonucleotide microarray e.g., by hybridization of polynucleotide sequences derived from a sample to oligonucleotides attached to a solid surface [e.g., a glass wafer) with addressable location, such as Affymetrix microarray (Affymetrix®, Santa Clara, Calif.)].
  • Affymetrix microarray Affymetrix®, Santa Clara, Calif.
  • the level of RRN3 in a sample can be determined by RT-PCR using primers available from Santa Cruz Biotechnology Inc. (sc-106866-PR), or Taqman Gene Expression Assay HS00607907_ml (Applied Biosystems, Foster City, Calif., USA), according to manufacturer's recommendation.
  • Non-limiting examples of methods of detecting the level and/or activity of specific protein molecules in a cell sample include Enzyme linked immunosorbent assay (ELISA), Western blot analysis, radio-immunoassay (RIA), Fluorescence activated cell sorting (FACS), immunohistochemical analysis, in situ activity assay (using e.g., a chromogenic substrate applied on the cells containing an active enzyme), in vitro activity assays (in which the activity of a particular enzyme is measured in a protein mixture extracted from the cells).
  • ELISA assay may be performed on a sample of fluid obtained from the subject (e.g., serum), which contains cell-secreted content.
  • reference expression data refers to the expression level of the gene in a cell of at least one subject who is pre-diagnosed as having BMS or typical RRMS.
  • Such as an expression level can be known from the literature, from the database, or from biological samples comprising RNA or protein molecules obtained from a reference subject who is already diagnosed as having BMS or typical RRMS.
  • pre-diagnosed refers to being diagnosed based on the acceptable clinical tools/markers as described above (e.g., by evaluating the EDSS score after 10 years from onset or diagnosis of MS).
  • the reference expression data is obtained from at least subject who is pre-diagnosed as having BMS, e.g., from at least 2, from at least 3, from at least 4, from at least 5, from at least 6, from at least 7, from at least 8, from at least 9, from at least 10, from at least 20, from at least 30, from at least 40, from at least 50, from at least 100 or more subjects who are pre-diagnosed as having BMS.
  • the reference expression data is obtained from at least one subject who is pre-diagnosed as having typical RRMS, e.g., from at least 2, from at least 3, from at least 4, from at least 5, from at least 6, from at least 7, from at least 8, from at least 9, from at least 10, from at least 20, from at least 30, from at least 40, from at least 50, from at least 100 or more subjects who are pre-diagnosed as having typical RRMS.
  • the reference expression data may comprise an average of the expression level of several or all subjects, and those of skills in the art are capable of averaging expression levels from 2 or more subject, using e.g., normalized expression values.
  • a decrease above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the typical RRMS classifies the subject as being more likely to have the BMS.
  • a decrease above a predetermined threshold refers to a decrease in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the at least one subject having the typical RRMS which is higher than a predetermined threshold such as a about 10%, e.g., higher than about 20%, e.g., higher than about 30%, e.g., higher than about 40%, e.g., higher than about 50%, e.g., higher than about 60%, higher than about 70%, higher than about 80%, higher than about 90%, higher than about 2 times, higher than about three times, higher than about four time, higher than about five times, higher than about six times, higher than about seven times, higher than about eight times, higher than about nine times, higher than about 20 times, higher than about 50 times, higher than about 100 times, higher than about 200 times, higher than about 350, higher than about 500 times, higher than about 1000 times, or more relative to the reference expression data obtained from a cell of the at least subject having the typical RRMS which is higher than
  • an increase above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the BMS classifies the subject as being more likely to have the typical RRMS.
  • an increase above a predetermined threshold refers to an increase in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the at least one subject having the BMS which is higher than a predetermined threshold such as a about 10%, e.g., higher than about 20%, e.g., higher than about 30%, e.g., higher than about 40%, e.g., higher than about 50%, e.g., higher than about 60%, higher than about 70%, higher than about 80%, higher than about 90%, higher than about 2 times, higher than about three times, higher than about four time, higher than about five times, higher than about six times, higher than about seven times, higher than about eight times, higher than about nine times, higher than about 20 times, higher than about 50 times, higher than about 100 times, higher than about 200 times, higher than about 350, higher than about 500 times, higher than about 1000 times, or more relative to the reference expression data obtained from a cell of the at least one subject having the BMS.
  • a predetermined threshold such as
  • the subject when a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the BMS, then the subject is classified as being more likely to have the BMS.
  • a predetermined threshold as compared to the reference expression data . . . subject having the BMS refers to an increase or a decrease in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the at least one subject having the BMS which is lower than a predetermined threshold, such as lower than about 10 times, e.g., lower than about 9 times, e.g., lower than about 8 times, e.g., lower than about 7 times, e.g., lower than about 6 times, e.g., lower than about 5 times, e.g., lower than about 4 times, e.g., lower than about 3 times, e.g., lower than about 2 times, e.g., lower than about 90%, e.g., lower than about 80%, e.g., lower than about 70%, e.g., lower than about 60%, e.g., lower than about 50%, e.g., lower than about
  • a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the typical RRMS, then the subject is classified as being more likely to have the typical RRMS.
  • a predetermined threshold as compared to the reference expression data . . . subject having the typical RRMS refers to an increase or a decrease in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the one subject having the typical RRMS which is lower than a predetermined threshold, such as lower than about 10 times, e.g., lower than about 9 times, e.g., lower than about 8 times, e.g., lower than about 7 times, e.g., lower than about 6 times, e.g., lower than about 5 times, e.g., lower than about 4 times, e.g., lower than about 3 times, e.g., lower than about 2 times, e.g., lower than about 90%, e.g., lower than about 80%, e.g., lower than about 70%, e.g., lower than about 60%, e.g., lower than about 50%, e.g., lower
  • Non-limiting examples of genes involved in the RNA polymerase I pathway which can be used according to the method of the invention are provided in Table 3 along with representative polynucleotides thereof and probes which can be used to detect thereof (Example 1 of the Examples section which follows; e.g., RRN3, LRPPRC, POLR1B, POLR1c, POLR1D, POLR2A, POLR2B, POLR2c, POLR2D, POLR2E, POLR2E, POLR2F, POLR2G, POLR2H, POLR2I, POLR2J, POLR2J2, MGC13098, POLR2K, POLR2L, POLR3B, POLR3c, POLR3D, POLR3E, POLR3F, POLR3G, POLR3K, POLRMT, POLRMT and POLS).
  • the at least one gene involved in the RNA polymerase 1 pathway is selected from the group consisting of POLR1D, LRPPRC, RRN3 and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway is RRN3.
  • the at least one gene involved in the RNA polymerase 1 pathway is LRPPRC.
  • the at least one gene involved in the RNA polymerase 1 pathway is POLR1D.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3 and POLR1D.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3 and LRPPRC.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises POLR1D and LRPPRC.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, LRPPRC and POLR1D.
  • the at least one gene involved in the RNA polymerase 1 pathway is RRN3 and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway is LRPPRC and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway is POLR1D and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, POLR1D and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, LRPPRC and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises POLR1D, LRPPRC and NCL.
  • the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, LRPPRC, POLR1D and NCL.
  • Tables 4A-C in the Examples section which follows demonstrate exemplary combinations of genes of the RNA polymerase I pathway along with their classification rates for BMS and typical RRMS.
  • the prediction of the MS course is important in terms of monitoring the clinical state of the subject (e.g., how often does the patient need to be evaluated for the disease progression in terms of neurological evaluation and EDSS), planning of subject's future life (e.g., making decisions regarding marriage, having children, being involved in high risk activities, getting a life-insurance, etc.) and planning the treatment regimen of the subject.
  • a subject who is more likely to have BMS may be advised to reduce the frequency of neurological clinical evaluations to no more than once per year; to avoid frequent MRI examinations; to not be included in treatment schedule of MS; and/or to avoid receiving immunomodulatory drugs which have side effects or adverse events that can be even life-threatening [e.g., progressive multifocal leukoencephalopathy (PML) in MS patients treated with natalizumab (Tysabri®, Biogen-Idec); Hypertext Transfer Protocol://World Wide Web (dot) va (dot) gov/MS/pressreleases/Treating_Natalizumab_and_Risk_of_PML (dot) asp].
  • PML progressive multifocal leukoencephalopathy
  • a subject who is more likely to have typical RRMS may be advised to have neurological clinical evaluations at a higher frequency, e.g., about 3-4 times per year; to have frequent MRI examinations; to be included in treatment schedule of MS; and/or to receive immunomodulatory drugs.
  • classification of the subject as being more likely to have BMS or typical RRMS can be used to diagnose the subject as having BMS or typical RRMS.
  • diagnosis refers to determining presence or absence of a pathology (e.g., a disease, disorder, condition or syndrome) and/or likelihood of same, classifying a pathology or a symptom, determining a severity of the pathology, monitoring pathology progression, forecasting an outcome of a pathology and/or prospects of recovery and screening of a subject for a specific disease.
  • a pathology e.g., a disease, disorder, condition or syndrome
  • the method of diagnosing is effected by (a) classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS according to the method of the invention,
  • the subject is pre-diagnosed with multiple sclerosis (MS), i.e., has a confirmed diagnosis of MS without knowing the disease course, e.g., typical RRMS, BMS.
  • MS multiple sclerosis
  • the term “informing” refers to providing to the subject the results of the diagnosis of the disease sub-class (i.e., BMS or typical RRMS).
  • the results may be provided as a computer output and/or oral conversation with the subject.
  • the teachings of the invention can be also used to determine efficiency anti multiple sclerosis drugs by determining the effect of the drug(s) on the expression level of the at least one gene of the RNA polymerase I pathway.
  • a method of monitoring an efficiency of an anti multiple sclerosis (MS) drug in treating a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS) course the method is effected by:
  • treating refers to inhibiting or arresting the development of pathology [multiple sclerosis, e.g., typical RRMS] and/or causing the reduction, remission, or regression of a pathology and/or optimally curing the pathology.
  • pathology multiple sclerosis, e.g., typical RRMS
  • RRMS RRMS
  • Those of skill in the art will understand that various methodologies and assays can be used to assess the development of pathology, and similarly, various methodologies and assays may be used to assess the reduction, remission or regression of the pathology.
  • treating the subject refers to changing the disease course of the subject from a typical RRMS course to a BMS course.
  • treating the subject refers to preventing a typical RRMS course.
  • following treating with the anti MS drug refers to any time period after administering the anti MS drug to the subject, e.g., from a few minutes to hours, or from a few days to weeks or months after drug administration.
  • the level of expression is determined following the first dose of the anti MS drug.
  • the level of expression is determined following any dose of the anti MS drug.
  • the phrase “prior to treating with the anti MS drug” refers to any time period prior administering the anti MS drug to the subject, e.g., from a few minutes to hours, or from a few days to weeks or months prior to drug administration.
  • the level of expression is determined prior any dose of the anti MS drug (e.g., when the subject is na ⁇ ve to treatment).
  • prior to treating refers to when the subject is first diagnosed with multiple sclerosis.
  • prior to treating refers to when the subject is suspected of having multiple sclerosis, or diagnosed with probable multiple sclerosis.
  • prior to treating refers to upon MS disease onset.
  • the effect of the treatment on the subject can be evaluated by monitoring the level of expression of at least one of the polynucleotides described hereinabove.
  • downregulation in the level of RRN3 in the subject following treatment can be indicative of the positive effect of the treatment on the subject, i.e., switching from a typical RRMS to a BMS course of disease.
  • teachings of the invention can be also used to predict efficiency of a drug in vitro.
  • an in vitro method of predicting an efficiency of an anti multiple sclerosis there is provided an in vitro method of predicting an efficiency of an anti multiple sclerosis
  • MS relapsing remitting multiple sclerosis
  • Contacting cells with the anti MS drug can be performed by any in vitro conditions including for example, adding the anti MS drug to cells derived from a subject (e.g., a primary cell culture, a cell line) or to a biological sample comprising same (e.g., a fluid, liquid which comprises the cells) such that the drug is in direct contact with the cells.
  • a subject e.g., a primary cell culture, a cell line
  • a biological sample e.g., a fluid, liquid which comprises the cells
  • the cells of the subject are incubated with the anti MS drug.
  • the conditions used for incubating the cells are selected for a time period/concentration of cells/concentration of drug/ratio between cells and drug and the like which enable the drug to induce cellular changes, such as changes in transcription and/or translation rate of specific genes, proliferation rate, differentiation, cell death, necrosis, apoptosis and the like.
  • Methods of monitoring cellular changes induced by the drugs include for example, the MTT test which is based on the selective ability of living cells to reduce the yellow salt MTT (3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide) (Sigma, Aldrich St Louis, Mo., USA) to a purple-blue insoluble formazan precipitate; the BrDu assay [Cell Proliferation ELISA BrdU colorimetric kit (Roche, Mannheim, Germany]; the TUNEL assay [Roche, Mannheim, Germany]; the Annexin V assay [ApoAlert® Annexin V Apoptosis Kit (Clontech Laboratories, Inc., CA, USA)]; the Senescence associated- ⁇ -galactosidase assay (Dimri G P, Lee X, et al.
  • the cells are incubated under conditions which enable the effect of the drug on cellular processes such as downregulation of the at least one gene of the RNA polymerase I pathway.
  • a method of treating a subject diagnosed with multiple sclerosis is effected by: (a) classifying the subject as being more likely to have BMS or typical RRMS according to the method of the invention, (b) selecting a treatment regimen based on classification results of step (a); thereby treating the subject diagnosed with multiple sclerosis.
  • treatment regimen refers to a treatment plan that specifies the type of treatment, dosage, schedule and/or duration of a treatment provided to a subject in need thereof (e.g., a subject diagnosed with MS).
  • the selected treatment regimen can be an aggressive one which is expected to result in the best clinical outcome (e.g., complete cure of the pathology) or a more moderate one which may relief symptoms of the pathology yet results in incomplete cure of the pathology. It will be appreciated that in certain cases the more aggressive treatment regimen may be associated with some discomfort to the subject or adverse side effects (e.g., a damage to healthy cells or tissue).
  • the dosage, schedule and duration of treatment can vary, depending on the severity of pathology and the selected type of treatment, and those of skills in the art are capable of adjusting the type of treatment with the dosage, schedule and duration of treatment.
  • the treatment regimen is an aggressive therapy such as an immunomodulation therapy, e.g., a high dosage of interferon beta 1a [Rebif, which can be administered subcutaneously, at a dosage of e.g., 44 ⁇ g, three times a week].
  • an immunomodulation therapy e.g., a high dosage of interferon beta 1a [Rebif, which can be administered subcutaneously, at a dosage of e.g., 44 ⁇ g, three times a week].
  • MS drugs which can be administered to a subject predicted to have an RRMS course of disease according to the present teachings include, but are not limited to Diterpenoid triepoxide Triptolide (TPT), Adderall; Ambien; Avonex; Baclofen; Beta interferon; Betaseron; Celexa; Clonazepam; Copaxone; Corticosteroids; Cymbalta; Cytoxan; Dexamethasone; Effexor; Elavil; Gabapentin; Hydrocodone; Lexapro; Lyrica; Mitoxantrone; Naltrexone; Neurontin; Novantrone; Prednisone; Provigil; Rebif; Solumedrol; Symmetrel; Topamax; Tysabri; Wellbutrin; Xanax; Zanaflex; Zoloft; Novartis' fingolimod [sphingosine 1-phosphate receptor (S1P-R) modulator]; Teva's la
  • a method of treating a subject diagnosed with multiple sclerosis is effected by (a) diagnosing a typical relapsing remitting multiple sclerosis (RRMS) according to the method of the invention, and (b) administering to the subject a therapeutically effective amount of diterpenoid triepoxide Triptolide (TPT) or a derivative thereof, thereby treating the subject
  • RRMS typical relapsing remitting multiple sclerosis
  • TPT diterpenoid triepoxide Triptolide
  • TPT derivatives and preparation thereof are described in WO9852933A1, which is fully incorporated herein by reference.
  • Non-limiting examples of TPT derivatives include, compounds of the general formulas.
  • R 1 and R 2 each independently is H or —OR 5 ;
  • R3 is H, —C( ⁇ O)(CH2)nCO2H or a suitable amino acid;
  • R is H or —OH;
  • R is H, —C( ⁇ O)(CH2)nCO2H or a suitable amino acid;
  • n is the integer 2, 3, 4, 5 or 6; and the stereoisomers, enantiomers and pharmaceutically acceptable salts thereof; provided that R, and R2 are H when R, is other than H (for further details see WO9852933A1).
  • Triptolide A commercially available preparation of Triptolide which can be used according to the teachings of the invention is Trisoxireno(4b, 5:6, 7:8a,9)phenanthro(1,2-c)furan-1(3H)-one, 3b,4,4a,6,6a,7a,7b,8b,9,10-decahydro-6-hydroxy-8b-methyl-6a-(1-methylethyl)-, (3bS,4aS,5aS,6R,6aR,7aS,7bS,8aS,8bS)-[CAS No.: 38748-32-2; PG490, Chengdu Biopurify Phytochemicals Ltd. Chengdu, Sichuan, China].
  • the treatment regimen comprises administering to the subject an agent which downregulates the level of expression of the at least one gene involved in the RNA polymerase I pathway.
  • treating the subject is effected by downregulating the expression level and/or activity (RNA and/or polypeptide encoded thereby) of at least one polynucleotide of the polymerase I pathway (for details see the list of genes/polynucleotide in Table 3 in Example 1 of the Examples section which follows).
  • RNA or protein molecules RNA or protein molecules
  • Downregulation can be effected on the genomic and/or the transcript level using a variety of molecules which interfere with transcription and/or translation (e.g., RNA silencing agents, Ribozyme, DNAzyme and antisense), or on the protein level using e.g., an antibody, antagonists, enzymes that cleave the polypeptide and the like.
  • RNA silencing agents e.g., Ribozyme, DNAzyme and antisense
  • protein level e.g., an antibody, antagonists, enzymes that cleave the polypeptide and the like.
  • an agent capable of downregulating a polypeptide-of-interest is an antibody or antibody fragment capable of specifically binding the polypeptide-of-interest.
  • the antibody specifically binds at least one epitope of the polypeptide-of-interest.
  • epitope refers to any antigenic determinant on an antigen to which the paratope of an antibody binds.
  • Epitopic determinants usually consist of chemically active surface groupings of molecules such as amino acids or carbohydrate side chains and usually have specific three dimensional structural characteristics, as well as specific charge characteristics.
  • antibody as used in this invention includes intact molecules as well as functional fragments thereof, such as Fab, F(ab′)2, and Fv that are capable of binding to macrophages.
  • These functional antibody fragments are defined as follows: (1) Fab, the fragment which contains a monovalent antigen-binding fragment of an antibody molecule, can be produced by digestion of whole antibody with the enzyme papain to yield an intact light chain and a portion of one heavy chain; (2) Fab′, the fragment of an antibody molecule that can be obtained by treating whole antibody with pepsin, followed by reduction, to yield an intact light chain and a portion of the heavy chain; two Fab′ fragments are obtained per antibody molecule; (3) (Fab′) 2 , the fragment of the antibody that can be obtained by treating whole antibody with the enzyme pepsin without subsequent reduction; F(ab′)2 is a dimer of two Fab′ fragments held together by two disulfide bonds; (4) Fv, defined as a genetically engineered fragment containing the variable region of the light chain and the variable
  • Antibody fragments according to the present invention can be prepared by proteolytic hydrolysis of the antibody or by expression in E. coli or mammalian cells (e.g. Chinese hamster ovary cell culture or other protein expression systems) of DNA encoding the fragment.
  • Antibody fragments can be obtained by pepsin or papain digestion of whole antibodies by conventional methods.
  • antibody fragments can be produced by enzymatic cleavage of antibodies with pepsin to provide a 5S fragment denoted F(ab′)2.
  • This fragment can be further cleaved using a thiol reducing agent, and optionally a blocking group for the sulfhydryl groups resulting from cleavage of disulfide linkages, to produce 3.5S Fab′ monovalent fragments.
  • a thiol reducing agent optionally a blocking group for the sulfhydryl groups resulting from cleavage of disulfide linkages
  • an enzymatic cleavage using pepsin produces two monovalent Fab′ fragments and an Fc fragment directly.
  • cleaving antibodies such as separation of heavy chains to form monovalent light-heavy chain fragments, further cleavage of fragments, or other enzymatic, chemical, or genetic techniques may also be used, so long as the fragments bind to the antigen that is recognized by the intact antibody.
  • Fv fragments comprise an association of VH and VL chains. This association may be noncovalent, as described in Inbar et al. [Proc. Nat'l Acad. Sci. USA 69:2659-62 (19720]. Alternatively, the variable chains can be linked by an intermolecular disulfide bond or cross-linked by chemicals such as glutaraldehyde. Preferably, the Fv fragments comprise VH and VL chains connected by a peptide linker.
  • sFv single-chain antigen binding proteins
  • the structural gene is inserted into an expression vector, which is subsequently introduced into a host cell such as E. coli .
  • the recombinant host cells synthesize a single polypeptide chain with a linker peptide bridging the two V domains.
  • Methods for producing sFvs are described, for example, by [Whitlow and Filpula, Methods 2: 97-105 (1991); Bird et al., Science 242:423-426 (1988); Pack et al., Bio/Technology 11:1271-77 (1993); and U.S. Pat. No. 4,946,778, which is hereby incorporated by reference in its entirety.
  • CDR peptides (“minimal recognition units”) can be obtained by constructing genes encoding the CDR of an antibody of interest. Such genes are prepared, for example, by using the polymerase chain reaction to synthesize the variable region from RNA of antibody-producing cells. See, for example, Larrick and Fry [Methods, 2: 106-10 (1991)].
  • Humanized forms of non-human (e.g., murine) antibodies are chimeric molecules of immunoglobulins, immunoglobulin chains or fragments thereof (such as Fv, Fab, Fab′, F(ab′).sub.2 or other antigen-binding subsequences of antibodies) which contain minimal sequence derived from non-human immunoglobulin.
  • Humanized antibodies include human immunoglobulins (recipient antibody) in which residues form a complementary determining region (CDR) of the recipient are replaced by residues from a CDR of a non-human species (donor antibody) such as mouse, rat or rabbit having the desired specificity, affinity and capacity.
  • CDR complementary determining region
  • donor antibody such as mouse, rat or rabbit having the desired specificity, affinity and capacity.
  • Fv framework residues of the human immunoglobulin are replaced by corresponding non-human residues.
  • Humanized antibodies may also comprise residues which are found neither in the recipient antibody nor in the imported CDR or framework sequences.
  • the humanized antibody will comprise substantially all of at least one, and typically two, variable domains, in which all or substantially all of the CDR regions correspond to those of a non-human immunoglobulin and all or substantially all of the FR regions are those of a human immunoglobulin consensus sequence.
  • the humanized antibody optimally also will comprise at least a portion of an immunoglobulin constant region (Fc), typically that of a human immunoglobulin [Jones et al., Nature, 321:522-525 (1986); Riechmann et al., Nature, 332:323-329 (1988); and Presta, Curr. Op. Struct. Biol., 2:593-596 (1992)].
  • Fc immunoglobulin constant region
  • a humanized antibody has one or more amino acid residues introduced into it from a source which is non-human. These non-human amino acid residues are often referred to as import residues, which are typically taken from an import variable domain. Humanization can be essentially performed following the method of Winter and co-workers [Jones et al., Nature, 321:522-525 (1986); Riechmann et al., Nature 332:323-327 (1988); Verhoeyen et al., Science, 239:1534-1536 (1988)], by substituting rodent CDRs or CDR sequences for the corresponding sequences of a human antibody.
  • humanized antibodies are chimeric antibodies (U.S. Pat. No. 4,816,567), wherein substantially less than an intact human variable domain has been substituted by the corresponding sequence from a non-human species.
  • humanized antibodies are typically human antibodies in which some CDR residues and possibly some FR residues are substituted by residues from analogous sites in rodent antibodies.
  • Human antibodies can also be produced using various techniques known in the art, including phage display libraries [Hoogenboom and Winter, J. Mol. Biol., 227:381 (1991); Marks et al., J. Mol. Biol., 222:581 (1991)].
  • the techniques of Cole et al. and Boerner et al. are also available for the preparation of human monoclonal antibodies (Cole et al., Monoclonal Antibodies and Cancer Therapy, Alan R. Liss, p. 77 (1985) and Boerner et al., J. Immunol., 147(1):86-95 (1991)].
  • human antibodies can be made by introduction of human immunoglobulin loci into transgenic animals, e.g., mice in which the endogenous immunoglobulin genes have been partially or completely inactivated. Upon challenge, human antibody production is observed, which closely resembles that seen in humans in all respects, including gene rearrangement, assembly, and antibody repertoire. This approach is described, for example, in U.S. Pat. Nos.
  • the antibody of the invention can be expressed within the cell intracellular antibodies (also known as “intrabodies”) or a particular compartment thereof.
  • Intrabodies are essentially SCA to which intracellular localization signals have been added (e.g., ER, mitochondrial, nuclear, cytoplasmic). This technology has been successfully applied in the art (for review, see Richardson and Marasco, 1995, TIBTECH vol. 13). Intrabodies have been shown to virtually eliminate the expression of otherwise abundant cell surface receptors and to inhibit a protein function within a cell (See, for example, Richardson et al., 1995, Proc. Natl. Acad. Sci.
  • the cDNA encoding the antibody light and heavy chains specific for the target protein of interest are isolated, typically from a hybridoma that secretes a monoclonal antibody specific for the marker.
  • Hybridomas secreting anti-marker monoclonal antibodies, or recombinant monoclonal antibodies can be prepared using methods known in the art.
  • a monoclonal antibody specific for the marker protein is identified (e.g., either a hybridoma-derived monoclonal antibody or a recombinant antibody from a combinatorial library)
  • DNAs encoding the light and heavy chains of the monoclonal antibody are isolated by standard molecular biology techniques.
  • light and heavy chain cDNAs can be obtained, for example, by PCR amplification or cDNA library screening.
  • cDNA encoding the light and heavy chains can be recovered from the display package (e.g., phage) isolated during the library screening process and the nucleotide sequences of antibody light and heavy chain genes are determined.
  • display package e.g., phage
  • nucleotide sequences of antibody light and heavy chain genes are determined.
  • many such sequences are disclosed in Kabat, E. A., et al. (1991) Sequences of Proteins of Immunological Interest, Fifth Edition, U.S. Department of Health and Human Services, NIH Publication No. 91-3242 and in the “Vbase” human germline sequence database.
  • an intracellular antibody expression vector can encode an intracellular antibody in one of several different forms. For example, in one embodiment, the vector encodes full-length antibody light and heavy chains such that a full-length antibody is expressed intracellularly. In another embodiment, the vector encodes a full-length light chain but only the VH/CH1 region of the heavy chain such that a Fab fragment is expressed intracellularly.
  • the vector encodes a single chain antibody (scFv) wherein the variable regions of the light and heavy chains are linked by a flexible peptide linker [e.g., (Gly 4 Ser) 3 and expressed as a single chain molecule.
  • a flexible peptide linker e.g., (Gly 4 Ser) 3
  • the expression vector encoding the intracellular antibody is introduced into the cell by standard transfection methods, as discussed hereinbefore.
  • antibodies may be tested for activity, for example via ELISA.
  • RNA silencing refers to a group of regulatory mechanisms [e.g. RNA interference (RNAi), transcriptional gene silencing (TGS), post-transcriptional gene silencing (PTGS), quelling, co-suppression, and translational repression] mediated by RNA molecules which result in the inhibition or “silencing” of the expression of a corresponding protein-coding gene.
  • RNA silencing has been observed in many types of organisms, including plants, animals, and fungi.
  • RNA silencing agent refers to an RNA which is capable of inhibiting or “silencing” the expression of a target gene.
  • the RNA silencing agent is capable of preventing complete processing (e.g., the full translation and/or expression) of an mRNA molecule through a post-transcriptional silencing mechanism.
  • RNA silencing agents include noncoding RNA molecules, for example RNA duplexes comprising paired strands, as well as precursor RNAs from which such small non-coding RNAs can be generated.
  • Exemplary RNA silencing agents include dsRNAs such as siRNAs, miRNAs and shRNAs.
  • the RNA silencing agent is capable of inducing RNA interference.
  • the RNA silencing agent is capable of mediating translational repression.
  • RNA silencing agent can be directed to a specific compartment within the cells, such as to the nucleus (see e.g., Shim M S and Kwon Y J. 2009, “Controlled cytoplasmic and nuclear localization of plasmid DNA and siRNA by differentially tailored polyethylenimine”; J. Control Release. 133:206-13, Epub 2008 Nov. 1), nucleoli, and the like.
  • RNA interference refers to the process of sequence-specific post-transcriptional gene silencing in animals mediated by short interfering RNAs (siRNAs).
  • siRNAs short interfering RNAs
  • the corresponding process in plants is commonly referred to as post-transcriptional gene silencing or RNA silencing and is also referred to as quelling in fungi.
  • the process of post-transcriptional gene silencing is thought to be an evolutionarily-conserved cellular defense mechanism used to prevent the expression of foreign genes and is commonly shared by diverse flora and phyla.
  • Such protection from foreign gene expression may have evolved in response to the production of double-stranded RNAs (dsRNAs) derived from viral infection or from the random integration of transposon elements into a host genome via a cellular response that specifically destroys homologous single-stranded RNA or viral genomic RNA.
  • dsRNAs double-stranded RNAs
  • RNA-induced silencing complex RISC
  • the present invention contemplates use of dsRNA to down-regulate protein expression from mRNA.
  • the dsRNA is greater than 30 bp.
  • the use of long dsRNAs i.e. dsRNA greater than 30 bp
  • the use of long dsRNAs can provide numerous advantages in that the cell can select the optimal silencing sequence alleviating the need to test numerous siRNAs; long dsRNAs will allow for silencing libraries to have less complexity than would be necessary for siRNAs; and, perhaps most importantly, long dsRNA could prevent viral escape mutations when used as therapeutics.
  • the present invention also contemplates introduction of long dsRNA (over 30 base transcripts) for gene silencing in cells where the interferon pathway is not activated (e.g. embryonic cells and oocytes) see for example Billy et al., PNAS 2001, Vol 98, pages 14428-14433. and Diallo et al, Oligonucleotides, Oct. 1, 2003, 13(5): 381-392. doi:10.1089/154545703322617069.
  • long dsRNA over 30 base transcripts
  • the present invention also contemplates introduction of long dsRNA specifically designed not to induce the interferon and PKR pathways for down-regulating gene expression.
  • Shinagwa and Ishii [ Genes & Dev. 17 (11): 1340-1345, 2003] have developed a vector, named pDECAP, to express long double-strand RNA from an RNA polymerase II (Pol II) promoter. Because the transcripts from pDECAP lack both the 5′-cap structure and the 3′-poly(A) tail that facilitate ds-RNA export to the cytoplasm, long ds-RNA from pDECAP does not induce the interferon response.
  • pDECAP RNA polymerase II
  • siRNAs small inhibitory RNAs
  • siRNA refers to small inhibitory RNA duplexes (generally between 18-30 basepairs) that induce the RNA interference (RNAi) pathway.
  • RNAi RNA interference
  • siRNAs are chemically synthesized as 21mers with a central 19 by duplex region and symmetric 2-base 3′-overhangs on the termini, although it has been recently described that chemically synthesized RNA duplexes of 25-30 base length can have as much as a 100-fold increase in potency compared with 21mers at the same location.
  • RNA silencing agent of the present invention may also be a short hairpin RNA (shRNA).
  • Rrn3 siRNA RNA polymerase I transcription factor homolog
  • sc-106866 RNA polymerase I transcription factor homolog
  • downregulation of RRN3 can be achieved by Rrn3 shRNA plasmid (h): sc-106866-SH and Rrn3 shRNA (h) Lentiviral Particles: sc-106866-V ((Santa Cruz Biotechnology, Inc. Santa Cruz, Calif., USA).
  • RNA agent refers to an RNA agent having a stem-loop structure, comprising a first and second region of complementary sequence, the degree of complementarity and orientation of the regions being sufficient such that base pairing occurs between the regions, the first and second regions being joined by a loop region, the loop resulting from a lack of base pairing between nucleotides (or nucleotide analogs) within the loop region.
  • the number of nucleotides in the loop is a number between and including 3 to 23, or 5 to 15, or 7 to 13, or 4 to 9, or 9 to 11. Some of the nucleotides in the loop can be involved in base-pair interactions with other nucleotides in the loop.
  • oligonucleotide sequences that can be used to form the loop include 5′-UUCAAGAGA-3′ (Brummelkamp, T. R. et al. (2002) Science 296: 550) and 5′-UUUGUGUAG-3′ (Castanotto, D. et al. (2002) RNA 8:1454). It will be recognized by one of skill in the art that the resulting single chain oligonucleotide forms a stem-loop or hairpin structure comprising a double-stranded region capable of interacting with the RNAi machinery.
  • the RNA silencing agent may be a miRNA.
  • miRNAs are small RNAs made from genes encoding primary transcripts of various sizes. They have been identified in both animals and plants.
  • the primary transcript (termed the “pri-miRNA”) is processed through various nucleolytic steps to a shorter precursor miRNA, or “pre-miRNA.”
  • the pre-miRNA is present in a folded form so that the final (mature) miRNA is present in a duplex, the two strands being referred to as the miRNA (the strand that will eventually basepair with the target)
  • the pre-miRNA is a substrate for a form of dicer that removes the miRNA duplex from the precursor, after which, similarly to siRNAs, the duplex can be taken into the RISC complex.
  • miRNAs can be transgenically expressed and be effective through expression of a precursor form, rather than the entire primary form (Parizotto et al. (2004) Genes & Development 18:2237-2242 and Guo et al. (2005) Plant Cell 17:1376-1386).
  • miRNAs bind to transcript sequences with only partial complementarity (Zeng et al., 2002, Molec. Cell 9:1327-1333) and repress translation without affecting steady-state RNA levels (Lee et al., 1993, Cell 75:843-854; Wightman et al., 1993, Cell 75:855-862). Both miRNAs and siRNAs are processed by Dicer and associate with components of the RNA-induced silencing complex (Hutvagner et al., 2001, Science 293:834-838; Grishok et al., 2001, Cell 106: 23-34; Ketting et al., 2001, Genes Dev.
  • RNA silencing agents suitable for use with the present invention can be effected as follows. First, the mRNA sequence of the polynucleotide-of-interest is scanned downstream of the AUG start codon for AA dinucleotide sequences. Occurrence of each AA and the 3′ adjacent 19 nucleotides is recorded as potential siRNA target sites. Preferably, siRNA target sites are selected from the open reading frame, as untranslated regions (UTRs) are richer in regulatory protein binding sites. UTR-binding proteins and/or translation initiation complexes may interfere with binding of the siRNA endonuclease complex [Tuschl ChemBiochem. 2:239-245].
  • UTRs untranslated regions
  • siRNAs directed at untranslated regions may also be effective, as demonstrated for GAPDH wherein siRNA directed at the 5′ UTR mediated about 90% decrease in cellular GAPDH mRNA and completely abolished protein level (www.ambion.com/techlib/tn/91/912.html).
  • potential target sites are compared to an appropriate genomic database (e.g., human, mouse, rat etc.) using any sequence alignment software, such as the BLAST software available from the NCBI server (www.ncbi.nlm.nih.gov/BLAST/). Putative target sites which exhibit significant homology to other coding sequences are filtered out.
  • an appropriate genomic database e.g., human, mouse, rat etc.
  • sequence alignment software such as the BLAST software available from the NCBI server (www.ncbi.nlm.nih.gov/BLAST/).
  • Qualifying target sequences are selected as template for siRNA synthesis.
  • Preferred sequences are those including low G/C content as these have proven to be more effective in mediating gene silencing as compared to those with G/C content higher than 55%.
  • Several target sites are preferably selected along the length of the target gene for evaluation.
  • a negative control is preferably used in conjunction.
  • Negative control siRNA preferably include the same nucleotide composition as the siRNAs but lack significant homology to the genome.
  • a scrambled nucleotide sequence of the siRNA is preferably used, provided it does not display any significant homology to any other gene.
  • RNA silencing agent of the present invention need not be limited to those molecules containing only RNA, but further encompasses chemically-modified nucleotides and non-nucleotides.
  • the RNA silencing agent provided herein can be functionally associated with a cell-penetrating peptide.
  • a “cell-penetrating peptide” is a peptide that comprises a short (about 12-30 residues) amino acid sequence or functional motif that confers the energy-independent (i.e., non-endocytotic) translocation properties associated with transport of the membrane-permeable complex across the plasma and/or nuclear membranes of a cell.
  • the cell-penetrating peptide used in the membrane-permeable complex of the present invention preferably comprises at least one non-functional cysteine residue, which is either free or derivatized to form a disulfide link with a double-stranded ribonucleic acid that has been modified for such linkage.
  • Representative amino acid motifs conferring such properties are listed in U.S. Pat. No. 6,348,185, the contents of which are expressly incorporated herein by reference.
  • the cell-penetrating peptides of the present invention preferably include, but are not limited to, penetratin, transportan, pIsl, TAT(48-60), pVEC, MTS, and MAP.
  • RNA silencing agents include, but are not limited to, those whose expression is correlated with an undesired phenotypic trait.
  • Exemplary mRNAs that may be targeted are those that encode truncated proteins i.e. comprise deletions. Accordingly the RNA silencing agent of the present invention may be targeted to a bridging region on either side of the deletion. Introduction of such RNA silencing agents into a cell would cause a down-regulation of the mutated protein while leaving the non-mutated protein unaffected.
  • DNAzyme molecule capable of specifically cleaving an mRNA transcript or DNA sequence of the polynucleotide-of-interest.
  • DNAzymes are single-stranded polynucleotides which are capable of cleaving both single and double stranded target sequences (Breaker, R. R. and Joyce, G. Chemistry and Biology 1995; 2:655; Santoro, S. W. & Joyce, G. F. Proc. Natl, Acad. Sci. USA 1997; 943:4262)
  • a general model (the “10-23” model) for the DNAzyme has been proposed.
  • DNAzymes have a catalytic domain of 15 deoxyribonucleotides, flanked by two substrate-recognition domains of seven to nine deoxyribonucleotides each. This type of DNAzyme can effectively cleave its substrate RNA at purine:pyrimidine junctions (Santoro, S. W. & Joyce, G. F. Proc. Natl, Acad. Sci. USA 199; for rev of DNAzymes see Khachigian, L M [Curr Opin Mol Ther 4:119-21 (2002)].
  • DNAzymes recognizing single and double-stranded target cleavage sites have been disclosed in U.S. Pat. No. 6,326,174 to Joyce et al. DNAzymes of similar design directed against the human Urokinase receptor were recently observed to inhibit Urokinase receptor expression, and successfully inhibit colon cancer cell metastasis in vivo (Itoh et al, 20002, Abstract 409, Ann Meeting Am Soc Gen Ther World Wide Web (dot) asgt (dot) org). In another application, DNAzymes complementary to bcr-abl oncogenes were successful in inhibiting the oncogenes expression in leukemia cells, and lessening relapse rates in autologous bone marrow transplant in cases of CML and ALL.
  • Downregulation of the polynucleotide-of-interest can also be effected by using an antisense polynucleotide capable of specifically hybridizing with an mRNA transcript encoding the polynucleotide-of-interest.
  • the first aspect is delivery of the oligonucleotide into the cytoplasm of the appropriate cells, while the second aspect is design of an oligonucleotide which specifically binds the designated mRNA within cells in a way which inhibits translation thereof.
  • antisense oligonucleotides suitable for the treatment of cancer have been successfully used [Holmund et al., Curr Opin Mol Ther 1:372-85 (1999)], while treatment of hematological malignancies via antisense oligonucleotides targeting c-myb gene, p53 and Bcl-2 had entered clinical trials and had been shown to be tolerated by patients [Gerwitz Curr Opin Mol Ther 1:297-306 (1999)].
  • Another agent capable of downregulating the polynucleotide-of-interest is a ribozyme molecule capable of specifically cleaving an mRNA transcript encoding the polynucleotide-of-interest.
  • Ribozymes are being increasingly used for the sequence-specific inhibition of gene expression by the cleavage of mRNAs encoding proteins of interest [Welch et al., Curr Opin Biotechnol. 9:486-96 (1998)].
  • the possibility of designing ribozymes to cleave any specific target RNA has rendered them valuable tools in both basic research and therapeutic applications.
  • ribozymes have been exploited to target viral RNAs in infectious diseases, dominant oncogenes in cancers and specific somatic mutations in genetic disorders [Welch et al., Clin Diagn Virol. 10:163-71 (1998)]. Most notably, several ribozyme gene therapy protocols for HIV patients are already in Phase 1 trials. More recently, ribozymes have been used for transgenic animal research, gene target validation and pathway elucidation. Several ribozymes are in various stages of clinical trials. ANGIOZYME was the first chemically synthesized ribozyme to be studied in human clinical trials.
  • ANGIOZYME specifically inhibits formation of the VEGF-r (Vascular Endothelial Growth Factor receptor), a key component in the angiogenesis pathway.
  • Ribozyme Pharmaceuticals, Inc. as well as other firms have demonstrated the importance of anti-angiogenesis therapeutics in animal models.
  • HEPTAZYME a ribozyme designed to selectively destroy Hepatitis C Virus (HCV) RNA, was found effective in decreasing Hepatitis C viral RNA in cell culture assays (Ribozyme Pharmaceuticals, Incorporated—WEB home page).
  • TFOs triplex forming oligonucleotides
  • Another agent capable of downregulating the expression level of the polynucleotide-of-interest is a small molecule which inhibits the activity, level and/or interactions of the gene product of polynucleotide-of-interest, such as by interfering with the pathway in which the gene product of the polynucleotide-of-interest is involved.
  • Non-limiting examples of small molecules which can be used along with the method of the invention to treat the subject include Cycloheximide and diterpenoid triepoxide Triptolide (TPT) or a derivative thereof.
  • TPT diterpenoid triepoxide Triptolide
  • the treatment can be with diterpenoid triepoxide Triptolide (TPT) or a derivative thereof; and/or with Cycloheximide or a derivative thereof.
  • TPT diterpenoid triepoxide Triptolide
  • any of the downregulating agents described hereinabove e.g., the agent which downregulates the gene of the RNA polymerase I pathway, e.g., siRNA, antibody
  • the agent which downregulates the gene of the RNA polymerase I pathway e.g., siRNA, antibody
  • any of the known multiple sclerosis therapies e.g., the anti MS drugs
  • Triptolide or a derivative thereof can be provided to the subject in need thereof along with any of the known multiple sclerosis therapies (e.g., the anti MS drugs) described hereinabove (combination therapy) and/or with Triptolide or a derivative thereof.
  • any of the downregulating agents described above can be administered to the subject per se, or in a pharmaceutical composition where it is mixed with suitable carriers or excipients.
  • a “pharmaceutical composition” refers to a preparation of one or more of the active ingredients described herein with other chemical components such as physiologically suitable carriers and excipients.
  • the purpose of a pharmaceutical composition is to facilitate administration of a compound to an organism.
  • active ingredient refers to the downregulating agent accountable for the biological effect.
  • physiologically acceptable carrier and “pharmaceutically acceptable carrier” which may be interchangeably used refer to a carrier or a diluent that does not cause significant irritation to an organism and does not abrogate the biological activity and properties of the administered compound.
  • An adjuvant is included under these phrases.
  • excipient refers to an inert substance added to a pharmaceutical composition to further facilitate administration of an active ingredient.
  • excipients include calcium carbonate, calcium phosphate, various sugars and types of starch, cellulose derivatives, gelatin, vegetable oils and polyethylene glycols.
  • Suitable routes of administration may, for example, include oral, rectal, transmucosal, especially transnasal, intestinal or parenteral delivery, including intramuscular, subcutaneous and intramedullary injections as well as intrathecal, direct intraventricular, intracardiac, e.g., into the right or left ventricular cavity, into the common coronary artery, intravenous, inrtaperitoneal, intranasal, or intraocular injections.
  • the pharmaceutical composition may be administered using a dermal patch which releases the active ingredient [e.g., Diterpenoid triepoxide Triptolide (TPT) has a molecular weight of 360.40 and it will thus be suitable to be used in a dermal patch].
  • TPT Diterpenoid triepoxide Triptolide
  • neurosurgical strategies e.g., intracerebral injection or intracerebroventricular infusion
  • molecular manipulation of the agent e.g., production of a chimeric fusion protein that comprises a transport peptide that has an affinity for an endothelial cell surface molecule in combination with an agent that is itself incapable of crossing the BBB
  • pharmacological strategies designed to increase the lipid solubility of an agent (e.g., conjugation of water-soluble agents to lipid or cholesterol carriers)
  • the transitory disruption of the integrity of the BBB by hyperosmotic disruption resulting from the infusion of a mannitol solution into the carotid artery or the use of a biologically active agent such as an angiotensin peptide).
  • each of these strategies has limitations, such as the inherent risks associated with an invasive surgical procedure, a size limitation imposed by a limitation inherent in the endogenous transport systems, potentially undesirable biological side effects associated with the systemic administration of a chimeric molecule comprised of a carrier motif that could be active outside of the CNS, and the possible risk of brain damage within regions of the brain where the BBB is disrupted, which renders it a suboptimal delivery method.
  • compositions of the present invention may be manufactured by processes well known in the art, e.g., by means of conventional mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping or lyophilizing processes.
  • compositions for use in accordance with the present invention thus may be formulated in conventional manner using one or more physiologically acceptable carriers comprising excipients and auxiliaries, which facilitate processing of the active ingredients into preparations which, can be used pharmaceutically. Proper formulation is dependent upon the route of administration chosen.
  • the active ingredients of the pharmaceutical composition may be formulated in aqueous solutions, preferably in physiologically compatible buffers such as Hank's solution, Ringer's solution, or physiological salt buffer.
  • physiologically compatible buffers such as Hank's solution, Ringer's solution, or physiological salt buffer.
  • penetrants appropriate to the barrier to be permeated are used in the formulation. Such penetrants are generally known in the art.
  • the pharmaceutical composition can be formulated readily by combining the active compounds with pharmaceutically acceptable carriers well known in the art.
  • Such carriers enable the pharmaceutical composition to be formulated as tablets, pills, dragees, capsules, liquids, gels, syrups, slurries, suspensions, and the like, for oral ingestion by a patient.
  • Pharmacological preparations for oral use can be made using a solid excipient, optionally grinding the resulting mixture, and processing the mixture of granules, after adding suitable auxiliaries if desired, to obtain tablets or dragee cores.
  • Suitable excipients are, in particular, fillers such as sugars, including lactose, sucrose, mannitol, or sorbitol; cellulose preparations such as, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, sodium carbomethylcellulose; and/or physiologically acceptable polymers such as polyvinylpyrrolidone (PVP).
  • disintegrating agents may be added, such as cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof such as sodium alginate.
  • Dragee cores are provided with suitable coatings.
  • suitable coatings For this purpose, concentrated sugar solutions may be used which may optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, titanium dioxide, lacquer solutions and suitable organic solvents or solvent mixtures.
  • Dyestuffs or pigments may be added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.
  • compositions which can be used orally include push-fit capsules made of gelatin as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol.
  • the push-fit capsules may contain the active ingredients in admixture with filler such as lactose, binders such as starches, lubricants such as talc or magnesium stearate and, optionally, stabilizers.
  • the active ingredients may be dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene glycols.
  • stabilizers may be added. All formulations for oral administration should be in dosages suitable for the chosen route of administration.
  • compositions may take the form of tablets or lozenges formulated in conventional manner.
  • the active ingredients for use according to the present invention are conveniently delivered in the form of an aerosol spray presentation from a pressurized pack or a nebulizer with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichloro-tetrafluoroethane or carbon dioxide.
  • a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichloro-tetrafluoroethane or carbon dioxide.
  • the dosage unit may be determined by providing a valve to deliver a metered amount.
  • Capsules and cartridges of, e.g., gelatin for use in a dispenser may be formulated containing a powder mix of the compound and a suitable powder base such as lactose or starch.
  • compositions described herein may be formulated for parenteral administration, e.g., by bolus injection or continuous infusion.
  • Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in multidose containers with optionally, an added preservative.
  • the compositions may be suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
  • compositions for parenteral administration include aqueous solutions of the active preparation in water-soluble form. Additionally, suspensions of the active ingredients may be prepared as appropriate oily or water based injection suspensions. Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acids esters such as ethyl oleate, triglycerides or liposomes. Aqueous injection suspensions may contain substances, which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol or dextran. Optionally, the suspension may also contain suitable stabilizers or agents which increase the solubility of the active ingredients to allow for the preparation of highly concentrated solutions.
  • the active ingredient may be in powder form for constitution with a suitable vehicle, e.g., sterile, pyrogen-free water based solution, before use.
  • a suitable vehicle e.g., sterile, pyrogen-free water based solution
  • compositions of the present invention may also be formulated in rectal compositions such as suppositories or retention enemas, using, e.g., conventional suppository bases such as cocoa butter or other glycerides.
  • compositions suitable for use in context of the present invention include compositions wherein the active ingredients are contained in an amount effective to achieve the intended purpose. More specifically, a therapeutically effective amount means an amount of active ingredients (the downregulating agent) effective to prevent, alleviate or ameliorate symptoms of a disorder (e.g., RRMS) or prolong the survival of the subject being treated.
  • a therapeutically effective amount means an amount of active ingredients (the downregulating agent) effective to prevent, alleviate or ameliorate symptoms of a disorder (e.g., RRMS) or prolong the survival of the subject being treated.
  • the therapeutically effective amount or dose can be estimated initially from in vitro and cell culture assays.
  • a dose can be formulated in animal models to achieve a desired concentration or titer. Such information can be used to more accurately determine useful doses in humans.
  • Toxicity and therapeutic efficacy of the active ingredients described herein can be determined by standard pharmaceutical procedures in vitro, in cell cultures or experimental animals.
  • the data obtained from these in vitro and cell culture assays and animal studies can be used in formulating a range of dosage for use in human.
  • the dosage may vary depending upon the dosage form employed and the route of administration utilized.
  • the exact formulation, route of administration and dosage can be chosen by the individual physician in view of the patient's condition. (See e.g., Fingl, et al., 1975, in “The Pharmacological Basis of Therapeutics”, Ch. 1 p. 1).
  • Dosage amount and interval may be adjusted individually to provide levels of the active ingredient are sufficient to induce or suppress the biological effect (minimal effective concentration, MEC).
  • MEC minimum effective concentration
  • the MEC will vary for each preparation, but can be estimated from in vitro data. Dosages necessary to achieve the MEC will depend on individual characteristics and route of administration. Detection assays can be used to determine plasma concentrations.
  • dosing can be of a single or a plurality of administrations, with course of treatment lasting from several days to several weeks or until cure is effected or diminution of the disease state is achieved.
  • compositions to be administered will, of course, be dependent on the subject being treated, the severity of the affliction, the manner of administration, the judgment of the prescribing physician, etc.
  • compositions of the present invention may, if desired, be presented in a pack or dispenser device, such as an FDA approved kit, which may contain one or more unit dosage forms containing the active ingredient.
  • the pack may, for example, comprise metal or plastic foil, such as a blister pack.
  • the pack or dispenser device may be accompanied by instructions for administration.
  • the pack or dispenser may also be accommodated by a notice associated with the container in a form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals, which notice is reflective of approval by the agency of the form of the compositions or human or veterinary administration. Such notice, for example, may be of labeling approved by the U.S. Food and Drug Administration for prescription drugs or of an approved product insert.
  • Compositions comprising a preparation of the invention formulated in a compatible pharmaceutical carrier may also be prepared, placed in an appropriate container, and labeled for treatment of an indicated condition, as is further detailed above.
  • a method of selecting a drug for treating a typical relapsing remitting multiple sclerosis (RRMS) in a subject is effected by (a) contacting cells of a subject classified as having a typical RRMS with a plurality of drug molecules, (b) identifying at least one drug molecule which downregulates a level of expression of at least one gene involved in the RNA polymerase I pathway, the at least one drug molecule is suitable for treating the typical RRMS in the subject, thereby selecting the drug for treating the typical RRMS in the subject.
  • the plurality of drug molecules can be peptides, RNA, DNA, aptamers and small molecules.
  • the polynucleotides described hereinabove can form a part of a probeset.
  • the probeset comprises a plurality of oligonucleotides and no more than 50 oligonucleotides (e.g., no more than about 40, no more than about 30, e.g., no more than about 20, e.g., no more than about 15, e.g., no more than about 10 oligonucleotides) wherein an oligonucleotide of the plurality of oligonucleotides specifically recognizes a polynucleotide of at least one gene involved in the RNA polymerase pathway.
  • each of the oligonucleotides can specifically recognize a polynucleotide of the RNA polymerase I pathway.
  • the probeset comprises a plurality of oligonucleotides and no more than 500 oligonucleotides wherein each of the plurality of oligonucleotides is capable of specifically recognizing at least one polynucleotide sequence selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IPW, FL
  • isolated nucleic acid sequences included in the kit or the probeset of the present invention can be bound to a solid support e.g., a glass wafer in a specific order, i.e., in the form of a microarray.
  • isolated nucleic acid sequences can be synthesized directly on the solid support using well known prior art approaches (Seo T S, et al., 2004, Proc. Natl. Acad. Sci. USA, 101: 5488-93.).
  • the isolated nucleic acid sequences are attached to the support in a location specific manner such that each specific isolated nucleic acid sequence has a specific address on the support (i.e., an addressable location) which denotes the identity (i.e., the sequence) of that specific isolated nucleic acid sequence.
  • the kit may further include a positive control for an expression level of at least one of the polynucleotides of the invention (e.g., which involves in the RNA polymerase I pathway).
  • the positive control can be any biological sample derived from a reference subject (i.e., a subject with a known course of MS, i.e., BMS or typical RRMS), a biological sample with known amount/concentration of the gene product (i.e., RNA or protein) of at least one of the polynucleotides of the invention; or a pre-determined level (amount/concentration) of purified, chemically synthesized or recombinantly generated RNA or protein molecules (gene products) of the at least one polynucleotide of the invention.
  • the kit may further comprise instructions for use in classifying a subject as being more like to have BMS or typical RRMS, to diagnose BMS or typical RRMS, to monitor treatment efficiency, to select a treatment regimen, to treat a subject having multiple sclerosis and/or to select for drugs suitable for treating multiple sclerosis.
  • compositions, method or structure may include additional ingredients, steps and/or parts, but only if the additional ingredients, steps and/or parts do not materially alter the basic and novel characteristics of the claimed composition, method or structure.
  • a compound or “at least one compound” may include a plurality of compounds, including mixtures thereof.
  • range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.
  • a numerical range is indicated herein, it is meant to include any cited numeral (fractional or integral) within the indicated range.
  • the phrases “ranging/ranges between” a first indicate number and a second indicate number and “ranging/ranges from” a first indicate number “to” a second indicate number are used herein interchangeably and are meant to include the first and second indicated numbers and all the fractional and integral numerals therebetween.
  • method refers to manners, means, techniques and procedures for accomplishing a given task including, but not limited to, those manners, means, techniques and procedures either known to, or readily developed from known manners, means, techniques and procedures by practitioners of the chemical, pharmacological, biological, biochemical and medical arts.
  • RNA isolation and microarray expression profiling Peripheral blood mononuclear cells (PBMC) were separated on ficoll-hypaque gradient. Total RNA was isolated using the TRIzol Reagent (Invitrogen, Carlsbad, Calif.), and cDNA was synthesized, labeled and hybridized to HG-U133A-2 array (Affymetrix, Inc, Santa Clara, Calif.) containing 22,215 gene-transcripts, washed and scanned (Hewlett Packard, GeneArrayTM scanner G2500A) according to manufacturer's protocol Affymetrix (Inc, Santa Clara, Calif.).
  • BMS patients differentiated from typical RRMS by 406 MIGs (most informative genes), 171 genes were over-expressed (upregulated) and 235 were down-expressed (downregulated), with the log fold change ranged from ⁇ 3.1 to 3.3 ( FIG. 2 ).
  • Table 1 hereinbelow provides the differentiating genes between BMS and typical RRMS patients.
  • Probeset ID Public ID typical typical Gene ID NO: ID NO: RRMS RRMS) Symbol Gene Title 216683_at 1 AL353949 407 6.85E ⁇ 04 ⁇ 1.129 — — 219629_at 2 NM_017911 408 5.51E ⁇ 03 ⁇ 1.117 C22orf8 chromosome 22 open reading frame 8 210379_s_at 3 AI469203 409 7.42E ⁇ 03 ⁇ 1.083 TLK1 tousled-like kinase 1 213472_at 4 AI022387 410 4.25E ⁇ 03 ⁇ 1.081 HNRPH1 heterogeneous nuclear ribonucleoprotein H1 (H) 219700_at 5 NM_020405 411 5.56E ⁇ 05 ⁇ 1.081 PLXDC1 plexin domain containing 1 211077_s_at 6 Z25421 412 9.89E ⁇ 04 ⁇ 1.080 TLK1 tousled-like kinase 1 /// tousled-like kinase 1 210969_at 7
  • Log Fold Change refers to the logarithms fold change between the expression level of a polynucleotide in a blood sample of a BMS subject as compared to the expression level in a blood sample of a typical RRMS subject:
  • the ( ⁇ ) sign means that the polynucleotide is downregulated (decreased in level) in BMS as compared to typical RRMS subjects; and the (+) sign means that the polynucleotide is upregulated (increased in level) in BMS as compared to typical RRMS subjects.
  • Table 2 hereinbelow discloses additional polynucleotides (RNA alternative transcripts) of the above identified 406 genes which expression level is differentiating between typical RRMS and BMS.
  • RNA polymerase I transcription factor RRN3
  • LRPRC leucine-rich PPR-motif containing protein
  • LRPPRC is a candidate gene for the French-Canadian type of Leigh syndrome, a form of cytochrome c oxidase deficiency, and plays a role in translation or stability of mitochondrially encoded cytochrome c oxidase (COX) subunits (Mootha V K, et al., 2003).
  • the LRPPC together with POLR1D molecules comprise a complex with NFkBIB protein (Bouwmeester T, et al., 2004) that inhibits proinflammatory NFkB pathway.
  • the suppression of molecules involved in polymerase I related mechanism, COXI and NFkB regulation could account for the differences between BMS and typical RRMS patients.
  • the polymerase I related mechanism can be potential drug targets for the treatment of RRMS aimed to switch RRMS to the BMS variant.
  • One of commercially available drug that has proven effects on polymerase I mechanism is a diterpenoid triepoxide Triptolide (TPT), isolated from the Chinese herb Tripterygium wilfordii (Leuenroth S J and Crews C M. Triptolide-induced transcriptional arrest is associated with changes in nuclear substructure. Cancer Res. 2008; 68:5257-5266).
  • Triptolide has various anti-inflammatory effects (Liu Y, et al. Triptolide, a component of Chinese herbal medicine, modulates the functional phenotype of dendritic cells. Transplantation. 2007; 84:1517-1526), it modulates T-cell inflammatory responses and ameliorates Experimental Autoimmune Encephalomyelitis (Wang Y, et al. Triptolide modulates T-cell inflammatory responses and ameliorates experimental autoimmune encephalomyelitis. J Neurosci Res. 2008; 86:2441-2449).
  • TPT demonstrated to suppress of T lymphocyte function including T cell apoptosis induction, inhibition of lymphocyte prolipheration and IFN ⁇ production
  • Triptolide a novel immunosuppressive and anti-inflammatory agent purified from a Chinese herb Tripterygium wilfordii Hook f. Leuk Lymphoma 42:253-265; Qiu D, Kao P N. 2003. Immunosuppressive and anti-inflammatory mechanisms of triptolide, the principal active diterpenoid from the Chinese medicinal herb Tripterygium wilfordii Hook f. Drugs R D 4:1-18; Yang Y, Liu Z, Tolosa E, Yang J, Li L. 1998.
  • Triptolide induces apoptotic death of T lymphocyte. Immunopharmacology 40:139-149; Chan M A, Kohlmeier J E, Branden M, Jung M, Benedict S H. 1999. Triptolide is more effective in preventing T cell proliferation and interferon-gamma production than is FK506. Phytother Res 13:464-467). The TPT decreased IL2 and IL2 receptor expression by inhibiting activation of the purine box regulator of the NFkB of activated T cells (Qiu 1999).
  • TPT tumor necrosis factor
  • Table 3 discloses the genes involved in the RNA polymerase I pathway, which are likely to be involved in typical RRMS or BMS pathology.
  • RNA polymerase I pathway SEQ Representative Affymetrix ID Public ID/SEQ ID ProbSet NO: NO: Gene Symbol Gene Title 216902_s_at 62 AF001549/1284; RRN3 RRN3 RNA polymerase I NM_018427/1285 transcription factor homolog 211971_s_at 204 AI653608/1286; LRPPRC leucine-rich PPR-motif NM_133259/1287 containing 220113_x_at 1248 NM_019014/1288 POLR1B polymerase (RNA) I polypeptide B, 128 kDa 207515_s_at 1249 NM_004875/1289 POLR1C polymerase (RNA) I polypeptide C, 30 kDa 209317_at 1250 AF008442/1290 POLR1C polymerase (RNA) I polypeptide C, 30 kDa 218258_at 173 NM_015972/1291 POLR1D polyme
  • RRN3, LRPPRC, POLR1D and other polymerase I mechanism related biomarkers could be used for diagnosis and prediction of BMS. Additionally those markers could be useful for typical RRMS patients to monitor the efficacy of various immunomodulatory drugs for assessment of patients with good response to treatment.
  • Measurement of BMS biomarkers can be performed on the mRNA level by the quantitative reverse-transcriptase polymerase chain reaction (QRT-PCR) method and on protein level by LUMINEX technology.
  • QRT-PCR quantitative reverse-transcriptase polymerase chain reaction
  • Possible modification of the invention is developing biomarkers on protein level (e.g., using ELISA, Western Blot analysis and the like) in PBMC and serum.
  • MS Multiple sclerosis
  • the teachings of the invention enable, for the first time, to distinguish between BMS and typical RRMS patients using molecular tools, which when combined with accurate clinical information enables to dissect the biological complexity of MS.
  • gene expression profiling enabled to diagnose benign MS using a phenotypic approach to differentiate subtypes of the disease.
  • the identified gene expression phenotypes also enable to better understand the biology of benign MS and to develop therapeutics strategies to treat MS.
  • the gene expression signature generated herein of benign MS enables refining MS to diagnose low risk patients versus high risk patients and accordingly suggest appropriate treatment.
  • the benign MS patients that represent low risk would not be treated while the high risk relapsing-remitting MS patients will be treated.
  • teachings of the invention enable to monitor response to treatment and better use of current approved medications.
  • the teachings of the invention can be used to develop a kit or device for diagnosis and prediction of typical RRMS clinical outcome, improving medical decision support systems and individualizing patient care.
  • the teachings of the invention can be used to develop new drugs that will imitate BMS gene expression signature and will result in silencing of the active RRMS.
  • RNA isolation and microarray expression profiling Peripheral blood mononuclear cells (PBMC) were separated on ficoll-hypaque gradient. Total RNA was isolated using the TRIzol Reagent (Invitrogen, Carlsbad, Calif.), and cDNA was synthesized, labeled and hybridized to HG-U133A-2 array (Affymetrix, Inc, Santa Clara, Calif.) containing 22,215 gene-transcripts, washed and scanned (Hewlett Packard, GeneArrayTM scanner G2500A) according to manufacturer's protocol Affymetrix (Inc, Santa Clara, Calif.).
  • MIGs Most informative genes
  • FDR Falls Discovery Rate
  • SVM Super Vector Machine
  • K-Nearest Neighbor algorithms were applied to calculate MIGs classification rates. Only genes which were included in classifiers (from 1 to 10 genes) with more than 70% correct classification rates were analyzed.
  • Tables 4A-C presents the corrected classification rates for all combinations of RRN3, LRPPRC and POLR1D genes of the RNA polymerase I pathway for the entire BMS and typical RRMS group (Table 4A), for the BMS group (Table 4B) and for the typical RRMS group (Table 4C). The best predictive performance for each classifier is presented.
  • results presented in Table 4B demonstrate that for classification of BMS, each of the genes of the RNA polymerase I pathway, i.e., RRN3, LRPPRC and POLR1D exhibits a correct classification rate of 67%, 80% and 60%, respectively.
  • results presented in Table 4C demonstrate that for classification of typical RRMS, each of RRN3, LRPPRC and POLR1D exhibits a correct classification rate of 60%, 67% and 80%, respectively.
  • an increased rate of correct classification of typical RRMS which is a more complex and heterogenous condition, can be achieved using a combination of 2 or 3 genes of the RNA polymerase I pathway.
  • a correct classification rate of 83% is obtained using the combination of RRN3 and POLR1D; a correct classification rate of 83% is obtained using the combination of POLR1D and LRPPRC; and a correct classification rate of 90% is obtained using the combination of RRN3 and LRPPRC (Table 4C, above).
  • the ( ⁇ ) sign means that the polynucleotide is downregulated (decreased in level) in BMS as compared to typical RRMS subjects; and the (+) sign means that the polynucleotide is upregulated (increased in level) in BMS as compared to RRMS subjects.
  • classifiers are presented as following:
  • NCL, MKL1, CTSW, KLRB1 and LRPPRC which results in correct classification rate of 79% of BMS and typical RRMS
  • NCL, MKL1, CTSW, KLRB1, POLR1D, CD1D, and CAMKK2 which results in correct classification rate of 77% of BMS and typical RRMS.
  • the EAE is scored as follows: 0—No obvious changes in motor function on of the rats in comparison to non-immunized rats; 1—Limp tail; 2—Limp tail and weakness of hind legs; 3—Limp tail and complete paralysis of hind legs, or limp tail with paralysis of one front and one hind leg. Or all of: walking only along the edges of the cage, pushing against the cage wall, pushing against the cage wall, spinning when picked up by the tail; 4—Limp tail, complete hind leg and partial front leg paralysis; 5—Complete hind and complete front leg paralysis, no movement around the cage, or mouse is spontaneously rolling in the cage, mouse is found dead due to paralysis.
  • RNA polymerase I pathway Testing the level of expression of genes involved in the RNA polymerase I pathway.
  • bio-markers of benign multiple sclerosis e.g., RRN 3 , POLR 1 D and LRPPRC.
  • Control animals are compared to animals on the peak of EAE disease and to animals treated by the anti MS drug (e.g., TPT).
  • Peripheral blood samples are obtained from female subjects with typical RRMS disease course. All patients are free of immunomodulatory or corticosteroid treatments at least 30 days before blood withdrawal.
  • PBMC are extracted from peripheral blood, separated by Ficoll-Hypaque gradient. 15 ml of peripheral blood from patients is diluted 1:1 with Phosphate Buffered Saline (PBS) (without Ca 2+ /Mg 2+ ). Blood samples are underlied with 10 ml of Ficoll-Lymphoprep (Axis Chield, Norway) and spinned (Eppendorf centrifuge, Germany) at 2300 RPM for 30 minutes. PBMCs are collected, washed with PBS and counted and incubated at 37° C.
  • PBS Phosphate Buffered Saline
  • RNA integrity is assessed by RNA Experion automated electrophoresis system.
  • Treatment with an anti MS drug or with an agent which downregulates at least one gene of the RNA polymerase pathway is incubated during 3 hours with the PBMC (of the subject having typical RRMS) and compared with PBMC (of the subject having typical RRMS) incubated during 3 hours without drug or with placebo excluding therapeutic component.
  • RNA polymerase I pathway Test the level of expression of genes involved in the RNA polymerase I pathway—Total RNA samples, obtained from PBMC of a subject having typical RRMS trayed in-vitro with anti-RNA polymerase I agents (e.g. TPT), are tested using Q-RT-PCR for bio-markers of benign multiple sclerosis (e.g., RRN 3 , POLR 1 D and LRPPRC). The results compared with PBMC from same patients incubated without drag or with placebo.
  • bio-markers of benign multiple sclerosis e.g., RRN 3 , POLR 1 D and LRPPRC

Abstract

Provided are methods and kits for classifying a subject as being more likely to have benign multiple sclerosis (BMS) or as being more likely to have typical relapsing remitting multiple sclerosis (RRMS). Classification of multiple sclerosis disease course is performed by comparing a level of expression of at least one gene involved in the RNA polymerase I pathway in a cell of the subject to a reference expression data of said at least one gene obtained from a cell of at least one subject pre-diagnosed as having BMS and/or from a cell of at least one subject pre-diagnosed as having typical RRMS, thereby classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS. Also provided are methods of diagnosing and treating multiple sclerosis and methods of monitoring treatment efficiency.

Description

    FIELD AND BACKGROUND OF THE INVENTION
  • The present invention, in some embodiments thereof, relates to methods of classifying a subject as having benign multiple sclerosis or typical relapsing remitting multiple sclerosis and, more particularly, but not exclusively, to methods of treating multiple sclerosis based on same.
  • Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system (CNS) affecting young adults (disease onset between 20 to 40 years of age) and is the third leading cause for disability after trauma and rheumatic diseases, with an estimated annual cost 34,000 USD per patient (total life time cost of 2.2 million USD per patient).
  • The disease is characterized by destruction of myelin, associated with death of oligodendrocytes and axonal loss. The main pathologic finding in MS is the presence of infiltrating mononuclear cells, predominantly T lymphocytes and macrophages, which surpass the blood brain barrier and induce an active inflammation within the brain and spinal cord. The neurological symptoms that characterize MS include complete or partial vision loss, diplopia, sensory symptoms, motor weakness that can worsen to complete paralysis, bladder dysfunction and cognitive deficits, which eventually may lead to a significant disability. The associated multiple inflammatory foci lead to myelin destruction, plaques of demyelination, gliosis and axonal loss within the brain and spinal cord and are the reasons contribute to the clinical manifestations of neurological disability.
  • The etiology of MS is not fully understood. The disease develops in genetically predisposed subjects exposed to yet undefined environmental factors and the pathogenesis involves autoimmune mechanisms associated with autoreactive T cells against myelin antigens. It is well established that not one dominant gene determines genetic susceptibility to develop MS, but rather many genes, each with different influence, are involved.
  • Clinically, in 85% of MS patients the illness is initiated with a relapsing-remitting course (RRMS), and in about 10-15% of MS patients have an a-priori primary progressive course (PPMS) without relapses. RRMS is characterized by inflammatory attacks associated with neurological deficits with periods of remissions between the relapses that vary in time. After a period of 10 years, about 50% of RRMS patients will progress to a secondary progressive MS (SPMS) course, characterized by permanent neurological dysfunction, with or without relapses and progressive disability.
  • Benign MS (BMS) is a clinical variant of RRMS in which the patients develop low neurological disability if at all after a disease duration of at least 10 years. Accordingly, this group of MS patients do not experience devastating accumulating disability over-time and when these patients are examined neurologically and scored by the Expanded Disability Status Scale (EDSS) they receive a score that is equal to or lower than 3.0. This low EDSS score signifies mild disability and when this low disability occurs more than 10 years after disease onset, the course of MS is defined as benign (Pittock S J and Rodriguez M, 2008; Costelloe, L., et al., 2008). Prediction of patients that will have BMS is currently impossible and the definition of these patients is retrospective. The molecular events accountable for the BMS variant of disease are not understood.
  • Diterpenoid triepoxide Triptolide (TPT), isolated from the Chinese herb Tripterygium wilfordii (Leuenroth S J and Crews C M. Triptolide-induced transcriptional arrest is associated with changes in nuclear substructure. Cancer Res. 2008; 68:5257-5266) has various anti-inflammatory effects (Liu Y, et al. Triptolide, a component of Chinese herbal medicine, modulates the functional phenotype of dendritic cells. Transplantation. 2007; 84:1517-1526), it modulates T-cell inflammatory responses and ameliorates Experimental Autoimmune Encephalomyelitis (Wang Y, et al. Triptolide modulates T-cell inflammatory responses and ameliorates experimental autoimmune encephalomyelitis. J Neurosci Res. 2008; 86:2441-2449). Derivatives of TPT were suggested for treating autoimmune diseases (EP 0983256, PCT/US1998/008562; WO9852933A1).
  • Cycloheximide, inhibits the phosphorylation of RRN3 and causes its dissociation from RNA polymerase I. RRN3 interacts with the rpa43 subunit of RNA polymerase I, and treatment with cycloheximide inhibits the formation of a RRN3/rpa43 complex in vivo (Alice H. Cavanaugh, et al., 2002. Rrn3 Phosphorylation is a regulatory checkpoint for ribosome biogenesis J. Biol. Chem., 2002; 277: 27423-27432).
  • PCT Application No. PCT/IL2007/32856 discloses methods and kits for predicting prognosis of multiple sclerosis.
  • PCT Application No. PCT/IL2007/001617 discloses methods and kits for predicting the prognosis of a subject diagnosed with multiple sclerosis and methods of selecting a treatment regimen of a subject diagnosed with multiple sclerosis.
  • Achiron A, et al., 2007 (Clinical and Experimental Immunology, 149: 235-242) describe genes of the zinc-ion binding and cytokine activity regulation pathways which predict outcome in relapsing-remitting multiple sclerosis.
  • Additional background art includes PCT Pub. No. WO03081201A2.
    • SUMMARY OF THE INVENTION
  • According to an aspect of some embodiments of the present invention there is provided a method of classifying a subject as being more likely to have benign multiple sclerosis (BMS) or as being more likely to have typical relapsing remitting multiple sclerosis (RRMS), the method comprising comparing a level of expression of at least one gene involved in the RNA polymerase I pathway in a cell of the subject to a reference expression data of the at least one gene obtained from a cell of at least one subject pre-diagnosed as having BMS and/or from a cell of at least one subject pre-diagnosed as having typical RRMS, thereby classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS.
  • According to an aspect of some embodiments of the present invention there is provided a method of diagnosing a subject pre-diagnosed with multiple sclerosis (MS) as having benign multiple sclerosis (BMS) or typical relapsing remitting multiple sclerosis (RRMS), the method comprising:
  • (a) classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS according to the method of claim 1,
  • (i) wherein when the subject is classified as being more likely to have the BMS then the subject is diagnosed as having BMS;
  • (ii) wherein when the subject is classified as being more likely to have the typical RRMS, then the subject is diagnosed as having typical RRMS; and
  • (c) informing the subject of the diagnosis,
  • thereby diagnosing the subject pre-diagnosed with the MS as having the BMS or the typical RRMS.
  • According to an aspect of some embodiments of the present invention there is provided a method of monitoring an efficiency of an anti multiple sclerosis (MS) drug in treating a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS) course, the method comprising:
  • (a) treating the subject with the anti MS drug; and
  • (b) comparing a level of expression of least one gene involved in the RNA polymerase I pathway in a cell of the subject following the treating with the anti MS drug to a level of expression of the at least one gene in a cell of the subject prior to the treating the subject with the anti MS drug,
  • (i) wherein a decrease above a predetermined threshold in the level of expression of the at least one gene following the treating with the anti MS drug relative to the level of expression of the at least one gene prior to the treating with the anti MS drug indicates that the anti MS drug is efficient for treating the subject;
  • (ii) wherein an increase above a predetermined threshold in the level of expression of the at least one gene following the treating with the anti MS drug relative to the level of expression of the at least one gene prior to the treating with the anti MS drug indicates that the anti MS drug is not efficient for treating the subject; or
  • (iii) wherein when a level of expression of the at least one gene following the treating with the anti MS drug is identical or changed below a predetermined threshold as compared to prior to the treating with the anti MS drug then the treatment is not efficient for treating the subject.
  • thereby monitoring the efficiency of the anti multiple sclerosis (MS) drug in treating the subject diagnosed with the typical RRMS course.
  • According to an aspect of some embodiments of the present invention there is provided an in vitro method of predicting an efficiency of an anti multiple sclerosis (MS) drug for treatment of a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS), the method comprising:
  • (a) contacting cells of the subject with a therapeutically effective amount of the anti MS drug; and
  • (b) comparing a level of expression in the cells of at least one gene involved in the RNA polymerase I pathway following the contacting with the anti MS drug to a level of expression of the at least one gene in the cells prior to the contacting with the anti MS drug,
  • (i) wherein a decrease above a predetermined threshold in the level of expression of the at least one gene following the contacting with the anti MS drug relative to the level of expression of the at least one gene prior to the contacting with the anti MS drug indicates that the treatment is efficient for treating the subject;
  • (ii) wherein an increase above a predetermined threshold in the level of expression of the at least one gene following the contacting with the anti MS drug relative to the level of expression of the at least one gene prior to the contacting with the anti MS drug indicates that the treatment is not efficient for treating the subject; or
  • (iii) wherein when a level of expression of the at least one gene following the contacting with the anti MS drug is identical or changed below a predetermined threshold as compared to prior to the contacting with the anti MS drug then the treatment is not efficient for treating the subject.
  • thereby predicting the efficiency of the anti MS drug for treatment of the subject diagnosed with the typical RRMS.
  • According to an aspect of some embodiments of the present invention there is provided a method of treating a subject diagnosed with multiple sclerosis, the method comprising
  • (a) classifying the subject as being more likely to have BMS or typical RRMS according to the method of claim 1,
  • (b) selecting a treatment regimen based on classification results of step (a); thereby treating the subject diagnosed with multiple sclerosis.
  • According to an aspect of some embodiments of the present invention there is provided a method of treating a subject diagnosed with multiple sclerosis, the method comprising:
  • (a) diagnosing a typical relapsing remitting multiple sclerosis (RRMS) according to the method of claim 2,
  • (b) administering to the subject a therapeutically effective amount of diterpenoid triepoxide Triptolide (TPT) or a derivative thereof, thereby treating the subject.
  • According to an aspect of some embodiments of the present invention there is provided a probeset comprising a plurality of oligonucleotides and no more than 50 oligonucleotides, wherein an oligonucleotide of the plurality of oligonucleotides specifically recognizes a polynucleotide of at least one gene involved in the RNA polymerase pathway.
  • According to an aspect of some embodiments of the present invention there is provided a kit for classifying a disease course in a subject diagnosed with multiple sclerosis (MS), comprising the probeset of claim 7.
  • According to an aspect of some embodiments of the present invention there is provided a method of selecting a drug for treating a typical relapsing remitting multiple sclerosis (RRMS) in a subject, the method comprising:
  • contacting cells of a subject classified as having a typical RRMS with a plurality of drug molecules,
  • identifying at least one drug molecule which downregulates a level of expression of at least one gene involved in the RNA polymerase I pathway, the at least one drug molecule is suitable for treating the typical RRMS in the subject,
  • thereby selecting the drug for treating the typical RRMS in the subject.
  • According to some embodiments of the invention, a decrease above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from the at least one subject having the typical RRMS classifies the subject as being more likely to have the BMS.
  • According to some embodiments of the invention, an increase above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from the at least one subject having the BMS classifies the subject as being more likely to have the typical RRMS.
  • According to some embodiments of the invention, a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from the at least one subject having the BMS, then the subject is classified as being more likely to have the BMS.
  • According to some embodiments of the invention, a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from the at least one subject having the typical RRMS, then the subject is classified as being more likely to have the typical RRMS.
  • According to some embodiments of the invention, when the subject being more likely to have typical RRMS then the treatment regimen comprises administering to the subject an agent which downregulates the level of expression of the at least one gene involved in the RNA polymerase I pathway.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is selected from the group consisting of POLR1D, LRPPRC, RRN3 and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises the POLR1D, LRPPRC, RRN3 and NCL genes.
  • According to some embodiments of the invention, the agent is selected from the group consisting of an siRNA, an antisense, an antibody and a small molecule.
  • According to some embodiments of the invention, the small molecule is Cycloheximide.
  • According to some embodiments of the invention, the at least one gene is RRN3, and whereas the downregulating is effected using diterpenoid triepoxide Triptolide (TPT) or a derivative thereof.
  • According to some embodiments of the invention, the at least one gene is RRN3, and whereas the downregulating is effected using Cycloheximide.
  • According to some embodiments of the invention, the kit further comprising a positive control for an expression level of the at least one gene involved in the RNA polymerase pathway.
  • According to some embodiments of the invention, each of the plurality of oligonucleotides is bound to a solid support.
  • According to some embodiments of the invention, the plurality of oligonucleotides are bound to the solid support in an addressable location.
  • According to some embodiments of the invention, the level of expression is determined using an RNA detection method.
  • According to some embodiments of the invention, the level of expression is determined using a protein detection method.
  • According to some embodiments of the invention, the cell is a blood cell.
  • According to some embodiments of the invention, the method further comprising administering to the subject a therapeutically effective amount of an anti MS agent.
  • According to some embodiments of the invention, the anti-MS agent is selected from the group consisting of Diterpenoid triepoxide Triptolide (TPT), Adderall, Ambien, Avonex, Baclofen, Beta interferon, Betaseron, Celexa, Clonazepam, Copaxone, Corticosteroids, Cymbalta, Cytoxan, Dexamethasone, Effexor, Elavil, Gabapentin, Hydrocodone, Lexapro, Lyrica, Mitoxantrone, Naltrexone, Neurontin, Novantrone, Prednisone, Provigil, Rebif, Solumedrol, Symmetrel, Topamax, Tysabri, Wellbutrin, Xanax, Zanaflex, Zoloft, fingolimod, laquinimod, Mylinax (cladribine), teriflunomide, BG-12 (Biogen Idec's), firategrast (GSK/Mitsubishi Tanabe Pharma), ibudilast (MediciNova's), and CDP323 (Biogen/UCB).
  • According to an aspect of some embodiments of the present invention there is provided a method of predicting a benign multiple sclerosis course in a subject diagnosed with multiple sclerosis, the method comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IPW, FLJ20152, SIRPB2, GALNT4, CD28, TXK, ETS1, DGCR5, ZNF192, TCF7, CAMK4, SIM2, MGEA5, TGFBR2, RET, MAPK8IP3, RRN3, DKFZp547H025, FBXW11, ZNF423, DLG1, MGC17330, CD164L1, REPS1, ACHE, ITGB1BP2, LOC94431, LTK, RUNX1, EVER1, KIAA2010, CEACAM7, STX16, SLC4A5, CRTAP, RECQL5, MAGEF1, VIPR1, FLJ10979, TTC3, CRSP2, BAZ2A, GTF2I, MGC50853, KIAA0508, BPHL, LTBP4, FN3KRP, SCARB1, MGC17330, HYAL4, DGKA, FLJ11196, DHRS6, EPHB4, IDI2/GTPBP4, SNTG2, SLC7A6, PMS2L2, KIAA0436, TOSO, THRAP3, T3JAM, LOC283232, LOC92482, PTER, ATM, NUCB2, PIK3R2, MGC1136, CD59, JARID1A, FLJ39616, ABLIM1, PBP, MAPK8IP3, FTS, LHX5, TNFRSF7, MYC, PBXIP1, DATF1, HTF9C, PUS1, KIAA0924, C6orf4, KIAA0372, WDR42A, CRYZL1, TERE1, LTBP4, TTC3, NFATC1, POM121/LOC340318, TOSO, LOC348926/MGC16279/SB153/FLJ10661, SPOCK2, KIAA0515, SLC37A4, CD44, SMARCA2, SPTBN1, C6orf130, TTC3, DLG1, SLC35E2, MCCC1, PMS2L11, RCN3, STX16, FLJ20618, STAT5B, SMARCA2, SATB1, POLR1D, ASXL1, REV1L, PMS2L2/PMS2L5, FLJ12355, CCNB1IP1, FLJ12270, KIAA0692, MCM7, GPSN2, STX16, MMS19L, GTF2I/GTF2IP1, AKAP7, ZNF444, SLC35A3, MGEA5, RUTBC3, C20orf36, RAD17, ALG12, LOC112869, C6orf48, CUTC, LGTN, DEF6, WAC, HNRPH3, NS, KIAA0892, LRPPRC, HMG20A, DDX42, TINP1, ZDHHC17, C19orf2, EIF4B, LOC376745, DKFZP434C171, TH1L, C19orf13, RPL22, PHF15, EWSR1, EIF4B, FAM48A, YT521, NEK9, EIF3S7, RPS6, RPL35A, EEF2, RPL3, RPS6, UBA52, RPL6, RPS6, RPL13, AL353949, AL580863, AF052160, AW128846, AW974481, N92920, BG178274, AW303460, BF057458, AL050035, M59917, AK025422, AI693985, AU158442, AK021460, AL023773, NM—003790, AC005011, M90355, AL353580, U38964, D50683 and BE967207, wherein downregulation below a predetermined threshold in the level of expression relative to a level of expression of the at least one polynucleotide in a biological sample of a subject diagnosed with typical relapsing-remitting multiple sclerosis (RRMS) is indicative of the prediction of the benign multiple sclerosis course of the subject; (b) informing the subject of the prediction of the benign multiple sclerosis course; thereby predicting the benign multiple sclerosis course in the subject diagnosed with the multiple sclerosis.
  • According to an aspect of some embodiments of the present invention there is provided a method of predicting a benign multiple sclerosis course in a subject diagnosed with multiple sclerosis, the method comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036, TUBB2, PDCL, CCL5, CDS2, RAP1GDS1, ATP6V1D, OBRGRP/LEPR, SF4, GCLC, MGST3, BICD2, BRF1, CHST12, EXOSC7, TOR1B, ZFP95, ILK, UNC13A, MTHFD2, CASP10, FLJ45850, CMRF-35H, ARF3, NDOR1, DUSP10, AP1M2, VRK2, GSN, PTRF, RBM19, RABGAP1L, ATP5S, STOM, TFPI2, SLCO3A1, PTPN12, CSF1, SIGLEC6, KIRREL, OBRGRP, TP53AP1, SUHW1, NUP98, IL15RA, MICB, CMRF-35H, SPHK1, TNFRSF6, FLJ11301, LRP5, STOM, EPHA2, SRC, FLJ11301, PSTPIP2, EBP, MCPH1, PTPRF, LIMK2, FSTL4, CBR1, MGC2654, MYCT1, NOL3, MITF, ATP10B, FBXO31, TBX21, LSS, SLC17A3, MNAB, CHPPR, G1F, VAMPS, ABCG2, KIF1B, LOH11CR2A, NID2, RBBP8, ETV7, CTSL, RUFY1, RSU1, PARD3, APOB, ACOX3, DAB2, LDLR, TJP2, GNAS, PARD3, NCKAP1, TAP2, HDGFRP3, LDLR, PIK3R3, HTR2B, GAS2L1, FER1L3, C3orf14, TP53TG3, LEPR, CLIC5, PDE4DIP, ATP9A, ITGB1BP1, INDO, SELP, FHL2, FER1L3, EGF, SIAT8A, HDGFRP3, LRAP, VWF, FLJ10134, IMP-3, DMN, MCTP1, FSTL1, CTNNAL1, RAB27B, THBS1, PROS1, MMRN1, CTTN, AL078596, AI148659, U00956 and M29383, wherein upregulation above a predetermined threshold in the level of expression relative to a level of expression of the at least one polynucleotide in a biological sample of a subject diagnosed with typical relapsing-remitting multiple sclerosis (RRMS) is indicative of the prediction of the benign multiple sclerosis course of the subject; (b) informing the subject of the prediction of the benign multiple sclerosis course; thereby predicting the benign multiple sclerosis course in the subject diagnosed with the multiple sclerosis.
  • According to an aspect of some embodiments of the present invention there is provided a method of monitoring treatment with an anti MS drug in a subject in need thereof, the method comprising: (a) treating the subject with the anti MS drug; and (b) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036, TUBB2, PDCL, CCL5, CDS2, RAP1GDS1, ATP6V1D, OBRGRP/LEPR, SF4, GCLC, MGST3, BICD2, BRF1, CHST12, EXOSC7, TOR1B, ZFP95, ILK, UNC13A, MTHFD2, CASP10, FLJ45850, CMRF-35H, ARF3, NDOR1, DUSP10, AP1M2, VRK2, GSN, PTRF, RBM19, RABGAP1L, ATP5S, STOM, TFPI2, SLCO3A1, PTPN12, CSF1, SIGLEC6, KIRREL, OBRGRP, TP53AP1, SUHW1, NUP98, IL15RA, MICB, CMRF-35H, SPHK1, TNFRSF6, FLJ11301, LRP5, STOM, EPHA2, SRC, FLJ11301, PSTPIP2, EBP, MCPH1, PTPRF, LIMK2, FSTL4, CBR1, MGC2654, MYCT1, NOL3, MITF, ATP10B, FBXO31, TBX21, LSS, SLC17A3, MNAB, CHPPR, G1F, VAMPS, ABCG2, KIF1B, LOH11CR2A, NID2, RBBP8, ETV7, CTSL, RUFY1, RSU1, PARD3, APOB, ACOX3, DAB2, LDLR, TJP2, GNAS, PARD3, NCKAP1, TAP2, HDGFRP3, LDLR, PIK3R3, HTR2B, GAS2L1, FER1L3, C3orf14, TP53TG3, LEPR, CLIC5, PDE4DIP, ATP9A, ITGB1BP1, INDO, SELP, FHL2, FER1L3, EGF, SIAT8A, HDGFRP3, LRAP, VWF, FLJ10134, IMP-3, DMN, MCTP1, FSTL1, CTNNAL1, RAB27B, THBS1, PROS1, MMRN1, CTTN, AL078596, AI148659, U00956 and M29383, wherein an upregulation above a predetermined threshold in the level of expression relative to a level of expression of the at least one polynucleotide in a biological sample of a subject diagnosed with typical relapsing-remitting multiple sclerosis (RRMS) is indicative of treatment efficacy.
  • According to some embodiments of the invention, step (b) is effected also prior to step (a) and wherein the upregulation is with respect to a level of the at least one polynucleotide prior to the treating.
  • According to an aspect of some embodiments of the present invention there is provided a method of monitoring treatment with an anti MS drug in a subject in need thereof, the method comprising: (a) treating the subject with the anti MS drug; and (b) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IPW, FLJ20152, SIRPB2, GALNT4, CD28, TXK, ETS1, DGCR5, ZNF192, TCF7, CAMK4, SIM2, MGEA5, TGFBR2, RET, MAPK8IP3, RRN3, DKFZp547H025, FBXW11, ZNF423, DLG1, MGC17330, CD164L1, REPS1, ACHE, ITGB1BP2, LOC94431, LTK, RUNX1, EVER1, KIAA2010, CEACAM7, STX16, SLC4A5, CRTAP, RECQL5, MAGEF1, VIPR1, FLJ10979, TTC3, CRSP2, BAZ2A, GTF2I, MGC50853, KIAA0508, BPHL, LTBP4, FN3KRP, SCARB1, MGC17330, HYAL4, DGKA, FLJ11196, DHRS6, EPHB4, IDI2/GTPBP4, SNTG2, SLC7A6, PMS2L2, KIAA0436, TOSO, THRAP3, T3JAM, LOC283232, LOC92482, PTER, ATM, NUCB2, PIK3R2, MGC1136, CD59, JARID1A, FLJ39616, ABLIM1, PBP, MAPK8IP3, FTS, LHX5, TNFRSF7, MYC, PBXIP1, DATF1, HTF9C, PUS1, KIAA0924, C6orf4, KIAA0372, WDR42A, CRYZL1, TERE1, LTBP4, TTC3, NFATC1, POM121/LOC340318, TOSO, LOC348926/MGC16279/SB153/FLJ10661, SPOCK2, KIAA0515, SLC37A4, CD44, SMARCA2, SPTBN1, C6orf130, TTC3, DLG1, SLC35E2, MCCC1, PMS2L11, RCN3, STX16, FLJ20618, STAT5B, SMARCA2, SATB1, POLR1D, ASXL1, REV1L, PMS2L2/PMS2L5, FLJ12355, CCNB1IP1, FLJ12270, KIAA0692, MCM7, GPSN2, STX16, MMS19L, GTF2I/GTF2IP1, AKAP7, ZNF444, SLC35A3, MGEA5, RUTBC3, C20orf36, RAD17, ALG12, LOC112869, C6orf48, CUTC, LGTN, DEF6, WAC, HNRPH3, NS, KIAA0892, LRPPRC, HMG20A, DDX42, TINP1, ZDHHC17, C19orf2, EIF4B, LOC376745, DKFZP434C171, TH1L, C19orf13, RPL22, PHF15, EWSR1, EIF4B, FAM48A, YT521, NEK9, EIF3S7, RPS6, RPL35A, EEF2, RPL3, RPS6, UBA52, RPL6, RPS6, RPL13, AL353949, AL580863, AF052160, AW128846, AW974481, N92920, BG178274, AW303460, BF057458, AL050035, M59917, AK025422, AI693985, AU158442, AK021460, AL023773, NM—003790, AC005011, M90355, AL353580, U38964, D50683 and BE967207, wherein downregulation below a predetermined threshold in the level of expression relative to a level of expression of the at least one polynucleotide in a biological sample of a subject diagnosed with typical relapsing-remitting multiple sclerosis (RRMS) is indicative of treatment efficacy.
  • According to some embodiments of the invention, step (b) is effected also prior to step (a) and wherein the downregulation is with respect to a level of the at least one polynucleotide prior to the treating.
  • According to an aspect of some embodiments of the present invention there is provided a method of predicting a typical relapsing-remitting multiple sclerosis (RRMS) course in a subject diagnosed with multiple sclerosis, the method comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036, TUBB2, PDCL, CCL5, CDS2, RAP1GDS1, ATP6V1D, OBRGRP/LEPR, SF4, GCLC, MGST3, BICD2, BRF1, CHST12, EXOSC7, TOR1B, ZFP95, ILK, UNC13A, MTHFD2, CASP10, FLJ45850, CMRF-35H, ARF3, NDOR1, DUSP10, AP1M2, VRK2, GSN, PTRF, RBM19, RABGAP1L, ATP5S, STOM, TFPI2, SLCO3A1, PTPN12, CSF1, SIGLEC6, KIRREL, OBRGRP, TP53AP1, SUHW1, NUP98, IL15RA, MICB, CMRF-35H, SPHK1, TNFRSF6, FLJ11301, LRP5, STOM, EPHA2, SRC, FLJ11301, PSTPIP2, EBP, MCPH1, PTPRF, LIMK2, FSTL4, CBR1, MGC2654, MYCT1, NOL3, MITF, ATP10B, FBXO31, TBX21, LSS, SLC17A3, MNAB, CHPPR, G1F, VAMPS, ABCG2, KIF1B, LOH11CR2A, NID2, RBBP8, ETV7, CTSL, RUFY1, RSU1, PARD3, APOB, ACOX3, DAB2, LDLR, TJP2, GNAS, PARD3, NCKAP1, TAP2, HDGFRP3, LDLR, PIK3R3, HTR2B, GAS2L1, FER1L3, C3orf14, TP53TG3, LEPR, CLIC5, PDE4DIP, ATP9A, ITGB1BP1, INDO, SELP, FHL2, FER1L3, EGF, SIAT8A, HDGFRP3, LRAP, VWF, FLJ10134, IMP-3, DMN, MCTP1, FSTL1, CTNNAL1, RAB27B, THBS1, PROS1, MMRN1, CTTN, AL078596, AI148659, U00956 and M29383, wherein downregulation below a predetermined threshold in the level of expression relative to a level of expression of the at least one polynucleotide in a biological sample of a subject diagnosed with benign multiple sclerosis (BMS) is indicative of the prediction of the relapsing-remitting multiple sclerosis course of the subject; (b) informing the subject of the prediction of the relapsing-remitting multiple sclerosis course; thereby predicting the relapsing-remitting multiple sclerosis course in the subject diagnosed with the multiple sclerosis.
  • According to an aspect of some embodiments of the present invention there is provided a method of predicting a typical relapsing-remitting multiple sclerosis (RRMS) course in a subject diagnosed with multiple sclerosis, the method comprising: (a) determining in a biological sample of the subject a level of expression of at least one polynucleotide selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IPW, FLJ20152, SIRPB2, GALNT4, CD28, TXK, ETS1, DGCR5, ZNF192, TCF7, CAMK4, SIM2, MGEA5, TGFBR2, RET, MAPK8IP3, RRN3, DKFZp547H025, FBXW11, ZNF423, DLG1, MGC17330, CD164L1, REPS1, ACHE, ITGB1BP2, LOC94431, LTK, RUNX1, EVER1, KIAA2010, CEACAM7, STX16, SLC4A5, CRTAP, RECQL5, MAGEF1, VIPR1, FLJ10979, TTC3, CRSP2, BAZ2A, GTF2I, MGC50853, KIAA0508, BPHL, LTBP4, FN3KRP, SCARB1, MGC17330, HYAL4, DGKA, FLJ11196, DHRS6, EPHB4, IDI2/GTPBP4, SNTG2, SLC7A6, PMS2L2, KIAA0436, TOSO, THRAP3, T3JAM, LOC283232, LOC92482, PTER, ATM, NUCB2, PIK3R2, MGC1136, CD59, JARID1A, FLJ39616, ABLIM1, PBP, MAPK8IP3, FTS, LHX5, TNFRSF7, MYC, PBXIP1, DATF1, HTF9C, PUS1, KIAA0924, C6orf4, KIAA0372, WDR42A, CRYZL1, TERE1, LTBP4, TTC3, NFATC1, POM121/LOC340318, TOSO, LOC348926/MGC16279/SB153/FLJ10661, SPOCK2, KIAA0515, SLC37A4, CD44, SMARCA2, SPTBN1, C6orf130, TTC3, DLG1, SLC35E2, MCCC1, PMS2L11, RCN3, STX16, FLJ20618, STAT5B, SMARCA2, SATB1, POLR1D, ASXL1, REV1L, PMS2L2/PMS2L5, FLJ12355, CCNB1IP1, FLJ12270, KIAA0692, MCM7, GPSN2, STX16, MMS19L, GTF2I/GTF2IP1, AKAP7, ZNF444, SLC35A3, MGEA5, RUTBC3, C20orf36, RAD17, ALG12, LOC112869, C6orf48, CUTC, LGTN, DEF6, WAC, HNRPH3, NS, KIAA0892, LRPPRC, HMG20A, DDX42, TINP1, ZDHHC17, C19orf2, EIF4B, LOC376745, DKFZP434C171, TH1L, C19orf13, RPL22, PHF15, EWSR1, EIF4B, FAM48A, YT521, NEK9, EIF3S7, RPS6, RPL35A, EEF2, RPL3, RPS6, UBA52, RPL6, RPS6, RPL13, AL353949, AL580863, AF052160, AW128846, AW974481, N92920, BG178274, AW303460, BF057458, AL050035, M59917, AK025422, AI693985, AU158442, AK021460, AL023773, NM—003790, AC005011, M90355, AL353580, U38964, D50683 and BE967207, wherein upregulation above a predetermined threshold in the level of expression relative to a level of expression of the at least one polynucleotide in a biological sample of a subject diagnosed with benign multiple sclerosis (BMS) is indicative of the prediction of the relapsing-remitting multiple sclerosis course of the subject; (b) informing the subject of the prediction of the relapsing-remitting multiple sclerosis course; thereby predicting the relapsing-remitting multiple sclerosis course in the subject diagnosed with the multiple sclerosis.
  • According to an aspect of some embodiments of the present invention there is provided a method of treating a subject diagnosed with multiple sclerosis, the method comprising: (a) determining if the subject is predicted to have a relapsing-remitting multiple sclerosis course according to the method of the invention, (b) selecting a treatment regimen based on the prediction of the relapsing-remitting multiple sclerosis course; thereby treating the subject diagnosed with multiple sclerosis.
  • According to an aspect of some embodiments of the present invention there is provided a method of treating a subject diagnosed with multiple sclerosis, the method comprising: (a) determining in a biological sample of the subject a level of expression of RRN3, wherein upregulation above a predetermined threshold in the level of expression relative to a level of expression of the RRN3 in a biological sample of a subject diagnosed with benign multiple sclerosis (BMS) is indicative of the prediction of the relapsing-remitting multiple sclerosis course of the subject; (b) administering to the subject a therapeutically effective amount of diterpenoid triepoxide Triptolide (TPT) or a derivative thereof, thereby treating the subject.
  • According to an aspect of some embodiments of the present invention there is provided a method of treating a subject diagnosed with multiple sclerosis, the method comprising: administering to the subject an agent which downregulates the expression level and/or activity of at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway, with the proviso that the agent is not diterpenoid triepoxide Triptolide (TPT), thereby treating the subject.
  • According to an aspect of some embodiments of the present invention there is provided a probeset comprising a plurality of oligonucleotides and no more than 500 oligonucleotides, the plurality of oligonucleotides specifically recognizing the polynucleotides of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IPW, FLJ20152, SIRPB2, GALNT4, CD28, TXK, ETS1, DGCR5, ZNF192, TCF7, CAMK4, SIM2, MGEA5, TGFBR2, RET, MAPK8IP3, RRN3, DKFZp547H025, FBXW11, ZNF423, DLG1, MGC17330, CD164L1, REPS1, ACHE, ITGB1BP2, LOC94431, LTK, RUNX1, EVER1, KIAA2010, CEACAM7, STX16, SLC4A5, CRTAP, RECQL5, MAGEF1, VIPR1, FLJ10979, TTC3, CRSP2, BAZ2A, GTF2I, MGC50853, KIAA0508, BPHL, LTBP4, FN3KRP, SCARB1, MGC17330, HYAL4, DGKA, FLJ11196, DHRS6, EPHB4, IDI2/GTPBP4, SNTG2, SLC7A6, PMS2L2, KIAA0436, TOSO, THRAP3, T3JAM, LOC283232, LOC92482, PTER, ATM, NUCB2, PIK3R2, MGC1136, CD59, JARID1A, FLJ39616, ABLIM1, PBP, MAPK8IP3, FTS, LHX5, TNFRSF7, MYC, PBXIP1, DATF1, HTF9C, PUS1, KIAA0924, C6orf4, KIAA0372, WDR42A, CRYZL1, TERE1, LTBP4, TTC3, NFATC1, POM121/LOC340318, TOSO, LOC348926/MGC16279/SB153/FLJ10661, SPOCK2, KIAA0515, SLC37A4, CD44, SMARCA2, SPTBN1, C6orf130, TTC3, DLG1, SLC35E2, MCCC1, PMS2L11, RCN3, STX16, FLJ20618, STAT5B, SMARCA2, SATB1, POLR1D, ASXL1, REV1L, PMS2L2/PMS2L5, FLJ12355, CCNB1IP1, FLJ12270, KIAA0692, MCM7, GPSN2, STX16, MMS19L, GTF2I/GTF2IP1, AKAP7, ZNF444, SLC35A3, MGEA5, RUTBC3, C20orf36, RAD17, ALG12, LOC112869, C6orf48, CUTC, LGTN, DEF6, WAC, HNRPH3, NS, KIAA0892, LRPPRC, HMG20A, DDX42, TINP1, ZDHHC17, C19orf2, EIF4B, LOC376745, DKFZP434C171, TH1L, C19orf13, RPL22, PHF15, EWSR1, EIF4B, FAM48A, YT521, NEK9, EIF3S7, RPS6, RPL35A, EEF2, RPL3, RPS6, UBA52, RPL6, RPS6, RPL13, AL353949, AL580863, AF052160, AW128846, AW974481, N92920, BG178274, AW303460, BF057458, AL050035, M59917, AK025422, AI693985, AU158442, AK021460, AL023773, NM—003790, AC005011, M90355, AL353580, U38964, D50683, BE967207, YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036, TUBB2, PDCL, CCL5, CDS2, RAP1GDS1, ATP6V1D, OBRGRP/LEPR, SF4, GCLC, MGST3, BICD2, BRF1, CHST12, EXOSC7, TOR1B, ZFP95, ILK, UNC13A, MTHFD2, CASP10, FLJ45850, CMRF-35H, ARF3, NDOR1, DUSP10, AP1M2, VRK2, GSN, PTRF, RBM19, RABGAP1L, ATP5S, STOM, TFPI2, SLCO3A1, PTPN12, CSF1, SIGLEC6, KIRREL, OBRGRP, TP53AP1, SUHW1, NUP98, IL15RA, MICB, CMRF-35H, SPHK1, TNFRSF6, FLJ11301, LRP5, STOM, EPHA2, SRC, FLJ11301, PSTPIP2, EBP, MCPH1, PTPRF, LIMK2, FSTL4, CBR1, MGC2654, MYCT1, NOL3, MITF, ATP10B, FBXO31, TBX21, LSS, SLC17A3, MNAB, CHPPR, G1F, VAMPS, ABCG2, KIF1B, LOH11CR2A, NID2, RBBP8, ETV7, CTSL, RUFY1, RSU1, PARD3, APOB, ACOX3, DAB2, LDLR, TJP2, GNAS, PARD3, NCKAP1, TAP2, HDGFRP3, LDLR, PIK3R3, HTR2B, GAS2L1, FER1L3, C3orf14, TP53TG3, LEPR, CLIC5, PDE4DIP, ATP9A, ITGB1BP1, INDO, SELP, FHL2, FER1L3, EGF, SIAT8A, HDGFRP3, LRAP, VWF, FLJ10134, IMP-3, DMN, MCTP1, FSTL1, CTNNAL1, RAB27B, THBS1, PROS1, MMRN1, CTTN, AL078596, AI148659, U00956 and M29383.
  • According to an aspect of some embodiments of the present invention there is provided a kit for predicting a benign or relapsing-remitting course in a subject diagnosed with multiple sclerosis, comprising the probeset of the invention.
  • According to some embodiments of the invention, the kit further comprising a positive control for an expression level of at least one of the polynucleotides.
  • According to some embodiments of the invention, the at least one polynucleotide comprises the polynucleotides of RRN3, POLR1D and LRPPRC.
  • According to some embodiments of the invention, the treatment regimen comprises administering to the subject an agent which downregulates the expression level and/or activity of at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway, thereby treating the subject.
  • According to some embodiments of the invention, the at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway comprises RRN3.
  • According to some embodiments of the invention, the at least one polynucleotide or polypeptide of the RNA polymerase 1 pathway further comprises POLR1D and LRPPRC.
  • According to some embodiments of the invention, the method further comprising determining in the biological sample of the subject the level of expression of POLR1D and/or LRPPRC, wherein upregulation above a predetermined threshold in the level of expression relative to a level of expression of the POLR1D and/or LRPPRC in a biological sample of a subject diagnosed with benign multiple sclerosis (BMS) is indicative of the prediction of the relapsing-remitting multiple sclerosis course of the subject.
  • Unless otherwise defined, all technical and/or scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention pertains. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of embodiments of the invention, exemplary methods and/or materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and are not intended to be necessarily limiting.
  • Implementation of the method and/or system of embodiments of the invention can involve performing or completing selected tasks manually, automatically, or a combination thereof. Moreover, according to actual instrumentation and equipment of embodiments of the method and/or system of the invention, several selected tasks could be implemented by hardware, by software or by firmware or by a combination thereof using an operating system.
  • For example, hardware for performing selected tasks according to embodiments of the invention could be implemented as a chip or a circuit. As software, selected tasks according to embodiments of the invention could be implemented as a plurality of software instructions being executed by a computer using any suitable operating system. In an exemplary embodiment of the invention, one or more tasks according to exemplary embodiments of method and/or system as described herein are performed by a data processor, such as a computing platform for executing a plurality of instructions. Optionally, the data processor includes a volatile memory for storing instructions and/or data and/or a non-volatile storage, for example, a magnetic hard-disk and/or removable media, for storing instructions and/or data. Optionally, a network connection is provided as well. A display and/or a user input device such as a keyboard or mouse are optionally provided as well.
    • BRIEF DESCRIPTION OF THE DRAWINGS
  • Some embodiments of the invention are herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of embodiments of the invention. In this regard, the description taken with the drawings makes apparent to those skilled in the art how embodiments of the invention may be practiced.
  • In the drawings:
  • FIG. 1 is a schematic illustration depicting the design of the study for identification of genes which predict benign multiple sclerosis;
  • FIG. 2 depicts Principal Component Analysis (PCA) based on 406 most informative genes (MIGs);
    •  DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION
  • The present invention, in some embodiments thereof, relates to methods of classifying a subject as being more likely to have BMS or to be more likely to have typical RRMS and, more particularly, but not exclusively, to methods of diagnosing typical RRMS or BMS and treating a subject based on the diagnosis.
  • Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not necessarily limited in its application to the details set forth in the following description or exemplified by the Examples. The invention is capable of other embodiments or of being practiced or carried out in various ways.
  • The present inventors have applied a high throughput gene expression technology to identify biomarkers for the diagnosis of benign multiple sclerosis (BMS) and for potential targets for therapeutic interventions in order switch RRMS course of disease to a BMS course of disease.
  • Thus, as shown in Example 1 of the Examples section which follows, the present inventors have identified 406 genes which are differentially expressed between multiple sclerosis subjects having a benign MS course or an RRMS course (typical RRMS) (Tables 1 and 2). These genes can be used for classification of MS disease course, diagnosis of a typical RRMS course and selecting a suitable treatment regimen for a subject diagnosed with MS which will prevent deterioration in the subject's state while avoiding unnecessary side effects. In addition, as shown in Table 3 (Example 1) and Tables 4A-C (Example 2) the present inventors have uncovered that the expression level of genes which are involved in the RNA polymerase I pathway such as POLR1D, LRPPRC, RRN3 and NCL is downregulated in subjects having a BMS course of MS as compared to the expression level of these genes in subjects having an RRMS course of MS. Moreover, as shown in Tables 5 and 6 (Example 2) the present inventors identified MIGs (most informative genes) discriminating between BMS and typical RRMS and genes which can classify subjects as having a BMS or a typical RRMS. These results suggest the use of genes involved in the RNA polymerase I pathway as diagnostic markers and drug targets for treating and preventing a typical RRMS course in a subject diagnosed with MS.
  • Thus, according to an aspect of some embodiments of the invention there is provided a method of classifying a subject as being more likely to have benign multiple sclerosis (BMS) or as being more likely to have typical relapsing remitting multiple sclerosis (RRMS), the method comprising comparing a level of expression of at least one gene involved in the RNA polymerase I pathway in a cell of the subject to a reference expression data of the at least one gene obtained from a cell of at least one subject pre-diagnosed as having BMS and/or from a cell of at least one subject pre-diagnosed as having typical RRMS, thereby classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS.
  • The term “subject” refers to mammal, preferably a human being.
  • According to some embodiments of the invention, the subject is diagnosed with multiple sclerosis.
  • As used herein, the phrase “diagnosed with multiple sclerosis” refers to a subject who experienced at least one neurological attack affecting the central nervous system (CNS) accompanied by demyelinating lesions within the brain or spinal cord, which may have, but not necessarily confirmed by magnetic resonance imaging (MRI). The neurological attack can involve acute or sub-acute neurological symptomatology (attack) manifested by various clinical presentations like unilateral loss of vision, vertigo, ataxia, incoordination, gait difficulties, sensory impairment characterized by paresthesia, dysesthesia, sensory loss, urinary disturbances until incontinence, diplopia, dysarthria, various degrees of motor weakness until paralysis, cognitive decline either as a monosymptomatic or in combination. The symptoms usually remain for several days to few weeks, and then partially or completely resolve.
  • The accepted diagnostic criteria of multiple sclerosis are presented in Hypertext Transfer Protocol://World Wide Web (dot) multi-sclerosis (dot) org/DiagnosticCriteria (dot) html.
  • According to some embodiments of the invention, the subject is suspected of having multiple sclerosis.
  • According to some embodiments of the invention, the subject has probable multiple sclerosis.
  • According to some embodiments of the invention, the subject does not have a primary progressive course (PPMS).
  • According to some embodiments of the invention, the subject does not have a secondary progressive MS course (SPMS).
  • As used herein the term “classifying” refers to determining if the subject is more likely to have benign multiple sclerosis (BMS) or typical relapsing remitting multiple sclerosis (RRMS).
  • As used herein the phrase “being more likely to have” refers to having increased probability to have a certain disease course (classification of disease) than another disease course.
  • According to some embodiments of the invention, the phrase “being more likely to have” refers to a probability of at least about 51%, at least about 52%, at least about 53%, at least about 54%, at least about 55%, at least about 56%, at least about 57%, at least about 58%, at least about 59%, at least about 60%, at least about 61%, at least about 62%, at least about 63%, at least about 64%, at least about 65%, at least about 66%, at least about 67%, at least about 68%, at least about 69%, at least about 70%, at least about 71%, at least about 72%, at least about 73%, at least about 74%, at least about 75%, at least about 76%, at least about 77%, at least about 78%, at least about 79%, at least about 80%, at least about 81%, at least about 82%, at least about 83%, at least about 84%, at least about 85%, at least about 86%, at least about 87%, at least about 88%, at least about 89%, at least about 90%, at least about 91%, at least about 92%, at least about 93%, at least about 94%, at least about 95%, at least about 96%, at least about 97%, at least about 98%, at least about 99%, e.g., about 100% that the subject has a certain disease course and not the other disease course, i.e., a BMS or typical RRMS.
  • As used herein, the phrase “benign multiple sclerosis” refers to a subject having MS and exhibiting an Expanded Disability Status Scale (EDSS) of less than 3.0 following at least 10 years from onset and/or diagnosis of MS.
  • As used herein, the phrase “typical RRMS” or a “relapsing-remitting multiple sclerosis course”, which is interchangeably used herein, refers to a subject having MS and exhibiting an Expanded Disability Status Scale (EDSS) higher than 3.0 within less than 10 years of disease onset and/or diagnosis.
  • The phrase “onset of multiple sclerosis (MS)” as used herein refers to the time of occurrence of the first clinical neurological symptomatology suggestive of MS.
  • The Kurtzke EDSS is a method scale of quantifying disability in MS by scoring eight Functional Systems (FS) (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, cerebral, and other) and allows neurologists to assign a Functional System Score (FSS) in each and to combine the FSS scores into the EDSS score as follows:
  • EDSS 0.0—Normal neurological examination;
  • EDSS 1.0—No disability, minimal signs in one FS;
  • EDSS 1.5—No disability, minimal signs in more than one FS;
  • EDSS 2.0—Minimal disability in one FS;
  • EDSS 2.5—Mild disability in one FS or minimal disability in two FS;
  • EDSS 3.0—Moderate disability in one FS, or mild disability in three or four FS. Fully ambulatory;
  • EDSS 3.5—Fully ambulatory but with moderate disability in one FS and more than minimal disability in several others;
  • EDSS 4.0—Fully ambulatory without aid, self-sufficient, up and about some 12 hours a day despite relatively severe disability; able to walk without aid or rest some 500 meters;
  • EDSS 4.5—Fully ambulatory without aid, up and about much of the day, able to work a full day, may otherwise have some limitation of full activity or require minimal assistance; characterized by relatively severe disability; able to walk without aid or rest some 300 meters;
  • EDSS 5.0—Ambulatory without aid or rest for about 200 meters; disability severe enough to impair full daily activities (work a full day without special provisions);
  • EDSS 5.5—Ambulatory without aid or rest for about 100 meters; disability severe enough to preclude full daily activities;
  • EDSS 6.0—Intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about 100 meters with or without resting;
  • EDSS 6.5—Constant bilateral assistance (canes, crutches, braces) required to walk about 20 meters without resting;
  • EDSS 7.0—Unable to walk beyond approximately five meters even with aid, essentially restricted to wheelchair; wheels self in standard wheelchair and transfers alone; up and about in wheelchair some 12 hours a day;
  • EDSS 7.5—Unable to take more than a few steps; restricted to wheelchair; may need aid in transfer; wheels self but cannot carry on in standard wheelchair a full day, May require motorized wheelchair;
  • EDSS 8.0—Essentially restricted to bed or chair or perambulated in wheelchair, but may be out of bed itself much of the day; retains many self-care functions; generally has effective use of arms;
  • EDSS 8.5—Essentially restricted to bed much of day, has some effective use of arms retains some self care functions;
  • EDSS 9.0—Confined to bed; can still communicate and eat;
  • EDSS 9.5—Totally helpless bed patient; unable to communicate effectively or eat/swallow;
  • EDSS 10.0—Death due to MS;
  • As mentioned, the diagnosis of MS is performed by clinical neurological symptoms and/or findings such as laboratory tests involving evaluation of IgG synthesis and oligoclonal bands (immunoglobulins) in the cerebrospinal fluid (CSF) which provide evidence of chronic inflammation of the central nervous system, and brain or spinal cord MRI according to the McDonald criteria [McDonald W I, Compston A, Edan G, et al., 2001, “Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis”. Ann. Neurol. 50 (1): 121-7; Polman C H, Reingold S C, Edan G, et al., 2005, “Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria””. Ann. Neurol. 58 (6): 840-6].
  • It should be noted that onset of multiple sclerosis and the diagnosis of multiple sclerosis could occur on the same time.
  • As used herein, the phrase “level of expression” refers to the degree of gene expression and/or gene product activity in a specific cell. For example, up-regulation or down-regulation of various genes can affect the level of the gene product (i.e., RNA and/or protein) in a specific cell.
  • Sequence information regarding gene products (i.e., RNA transcripts and polypeptide sequences) of the genes of the polynucleotides of the invention such as the genes of RNA polymerase I pathway and of probes which can be used to detect thereof can be found in Tables 1, 2, 3, 5 and 6 of the Examples section which follows.
  • It should be noted that the level of expression can be determined in arbitrary absolute units, or in normalized units (relative to known expression levels of a control reference). For example, when using DNA chips, the expression levels are normalized according to the chips' internal controls or by using quantile normalization such as RMA.
  • As used herein the phrase “a cell of the subject” refers to at least one cell (e.g., an isolated cell), cell culture, cell content and/or cell secreted content which contains RNA and/or proteins of the subject. Examples include a blood cell, a cell obtained from any tissue biopsy [e.g., cerebrospinal fluid, (CSF), brain biopsy], a bone marrow cell, body fluids such as plasma, serum, saliva, spinal fluid, lymph fluid, the external sections of the skin, respiratory, intestinal, and genitourinary tracts, tears, saliva, sputum and milk. According to an embodiment of the invention, the cell is a blood cell (e.g., white blood cells, macrophages, B- and T-lymphocytes, monocytes, neutrophiles, eosinophiles, and basophiles) which can be obtained using a syringe needle from a vein of the subject. It should be noted that the cell may be isolated from the subject (e.g., for in vitro detection) or may optionally comprise a cell that has not been physically removed from the subject (e.g., in vivo detection).
  • According to some embodiments of the invention, the white blood cell comprises peripheral blood mononuclear cells (PBMC). The phrase, “peripheral blood mononuclear cells (PBMCs)” as used herein, refers to a mixture of monocytes and lymphocytes. Several methods for isolating white blood cells are known in the art. For example, PBMCs can be isolated from whole blood samples using density gradient centrifugation procedures. Typically, anticoagulated whole blood is layered over the separating medium. At the end of the centrifugation step, the following layers are visually observed from top to bottom: plasma/platelets, PBMCs, separating medium and erythrocytes/granulocytes. The PBMC layer is then removed and washed to remove contaminants (e.g., red blood cells) prior to determining the expression level of the polynucleotide(s) therein.
  • The cell or the biological sample comprising same can be obtained from the subject at any time, e.g., immediately after an attack or at any time during remission.
  • According to some embodiments of the invention, the level of expression of the gene(s) of the invention is determined using an RNA and/or a protein detection method.
  • According to some embodiments of the invention, the RNA or protein molecules are extracted from the cell of the subject.
  • Methods of extracting RNA or protein molecules from cells of a subject are well known in the art. Once obtained, the RNA or protein molecules can be characterized for the expression and/or activity level of various RNA and/or protein molecules using methods known in the arts.
  • Non-limiting examples of methods of detecting RNA molecules in a cell sample include Northern blot analysis, RT-PCR, RNA in situ hybridization (using e.g., DNA or RNA probes to hybridize RNA molecules present in the cells or tissue sections), in situ RT-PCR (e.g., as described in Nuovo G J, et al. Am J Surg Pathol. 1993, 17: 683-90; Komminoth P, et al. Pathol Res Pract. 1994, 190: 1017-25), and oligonucleotide microarray (e.g., by hybridization of polynucleotide sequences derived from a sample to oligonucleotides attached to a solid surface [e.g., a glass wafer) with addressable location, such as Affymetrix microarray (Affymetrix®, Santa Clara, Calif.)].
  • For example, the level of RRN3 in a sample can be determined by RT-PCR using primers available from Santa Cruz Biotechnology Inc. (sc-106866-PR), or Taqman Gene Expression Assay HS00607907_ml (Applied Biosystems, Foster City, Calif., USA), according to manufacturer's recommendation.
  • Non-limiting examples of methods of detecting the level and/or activity of specific protein molecules in a cell sample include Enzyme linked immunosorbent assay (ELISA), Western blot analysis, radio-immunoassay (RIA), Fluorescence activated cell sorting (FACS), immunohistochemical analysis, in situ activity assay (using e.g., a chromogenic substrate applied on the cells containing an active enzyme), in vitro activity assays (in which the activity of a particular enzyme is measured in a protein mixture extracted from the cells). For example, in case the detection of the expression level of a secreted protein is desired, ELISA assay may be performed on a sample of fluid obtained from the subject (e.g., serum), which contains cell-secreted content.
  • As used herein the phrase “reference expression data” refers to the expression level of the gene in a cell of at least one subject who is pre-diagnosed as having BMS or typical RRMS. Such as an expression level can be known from the literature, from the database, or from biological samples comprising RNA or protein molecules obtained from a reference subject who is already diagnosed as having BMS or typical RRMS.
  • As used herein the phrase “pre-diagnosed” refers to being diagnosed based on the acceptable clinical tools/markers as described above (e.g., by evaluating the EDSS score after 10 years from onset or diagnosis of MS).
  • According to some embodiments of the invention, the reference expression data is obtained from at least subject who is pre-diagnosed as having BMS, e.g., from at least 2, from at least 3, from at least 4, from at least 5, from at least 6, from at least 7, from at least 8, from at least 9, from at least 10, from at least 20, from at least 30, from at least 40, from at least 50, from at least 100 or more subjects who are pre-diagnosed as having BMS.
  • According to some embodiments of the invention, the reference expression data is obtained from at least one subject who is pre-diagnosed as having typical RRMS, e.g., from at least 2, from at least 3, from at least 4, from at least 5, from at least 6, from at least 7, from at least 8, from at least 9, from at least 10, from at least 20, from at least 30, from at least 40, from at least 50, from at least 100 or more subjects who are pre-diagnosed as having typical RRMS.
  • It should be noted that when more than one reference subjects (i.e., a subject who is pre-diagnosed as having BMS or typical RRMS) is used, the reference expression data may comprise an average of the expression level of several or all subjects, and those of skills in the art are capable of averaging expression levels from 2 or more subject, using e.g., normalized expression values.
  • According to some embodiments of the invention, a decrease above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the typical RRMS classifies the subject as being more likely to have the BMS.
  • As used herein the phrase “a decrease above a predetermined threshold” refers to a decrease in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the at least one subject having the typical RRMS which is higher than a predetermined threshold such as a about 10%, e.g., higher than about 20%, e.g., higher than about 30%, e.g., higher than about 40%, e.g., higher than about 50%, e.g., higher than about 60%, higher than about 70%, higher than about 80%, higher than about 90%, higher than about 2 times, higher than about three times, higher than about four time, higher than about five times, higher than about six times, higher than about seven times, higher than about eight times, higher than about nine times, higher than about 20 times, higher than about 50 times, higher than about 100 times, higher than about 200 times, higher than about 350, higher than about 500 times, higher than about 1000 times, or more relative to the reference expression data obtained from a cell of the at least subject having the typical RRMS.
  • According to some embodiments of the invention, an increase above a predetermined threshold in the level of expression of the at least one gene in the cell of the subject relative to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the BMS classifies the subject as being more likely to have the typical RRMS.
  • As used herein the phrase “an increase above a predetermined threshold” refers to an increase in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the at least one subject having the BMS which is higher than a predetermined threshold such as a about 10%, e.g., higher than about 20%, e.g., higher than about 30%, e.g., higher than about 40%, e.g., higher than about 50%, e.g., higher than about 60%, higher than about 70%, higher than about 80%, higher than about 90%, higher than about 2 times, higher than about three times, higher than about four time, higher than about five times, higher than about six times, higher than about seven times, higher than about eight times, higher than about nine times, higher than about 20 times, higher than about 50 times, higher than about 100 times, higher than about 200 times, higher than about 350, higher than about 500 times, higher than about 1000 times, or more relative to the reference expression data obtained from a cell of the at least one subject having the BMS.
  • According to some embodiments of the invention, when a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the BMS, then the subject is classified as being more likely to have the BMS.
  • As used herein the phrase “changed below a predetermined threshold as compared to the reference expression data . . . subject having the BMS” refers to an increase or a decrease in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the at least one subject having the BMS which is lower than a predetermined threshold, such as lower than about 10 times, e.g., lower than about 9 times, e.g., lower than about 8 times, e.g., lower than about 7 times, e.g., lower than about 6 times, e.g., lower than about 5 times, e.g., lower than about 4 times, e.g., lower than about 3 times, e.g., lower than about 2 times, e.g., lower than about 90%, e.g., lower than about 80%, e.g., lower than about 70%, e.g., lower than about 60%, e.g., lower than about 50%, e.g., lower than about 40%, e.g., lower than about 30%, e.g., lower than about 20%, e.g., lower than about 10%, e.g., lower than about 9%, e.g., lower than about 8%, e.g., lower than about 7%, e.g., lower than about 6%, e.g., lower than about 5%, e.g., lower than about 4%, e.g., lower than about 3%, e.g., lower than about 2%, e.g., lower than about 1% relative to the reference expression data obtained from a cell of the at least one subject having the BMS.
  • According to some embodiments of the invention, when a level of expression of the at least one gene in the cell of the subject is identical or changed below a predetermined threshold as compared to the reference expression data of the at least one gene obtained from a cell of the at least one subject having the typical RRMS, then the subject is classified as being more likely to have the typical RRMS.
  • As used herein the phrase “changed below a predetermined threshold as compared to the reference expression data . . . subject having the typical RRMS” refers to an increase or a decrease in the level of expression in the cell of the subject relative to the reference expression data obtained from a cell of the one subject having the typical RRMS which is lower than a predetermined threshold, such as lower than about 10 times, e.g., lower than about 9 times, e.g., lower than about 8 times, e.g., lower than about 7 times, e.g., lower than about 6 times, e.g., lower than about 5 times, e.g., lower than about 4 times, e.g., lower than about 3 times, e.g., lower than about 2 times, e.g., lower than about 90%, e.g., lower than about 80%, e.g., lower than about 70%, e.g., lower than about 60%, e.g., lower than about 50%, e.g., lower than about 40%, e.g., lower than about 30%, e.g., lower than about 20%, e.g., lower than about 10%, e.g., lower than about 9%, e.g., lower than about 8%, e.g., lower than about 7%, e.g., lower than about 6%, e.g., lower than about 5%, e.g., lower than about 4%, e.g., lower than about 3%, e.g., lower than about 2%, e.g., lower than about 1% relative to the reference expression data obtained from the at least one subject having the typical RRMS.
  • Non-limiting examples of genes involved in the RNA polymerase I pathway which can be used according to the method of the invention are provided in Table 3 along with representative polynucleotides thereof and probes which can be used to detect thereof (Example 1 of the Examples section which follows; e.g., RRN3, LRPPRC, POLR1B, POLR1c, POLR1D, POLR2A, POLR2B, POLR2c, POLR2D, POLR2E, POLR2E, POLR2F, POLR2G, POLR2H, POLR2I, POLR2J, POLR2J2, MGC13098, POLR2K, POLR2L, POLR3B, POLR3c, POLR3D, POLR3E, POLR3F, POLR3G, POLR3K, POLRMT, POLRMT and POLS).
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is selected from the group consisting of POLR1D, LRPPRC, RRN3 and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is RRN3.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is LRPPRC.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is POLR1D.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3 and POLR1D.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3 and LRPPRC.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises POLR1D and LRPPRC.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, LRPPRC and POLR1D.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is RRN3 and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is LRPPRC and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway is POLR1D and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, POLR1D and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, LRPPRC and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises POLR1D, LRPPRC and NCL.
  • According to some embodiments of the invention, the at least one gene involved in the RNA polymerase 1 pathway comprises RRN3, LRPPRC, POLR1D and NCL.
  • Tables 4A-C in the Examples section which follows demonstrate exemplary combinations of genes of the RNA polymerase I pathway along with their classification rates for BMS and typical RRMS.
  • The prediction of the MS course is important in terms of monitoring the clinical state of the subject (e.g., how often does the patient need to be evaluated for the disease progression in terms of neurological evaluation and EDSS), planning of subject's future life (e.g., making decisions regarding marriage, having children, being involved in high risk activities, getting a life-insurance, etc.) and planning the treatment regimen of the subject.
  • For example, a subject who is more likely to have BMS may be advised to reduce the frequency of neurological clinical evaluations to no more than once per year; to avoid frequent MRI examinations; to not be included in treatment schedule of MS; and/or to avoid receiving immunomodulatory drugs which have side effects or adverse events that can be even life-threatening [e.g., progressive multifocal leukoencephalopathy (PML) in MS patients treated with natalizumab (Tysabri®, Biogen-Idec); Hypertext Transfer Protocol://World Wide Web (dot) va (dot) gov/MS/pressreleases/Treating_Natalizumab_and_Risk_of_PML (dot) asp].
  • On the other hand, a subject who is more likely to have typical RRMS may be advised to have neurological clinical evaluations at a higher frequency, e.g., about 3-4 times per year; to have frequent MRI examinations; to be included in treatment schedule of MS; and/or to receive immunomodulatory drugs.
  • It should be noted that the classification of the subject as being more likely to have BMS or typical RRMS can be used to diagnose the subject as having BMS or typical RRMS.
  • As used herein the term “diagnosing” refers to determining presence or absence of a pathology (e.g., a disease, disorder, condition or syndrome) and/or likelihood of same, classifying a pathology or a symptom, determining a severity of the pathology, monitoring pathology progression, forecasting an outcome of a pathology and/or prospects of recovery and screening of a subject for a specific disease.
  • According to some embodiments of the invention the method of diagnosing is effected by (a) classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS according to the method of the invention,
  • (i) wherein when the subject is classified as being more likely to have the BMS then the subject is diagnosed as having BMS;
  • (ii) wherein when the subject is classified as being more likely to have the typical RRMS, then the subject is diagnosed as having typical RRMS; and
  • (c) informing the subject of the diagnosis,
  • thereby diagnosing the subject pre-diagnosed with the MS as having the BMS or the typical RRMS.
  • According to some embodiments of the invention, the subject is pre-diagnosed with multiple sclerosis (MS), i.e., has a confirmed diagnosis of MS without knowing the disease course, e.g., typical RRMS, BMS.
  • As used herein the term “informing” refers to providing to the subject the results of the diagnosis of the disease sub-class (i.e., BMS or typical RRMS). The results may be provided as a computer output and/or oral conversation with the subject.
  • The teachings of the invention can be also used to determine efficiency anti multiple sclerosis drugs by determining the effect of the drug(s) on the expression level of the at least one gene of the RNA polymerase I pathway.
  • Thus, according to an aspect of some embodiments of the invention, there is provided a method of monitoring an efficiency of an anti multiple sclerosis (MS) drug in treating a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS) course, the method is effected by:
  • (a) treating the subject with the anti MS drug; and
  • (b) comparing a level of expression of least one gene involved in the RNA polymerase I pathway in a cell of the subject following treating with the anti MS drug to a level of expression of the at least one gene in a cell of the subject prior to the treating the subject with the anti MS drug,
  • (i) wherein a decrease above a predetermined threshold in the level of expression of the at least one gene following the treating with the anti MS drug relative to the level of expression of the at least one gene prior to the treating with the anti MS drug indicates that the anti MS drug is efficient for treating the subject;
  • (ii) wherein an increase above a predetermined threshold in the level of expression of the at least one gene following the treating with the anti MS drug relative to the level of expression of the at least one gene prior to the treating with the anti MS drug indicates that the anti MS drug is not efficient for treating the subject; or
  • (iii) wherein when a level of expression of the at least one gene following the treating with the anti MS drug is identical or changed below a predetermined threshold as compared to prior to the treating with the anti MS drug then the treatment is not efficient for treating the subject.
  • thereby monitoring the efficiency of the anti multiple sclerosis (MS) drug in treating the subject diagnosed with the typical RRMS course.
  • As used herein the phrase “treating” refers to inhibiting or arresting the development of pathology [multiple sclerosis, e.g., typical RRMS] and/or causing the reduction, remission, or regression of a pathology and/or optimally curing the pathology. Those of skill in the art will understand that various methodologies and assays can be used to assess the development of pathology, and similarly, various methodologies and assays may be used to assess the reduction, remission or regression of the pathology.
  • According to some embodiments of the invention, treating the subject refers to changing the disease course of the subject from a typical RRMS course to a BMS course.
  • According to some embodiments of the invention, treating the subject refers to preventing a typical RRMS course.
  • As used herein the phrase “following treating with the anti MS drug” refers to any time period after administering the anti MS drug to the subject, e.g., from a few minutes to hours, or from a few days to weeks or months after drug administration.
  • According to some embodiments of the invention the level of expression is determined following the first dose of the anti MS drug.
  • According to some embodiments of the invention the level of expression is determined following any dose of the anti MS drug.
  • As used herein the phrase “prior to treating with the anti MS drug” refers to any time period prior administering the anti MS drug to the subject, e.g., from a few minutes to hours, or from a few days to weeks or months prior to drug administration.
  • According to some embodiments of the invention the level of expression is determined prior any dose of the anti MS drug (e.g., when the subject is naïve to treatment).
  • According to some embodiments of the invention prior to treating refers to when the subject is first diagnosed with multiple sclerosis.
  • According to some embodiments of the invention prior to treating refers to when the subject is suspected of having multiple sclerosis, or diagnosed with probable multiple sclerosis.
  • According to some embodiments of the invention prior to treating refers to upon MS disease onset.
  • According to some embodiments of the invention the effect of the treatment on the subject can be evaluated by monitoring the level of expression of at least one of the polynucleotides described hereinabove. For example, downregulation in the level of RRN3 in the subject following treatment can be indicative of the positive effect of the treatment on the subject, i.e., switching from a typical RRMS to a BMS course of disease.
  • The teachings of the invention can be also used to predict efficiency of a drug in vitro.
  • Thus, according to an aspect of some embodiments of the invention there is provided an in vitro method of predicting an efficiency of an anti multiple sclerosis
  • (MS) drug for treatment of a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS), the method is effected by:
  • (a) contacting cells of the subject with a therapeutically effective amount of the anti MS drug; and
  • (b) comparing a level of expression in the cells of at least one gene involved in the RNA polymerase I pathway following the contacting with the anti MS drug to a level of expression of the at least one gene in the cells prior to the contacting with the anti MS drug,
  • (i) wherein a decrease above a predetermined threshold in the level of expression of the at least one gene following the contacting with the anti MS drug relative to the level of expression of the at least one gene prior to the contacting with the anti MS drug indicates that the treatment is efficient for treating the subject;
  • (ii) wherein an increase above a predetermined threshold in the level of expression of the at least one gene following the contacting with the anti MS drug relative to the level of expression of the at least one gene prior to the contacting with the anti MS drug indicates that the treatment is not efficient for treating the subject; or
  • (iii) wherein when a level of expression of the at least one gene following the contacting with the anti MS drug is identical or changed below a predetermined threshold as compared to prior to the contacting with the anti MS drug then the treatment is not efficient for treating the subject.
  • thereby predicting the efficiency of the anti MS drug for treatment of the subject diagnosed with the typical RRMS.
  • Contacting cells with the anti MS drug can be performed by any in vitro conditions including for example, adding the anti MS drug to cells derived from a subject (e.g., a primary cell culture, a cell line) or to a biological sample comprising same (e.g., a fluid, liquid which comprises the cells) such that the drug is in direct contact with the cells. According to some embodiments of the invention, the cells of the subject are incubated with the anti MS drug. The conditions used for incubating the cells are selected for a time period/concentration of cells/concentration of drug/ratio between cells and drug and the like which enable the drug to induce cellular changes, such as changes in transcription and/or translation rate of specific genes, proliferation rate, differentiation, cell death, necrosis, apoptosis and the like.
  • Methods of monitoring cellular changes induced by the drugs are known in the art and include for example, the MTT test which is based on the selective ability of living cells to reduce the yellow salt MTT (3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide) (Sigma, Aldrich St Louis, Mo., USA) to a purple-blue insoluble formazan precipitate; the BrDu assay [Cell Proliferation ELISA BrdU colorimetric kit (Roche, Mannheim, Germany]; the TUNEL assay [Roche, Mannheim, Germany]; the Annexin V assay [ApoAlert® Annexin V Apoptosis Kit (Clontech Laboratories, Inc., CA, USA)]; the Senescence associated-β-galactosidase assay (Dimri G P, Lee X, et al. 1995. A biomarker that identifies senescent human cells in culture and in aging skin in vivo. Proc Natl Acad Sci USA 92:9363-9367); as well as various RNA and protein detection methods (which detect level of expression and/or activity) which are further described hereinabove.
  • According to some embodiments of the invention, the cells are incubated under conditions which enable the effect of the drug on cellular processes such as downregulation of the at least one gene of the RNA polymerase I pathway.
  • According to an aspect of some embodiments of the invention there is provided a method of treating a subject diagnosed with multiple sclerosis, the method is effected by: (a) classifying the subject as being more likely to have BMS or typical RRMS according to the method of the invention, (b) selecting a treatment regimen based on classification results of step (a); thereby treating the subject diagnosed with multiple sclerosis.
  • As used herein the phrase “treatment regimen” refers to a treatment plan that specifies the type of treatment, dosage, schedule and/or duration of a treatment provided to a subject in need thereof (e.g., a subject diagnosed with MS). The selected treatment regimen can be an aggressive one which is expected to result in the best clinical outcome (e.g., complete cure of the pathology) or a more moderate one which may relief symptoms of the pathology yet results in incomplete cure of the pathology. It will be appreciated that in certain cases the more aggressive treatment regimen may be associated with some discomfort to the subject or adverse side effects (e.g., a damage to healthy cells or tissue). The dosage, schedule and duration of treatment can vary, depending on the severity of pathology and the selected type of treatment, and those of skills in the art are capable of adjusting the type of treatment with the dosage, schedule and duration of treatment.
  • For example, when the subject is classified as being more likely to have typical RRMS (or being diagnosed with typical RRMS) then the treatment regimen is an aggressive therapy such as an immunomodulation therapy, e.g., a high dosage of interferon beta 1a [Rebif, which can be administered subcutaneously, at a dosage of e.g., 44 μg, three times a week].
  • MS drugs which can be administered to a subject predicted to have an RRMS course of disease according to the present teachings include, but are not limited to Diterpenoid triepoxide Triptolide (TPT), Adderall; Ambien; Avonex; Baclofen; Beta interferon; Betaseron; Celexa; Clonazepam; Copaxone; Corticosteroids; Cymbalta; Cytoxan; Dexamethasone; Effexor; Elavil; Gabapentin; Hydrocodone; Lexapro; Lyrica; Mitoxantrone; Naltrexone; Neurontin; Novantrone; Prednisone; Provigil; Rebif; Solumedrol; Symmetrel; Topamax; Tysabri; Wellbutrin; Xanax; Zanaflex; Zoloft; Novartis' fingolimod [sphingosine 1-phosphate receptor (S1P-R) modulator]; Teva's laquinimod; Merck KGaA's Mylinax (cladribine); Sanofi-aventis' teriflunomide; Biogen Idec's BG-12 (Phase III); GSK/Mitsubishi Tanabe Pharma's firategrast; MediciNova's ibudilast; Biogen/UCB's CDP323 (Phase II).
  • One the other hand, when the subject is classified as being more likely to have BMS (or is diagnosed with BMS) then the aggressive treatment is not recommended, and these patients would not be treated or treatment can be delayed.
  • In addition, knowing the prediction or classification of MS disease course (BMS or typical RRMS) is highly beneficial in terms of saving un-necessary costs to the health system.
  • According to an aspect of some embodiments of the invention there is provided a method of treating a subject diagnosed with multiple sclerosis, the method is effected by (a) diagnosing a typical relapsing remitting multiple sclerosis (RRMS) according to the method of the invention, and (b) administering to the subject a therapeutically effective amount of diterpenoid triepoxide Triptolide (TPT) or a derivative thereof, thereby treating the subject
  • TPT derivatives and preparation thereof are described in WO9852933A1, which is fully incorporated herein by reference. Non-limiting examples of TPT derivatives include, compounds of the general formulas.
  • Figure US20120020954A1-20120126-C00001
    • Wherein
  • Figure US20120020954A1-20120126-P00001

    represents a single or double bond;
    R1 and R2 each independently is H or —OR5;
    R3 is H, —C(═O)(CH2)nCO2H or a suitable amino acid; R, is H or —OH; R, is H, —C(═O)(CH2)nCO2H or a suitable amino acid;
    n is the integer 2, 3, 4, 5 or 6;
    and the stereoisomers, enantiomers and pharmaceutically acceptable salts thereof;
    provided that R, and R2 are H when R, is other than H (for further details see WO9852933A1).
  • A commercially available preparation of Triptolide which can be used according to the teachings of the invention is Trisoxireno(4b, 5:6, 7:8a,9)phenanthro(1,2-c)furan-1(3H)-one, 3b,4,4a,6,6a,7a,7b,8b,9,10-decahydro-6-hydroxy-8b-methyl-6a-(1-methylethyl)-, (3bS,4aS,5aS,6R,6aR,7aS,7bS,8aS,8bS)-[CAS No.: 38748-32-2; PG490, Chengdu Biopurify Phytochemicals Ltd. Chengdu, Sichuan, China].
  • According to some embodiments of the invention, when the subject is more likely to have typical RRMS then the treatment regimen comprises administering to the subject an agent which downregulates the level of expression of the at least one gene involved in the RNA polymerase I pathway.
  • According to some embodiments of the invention, treating the subject is effected by downregulating the expression level and/or activity (RNA and/or polypeptide encoded thereby) of at least one polynucleotide of the polymerase I pathway (for details see the list of genes/polynucleotide in Table 3 in Example 1 of the Examples section which follows).
  • Following is a list of downregulating agents which can decrease the expression level of the gene product (RNA or protein molecules) of at least one of the polynucleotides of the polymerase I pathway.
  • Downregulation can be effected on the genomic and/or the transcript level using a variety of molecules which interfere with transcription and/or translation (e.g., RNA silencing agents, Ribozyme, DNAzyme and antisense), or on the protein level using e.g., an antibody, antagonists, enzymes that cleave the polypeptide and the like.
  • One example, of an agent capable of downregulating a polypeptide-of-interest is an antibody or antibody fragment capable of specifically binding the polypeptide-of-interest. Preferably, the antibody specifically binds at least one epitope of the polypeptide-of-interest. As used herein, the term “epitope” refers to any antigenic determinant on an antigen to which the paratope of an antibody binds.
  • Epitopic determinants usually consist of chemically active surface groupings of molecules such as amino acids or carbohydrate side chains and usually have specific three dimensional structural characteristics, as well as specific charge characteristics.
  • The term “antibody” as used in this invention includes intact molecules as well as functional fragments thereof, such as Fab, F(ab′)2, and Fv that are capable of binding to macrophages. These functional antibody fragments are defined as follows: (1) Fab, the fragment which contains a monovalent antigen-binding fragment of an antibody molecule, can be produced by digestion of whole antibody with the enzyme papain to yield an intact light chain and a portion of one heavy chain; (2) Fab′, the fragment of an antibody molecule that can be obtained by treating whole antibody with pepsin, followed by reduction, to yield an intact light chain and a portion of the heavy chain; two Fab′ fragments are obtained per antibody molecule; (3) (Fab′)2, the fragment of the antibody that can be obtained by treating whole antibody with the enzyme pepsin without subsequent reduction; F(ab′)2 is a dimer of two Fab′ fragments held together by two disulfide bonds; (4) Fv, defined as a genetically engineered fragment containing the variable region of the light chain and the variable region of the heavy chain expressed as two chains; and (5) Single chain antibody (“SCA”), a genetically engineered molecule containing the variable region of the light chain and the variable region of the heavy chain, linked by a suitable polypeptide linker as a genetically fused single chain molecule.
  • Methods of producing polyclonal and monoclonal antibodies as well as fragments thereof are well known in the art (See for example, Harlow and Lane, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, New York, 1988, incorporated herein by reference).
  • Antibody fragments according to the present invention can be prepared by proteolytic hydrolysis of the antibody or by expression in E. coli or mammalian cells (e.g. Chinese hamster ovary cell culture or other protein expression systems) of DNA encoding the fragment. Antibody fragments can be obtained by pepsin or papain digestion of whole antibodies by conventional methods. For example, antibody fragments can be produced by enzymatic cleavage of antibodies with pepsin to provide a 5S fragment denoted F(ab′)2. This fragment can be further cleaved using a thiol reducing agent, and optionally a blocking group for the sulfhydryl groups resulting from cleavage of disulfide linkages, to produce 3.5S Fab′ monovalent fragments. Alternatively, an enzymatic cleavage using pepsin produces two monovalent Fab′ fragments and an Fc fragment directly. These methods are described, for example, by Goldenberg, U.S. Pat. Nos. 4,036,945 and 4,331,647, and references contained therein, which patents are hereby incorporated by reference in their entirety. See also Porter, R. R. [Biochem. J. 73: 119-126 (1959)]. Other methods of cleaving antibodies, such as separation of heavy chains to form monovalent light-heavy chain fragments, further cleavage of fragments, or other enzymatic, chemical, or genetic techniques may also be used, so long as the fragments bind to the antigen that is recognized by the intact antibody.
  • Fv fragments comprise an association of VH and VL chains. This association may be noncovalent, as described in Inbar et al. [Proc. Nat'l Acad. Sci. USA 69:2659-62 (19720]. Alternatively, the variable chains can be linked by an intermolecular disulfide bond or cross-linked by chemicals such as glutaraldehyde. Preferably, the Fv fragments comprise VH and VL chains connected by a peptide linker. These single-chain antigen binding proteins (sFv) are prepared by constructing a structural gene comprising DNA sequences encoding the VH and VL domains connected by an oligonucleotide. The structural gene is inserted into an expression vector, which is subsequently introduced into a host cell such as E. coli. The recombinant host cells synthesize a single polypeptide chain with a linker peptide bridging the two V domains. Methods for producing sFvs are described, for example, by [Whitlow and Filpula, Methods 2: 97-105 (1991); Bird et al., Science 242:423-426 (1988); Pack et al., Bio/Technology 11:1271-77 (1993); and U.S. Pat. No. 4,946,778, which is hereby incorporated by reference in its entirety.
  • Another form of an antibody fragment is a peptide coding for a single complementarity-determining region (CDR). CDR peptides (“minimal recognition units”) can be obtained by constructing genes encoding the CDR of an antibody of interest. Such genes are prepared, for example, by using the polymerase chain reaction to synthesize the variable region from RNA of antibody-producing cells. See, for example, Larrick and Fry [Methods, 2: 106-10 (1991)].
  • Humanized forms of non-human (e.g., murine) antibodies are chimeric molecules of immunoglobulins, immunoglobulin chains or fragments thereof (such as Fv, Fab, Fab′, F(ab′).sub.2 or other antigen-binding subsequences of antibodies) which contain minimal sequence derived from non-human immunoglobulin. Humanized antibodies include human immunoglobulins (recipient antibody) in which residues form a complementary determining region (CDR) of the recipient are replaced by residues from a CDR of a non-human species (donor antibody) such as mouse, rat or rabbit having the desired specificity, affinity and capacity. In some instances, Fv framework residues of the human immunoglobulin are replaced by corresponding non-human residues. Humanized antibodies may also comprise residues which are found neither in the recipient antibody nor in the imported CDR or framework sequences. In general, the humanized antibody will comprise substantially all of at least one, and typically two, variable domains, in which all or substantially all of the CDR regions correspond to those of a non-human immunoglobulin and all or substantially all of the FR regions are those of a human immunoglobulin consensus sequence. The humanized antibody optimally also will comprise at least a portion of an immunoglobulin constant region (Fc), typically that of a human immunoglobulin [Jones et al., Nature, 321:522-525 (1986); Riechmann et al., Nature, 332:323-329 (1988); and Presta, Curr. Op. Struct. Biol., 2:593-596 (1992)].
  • Methods for humanizing non-human antibodies are well known in the art. Generally, a humanized antibody has one or more amino acid residues introduced into it from a source which is non-human. These non-human amino acid residues are often referred to as import residues, which are typically taken from an import variable domain. Humanization can be essentially performed following the method of Winter and co-workers [Jones et al., Nature, 321:522-525 (1986); Riechmann et al., Nature 332:323-327 (1988); Verhoeyen et al., Science, 239:1534-1536 (1988)], by substituting rodent CDRs or CDR sequences for the corresponding sequences of a human antibody. Accordingly, such humanized antibodies are chimeric antibodies (U.S. Pat. No. 4,816,567), wherein substantially less than an intact human variable domain has been substituted by the corresponding sequence from a non-human species. In practice, humanized antibodies are typically human antibodies in which some CDR residues and possibly some FR residues are substituted by residues from analogous sites in rodent antibodies.
  • Human antibodies can also be produced using various techniques known in the art, including phage display libraries [Hoogenboom and Winter, J. Mol. Biol., 227:381 (1991); Marks et al., J. Mol. Biol., 222:581 (1991)]. The techniques of Cole et al. and Boerner et al. are also available for the preparation of human monoclonal antibodies (Cole et al., Monoclonal Antibodies and Cancer Therapy, Alan R. Liss, p. 77 (1985) and Boerner et al., J. Immunol., 147(1):86-95 (1991)]. Similarly, human antibodies can be made by introduction of human immunoglobulin loci into transgenic animals, e.g., mice in which the endogenous immunoglobulin genes have been partially or completely inactivated. Upon challenge, human antibody production is observed, which closely resembles that seen in humans in all respects, including gene rearrangement, assembly, and antibody repertoire. This approach is described, for example, in U.S. Pat. Nos. 5,545,807; 5,545,806; 5,569,825; 5,625,126; 5,633,425; 5,661,016, and in the following scientific publications: Marks et al., Bio/Technology 10: 779-783 (1992); Lonberg et al., Nature 368: 856-859 (1994); Morrison, Nature 368 812-13 (1994); Fishwild et al., Nature Biotechnology 14, 845-51 (1996); Neuberger, Nature Biotechnology 14: 826 (1996); and Lonberg and Huszar, Intern. Rev. Immunol. 13, 65-93 (1995).
  • In case the target antigen (the protein which is detected by the antibody) is presented within the cell, the antibody of the invention can be expressed within the cell intracellular antibodies (also known as “intrabodies”) or a particular compartment thereof. Intrabodies are essentially SCA to which intracellular localization signals have been added (e.g., ER, mitochondrial, nuclear, cytoplasmic). This technology has been successfully applied in the art (for review, see Richardson and Marasco, 1995, TIBTECH vol. 13). Intrabodies have been shown to virtually eliminate the expression of otherwise abundant cell surface receptors and to inhibit a protein function within a cell (See, for example, Richardson et al., 1995, Proc. Natl. Acad. Sci. USA 92: 3137-3141; Deshane et al., 1994, Gene Ther. 1: 332-337; Marasco et al., 1998 Human Gene Ther 9: 1627-42; Shaheen et al., 1996 J. Virol. 70: 3392-400; Werge, T. M. et al., 1990, FEBS Letters 274:193-198; Carlson, J. R. 1993 Proc. Natl. Acad. Sci. USA 90:7427-7428; Biocca, S. et al., 1994, Bio/Technology 12: 396-399; Chen, S-Y. et al., 1994, Human Gene Therapy 5:595-601; Duan, L et al., 1994, Proc. Natl. Acad. Sci. USA 91:5075-5079; Chen, S-Y. et al., 1994, Proc. Natl. Acad. Sci. USA 91:5932-5936; Beerli, R. R. et al., 1994, J. Biol. Chem. 269:23931-23936; Mhashilkar, A. M. et al., 1995, EMBO J. 14:1542-1551; PCT Publication No. WO 94/02610 by Marasco et al.; and PCT Publication No. WO 95/03832 by Duan et al.).
  • To prepare an intracellular antibody expression vector, the cDNA encoding the antibody light and heavy chains specific for the target protein of interest are isolated, typically from a hybridoma that secretes a monoclonal antibody specific for the marker. Hybridomas secreting anti-marker monoclonal antibodies, or recombinant monoclonal antibodies, can be prepared using methods known in the art. Once a monoclonal antibody specific for the marker protein is identified (e.g., either a hybridoma-derived monoclonal antibody or a recombinant antibody from a combinatorial library), DNAs encoding the light and heavy chains of the monoclonal antibody are isolated by standard molecular biology techniques. For hybridoma derived antibodies, light and heavy chain cDNAs can be obtained, for example, by PCR amplification or cDNA library screening. For recombinant antibodies, such as from a phage display library, cDNA encoding the light and heavy chains can be recovered from the display package (e.g., phage) isolated during the library screening process and the nucleotide sequences of antibody light and heavy chain genes are determined. For example, many such sequences are disclosed in Kabat, E. A., et al. (1991) Sequences of Proteins of Immunological Interest, Fifth Edition, U.S. Department of Health and Human Services, NIH Publication No. 91-3242 and in the “Vbase” human germline sequence database. Once obtained, the antibody light and heavy chain sequences are cloned into a recombinant expression vector using standard methods.
  • For cytoplasmic expression of the light and heavy chains, the nucleotide sequences encoding the hydrophobic leaders of the light and heavy chains are removed. An intracellular antibody expression vector can encode an intracellular antibody in one of several different forms. For example, in one embodiment, the vector encodes full-length antibody light and heavy chains such that a full-length antibody is expressed intracellularly. In another embodiment, the vector encodes a full-length light chain but only the VH/CH1 region of the heavy chain such that a Fab fragment is expressed intracellularly. In another embodiment, the vector encodes a single chain antibody (scFv) wherein the variable regions of the light and heavy chains are linked by a flexible peptide linker [e.g., (Gly4Ser)3 and expressed as a single chain molecule. To inhibit marker activity in a cell, the expression vector encoding the intracellular antibody is introduced into the cell by standard transfection methods, as discussed hereinbefore.
  • Once antibodies are obtained, they may be tested for activity, for example via ELISA.
  • Downregulation of the polynucleotide-of-interest can be also achieved by RNA silencing. As used herein, the phrase “RNA silencing” refers to a group of regulatory mechanisms [e.g. RNA interference (RNAi), transcriptional gene silencing (TGS), post-transcriptional gene silencing (PTGS), quelling, co-suppression, and translational repression] mediated by RNA molecules which result in the inhibition or “silencing” of the expression of a corresponding protein-coding gene. RNA silencing has been observed in many types of organisms, including plants, animals, and fungi.
  • As used herein, the term “RNA silencing agent” refers to an RNA which is capable of inhibiting or “silencing” the expression of a target gene. In certain embodiments, the RNA silencing agent is capable of preventing complete processing (e.g., the full translation and/or expression) of an mRNA molecule through a post-transcriptional silencing mechanism. RNA silencing agents include noncoding RNA molecules, for example RNA duplexes comprising paired strands, as well as precursor RNAs from which such small non-coding RNAs can be generated. Exemplary RNA silencing agents include dsRNAs such as siRNAs, miRNAs and shRNAs. In one embodiment, the RNA silencing agent is capable of inducing RNA interference. In another embodiment, the RNA silencing agent is capable of mediating translational repression.
  • The RNA silencing agent can be directed to a specific compartment within the cells, such as to the nucleus (see e.g., Shim M S and Kwon Y J. 2009, “Controlled cytoplasmic and nuclear localization of plasmid DNA and siRNA by differentially tailored polyethylenimine”; J. Control Release. 133:206-13, Epub 2008 Nov. 1), nucleoli, and the like.
  • RNA interference refers to the process of sequence-specific post-transcriptional gene silencing in animals mediated by short interfering RNAs (siRNAs). The corresponding process in plants is commonly referred to as post-transcriptional gene silencing or RNA silencing and is also referred to as quelling in fungi. The process of post-transcriptional gene silencing is thought to be an evolutionarily-conserved cellular defense mechanism used to prevent the expression of foreign genes and is commonly shared by diverse flora and phyla. Such protection from foreign gene expression may have evolved in response to the production of double-stranded RNAs (dsRNAs) derived from viral infection or from the random integration of transposon elements into a host genome via a cellular response that specifically destroys homologous single-stranded RNA or viral genomic RNA.
  • The presence of long dsRNAs in cells stimulates the activity of a ribonuclease III enzyme referred to as dicer. Dicer is involved in the processing of the dsRNA into short pieces of dsRNA known as short interfering RNAs (siRNAs). Short interfering RNAs derived from dicer activity are typically about 21 to about 23 nucleotides in length and comprise about 19 base pair duplexes. The RNAi response also features an endonuclease complex, commonly referred to as an RNA-induced silencing complex (RISC), which mediates cleavage of single-stranded RNA having sequence complementary to the antisense strand of the siRNA duplex. Cleavage of the target RNA takes place in the middle of the region complementary to the antisense strand of the siRNA duplex.
  • Accordingly, the present invention contemplates use of dsRNA to down-regulate protein expression from mRNA.
  • According to one embodiment, the dsRNA is greater than 30 bp. The use of long dsRNAs (i.e. dsRNA greater than 30 bp) has been very limited owing to the belief that these longer regions of double stranded RNA will result in the induction of the interferon and PKR response. However, the use of long dsRNAs can provide numerous advantages in that the cell can select the optimal silencing sequence alleviating the need to test numerous siRNAs; long dsRNAs will allow for silencing libraries to have less complexity than would be necessary for siRNAs; and, perhaps most importantly, long dsRNA could prevent viral escape mutations when used as therapeutics.
  • Various studies demonstrate that long dsRNAs can be used to silence gene expression without inducing the stress response or causing significant off-target effects—see for example [Strat et al., Nucleic Acids Research, 2006, Vol. 34, No. 13 3803-3810; Bhargava A et al. Brain Res. Protoc. 2004; 13:115-125; Diallo M., et al., Oligonucleotides. 2003; 13:381-392; Paddison P. J., et al., Proc. Natl. Acad. Sci. USA. 2002; 99:1443-1448; Tran N., et al., FEBS Lett. 2004; 573:127-134].
  • In particular, the present invention also contemplates introduction of long dsRNA (over 30 base transcripts) for gene silencing in cells where the interferon pathway is not activated (e.g. embryonic cells and oocytes) see for example Billy et al., PNAS 2001, Vol 98, pages 14428-14433. and Diallo et al, Oligonucleotides, Oct. 1, 2003, 13(5): 381-392. doi:10.1089/154545703322617069.
  • The present invention also contemplates introduction of long dsRNA specifically designed not to induce the interferon and PKR pathways for down-regulating gene expression. For example, Shinagwa and Ishii [Genes & Dev. 17 (11): 1340-1345, 2003] have developed a vector, named pDECAP, to express long double-strand RNA from an RNA polymerase II (Pol II) promoter. Because the transcripts from pDECAP lack both the 5′-cap structure and the 3′-poly(A) tail that facilitate ds-RNA export to the cytoplasm, long ds-RNA from pDECAP does not induce the interferon response.
  • Another method of evading the interferon and PKR pathways in mammalian systems is by introduction of small inhibitory RNAs (siRNAs) either via transfection or endogenous expression.
  • The term “siRNA” refers to small inhibitory RNA duplexes (generally between 18-30 basepairs) that induce the RNA interference (RNAi) pathway. Typically, siRNAs are chemically synthesized as 21mers with a central 19 by duplex region and symmetric 2-base 3′-overhangs on the termini, although it has been recently described that chemically synthesized RNA duplexes of 25-30 base length can have as much as a 100-fold increase in potency compared with 21mers at the same location. The observed increased potency obtained using longer RNAs in triggering RNAi is theorized to result from providing Dicer with a substrate (27mer) instead of a product (21mer) and that this improves the rate or efficiency of entry of the siRNA duplex into RISC.
  • It has been found that position of the 3′-overhang influences potency of an siRNA and asymmetric duplexes having a 3′-overhang on the antisense strand are generally more potent than those with the 3′-overhang on the sense strand (Rose et al., 2005). This can be attributed to asymmetrical strand loading into RISC, as the opposite efficacy patterns are observed when targeting the antisense transcript.
  • The strands of a double-stranded interfering RNA (e.g., an siRNA) may be connected to form a hairpin or stem-loop structure (e.g., an shRNA). Thus, as mentioned the RNA silencing agent of the present invention may also be a short hairpin RNA (shRNA).
  • A non-limiting example for an siRNA which can be used to down regulate RRN3 (RNA polymerase I transcription factor homolog) expression level in a cell of a subject is Rrn3 siRNA (h): sc-106866 (Santa Cruz Biotechnology, Inc. Santa Cruz, Calif., USA). In addition, downregulation of RRN3 can be achieved by Rrn3 shRNA plasmid (h): sc-106866-SH and Rrn3 shRNA (h) Lentiviral Particles: sc-106866-V ((Santa Cruz Biotechnology, Inc. Santa Cruz, Calif., USA).
  • The term “shRNA”, as used herein, refers to an RNA agent having a stem-loop structure, comprising a first and second region of complementary sequence, the degree of complementarity and orientation of the regions being sufficient such that base pairing occurs between the regions, the first and second regions being joined by a loop region, the loop resulting from a lack of base pairing between nucleotides (or nucleotide analogs) within the loop region. The number of nucleotides in the loop is a number between and including 3 to 23, or 5 to 15, or 7 to 13, or 4 to 9, or 9 to 11. Some of the nucleotides in the loop can be involved in base-pair interactions with other nucleotides in the loop. Examples of oligonucleotide sequences that can be used to form the loop include 5′-UUCAAGAGA-3′ (Brummelkamp, T. R. et al. (2002) Science 296: 550) and 5′-UUUGUGUAG-3′ (Castanotto, D. et al. (2002) RNA 8:1454). It will be recognized by one of skill in the art that the resulting single chain oligonucleotide forms a stem-loop or hairpin structure comprising a double-stranded region capable of interacting with the RNAi machinery.
  • According to another embodiment the RNA silencing agent may be a miRNA. miRNAs are small RNAs made from genes encoding primary transcripts of various sizes. They have been identified in both animals and plants. The primary transcript (termed the “pri-miRNA”) is processed through various nucleolytic steps to a shorter precursor miRNA, or “pre-miRNA.” The pre-miRNA is present in a folded form so that the final (mature) miRNA is present in a duplex, the two strands being referred to as the miRNA (the strand that will eventually basepair with the target) The pre-miRNA is a substrate for a form of dicer that removes the miRNA duplex from the precursor, after which, similarly to siRNAs, the duplex can be taken into the RISC complex. It has been demonstrated that miRNAs can be transgenically expressed and be effective through expression of a precursor form, rather than the entire primary form (Parizotto et al. (2004) Genes & Development 18:2237-2242 and Guo et al. (2005) Plant Cell 17:1376-1386).
  • Unlike, siRNAs, miRNAs bind to transcript sequences with only partial complementarity (Zeng et al., 2002, Molec. Cell 9:1327-1333) and repress translation without affecting steady-state RNA levels (Lee et al., 1993, Cell 75:843-854; Wightman et al., 1993, Cell 75:855-862). Both miRNAs and siRNAs are processed by Dicer and associate with components of the RNA-induced silencing complex (Hutvagner et al., 2001, Science 293:834-838; Grishok et al., 2001, Cell 106: 23-34; Ketting et al., 2001, Genes Dev. 15:2654-2659; Williams et al., 2002, Proc. Natl. Acad. Sci. USA 99:6889-6894; Hammond et al., 2001, Science 293:1146-1150; Mourlatos et al., 2002, Genes Dev. 16:720-728). A recent report (Hutvagner et al., 2002, Sciencexpress 297:2056-2060) hypothesizes that gene regulation through the miRNA pathway versus the siRNA pathway is determined solely by the degree of complementarity to the target transcript. It is speculated that siRNAs with only partial identity to the mRNA target will function in translational repression, similar to an miRNA, rather than triggering RNA degradation.
  • Synthesis of RNA silencing agents suitable for use with the present invention can be effected as follows. First, the mRNA sequence of the polynucleotide-of-interest is scanned downstream of the AUG start codon for AA dinucleotide sequences. Occurrence of each AA and the 3′ adjacent 19 nucleotides is recorded as potential siRNA target sites. Preferably, siRNA target sites are selected from the open reading frame, as untranslated regions (UTRs) are richer in regulatory protein binding sites. UTR-binding proteins and/or translation initiation complexes may interfere with binding of the siRNA endonuclease complex [Tuschl ChemBiochem. 2:239-245]. It will be appreciated though, that siRNAs directed at untranslated regions may also be effective, as demonstrated for GAPDH wherein siRNA directed at the 5′ UTR mediated about 90% decrease in cellular GAPDH mRNA and completely abolished protein level (www.ambion.com/techlib/tn/91/912.html).
  • Second, potential target sites are compared to an appropriate genomic database (e.g., human, mouse, rat etc.) using any sequence alignment software, such as the BLAST software available from the NCBI server (www.ncbi.nlm.nih.gov/BLAST/). Putative target sites which exhibit significant homology to other coding sequences are filtered out.
  • Qualifying target sequences are selected as template for siRNA synthesis. Preferred sequences are those including low G/C content as these have proven to be more effective in mediating gene silencing as compared to those with G/C content higher than 55%. Several target sites are preferably selected along the length of the target gene for evaluation. For better evaluation of the selected siRNAs, a negative control is preferably used in conjunction. Negative control siRNA preferably include the same nucleotide composition as the siRNAs but lack significant homology to the genome. Thus, a scrambled nucleotide sequence of the siRNA is preferably used, provided it does not display any significant homology to any other gene.
  • It will be appreciated that the RNA silencing agent of the present invention need not be limited to those molecules containing only RNA, but further encompasses chemically-modified nucleotides and non-nucleotides.
  • In some embodiments, the RNA silencing agent provided herein can be functionally associated with a cell-penetrating peptide. As used herein, a “cell-penetrating peptide” is a peptide that comprises a short (about 12-30 residues) amino acid sequence or functional motif that confers the energy-independent (i.e., non-endocytotic) translocation properties associated with transport of the membrane-permeable complex across the plasma and/or nuclear membranes of a cell. The cell-penetrating peptide used in the membrane-permeable complex of the present invention preferably comprises at least one non-functional cysteine residue, which is either free or derivatized to form a disulfide link with a double-stranded ribonucleic acid that has been modified for such linkage. Representative amino acid motifs conferring such properties are listed in U.S. Pat. No. 6,348,185, the contents of which are expressly incorporated herein by reference. The cell-penetrating peptides of the present invention preferably include, but are not limited to, penetratin, transportan, pIsl, TAT(48-60), pVEC, MTS, and MAP.
  • mRNAs to be targeted using RNA silencing agents include, but are not limited to, those whose expression is correlated with an undesired phenotypic trait. Exemplary mRNAs that may be targeted are those that encode truncated proteins i.e. comprise deletions. Accordingly the RNA silencing agent of the present invention may be targeted to a bridging region on either side of the deletion. Introduction of such RNA silencing agents into a cell would cause a down-regulation of the mutated protein while leaving the non-mutated protein unaffected.
  • Another agent capable of downregulating the polynucleotide-of-interest is a DNAzyme molecule capable of specifically cleaving an mRNA transcript or DNA sequence of the polynucleotide-of-interest. DNAzymes are single-stranded polynucleotides which are capable of cleaving both single and double stranded target sequences (Breaker, R. R. and Joyce, G. Chemistry and Biology 1995; 2:655; Santoro, S. W. & Joyce, G. F. Proc. Natl, Acad. Sci. USA 1997; 943:4262) A general model (the “10-23” model) for the DNAzyme has been proposed. “10-23” DNAzymes have a catalytic domain of 15 deoxyribonucleotides, flanked by two substrate-recognition domains of seven to nine deoxyribonucleotides each. This type of DNAzyme can effectively cleave its substrate RNA at purine:pyrimidine junctions (Santoro, S. W. & Joyce, G. F. Proc. Natl, Acad. Sci. USA 199; for rev of DNAzymes see Khachigian, L M [Curr Opin Mol Ther 4:119-21 (2002)].
  • Examples of construction and amplification of synthetic, engineered DNAzymes recognizing single and double-stranded target cleavage sites have been disclosed in U.S. Pat. No. 6,326,174 to Joyce et al. DNAzymes of similar design directed against the human Urokinase receptor were recently observed to inhibit Urokinase receptor expression, and successfully inhibit colon cancer cell metastasis in vivo (Itoh et al, 20002, Abstract 409, Ann Meeting Am Soc Gen Ther World Wide Web (dot) asgt (dot) org). In another application, DNAzymes complementary to bcr-abl oncogenes were successful in inhibiting the oncogenes expression in leukemia cells, and lessening relapse rates in autologous bone marrow transplant in cases of CML and ALL.
  • Downregulation of the polynucleotide-of-interest can also be effected by using an antisense polynucleotide capable of specifically hybridizing with an mRNA transcript encoding the polynucleotide-of-interest.
  • Design of antisense molecules which can be used to efficiently downregulate the polynucleotide-of-interest must be effected while considering two aspects important to the antisense approach. The first aspect is delivery of the oligonucleotide into the cytoplasm of the appropriate cells, while the second aspect is design of an oligonucleotide which specifically binds the designated mRNA within cells in a way which inhibits translation thereof.
  • The prior art teaches of a number of delivery strategies which can be used to efficiently deliver oligonucleotides into a wide variety of cell types [see, for example, Luft J Mol Med 76: 75-6 (1998); Kronenwett et al. Blood 91: 852-62 (1998); Rajur et al. Bioconjug Chem 8: 935-40 (1997); Lavigne et al. Biochem Biophys Res Commun 237: 566-71 (1997) and Aoki et al. (1997) Biochem Biophys Res Commun 231: 540-5 (1997)].
  • In addition, algorithms for identifying those sequences with the highest predicted binding affinity for their target mRNA based on a thermodynamic cycle that accounts for the energetics of structural alterations in both the target mRNA and the oligonucleotide are also available [see, for example, Walton et al. Biotechnol Bioeng 65: 1-9 (1999)].
  • Such algorithms have been successfully used to implement an antisense approach in cells. For example, the algorithm developed by Walton et al. enabled scientists to successfully design antisense oligonucleotides for rabbit beta-globin (RBG) and mouse tumor necrosis factor-alpha (TNF alpha) transcripts. The same research group has more recently reported that the antisense activity of rationally selected oligonucleotides against three model target mRNAs (human lactate dehydrogenase A and B and rat gp130) in cell culture as evaluated by a kinetic PCR technique proved effective in almost all cases, including tests against three different targets in two cell types with phosphodiester and phosphorothioate oligonucleotide chemistries.
  • In addition, several approaches for designing and predicting efficiency of specific oligonucleotides using an in vitro system were also published (Matveeva et al., Nature Biotechnology 16: 1374-1375 (1998)].
  • Several clinical trials have demonstrated safety, feasibility and activity of antisense oligonucleotides. For example, antisense oligonucleotides suitable for the treatment of cancer have been successfully used [Holmund et al., Curr Opin Mol Ther 1:372-85 (1999)], while treatment of hematological malignancies via antisense oligonucleotides targeting c-myb gene, p53 and Bcl-2 had entered clinical trials and had been shown to be tolerated by patients [Gerwitz Curr Opin Mol Ther 1:297-306 (1999)].
  • More recently, antisense-mediated suppression of human heparanase gene expression has been reported to inhibit pleural dissemination of human cancer cells in a mouse model [Uno et al., Cancer Res 61:7855-60 (2001)].
  • Thus, the current consensus is that recent developments in the field of antisense technology which, as described above, have led to the generation of highly accurate antisense design algorithms and a wide variety of oligonucleotide delivery systems, enable an ordinarily skilled artisan to design and implement antisense approaches suitable for downregulating expression of known sequences without having to resort to undue trial and error experimentation.
  • Another agent capable of downregulating the polynucleotide-of-interest is a ribozyme molecule capable of specifically cleaving an mRNA transcript encoding the polynucleotide-of-interest. Ribozymes are being increasingly used for the sequence-specific inhibition of gene expression by the cleavage of mRNAs encoding proteins of interest [Welch et al., Curr Opin Biotechnol. 9:486-96 (1998)]. The possibility of designing ribozymes to cleave any specific target RNA has rendered them valuable tools in both basic research and therapeutic applications. In the therapeutics area, ribozymes have been exploited to target viral RNAs in infectious diseases, dominant oncogenes in cancers and specific somatic mutations in genetic disorders [Welch et al., Clin Diagn Virol. 10:163-71 (1998)]. Most notably, several ribozyme gene therapy protocols for HIV patients are already in Phase 1 trials. More recently, ribozymes have been used for transgenic animal research, gene target validation and pathway elucidation. Several ribozymes are in various stages of clinical trials. ANGIOZYME was the first chemically synthesized ribozyme to be studied in human clinical trials. ANGIOZYME specifically inhibits formation of the VEGF-r (Vascular Endothelial Growth Factor receptor), a key component in the angiogenesis pathway. Ribozyme Pharmaceuticals, Inc., as well as other firms have demonstrated the importance of anti-angiogenesis therapeutics in animal models. HEPTAZYME, a ribozyme designed to selectively destroy Hepatitis C Virus (HCV) RNA, was found effective in decreasing Hepatitis C viral RNA in cell culture assays (Ribozyme Pharmaceuticals, Incorporated—WEB home page).
  • An additional method of regulating the expression of the polynucleotide-of-interest in cells is via triplex forming oligonucleotides (TFOs). Recent studies have shown that TFOs can be designed which can recognize and bind to polypurine/polypirimidine regions in double-stranded helical DNA in a sequence-specific manner. These recognition rules are outlined by Maher III, L. J., et al., Science, 1989; 245:725-730; Moser, H. E., et al., Science, 1987; 238:645-630; Beal, P. A., et al, Science, 1992; 251:1360-1363; Cooney, M., et al., Science, 1988; 241:456-459; and Hogan, M. E., et al., EP Publication 375408. Modification of the oligonucleotides, such as the introduction of intercalators and backbone substitutions, and optimization of binding conditions (pH and cation concentration) have aided in overcoming inherent obstacles to TFO activity such as charge repulsion and instability, and it was recently shown that synthetic oligonucleotides can be targeted to specific sequences (for a recent review see Seidman and Glazer, J Clin Invest 2003; 112:487-94).
  • Another agent capable of downregulating the expression level of the polynucleotide-of-interest is a small molecule which inhibits the activity, level and/or interactions of the gene product of polynucleotide-of-interest, such as by interfering with the pathway in which the gene product of the polynucleotide-of-interest is involved.
  • Non-limiting examples of small molecules which can be used along with the method of the invention to treat the subject include Cycloheximide and diterpenoid triepoxide Triptolide (TPT) or a derivative thereof.
  • For example, when RRN3 is upregulated in the typical RRMS subject then the treatment can be with diterpenoid triepoxide Triptolide (TPT) or a derivative thereof; and/or with Cycloheximide or a derivative thereof.
  • Any of the downregulating agents described hereinabove (e.g., the agent which downregulates the gene of the RNA polymerase I pathway, e.g., siRNA, antibody) can be provided to the subject in need thereof along with any of the known multiple sclerosis therapies (e.g., the anti MS drugs) described hereinabove (combination therapy) and/or with Triptolide or a derivative thereof.
  • Any of the downregulating agents described above can be administered to the subject per se, or in a pharmaceutical composition where it is mixed with suitable carriers or excipients.
  • As used herein a “pharmaceutical composition” refers to a preparation of one or more of the active ingredients described herein with other chemical components such as physiologically suitable carriers and excipients. The purpose of a pharmaceutical composition is to facilitate administration of a compound to an organism.
  • Herein the term “active ingredient” refers to the downregulating agent accountable for the biological effect.
  • Hereinafter, the phrases “physiologically acceptable carrier” and “pharmaceutically acceptable carrier” which may be interchangeably used refer to a carrier or a diluent that does not cause significant irritation to an organism and does not abrogate the biological activity and properties of the administered compound. An adjuvant is included under these phrases.
  • Herein the term “excipient” refers to an inert substance added to a pharmaceutical composition to further facilitate administration of an active ingredient. Examples, without limitation, of excipients include calcium carbonate, calcium phosphate, various sugars and types of starch, cellulose derivatives, gelatin, vegetable oils and polyethylene glycols.
  • Techniques for formulation and administration of drugs may be found in “Remington's Pharmaceutical Sciences,” Mack Publishing Co., Easton, Pa., latest edition, which is incorporated herein by reference.
  • Suitable routes of administration may, for example, include oral, rectal, transmucosal, especially transnasal, intestinal or parenteral delivery, including intramuscular, subcutaneous and intramedullary injections as well as intrathecal, direct intraventricular, intracardiac, e.g., into the right or left ventricular cavity, into the common coronary artery, intravenous, inrtaperitoneal, intranasal, or intraocular injections.
  • For example, the pharmaceutical composition may be administered using a dermal patch which releases the active ingredient [e.g., Diterpenoid triepoxide Triptolide (TPT) has a molecular weight of 360.40 and it will thus be suitable to be used in a dermal patch].
  • Conventional approaches for drug delivery to the central nervous system (CNS) include: neurosurgical strategies (e.g., intracerebral injection or intracerebroventricular infusion); molecular manipulation of the agent (e.g., production of a chimeric fusion protein that comprises a transport peptide that has an affinity for an endothelial cell surface molecule in combination with an agent that is itself incapable of crossing the BBB) in an attempt to exploit one of the endogenous transport pathways of the BBB; pharmacological strategies designed to increase the lipid solubility of an agent (e.g., conjugation of water-soluble agents to lipid or cholesterol carriers); and the transitory disruption of the integrity of the BBB by hyperosmotic disruption (resulting from the infusion of a mannitol solution into the carotid artery or the use of a biologically active agent such as an angiotensin peptide). However, each of these strategies has limitations, such as the inherent risks associated with an invasive surgical procedure, a size limitation imposed by a limitation inherent in the endogenous transport systems, potentially undesirable biological side effects associated with the systemic administration of a chimeric molecule comprised of a carrier motif that could be active outside of the CNS, and the possible risk of brain damage within regions of the brain where the BBB is disrupted, which renders it a suboptimal delivery method.
  • Alternately, one may administer the pharmaceutical composition in a local rather than systemic manner, for example, via injection of the pharmaceutical composition directly into a tissue region of a patient.
  • Pharmaceutical compositions of the present invention may be manufactured by processes well known in the art, e.g., by means of conventional mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping or lyophilizing processes.
  • Pharmaceutical compositions for use in accordance with the present invention thus may be formulated in conventional manner using one or more physiologically acceptable carriers comprising excipients and auxiliaries, which facilitate processing of the active ingredients into preparations which, can be used pharmaceutically. Proper formulation is dependent upon the route of administration chosen.
  • For injection, the active ingredients of the pharmaceutical composition may be formulated in aqueous solutions, preferably in physiologically compatible buffers such as Hank's solution, Ringer's solution, or physiological salt buffer. For transmucosal administration, penetrants appropriate to the barrier to be permeated are used in the formulation. Such penetrants are generally known in the art.
  • For oral administration, the pharmaceutical composition can be formulated readily by combining the active compounds with pharmaceutically acceptable carriers well known in the art. Such carriers enable the pharmaceutical composition to be formulated as tablets, pills, dragees, capsules, liquids, gels, syrups, slurries, suspensions, and the like, for oral ingestion by a patient. Pharmacological preparations for oral use can be made using a solid excipient, optionally grinding the resulting mixture, and processing the mixture of granules, after adding suitable auxiliaries if desired, to obtain tablets or dragee cores. Suitable excipients are, in particular, fillers such as sugars, including lactose, sucrose, mannitol, or sorbitol; cellulose preparations such as, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, sodium carbomethylcellulose; and/or physiologically acceptable polymers such as polyvinylpyrrolidone (PVP). If desired, disintegrating agents may be added, such as cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof such as sodium alginate.
  • Dragee cores are provided with suitable coatings. For this purpose, concentrated sugar solutions may be used which may optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, titanium dioxide, lacquer solutions and suitable organic solvents or solvent mixtures. Dyestuffs or pigments may be added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.
  • Pharmaceutical compositions which can be used orally, include push-fit capsules made of gelatin as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol. The push-fit capsules may contain the active ingredients in admixture with filler such as lactose, binders such as starches, lubricants such as talc or magnesium stearate and, optionally, stabilizers. In soft capsules, the active ingredients may be dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene glycols. In addition, stabilizers may be added. All formulations for oral administration should be in dosages suitable for the chosen route of administration.
  • For buccal administration, the compositions may take the form of tablets or lozenges formulated in conventional manner.
  • For administration by nasal inhalation, the active ingredients for use according to the present invention are conveniently delivered in the form of an aerosol spray presentation from a pressurized pack or a nebulizer with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichloro-tetrafluoroethane or carbon dioxide. In the case of a pressurized aerosol, the dosage unit may be determined by providing a valve to deliver a metered amount. Capsules and cartridges of, e.g., gelatin for use in a dispenser may be formulated containing a powder mix of the compound and a suitable powder base such as lactose or starch.
  • The pharmaceutical composition described herein may be formulated for parenteral administration, e.g., by bolus injection or continuous infusion. Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in multidose containers with optionally, an added preservative. The compositions may be suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
  • Pharmaceutical compositions for parenteral administration include aqueous solutions of the active preparation in water-soluble form. Additionally, suspensions of the active ingredients may be prepared as appropriate oily or water based injection suspensions. Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acids esters such as ethyl oleate, triglycerides or liposomes. Aqueous injection suspensions may contain substances, which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol or dextran. Optionally, the suspension may also contain suitable stabilizers or agents which increase the solubility of the active ingredients to allow for the preparation of highly concentrated solutions.
  • Alternatively, the active ingredient may be in powder form for constitution with a suitable vehicle, e.g., sterile, pyrogen-free water based solution, before use.
  • The pharmaceutical composition of the present invention may also be formulated in rectal compositions such as suppositories or retention enemas, using, e.g., conventional suppository bases such as cocoa butter or other glycerides.
  • Pharmaceutical compositions suitable for use in context of the present invention include compositions wherein the active ingredients are contained in an amount effective to achieve the intended purpose. More specifically, a therapeutically effective amount means an amount of active ingredients (the downregulating agent) effective to prevent, alleviate or ameliorate symptoms of a disorder (e.g., RRMS) or prolong the survival of the subject being treated.
  • Determination of a therapeutically effective amount is well within the capability of those skilled in the art, especially in light of the detailed disclosure provided herein.
  • For any preparation used in the methods of the invention, the therapeutically effective amount or dose can be estimated initially from in vitro and cell culture assays. For example, a dose can be formulated in animal models to achieve a desired concentration or titer. Such information can be used to more accurately determine useful doses in humans.
  • Toxicity and therapeutic efficacy of the active ingredients described herein can be determined by standard pharmaceutical procedures in vitro, in cell cultures or experimental animals. The data obtained from these in vitro and cell culture assays and animal studies can be used in formulating a range of dosage for use in human. The dosage may vary depending upon the dosage form employed and the route of administration utilized. The exact formulation, route of administration and dosage can be chosen by the individual physician in view of the patient's condition. (See e.g., Fingl, et al., 1975, in “The Pharmacological Basis of Therapeutics”, Ch. 1 p. 1).
  • Dosage amount and interval may be adjusted individually to provide levels of the active ingredient are sufficient to induce or suppress the biological effect (minimal effective concentration, MEC). The MEC will vary for each preparation, but can be estimated from in vitro data. Dosages necessary to achieve the MEC will depend on individual characteristics and route of administration. Detection assays can be used to determine plasma concentrations.
  • Depending on the severity and responsiveness of the condition to be treated, dosing can be of a single or a plurality of administrations, with course of treatment lasting from several days to several weeks or until cure is effected or diminution of the disease state is achieved.
  • The amount of a composition to be administered will, of course, be dependent on the subject being treated, the severity of the affliction, the manner of administration, the judgment of the prescribing physician, etc.
  • Compositions of the present invention may, if desired, be presented in a pack or dispenser device, such as an FDA approved kit, which may contain one or more unit dosage forms containing the active ingredient. The pack may, for example, comprise metal or plastic foil, such as a blister pack. The pack or dispenser device may be accompanied by instructions for administration. The pack or dispenser may also be accommodated by a notice associated with the container in a form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals, which notice is reflective of approval by the agency of the form of the compositions or human or veterinary administration. Such notice, for example, may be of labeling approved by the U.S. Food and Drug Administration for prescription drugs or of an approved product insert. Compositions comprising a preparation of the invention formulated in a compatible pharmaceutical carrier may also be prepared, placed in an appropriate container, and labeled for treatment of an indicated condition, as is further detailed above.
  • According to an aspect of some embodiments of the invention, there is provided a method of selecting a drug for treating a typical relapsing remitting multiple sclerosis (RRMS) in a subject, the method is effected by (a) contacting cells of a subject classified as having a typical RRMS with a plurality of drug molecules, (b) identifying at least one drug molecule which downregulates a level of expression of at least one gene involved in the RNA polymerase I pathway, the at least one drug molecule is suitable for treating the typical RRMS in the subject, thereby selecting the drug for treating the typical RRMS in the subject.
  • The plurality of drug molecules can be peptides, RNA, DNA, aptamers and small molecules.
  • According to some embodiments of the invention the polynucleotides described hereinabove (e.g., oligonucleotides) can form a part of a probeset.
  • According to some embodiments of the invention, the probeset comprises a plurality of oligonucleotides and no more than 50 oligonucleotides (e.g., no more than about 40, no more than about 30, e.g., no more than about 20, e.g., no more than about 15, e.g., no more than about 10 oligonucleotides) wherein an oligonucleotide of the plurality of oligonucleotides specifically recognizes a polynucleotide of at least one gene involved in the RNA polymerase pathway. For example, each of the oligonucleotides can specifically recognize a polynucleotide of the RNA polymerase I pathway.
  • According to some embodiments of the invention the probeset comprises a plurality of oligonucleotides and no more than 500 oligonucleotides wherein each of the plurality of oligonucleotides is capable of specifically recognizing at least one polynucleotide sequence selected from the group consisting of C22orf8, TLK1, HNRPH1, PLXDC1, TLK1, PKN2, ALS2CR8, FLJ12547, ZNF238, PDPR, NT5E, PASK, HPGD, IL6ST, JARID1A, PASK, LEF1, FLJ10246, MTUS1, FLJ14011, VSIG4, MARCH-VI, FLJ10613, EWSR1, ATP8A1, SLC4A7, FLJ21127, HNRPH1, ABLIM1, ITGA6, ADCY9, CROCC, SH3YL1, SMA4, SPTBN1, DPEP3, PDE3B, AF5Q31, NRCAM, DOCK9, IPW, FLJ20152, SIRPB2, GALNT4, CD28, TXK, ETS1, DGCR5, ZNF192, TCF7, CAMK4, SIM2, MGEA5, TGFBR2, RET, MAPK8IP3, RRN3, DKFZp547H025, FBXW11, ZNF423, DLG1, MGC17330, CD164L1, REPS1, ACHE, ITGB1BP2, LOC94431, LTK, RUNX1, EVER1, KIAA2010, CEACAM7, STX16, SLC4A5, CRTAP, RECQL5, MAGEF1, VIPR1, FLJ10979, TTC3, CRSP2, BAZ2A, GTF2I, MGC50853, KIAA0508, BPHL, LTBP4, FN3KRP, SCARB1, MGC17330, HYAL4, DGKA, FLJ11196, DHRS6, EPHB4, IDI2/GTPBP4, SNTG2, SLC7A6, PMS2L2, KIAA0436, TOSO, THRAP3, T3JAM, LOC283232, LOC92482, PTER, ATM, NUCB2, PIK3R2, MGC1136, CD59, JARID1A, FLJ39616, ABLIM1, PBP, MAPK8IP3, FTS, LHX5, TNFRSF7, MYC, PBXIP1, DATF1, HTF9C, PUS1, KIAA0924, C6orf4, KIAA0372, WDR42A, CRYZL1, TERE1, LTBP4, TTC3, NFATC1, POM121/LOC340318, TOSO, LOC348926/MGC16279/SB153/FLJ10661, SPOCK2, KIAA0515, SLC37A4, CD44, SMARCA2, SPTBN1, C6orf130, TTC3, DLG1, SLC35E2, MCCC1, PMS2L11, RCN3, STX16, FLJ20618, STAT5B, SMARCA2, SATB1, POLR1D, ASXL1, REV1L, PMS2L2/PMS2L5, FLJ12355, CCNB1IP1, FLJ12270, KIAA0692, MCM7, GPSN2, STX16, MMS19L, GTF2I/GTF2IP1, AKAP7, ZNF444, SLC35A3, MGEA5, RUTBC3, C20orf36, RAD17, ALG12, LOC112869, C6orf48, CUTC, LGTN, DEF6, WAC, HNRPH3, NS, KIAA0892, LRPPRC, HMG20A, DDX42, TINP1, ZDHHC17, C19orf2, EIF4B, LOC376745, DKFZP434C171, TH1L, C19orf13, RPL22, PHF15, EWSR1, EIF4B, FAM48A, YT521, NEK9, EIF3S7, RPS6, RPL35A, EEF2, RPL3, RPS6, UBA52, RPL6, RPS6, RPL13, AL353949, AL580863, AF052160, AW128846, AW974481, N92920, BG178274, AW303460, BF057458, AL050035, M59917, AK025422, AI693985, AU158442, AK021460, AL023773, NM—003790, AC005011, M90355, AL353580, U38964, D50683, BE967207, YWHAB, ATP6V1E1, UBB, MRLC2/MRCL3, UQCR, MRLC2, RTN4, UBE2A, RTN4, WDR1, PSMA6, C14orf123, PP1201, TBK1, CAST, CAST, RSN, PSME1, SDF2, GSTO1, CAST, DNCL1, SQRDL, ADIPOR2, ICMT, NDUFA6, NDUFA6, COX17, HIF1AN, FLJ20257, TBPL1, RAPGEF2, CRSP8, APOL1, PAOX, CNDP2, ETFA, DPP3, KPNA1, MGC3036, TUBB2, PDCL, CCL5, CDS2, RAP1GDS1, ATP6V1D, OBRGRP/LEPR, SF4, GCLC, MGST3, BICD2, BRF1, CHST12, EXOSC7, TOR1B, ZFP95, ILK, UNC13A, MTHFD2, CASP10, FLJ45850, CMRF-35H, ARF3, NDOR1, DUSP10, AP1M2, VRK2, GSN, PTRF, RBM19, RABGAP1L, ATP5S, STOM, TFPI2, SLCO3A1, PTPN12, CSF1, SIGLEC6, KIRREL, OBRGRP, TP53AP1, SUHW1, NUP98, IL15RA, MICB, CMRF-35H, SPHK1, TNFRSF6, FLJ11301, LRP5, STOM, EPHA2, SRC, FLJ11301, PSTPIP2, EBP, MCPH1, PTPRF, LIMK2, FSTL4, CBR1, MGC2654, MYCT1, NOL3, MITF, ATP10B, FBXO31, TBX21, LSS, SLC17A3, MNAB, CHPPR, G1F, VAMPS, ABCG2, KIF1B, LOH11CR2A, NID2, RBBP8, ETV7, CTSL, RUFY1, RSU1, PARD3, APOB, ACOX3, DAB2, LDLR, TJP2, GNAS, PARD3, NCKAP1, TAP2, HDGFRP3, LDLR, PIK3R3, HTR2B, GAS2L1, FER1L3, C3orf14, TP53TG3, LEPR, CLIC5, PDE4DIP, ATP9A, ITGB1BP1, INDO, SELP, FHL2, FER1L3, EGF, SIAT8A, HDGFRP3, LRAP, VWF, FLJ10134, IMP-3, DMN, MCTP1, FSTL1, CTNNAL1, RAB27B, THBS1, PROS1, MMRN1, CTTN, AL078596, AI148659, U00956 and M29383.
  • It will be appreciated that the isolated nucleic acid sequences included in the kit or the probeset of the present invention can be bound to a solid support e.g., a glass wafer in a specific order, i.e., in the form of a microarray. Alternatively, isolated nucleic acid sequences can be synthesized directly on the solid support using well known prior art approaches (Seo T S, et al., 2004, Proc. Natl. Acad. Sci. USA, 101: 5488-93.). In any case, the isolated nucleic acid sequences are attached to the support in a location specific manner such that each specific isolated nucleic acid sequence has a specific address on the support (i.e., an addressable location) which denotes the identity (i.e., the sequence) of that specific isolated nucleic acid sequence.
  • The kit may further include a positive control for an expression level of at least one of the polynucleotides of the invention (e.g., which involves in the RNA polymerase I pathway). The positive control can be any biological sample derived from a reference subject (i.e., a subject with a known course of MS, i.e., BMS or typical RRMS), a biological sample with known amount/concentration of the gene product (i.e., RNA or protein) of at least one of the polynucleotides of the invention; or a pre-determined level (amount/concentration) of purified, chemically synthesized or recombinantly generated RNA or protein molecules (gene products) of the at least one polynucleotide of the invention. The kit may further comprise instructions for use in classifying a subject as being more like to have BMS or typical RRMS, to diagnose BMS or typical RRMS, to monitor treatment efficiency, to select a treatment regimen, to treat a subject having multiple sclerosis and/or to select for drugs suitable for treating multiple sclerosis.
  • As used herein the term “about” refers to ±10%.
  • The terms “comprises”, “comprising”, “includes”, “including”, “having” and their conjugates mean “including but not limited to”.
  • The term “consisting of means “including and limited to”.
  • The term “consisting essentially of” means that the composition, method or structure may include additional ingredients, steps and/or parts, but only if the additional ingredients, steps and/or parts do not materially alter the basic and novel characteristics of the claimed composition, method or structure.
  • As used herein, the singular form “a”, “an” and “the” include plural references unless the context clearly dictates otherwise. For example, the term “a compound” or “at least one compound” may include a plurality of compounds, including mixtures thereof.
  • Throughout this application, various embodiments of this invention may be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.
  • Whenever a numerical range is indicated herein, it is meant to include any cited numeral (fractional or integral) within the indicated range. The phrases “ranging/ranges between” a first indicate number and a second indicate number and “ranging/ranges from” a first indicate number “to” a second indicate number are used herein interchangeably and are meant to include the first and second indicated numbers and all the fractional and integral numerals therebetween.
  • As used herein the term “method” refers to manners, means, techniques and procedures for accomplishing a given task including, but not limited to, those manners, means, techniques and procedures either known to, or readily developed from known manners, means, techniques and procedures by practitioners of the chemical, pharmacological, biological, biochemical and medical arts.
  • It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination or as suitable in any other described embodiment of the invention. Certain features described in the context of various embodiments are not to be considered essential features of those embodiments, unless the embodiment is inoperative without those elements.
  • Various embodiments and aspects of the present invention as delineated hereinabove and as claimed in the claims section below find experimental support in the following examples.
    • EXAMPLES
  • Reference is now made to the following examples, which together with the above descriptions illustrate some embodiments of the invention in a non limiting fashion.
  • Generally, the nomenclature used herein and the laboratory procedures utilized in the present invention include molecular, biochemical, microbiological and recombinant DNA techniques. Such techniques are thoroughly explained in the literature. See, for example, “Molecular Cloning: A laboratory Manual” Sambrook et al., (1989); “Current Protocols in Molecular Biology” Volumes I-III Ausubel, R. M., ed. (1994); Ausubel et al., “Current Protocols in Molecular Biology”, John Wiley and Sons, Baltimore, Md. (1989); Perbal, “A Practical Guide to Molecular Cloning”, John Wiley & Sons, New York (1988); Watson et al., “Recombinant DNA”, Scientific American Books, New York; Birren et al. (eds) “Genome Analysis: A Laboratory Manual Series”, Vols. 1-4, Cold Spring Harbor Laboratory Press, New York (1998); methodologies as set forth in U.S. Pat. Nos. 4,666,828; 4,683,202; 4,801,531; 5,192,659 and 5,272,057; “Cell Biology: A Laboratory Handbook”, Volumes I-III Cellis, J. E., ed. (1994); “Current Protocols in Immunology” Volumes I-III Coligan J. E., ed. (1994); Stites et al. (eds), “Basic and Clinical Immunology” (8th Edition), Appleton & Lange, Norwalk, Conn. (1994); Mishell and Shiigi (eds), “Selected Methods in Cellular Immunology”, W. H. Freeman and Co., New York (1980); available immunoassays are extensively described in the patent and scientific literature, see, for example, U.S. Pat. Nos. 3,791,932; 3,839,153; 3,850,752; 3,850,578; 3,853,987; 3,867,517; 3,879,262; 3,901,654; 3,935,074; 3,984,533; 3,996,345; 4,034,074; 4,098,876; 4,879,219; 5,011,771 and 5,281,521; “Oligonucleotide Synthesis” Gait, M. J., ed. (1984); “Nucleic Acid Hybridization” Hames, B. D., and Higgins S. J., eds. (1985); “Transcription and Translation” Hames, B. D., and Higgins S. J., Eds. (1984); “Animal Cell Culture” Freshney, R. I., ed. (1986); “Immobilized Cells and Enzymes” IRL Press, (1986); “A Practical Guide to Molecular Cloning” Perbal, B., (1984) and “Methods in Enzymology” Vol. 1-317, Academic Press; “PCR Protocols: A Guide To Methods And Applications”, Academic Press, San Diego, Calif. (1990); Marshak et al., “Strategies for Protein Purification and Characterization—A Laboratory Course Manual” CSHL Press (1996); all of which are incorporated by reference as if fully set forth herein. Other general references are provided throughout this document. The procedures therein are believed to be well known in the art and are provided for the convenience of the reader. All the information contained therein is incorporated herein by reference.
    • General Materials and Experimental Methods
  • Subjects—31 patients (age 44.5±1.5; female to male ratio 24:7) with BMS were characterized by mean EDSS 1.95±0.15, disease duration 17.0±1.3 years, annual EDSS rate 0.13±0.01, annual relapse rate 0.23±0.04. 36 patients (age 40.3±1.8; female to male ratio 8:3) with typical RRMS were characterized by mean EDSS 3.54±0.23, disease duration 10.9±1.4 years, annual EDSS rate 0.45±0.06, annual relapse rate 0.64±0.09.
  • RNA isolation and microarray expression profiling—Peripheral blood mononuclear cells (PBMC) were separated on ficoll-hypaque gradient. Total RNA was isolated using the TRIzol Reagent (Invitrogen, Carlsbad, Calif.), and cDNA was synthesized, labeled and hybridized to HG-U133A-2 array (Affymetrix, Inc, Santa Clara, Calif.) containing 22,215 gene-transcripts, washed and scanned (Hewlett Packard, GeneArray™ scanner G2500A) according to manufacturer's protocol Affymetrix (Inc, Santa Clara, Calif.).
  • Data Analysis—Data analysis was performed using the Partek Genomics Solution software [World Wide Web (dot) partek (dot) com]. Expression values were computed from raw CEL (cell) files by applying the Robust Multi-Chip Average (RMA) background correction algorithm. The RMA correction included: 1) values background correction; 2) quantile normalization; 3) log 2 transformation; 4) median polish summarization. In order to avoid the noise caused by variable set effects each set was normalized to pre-saved distribution pattern of a well balanced set used as a reference distribution. To reduce batch effect ANOVA multiple model analysis was applied. Source of variation was analyzed; nuisance batches effects such as working batch, patient age, gender and treatment were eliminated. Most informative genes (MIGs) were defined as genes with p<0.01 by ANOVA linear contrasts model. For samples classification, principal component analyses (PCA) were performed.
  • Gene functional annotation, enrichment and pathway analysis were performed using functional classification tools, David Bioinformatics Resources [Hypertext Transfer Protocol://david (dot) abcc (dot) ncifcrf (dot) gov/home (dot) jsp], and Ingenuity Pathways Analysis web-software [World Wide Web (dot) ingenuity (dot) com]. Enrichment was defined as significantly (p<0.05) higher proportion of genes in a given gene set than expected by chance analysis. The study design is demonstrated in FIG. 1.
    • Example 1 Experimental Results
  • Identification of differentiating genes between patients with BMS and patients with typical RRMS—BMS patients differentiated from typical RRMS by 406 MIGs (most informative genes), 171 genes were over-expressed (upregulated) and 235 were down-expressed (downregulated), with the log fold change ranged from −3.1 to 3.3 (FIG. 2).
  • Table 1 hereinbelow provides the differentiating genes between BMS and typical RRMS patients.
  • TABLE 1
    Genes which are differentially expressed in blood samples of benign multiple
    sclerosis (BMS) and typical relapsing-remitting multiple sclerosis (RRMS) subjects
    p-value Log Fold
    BMS Change
    Affymetrix SEQ Representative SEQ vs. (BMS vs.
    Probeset ID Public ID typical typical Gene
    ID NO: ID NO: RRMS RRMS) Symbol Gene Title
    216683_at 1 AL353949 407 6.85E−04 −1.129 — —
    219629_at 2 NM_017911 408 5.51E−03 −1.117 C22orf8 chromosome 22
    open reading frame 8
    210379_s_at 3 AI469203 409 7.42E−03 −1.083 TLK1 tousled-like kinase 1
    213472_at 4 AI022387 410 4.25E−03 −1.081 HNRPH1 heterogeneous
    nuclear
    ribonucleoprotein
    H1 (H)
    219700_at 5 NM_020405 411 5.56E−05 −1.081 PLXDC1 plexin domain
    containing 1
    211077_s_at 6 Z25421 412 9.89E−04 −1.080 TLK1 tousled-like kinase 1
    /// tousled-like
    kinase 1
    210969_at 7 AF118089 413 4.20E−04 −1.078 PKN2 protein kinase N2
    216298_at 8 AL580863 414 3.57E−03 −1.075 — Similar to T-cell
    receptor gamma
    chain V region PT-
    gamma-1/2
    precursor /// Simil
    219834_at 9 NM_024744 415 1.20E−03 −1.069 ALS2CR8 amyotrophic lateral
    sclerosis 2 (juvenile)
    chromosome region,
    candidate 8
    215262_at 10 AF052160 416 2.29E−04 −1.068 — Clone 24629 mRNA
    sequence
    220715_at 11 NM_024992 417 1.53E−04 −1.067 FLJ12547 hypothetical protein
    FLJ12547
    207164_s_at 12 NM_006352 418 4.17E−03 −1.067 ZNF238 zinc finger protein
    238
    220236_at 13 NM_017990 419 7.14E−04 −1.067 PDPR pyruvate
    dehydrogenase
    phosphatase
    regulatory subunit
    203939_at 14 NM_002526 420 1.84E−03 −1.065 NT5E 5′-nucleotidase, ecto
    (CD73)
    216945_x_at 15 U79240 421 2.45E−03 −1.063 PASK PAS domain
    containing
    serine/threonine
    kinase
    203913_s_at 16 NM_000860 422 4.09E−03 −1.062 HPGD hydroxyprostaglandin
    dehydrogenase 15-
    (NAD)
    204864_s_at 17 BE856546 423 9.98E−03 −1.060 IL6ST interleukin 6 signal
    transducer (gp130,
    oncostatin M
    receptor)
    215698_at 18 AF007135 424 3.73E−03 −1.057 JARID1A Jumonji, AT rich
    interactive domain
    1A (RBBP2-like)
    213534_s_at 19 D50925 425 3.86E−03 −1.056 PASK PAS domain
    containing
    serine/threonine
    kinase
    210948_s_at 20 AF294627 426 1.98E−03 −1.056 LEF1 lymphoid enhancer-
    binding factor 1
    220458_at 21 NM_018038 427 8.30E−03 −1.055 FLJ10246 hypothetical protein
    FLJ10246
    212093_s_at 22 AI695017 428 8.37E−03 −1.052 MTUS1 mitochondrial tumor
    suppressor 1
    207120_at 23 NM_022103 429 1.75E−03 −1.050 FLJ14011 hypothetical zinc
    finger protein
    FLJ14011
    204787_at 24 NM_007268 430 3.61E−03 −1.050 VSIG4 V-set and
    immunoglobulin
    domain containing 4
    215512_at 25 AK000970 431 1.74E−03 −1.049 MARCH-VI membrane-
    associated RING-
    CH protein VI
    46947_at 26 T87245 432 1.23E−03 −1.049 FLJ10613 Hypothetical protein
    FLJ10613
    210012_s_at 27 BC000527 433 7.10E−03 −1.048 EWSR1 Ewing sarcoma
    breakpoint region 1
    210192_at 28 AB013452 434 7.32E−03 −1.048 ATP8A1 ATPase,
    aminophospholipid
    transporter (APLT),
    Class I, type 8A,
    member 1
    207603_at 29 NM_003615 435 2.30E−03 −1.047 SLC4A7 solute carrier family
    4, sodium
    bicarbonate
    cotransporter,
    member 7
    218584_at 30 NM_024549 436 7.79E−03 −1.047 FLJ21127 hypothetical protein
    FLJ21127
    213470_s_at 31 BF983406 437 8.91E−03 −1.047 HNRPH1 heterogeneous
    nuclear
    ribonucleoprotein
    H1 (H)
    210461_s_at 32 BC002448 438 1.63E−03 −1.047 ABLIM1 actin binding LIM
    protein 1
    217656_at 33 AW128846 439 5.27E−04 −1.045 — —
    215177_s_at 34 AV733308 440 4.01E−04 −1.045 ITGA6 integrin, alpha 6
    204498_s_at 35 NM_001116 441 3.72E−04 −1.043 ADCY9 adenylate cyclase 9
    216419_at 36 AK026910 442 7.82E−03 −1.043 CROCC ciliary rootlet
    coiled-coil, rootletin
    204019_s_at 37 NM_015677 443 1.11E−03 −1.043 SH3YL1 SH3 domain
    containing, Ysc84-
    like 1 (S. cerevisiae)
    214850_at 38 X75940 444 4.48E−03 −1.043 SMA4 SMA4
    200672_x_at 39 NM_003128 445 1.59E−03 −1.043 SPTBN1 spectrin, beta, non-
    erythrocytic 1
    220179_at 40 NM_022357 446 1.40E−03 −1.042 DPEP3 dipeptidase 3
    208591_s_at 41 NM_000922 447 6.54E−05 −1.042 PDE3B phosphodiesterase
    3B, cGMP-inhibited
    219199_at 42 NM_014423 448 5.72E−03 −1.042 AF5Q31 ALL1 fused gene
    from 5q31
    216959_x_at 43 U55258 449 1.65E−03 −1.041 NRCAM neuronal cell
    adhesion molecule
    215041_s_at 44 BE259050 450 6.36E−03 −1.040 DOCK9 dedicator of
    cytokinesis 9
    213447_at 45 AI672541 451 5.32E−05 −1.040 IPW imprinted in Prader-
    Willi syndrome
    218532_s_at 46 NM_019000 452 4.80E−03 −1.040 FLJ20152 hypothetical protein
    FLJ20152
    220485_s_at 47 NM_018556 453 1.56E−03 −1.039 SIRPB2 signal-regulatory
    protein beta 2
    220442_at 48 NM_003774 454 8.94E−03 −1.039 GALNT4 UDP-N-acetyl-
    alpha-D-
    galactosamine:polypeptide
    N-
    acetylgalactosaminyltransferase
    211856_x_at 49 AF222341 455 9.84E−03 −1.039 CD28 CD28 antigen
    (Tp44)
    206828_at 50 NM_003328 456 1.62E−03 −1.039 TXK TXK tyrosine kinase
    214447_at 51 NM_005238 457 3.28E−03 −1.038 ETS1 v-ets
    erythroblastosis
    virus E26 oncogene
    homolog 1 (avian)
    215244_at 52 AI479306 458 6.97E−03 −1.038 DGCR5 DiGeorge syndrome
    critical region gene
    5 (non-coding)
    206579_at 53 NM_006298 459 5.64E−03 −1.038 ZNF192 zinc finger protein
    192
    205254_x_at 54 AW027359 460 3.05E−03 −1.038 TCF7 transcription factor
    7 (T-cell specific,
    HMG-box)
    210349_at 55 L24959 461 3.07E−03 −1.037 CAMK4 calcium/calmodulin-
    dependent protein
    kinase IV
    208157_at 56 NM_009586 462 9.47E−03 −1.037 SIM2 single-minded
    homolog 2
    (Drosophila)
    214972_at 57 AU144791 463 4.25E−03 −1.037 MGEA5 Meningioma
    expressed antigen 5
    (hyaluronidase)
    207334_s_at 58 NM_003242 464 2.70E−03 −1.037 TGFBR2 transforming growth
    factor, beta receptor
    II (70/80 kDa)
    217666_at 59 AW974481 465 1.06E−03 −1.037 — —
    215771_x_at 60 X15786 466 1.14E−03 −1.036 RET ret proto-oncogene
    (multiple endocrine
    neoplasia and
    medullary thyroid
    carcinoma
    216139_s_at 61 AL031718 467 7.40E−03 −1.036 MAPK8IP3 mitogen-activated
    protein kinase 8
    interacting protein 3
    216902_s_at 62 AF001549 468 4.86E−05 −1.036 RRN3 RRN3 RNA
    polymerase I
    transcription factor
    homolog (yeast)
    208265_at 63 NM_020161 469 6.06E−04 −1.036 DKFZp547H025 hypothetical protein
    DKFZp547H025
    209456_s_at 64 AB033281 470 3.49E−03 −1.036 FBXW11 F-box and WD-40
    domain protein 11
    217237_at 65 Y10615 471 7.72E−03 −1.035 ZNF423 Zinc finger protein
    423
    217208_s_at 66 AL121981 472 2.91E−03 −1.035 DLG1 discs, large homolog
    1 (Drosophila)
    221757_at 67 BE042976 473 1.83E−04 −1.035 MGC17330 HGFL gene ///
    HGFL gene
    213481_at 68 N92920 474 4.47E−03 −1.035 — —
    219025_at 69 NM_020404 475 2.84E−03 −1.035 CD164L1 CD164 sialomucin-
    like 1
    215201_at 70 AW166925 476 9.15E−03 −1.034 REPS1 RALBP1 associated
    Eps domain
    containing 1
    205378_s_at 71 NM_015831 477 6.79E−03 −1.034 ACHE acetylcholinesterase
    (YT blood group)
    219829_at 72 NM_012278 478 6.24E−03 −1.033 ITGB1BP2 integrin beta 1
    binding protein
    (melusin) 2
    216908_x_at 73 AF001549 468 6.22E−04 −1.033 LOC94431 similar to RNA
    polymerase I
    transcription factor
    RRN3
    217184_s_at 74 X52213 479 4.40E−03 −1.033 LTK leukocyte tyrosine
    kinase
    211181_x_at 75 AF312386 480 4.63E−03 −1.033 RUNX1 runt-related
    transcription factor
    1 (acute myeloid
    leukemia 1; aml1
    oncogene)
    214958_s_at 76 AK021738 481 1.62E−03 −1.033 EVER1 epidermodysplasia
    verruciformis 1
    220369_at 77 NM_017936 482 7.90E−03 −1.033 KIAA2010 KIAA2010
    211848_s_at 78 AF006623 483 8.77E−04 −1.033 CEACAM7 carcinoembryonic
    antigen-related cell
    adhesion molecule 7
    221638_s_at 79 AF008937 484 8.81E−03 −1.033 STX16 syntaxin 16
    221723_s_at 80 AF243499 485 8.08E−03 −1.033 SLC4A5 solute carrier family
    4, sodium
    bicarbonate
    cotransporter,
    member 5
    201380_at 81 NM_006371 486 8.45E−04 −1.032 CRTAP cartilage associated
    protein
    34063_at 82 AB006533 487 1.03E−03 −1.032 RECQL5 RecQ protein-like 5
    214757_at 83 BG178274 488 5.20E−03 −1.032 — Hypothetical gene
    supported by
    AK024602
    218176_at 84 NM_022149 489 4.04E−03 −1.032 MAGEF1 melanoma antigen,
    family F, 1
    221977_at 85 AW303460 490 7.35E−03 −1.032 — —
    214161_at 86 BF057458 491 9.56E−03 −1.031 — —
    214857_at 87 AL050035 492 6.21E−03 −1.031 — MRNA; cDNA
    DKFZp566H0124
    (from clone
    DKFZp566H0124)
    216230_x_at 88 M59917 493 1.74E−03 −1.031 — —
    205019_s_at 89 NM_004624 494 3.56E−03 −1.031 VIPR1 vasoactive intestinal
    peptide receptor 1
    221707_s_at 90 BC006116 495 7.60E−03 −1.031 FLJ10979 hypothetical protein
    FLJ10979 ///
    hypothetical protein
    FLJ10979
    208664_s_at 91 AU131711 496 1.15E−04 −1.030 TTC3 tetratricopeptide
    repeat domain 3
    215167_at 92 BE567032 497 8.69E−03 −1.030 CRSP2 cofactor required for
    Sp1 transcriptional
    activation, subunit
    2, 150 kDa
    215437_x_at 93 BE513659 498 4.06E−03 −1.030 BAZ2A bromodomain
    adjacent to zinc
    finger domain, 2A
    210892_s_at 94 BC004472 499 3.77E−03 −1.029 GTF2I general transcription
    factor II, i
    212400_at 95 AL043266 500 1.57E−03 −1.029 MGC50853 hypothetical protein
    MGC50853
    215137_at 96 H92070 501 5.46E−03 −1.029 KIAA0508 KIAA0508 protein
    205750_at 97 NM_004332 502 1.95E−03 −1.028 BPHL biphenyl hydrolase-
    like (serine
    hydrolase; breast
    epithelial mucin-
    associated an
    210628_x_at 98 AF051344 503 1.93E−03 −1.028 LTBP4 latent transforming
    growth factor beta
    binding protein 4
    218210_at 99 NM_024619 504 1.42E−03 −1.028 FN3KRP fructosamine-3-
    kinase-related
    protein
    216784_at 100 AK025422 505 2.68E−03 −1.028 — Transcribed locus,
    weakly similar to
    XP_375174.1
    hypothetical gene
    supported by
    201819_at 101 NM_005505 506 7.48E−03 −1.028 SCARB1 scavenger receptor
    class B, member 1
    214312_at 102 AI693985 507 2.93E−03 −1.028 — —
    215556_at 103 AU158442 508 3.90E−03 −1.028 — —
    221756_at 104 BE042976 473 2.52E−03 −1.027 MGC17330 HGFL gene ///
    HGFL gene
    216909_at 105 AK021460 509 5.34E−03 −1.027 — —
    220249_at 106 NM_012269 510 8.17E−03 −1.027 HYAL4 hyaluronoglucosaminidase 4
    211272_s_at 107 AF064771 511 3.46E−03 −1.027 DGKA diacylglycerol
    kinase, alpha 80 kDa
    218651_s_at 108 NM_018357 512 7.30E−03 −1.027 FLJ11196 acheron
    218285_s_at 109 NM_020139 513 2.93E−03 −1.027 DHRS6 dehydrogenase/reductase
    (SDR family)
    member 6
    217385_at 110 AL023773 514 2.79E−03 −1.027 — —
    202894_at 111 NM_004444 515 1.52E−03 −1.026 EPHB4 EPH receptor B4
    217631_at 112 AI081107 516 6.97E−03 −1.026 IDI2 /// isopentenyl-
    GTPBP4 diphosphate delta
    isomerase 2 /// GTP
    binding protein 4
    220487_at 113 NM_018968 517 9.34E−03 −1.026 SNTG2 syntrophin, gamma 2
    203579_s_at 114 AI660619 518 1.98E−03 −1.026 SLC7A6 solute carrier family
    7 (cationic amino
    acid transporter, y+
    system), member 6
    215412_x_at 115 AB017007 519 7.10E−04 −1.026 PMS2L2 postmeiotic
    segregation
    increased 2-like 2
    212217_at 116 AU154782 520 1.32E−03 −1.026 KIAA0436 putative prolyl
    oligopeptidase
    221602_s_at 117 AI084226 521 3.58E−04 −1.026 TOSO regulator of Fas-
    induced apoptosis ///
    regulator of Fas-
    induced apoptosis
    217847_s_at 118 NM_005119 522 8.43E−03 −1.025 THRAP3 thyroid hormone
    receptor associated
    protein 3
    215275_at 119 AW963138 523 9.31E−03 −1.025 T3JAM TRAF3-interacting
    Jun N-terminal
    kinase (JNK)-
    activating modulator
    221951_at 120 AI739035 524 2.65E−03 −1.025 LOC283232 hypothetical protein
    LOC283232
    213224_s_at 121 AK025724 525 7.84E−05 −1.024 LOC92482 Hypothetical protein
    LOC92482
    218967_s_at 122 BF112019 526 5.08E−03 −1.024 PTER phosphotriesterase
    related
    208442_s_at 123 NM_000051 527 9.87E−04 −1.024 ATM ataxia telangiectasia
    mutated (includes
    complementation
    groups A, C and D)
    203675_at 124 NM_005013 528 5.38E−03 −1.024 NUCB2 nucleobindin 2
    207105_s_at 125 NM_005027 529 2.15E−03 −1.023 PIK3R2 phosphoinositide-3-
    kinase, regulatory
    subunit 2 (p85 beta)
    219144_at 126 NM_024025 530 3.23E−03 −1.023 MGC1136 hypothetical protein
    MGC1136
    212463_at 127 BE379006 531 9.58E−03 −1.023 CD59 CD59 antigen p18-20
    (antigen
    identified by
    monoclonal
    antibodies 16.3A5,
    EJ16, E
    202040_s_at 128 NM_005056 532 8.73E−03 −1.023 JARID1A Jumonji, AT rich
    interactive domain
    1A (RBBP2-like)
    64432_at 129 W05463 533 4.53E−03 −1.023 FLJ39616 apoptosis related
    protein PNAS-1
    200965_s_at 130 NM_006720 534 2.98E−03 −1.022 ABLIM1 actin binding LIM
    protein 1
    205353_s_at 131 NM_002567 535 9.67E−03 −1.022 PBP prostatic binding
    protein
    213177_at 132 AB028989 536 9.13E−03 −1.022 MAPK8IP3 mitogen-activated
    protein kinase 8
    interacting protein 3
    218373_at 133 NM_022476 537 6.35E−03 −1.022 FTS fused toes homolog
    (mouse)
    208333_at 134 NM_022363 538 4.11E−03 −1.022 LHX5 LIM homeobox 5
    206150_at 135 NM_001242 539 8.17E−03 −1.022 TNFRSF7 tumor necrosis
    factor receptor
    superfamily,
    member 7 /// tumor
    necrosis factor r
    202431_s_at 136 NM_002467 540 7.39E−03 −1.022 MYC v-myc
    myelocytomatosis
    viral oncogene
    homolog (avian)
    207838_x_at 137 NM_020524 541 3.63E−03 −1.021 PBXIP1 pre-B-cell leukemia
    transcription factor
    interacting protein 1
    218325_s_at 138 NM_022105 542 1.46E−03 −1.021 DATF1 death associated
    transcription factor 1
    218475_at 139 NM_022727 543 1.53E−03 −1.021 HTF9C HpaII tiny
    fragments locus 9C
    218670_at 140 NM_025215 544 1.05E−03 −1.021 PUS1 pseudouridylate
    synthase 1
    205594_at 141 NM_014897 545 8.79E−03 −1.021 KIAA0924 KIAA0924 protein
    215411_s_at 142 AL008730 546 7.21E−03 −1.021 C6orf4 chromosome 6 open
    reading frame 4
    203048_s_at 143 NM_014639 547 2.14E−03 −1.020 KIAA0372 KIAA0372
    216885_s_at 144 AK026481 548 4.07E−04 −1.020 WDR42A WD repeat domain
    42A
    219767_s_at 145 NM_005111 549 3.79E−03 −1.020 CRYZL1 crystallin, zeta
    (quinone reductase)-
    like 1
    219131_at 146 NM_013319 550 3.21E−03 −1.020 TERE1 transitional epithelia
    response protein
    213176_s_at 147 AI910869 551 6.21E−03 −1.020 LTBP4 latent transforming
    growth factor beta
    binding protein 4
    208661_s_at 148 D84294 552 4.85E−03 −1.020 TTC3 tetratricopeptide
    repeat domain 3
    208196_x_at 149 NM_006162 553 9.44E−03 −1.020 NFATC1 nuclear factor of
    activated T-cells,
    cytoplasmic,
    calcineurin-
    dependent 1
    212178_s_at 150 AK022555 554 2.95E−03 −1.020 POM121 /// POM121 membrane
    LOC340318 glycoprotein (rat) ///
    hypothetical protein
    LOC340318
    221601_s_at 151 AI084226 521 2.54E−03 −1.020 TOSO regulator of Fas-
    induced apoptosis ///
    regulator of Fas-
    induced apoptosis
    222013_x_at 152 BE348837 555 5.16E−03 −1.019 LOC348926 hypothetical protein
    /// LOC348926 ///
    MGC16279 hypothetical protein
    /// SB153 /// MGC16279 ///
    FLJ10661 hypothetica
    202524_s_at 153 AI952009 556 5.43E−03 −1.019 SPOCK2 sparc/osteonectin,
    cwcv and kazal-like
    domains
    proteoglycan
    (testican) 2
    212068_s_at 154 AB011087 557 9.23E−03 −1.019 KIAA0515 KIAA0515
    202830_s_at 155 NM_001467 558 5.82E−03 −1.019 SLC37A4 solute carrier family
    37 (glycerol-6-
    phosphate
    transporter),
    member 4
    209835_x_at 156 BC004372 559 5.79E−03 −1.019 CD44 CD44 antigen
    (homing function
    and Indian blood
    group system)
    212257_s_at 157 AW131754 560 1.51E−03 −1.019 SMARCA2 SWI/SNF related,
    matrix associated,
    actin dependent
    regulator of
    chromatin, subf
    212071_s_at 158 BE968833 561 2.68E−03 −1.019 SPTBN1 spectrin, beta, non-
    erythrocytic 1
    213322_at 159 AL031778 562 8.31E−04 −1.019 C6orf130 chromosome 6 open
    reading frame 130
    210645_s_at 160 D83077 563 2.20E−03 −1.019 TTC3 tetratricopeptide
    repeat domain 3
    202514_at 161 AW139131 564 4.70E−03 −1.018 DLG1 DKFZP586B0319
    protein
    217122_s_at 162 AL031282 565 4.05E−03 −1.018 SLC35E2 solute carrier family
    35, member E2
    218440_at 163 NM_020166 566 9.21E−05 −1.018 MCCC1 methylcrotonoyl-
    Coenzyme A
    carboxylase 1
    (alpha)
    210707_x_at 164 U38980 567 3.76E−04 −1.018 PMS2L11 postmeiotic
    segregation
    increased 2-like 11
    61734_at 165 AI797684 568 3.19E−03 −1.018 RCN3 reticulocalbin 3, EF-
    hand calcium
    binding domain
    221500_s_at 166 AK026970 569 1.50E−04 −1.018 STX16 syntaxin 16
    219422_at 167 NM_0003790 570 6.24E−03 −1.018 — —
    222244_s_at 168 AK000749 571 5.14E−03 −1.018 FLJ20618 hypothetical protein
    FLJ20618
    212550_at 169 AI149535 572 1.46E−03 −1.018 STAT5B signal transducer
    and activator of
    transcription 5B
    206544_x_at 170 NM_003070 573 5.64E−03 −1.018 SMARCA2 SWI/SNF related,
    matrix associated,
    actin dependent
    regulator of
    chromatin, subf
    216380_x_at 171 AC005011 574 3.97E−03 −1.018 — —
    203408_s_at 172 NM_002971 575 6.31E−03 −1.018 SATB1 special AT-rich
    sequence binding
    protein 1 (binds to
    nuclear
    matrix/scaffold-ass
    218258_at 173 NM_015972 576 2.71E−03 −1.017 POLR1D polymerase (RNA) I
    polypeptide D,
    16 kDa
    212234_at 174 AL034550 577 5.94E−03 −1.017 ASXL1 additional sex
    combs like 1
    (Drosophila)
    217461_x_at 175 M90355 578 7.56E−03 −1.017 — —
    218428_s_at 176 NM_016316 579 8.87E−03 −1.017 REV1L REV1-like (yeast)
    215667_x_at 177 AI375694 580 1.00E−03 −1.017 PMS2L2 /// postmeiotic
    PMS2L5 segregation
    increased 2-like 2 ///
    postmeiotic
    segregation
    increased
    220465_at 178 NM_024988 581 2.08E−03 −1.017 FLJ12355 hypothetical protein
    FLJ12355
    217988_at 179 NM_021178 582 9.05E−03 −1.017 CCNB1IP1 cyclin B1
    interacting protein 1
    221981_s_at 180 AA702154 583 3.45E−03 −1.017 FLJ12270 hypothetical protein
    FLJ12270
    212201_at 181 AW274877 584 5.96E−03 −1.017 KIAA0692 KIAA0692 protein
    208795_s_at 182 D55716 585 1.81E−03 −1.017 MCM7 MCM7
    minichromosome
    maintenance
    deficient 7 (S. cerevisiae)
    208336_s_at 183 NM_004868 586 5.33E−03 −1.017 GPSN2 glycoprotein,
    synaptic 2
    221499_s_at 184 AK026970 569 8.49E−03 −1.017 STX16 syntaxin 16
    202167_s_at 185 NM_022362 587 8.82E−03 −1.017 MMS19L MMS19-like
    (MET18 homolog,
    S. cerevisiae)
    201065_s_at 186 NM_001518 588 4.02E−03 −1.017 GTF2I /// general transcription
    GTF2IP1 factor II, i /// general
    transcription factor
    II, i, pseud
    211172_x_at 187 AF161075 589 2.00E−03 −1.017 AKAP7 A kinase (PRKA)
    anchor protein 7
    218707_at 188 NM_018337 590 7.16E−03 −1.016 ZNF444 zinc finger protein
    444
    206770_s_at 189 NM_012243 591 9.43E−03 −1.016 SLC35A3 solute carrier family
    35 (UDP-N-
    acetylglucosamine
    (UDP-GlcNAc)
    transporter), mem
    200898_s_at 190 AK002091 592 2.97E−03 −1.016 MGEA5 meningioma
    expressed antigen 5
    (hyaluronidase)
    215519_x_at 191 AI081779 593 3.72E−03 −1.016 RUTBC3 RUN and TBC1
    domain containing 3
    212406_s_at 192 AB028973 594 4.48E−03 −1.016 C20orf36 chromosome 20
    open reading frame
    36
    210826_x_at 193 AF098533 595 4.28E−03 −1.015 RAD17 RAD17 homolog (S. pombe)
    218444_at 194 NM_024105 596 6.99E−03 −1.015 ALG12 asparagine-linked
    glycosylation 12
    homolog (yeast,
    alpha-1,6-
    mannosyltransferase
    221822_at 195 BE544663 597 4.91E−03 −1.015 LOC112869 hypothetical protein
    BC011981
    220755_s_at 196 NM_016947 598 7.95E−04 −1.015 C6orf48 chromosome 6 open
    reading frame 48
    218970_s_at 197 NM_015960 599 9.75E−03 −1.015 CUTC cutC copper
    transporter homolog
    (E. coli)
    218253_s_at 198 NM_006893 600 5.75E−03 −1.015 LGTN ligatin
    221293_s_at 199 NM_022047 601 2.42E−03 −1.015 DEF6 differentially
    expressed in FDCP
    6 homolog (mouse)
    217742_s_at 200 NM_016628 602 5.14E−03 −1.015 WAC WW domain
    containing adaptor
    with coiled-coil
    207127_s_at 201 NM_021644 603 4.06E−03 −1.014 HNRPH3 heterogeneous
    nuclear
    ribonucleoprotein
    H3 (2H9)
    217850_at 202 NM_014366 604 5.81E−03 −1.014 NS nucleostemin
    212505_s_at 203 AL110250 605 8.73E−03 −1.014 KIAA0892 KIAA0892
    211971_s_at 204 AI653608 606 2.30E−05 −1.014 LRPPRC leucine-rich PPR-
    motif containing
    216387_x_at 205 AL353580 607 5.15E−03 −1.014 — —
    218152_at 206 NM_018200 608 8.22E−03 −1.014 HMG20A high-mobility group
    20A
    201788_at 207 NM_007372 609 4.77E−03 −1.014 DDX42 DEAD (Asp-Glu-
    Ala-Asp) box
    polypeptide 42
    201922_at 208 NM_014886 610 6.30E−03 −1.014 TINP1 TGF beta-inducible
    nuclear protein 1
    212982_at 209 AI621223 611 4.57E−03 −1.014 ZDHHC17 zinc finger, DHHC
    domain containing
    17
    214173_x_at 210 AW514900 612 2.20E−04 −1.014 C19orf2 chromosome 19
    open reading frame 2
    211937_at 211 NM_001417 613 3.24E−03 −1.014 EIF4B eukaryotic
    translation initiation
    factor 4B
    216843_x_at 212 U38964 614 6.22E−03 −1.014 — —
    212854_x_at 213 AB051480 615 1.60E−03 −1.013 LOC376745 AG1
    212886_at 214 AL080169 616 4.76E−03 −1.013 DKFZP434C171 DKFZP434C171
    protein
    220607_x_at 215 NM_016397 617 3.15E−03 −1.012 TH1L TH1-like
    (Drosophila)
    212132_at 216 AL117499 618 5.52E−04 −1.011 C19orf13 chromosome 19
    open reading frame
    13
    214042_s_at 217 AW071997 619 3.11E−03 −1.011 RPL22 ribosomal protein
    L22
    212660_at 218 AI735639 620 5.22E−03 −1.011 PHF15 PHD finger protein
    15
    208944_at 219 D50683 621 5.54E−03 −1.011 — —
    210011_s_at 220 BC000527 433 9.77E−03 −1.010 EWSR1 Ewing sarcoma
    breakpoint region 1
    211938_at 221 BF247371 622 8.55E−03 −1.010 EIF4B eukaryotic
    translation initiation
    factor 4B
    220408_x_at 222 NM_017569 623 6.06E−03 −1.010 FAM48A family with
    sequence similarity
    48, member A
    212114_at 223 BE967207 624 9.73E−03 −1.010 — Similar to
    microtubule-
    associated proteins
    1A/1B light chain 3
    212455_at 224 N36997 625 2.91E−03 −1.009 YT521 splicing factor
    YT521-B
    212299_at 225 AL117502 626 6.14E−03 −1.009 NEK9 NIMA (never in
    mitosis gene a)-
    related kinase 9
    200005_at 226 NM_003753 627 4.23E−03 −1.008 EIF3S7 eukaryotic
    translation initiation
    factor 3, subunit 7
    zeta, 66/67 kDa ///
    eukaryo
    200081_s_at 227 BE741754 628 1.02E−03 −1.007 RPS6 ribosomal protein
    S6 /// ribosomal
    protein S6
    213687_s_at 228 BE968801 629 8.26E−03 −1.006 RPL35A ribosomal protein
    L35a
    204102_s_at 229 NM_001961 630 5.59E−03 −1.006 EEF2 eukaryotic
    translation
    elongation factor 2
    211666_x_at 230 L22453 631 6.17E−03 −1.006 RPL3 ribosomal protein
    L3 /// ribosomal
    protein L3
    209134_s_at 231 BC000524 632 1.77E−03 −1.005 RPS6 ribosomal protein
    S6
    221700_s_at 232 AF348700 633 2.98E−04 −1.005 UBA52 ubiquitin A-52
    residue ribosomal
    protein fusion
    product 1 ///
    ubiquitin A-52 res
    200034_s_at 233 NM_000970 634 9.34E−03 −1.005 RPL6 ribosomal protein
    L6 /// ribosomal
    protein L6
    201254_x_at 234 NM_001010 635 7.37E−03 −1.004 RPS6 ribosomal protein
    S6
    212734_x_at 235 AI186735 636 8.06E−03 −1.003 RPL13 ribosomal protein
    L13
    217718_s_at 236 NM_014052 637 6.36E−03 1.005 YWHAB tyrosine 3-
    monooxygenase/tryptophan
    5-
    monooxygenase
    activation protein,
    beta pol
    208678_at 237 BC004443 638 8.57E−03 1.006 ATP6V1E1 ATPase, H+
    transporting,
    lysosomal 31 kDa,
    V1 subunit E
    isoform 1
    200633_at 238 NM_018955 639 2.94E−03 1.006 UBB ubiquitin B ///
    ubiquitin B
    201318_s_at 239 NM_006471 640 1.52E−03 1.007 MRLC2 /// myosin regulatory
    MRCL3 light chain MRLC2
    /// myosin
    regulatory light
    chain MRCL3
    202090_s_at 240 NM_006830 641 3.41E−03 1.008 UQCR ubiquinol-
    cytochrome c
    reductase (6.4 kD)
    subunit
    221474_at 241 U26162 642 7.75E−03 1.008 MRLC2 myosin regulatory
    light chain MRLC2
    214629_x_at 242 AF320999 643 3.29E−03 1.009 RTN4 reticulon 4
    200067_x_at 243 AL078596 644 9.11E−03 1.010 — —
    201899_s_at 244 NM_003336 645 8.17E−03 1.010 UBE2A ubiquitin-
    conjugating enzyme
    E2A (RAD6
    homolog)
    210968_s_at 245 AF333336 646 3.86E−03 1.010 RTN4 reticulon 4
    200609_s_at 246 NM_017491 647 5.41E−04 1.010 WDR1 WD repeat domain 1
    208805_at 247 BC002979 648 3.97E−03 1.011 PSMA6 proteasome
    (prosome,
    macropain) subunit,
    alpha type, 6
    218571_s_at 248 NM_014169 649 5.41E−03 1.011 C14orf123 chromosome 14
    open reading frame
    123
    217730_at 249 NM_022152 650 5.26E−03 1.013 PP1201 PP1201 protein
    218520_at 250 NM_013254 651 9.23E−03 1.013 TBK1 TANK-binding
    kinase 1
    208908_s_at 251 AF327443 652 7.99E−03 1.014 CAST calpastatin
    207467_x_at 252 NM_001750 653 8.54E−03 1.014 CAST calpastatin
    201975_at 253 NM_002956 654 5.39E−03 1.015 RSN restin (Reed-
    Steinberg cell-
    expressed
    intermediate
    filament-associated
    protein)
    200814_at 254 NM_006263 655 2.49E−04 1.015 PSME1 proteasome
    (prosome,
    macropain) activator
    subunit 1 (PA28
    alpha)
    203090_at 255 NM_006923 656 4.45E−03 1.015 SDF2 stromal cell-derived
    factor 2
    201470_at 256 NM_004832 657 2.35E−03 1.015 GSTO1 glutathione S-
    transferase omega 1
    212586_at 257 AA195244 658 6.42E−03 1.016 CAST calpastatin
    200703_at 258 NM_003746 659 5.88E−03 1.016 DNCL1 dynein, cytoplasmic,
    light polypeptide 1
    217995_at 259 NM_021199 660 9.02E−03 1.016 SQRDL sulfide quinone
    reductase-like
    (yeast)
    201346_at 260 NM_024551 661 3.81E−03 1.016 ADIPOR2 adiponectin receptor 2
    201609_x_at 261 AL578502 662 1.36E−03 1.016 ICMT isoprenylcysteine
    carboxyl
    methyltransferase
    202000_at 262 BC002772 663 6.15E−03 1.016 NDUFA6 NADH
    dehydrogenase
    (ubiquinone) 1 alpha
    subcomplex, 6,
    14 kDa
    202001_s_at 263 BC002772 663 7.78E−03 1.017 NDUFA6 NADH
    dehydrogenase
    (ubiquinone) 1 alpha
    subcomplex, 6,
    14 kDa
    203880_at 264 NM_005694 664 6.24E−03 1.017 COX17 COX17 homolog,
    cytochrome c
    oxidase assembly
    protein (yeast)
    218525_s_at 265 NM_017902 665 9.42E−03 1.017 HIF1AN hypoxia-inducible
    factor 1, alpha
    subunit inhibitor
    219798_s_at 266 NM_019606 666 3.38E−03 1.017 FLJ20257 hypothetical protein
    FLJ20257
    208398_s_at 267 NM_004865 667 7.76E−03 1.017 TBPL1 TBP-like 1
    218358_at 268 NM_024324 668 6.57E−03 1.017 — —
    203097_s_at 269 NM_014247 669 4.66E−03 1.017 RAPGEF2 Rap guanine
    nucleotide exchange
    factor (GEF) 2
    221598_s_at 270 BC002878 670 7.63E−03 1.017 CRSP8 cofactor required for
    Sp1 transcriptional
    activation, subunit
    8, 34 kDa
    209546_s_at 271 AF323540 671 6.71E−03 1.018 APOL1 apolipoprotein L, 1
    50400_at 272 AI743990 672 7.35E−03 1.018 PAOX polyamine oxidase
    (exo-N4-amino)
    217752_s_at 273 NM_018235 673 4.11E−03 1.018 CNDP2 CNDP dipeptidase 2
    (metallopeptidase
    M20 family)
    201931_at 274 NM_000126 674 6.90E−03 1.018 ETFA electron-transfer-
    flavoprotein, alpha
    polypeptide
    (glutaric aciduria II)
    218567_x_at 275 NM_005700 675 1.00E−02 1.019 DPP3 dipeptidylpeptidase 3
    202056_at 276 AW051311 676 8.93E−03 1.019 KPNA1 Karyopherin alpha 1
    (importin alpha 5)
    218907_s_at 277 NM_023942 677 2.62E−03 1.019 MGC3036 hypothetical protein
    MGC3036
    213726_x_at 278 AA515698 678 2.22E−03 1.019 TUBB2 tubulin, beta, 2
    204448_s_at 279 AF031463 679 7.00E−03 1.019 PDCL phosducin-like
    1405_i_at 280 M21121 680 9.54E−03 1.019 CCL5 chemokine (C-C
    motif) ligand 5
    212864_at 281 Y16521 681 9.17E−03 1.019 CDS2 CDP-diacylglycerol
    synthase
    (phosphatidate
    cytidylyltransferase) 2
    209444_at 282 BC001851 682 1.27E−04 1.019 RAP1GDS1 RAP1, GTP-GDP
    dissociation
    stimulator 1
    208898_at 283 AF077614 683 2.37E−03 1.019 ATP6V1D ATPase, H+
    transporting,
    lysosomal 34 kDa,
    V1 subunit D
    202377_at 284 AW026535 684 5.30E−03 1.019 OBRGRP /// leptin receptor gene-
    LEPR related protein ///
    leptin receptor
    209547_s_at 285 BC001043 685 4.14E−03 1.020 SF4 splicing factor 4
    202922_at 286 BF676980 686 4.19E−03 1.020 GCLC glutamate-cysteine
    ligase, catalytic
    subunit
    201403_s_at 287 NM_004528 687 3.64E−03 1.020 MGST3 microsomal
    glutathione S-
    transferase 3
    213154_s_at 288 AI934125 688 2.75E−03 1.020 BICD2 bicaudal D homolog
    2 (Drosophila)
    215676_at 289 N91109 689 8.42E−03 1.021 BRF1 BRF1 homolog,
    subunit of RNA
    polymerase III
    transcription
    initiation factor IIIB
    218927_s_at 290 BC002918 690 8.09E−03 1.021 CHST12 carbohydrate
    (chondroitin 4)
    sulfotransferase 12
    213648_at 291 AW614427 691 6.11E−03 1.021 EXOSC7 Exosome
    component 7
    209593_s_at 292 AF317129 692 8.82E−03 1.021 TOR1B torsin family 1,
    member B (torsin B)
    203731_s_at 293 NM_014569 693 1.78E−03 1.022 ZFP95 zinc finger protein
    95 homolog (mouse)
    201234_at 294 NM_004517 694 2.90E−03 1.022 ILK integrin-linked
    kinase
    214817_at 295 BE783668 695 8.61E−03 1.022 UNC13A unc-13 homolog A
    (C. elegans)
    201761_at 296 NM_006636 696 3.83E−03 1.022 MTHFD2 methylene
    tetrahydrofolate
    dehydrogenase
    (NAD+ dependent),
    methenyltetrahydrofol
    205467_at 297 NM_001230 697 6.50E−03 1.022 CASP10 caspase 10,
    apoptosis-related
    cysteine protease
    222318_at 298 AI744673 698 9.20E−03 1.022 FLJ45850 FLJ45850 protein
    209933_s_at 299 AF020314 699 6.24E−03 1.022 CMRF-35H leukocyte
    membrane antigen
    200734_s_at 300 BG341906 700 4.33E−03 1.023 ARF3 ADP-ribosylation
    factor 3
    219899_x_at 301 NM_014434 701 7.97E−03 1.023 NDOR1 NADPH dependent
    diflavin
    oxidoreductase 1
    221563_at 302 N36770 702 3.41E−03 1.024 DUSP10 dual specificity
    phosphatase 10
    65517_at 303 AA910946 703 4.00E−03 1.024 AP1M2 adaptor-related
    protein complex 1,
    mu 2 subunit
    205126_at 304 NM_006296 704 8.89E−03 1.024 VRK2 vaccinia related
    kinase 2
    200696_s_at 305 NM_000177 705 8.30E−03 1.024 GSN gelsolin
    (amyloidosis,
    Finnish type)
    208790_s_at 306 AF312393 706 4.43E−03 1.025 PTRF polymerase I and
    transcript release
    factor
    205115_s_at 307 NM_016196 707 8.06E−03 1.025 RBM19 RNA binding motif
    protein 19
    213982_s_at 308 BG107203 708 8.15E−03 1.025 RABGAP1L RAB GTPase
    activating protein 1-
    like
    206992_s_at 309 NM_015684 709 2.03E−03 1.025 ATP5S ATP synthase, H+
    transporting,
    mitochondrial F0
    complex, subunit s
    (factor B)
    201060_x_at 310 AI537887 710 9.12E−04 1.025 STOM stomatin
    209278_s_at 311 L27624 711 7.18E−03 1.026 TFPI2 tissue factor
    pathway inhibitor 2
    210542_s_at 312 BC000585 712 4.38E−03 1.026 SLCO3A1 solute carrier
    organic anion
    transporter family,
    member 3A1
    202006_at 313 NM_002835 713 3.01E−03 1.026 PTPN12 protein tyrosine
    phosphatase, non-
    receptor type 12
    210557_x_at 314 M76453 714 2.04E−03 1.026 CSF1 colony stimulating
    factor 1
    (macrophage)
    210796_x_at 315 D86359 715 2.95E−03 1.027 SIGLEC6 sialic acid binding
    Ig-like lectin 6
    220825_s_at 316 NM_018240 716 9.74E−03 1.027 KIRREL kin of IRRE like
    (Drosophila)
    202378_s_at 317 NM_017526 717 2.72E−03 1.027 OBRGRP leptin receptor gene-
    related protein
    210241_s_at 318 AB007458 718 3.02E−03 1.027 TP53AP1 TP53 activated
    protein 1
    213069_at 319 AI148659 719 2.90E−03 1.027 — —
    216034_at 320 AA558468 720 9.90E−03 1.027 SUHW1 suppressor of hairy
    wing homolog 1
    (Drosophila)
    210793_s_at 321 U41815 721 2.64E−03 1.029 NUP98 nucleoporin 98 kDa
    207375_s_at 322 NM_002189 722 3.71E−03 1.029 IL15RA interleukin 15
    receptor, alpha
    206247_at 323 NM_005931 723 2.70E−03 1.029 MICB MHC class I
    polypeptide-related
    sequence B
    217078_s_at 324 AJ010102 724 9.65E−03 1.029 CMRF-35H leukocyte
    membrane antigen
    219257_s_at 325 NM_021972 725 1.62E−03 1.030 SPHK1 sphingosine kinase 1
    204781_s_at 326 NM_000043 726 8.44E−03 1.030 TNFRSF6 tumor necrosis
    factor receptor
    superfamily,
    member 6
    221536_s_at 327 AL136897 727 2.28E−03 1.030 FLJ11301 hypothetical protein
    FLJ11301
    209468_at 328 AB017498 728 8.91E−03 1.030 LRP5 low density
    lipoprotein receptor-
    related protein 5
    201061_s_at 329 M81635 729 1.46E−04 1.030 STOM stomatin
    203499_at 330 NM_004431 730 6.49E−03 1.031 EPHA2 EPH receptor A2
    213324_at 331 AK024281 731 7.63E−03 1.031 SRC v-src sarcoma
    (Schmidt-Ruppin A-
    2) viral oncogene
    homolog (avian)
    221535_at 332 AL136897 727 3.81E−03 1.031 FLJ11301 hypothetical protein
    FLJ11301
    219938_s_at 333 NM_024430 732 3.19E−03 1.032 PSTPIP2 proline-serine-
    threonine
    phosphatase
    interacting protein 2
    213787_s_at 334 AV702405 733 1.78E−03 1.032 EBP emopamil binding
    protein (sterol
    isomerase)
    219592_at 335 NM_024596 734 8.43E−03 1.032 MCPH1 microcephaly,
    primary autosomal
    recessive 1
    200637_s_at 336 AI762627 735 5.52E−03 1.033 PTPRF protein tyrosine
    phosphatase,
    receptor type, F
    202193_at 337 NM_005569 736 4.88E−03 1.033 LIMK2 LIM domain kinase 2
    214859_at 338 AI635302 737 8.68E−03 1.034 FSTL4 follistatin-like 4
    209213_at 339 BC002511 738 5.69E−03 1.034 CBR1 carbonyl reductase 1
    218945_at 340 NM_024109 739 3.75E−03 1.034 MGC2654 hypothetical protein
    MGC2654
    220471_s_at 341 NM_025107 740 8.29E−03 1.035 MYCT1 myc target 1
    59625_at 342 AI912351 741 5.19E−03 1.035 NOL3 nucleolar protein 3
    (apoptosis repressor
    with CARD
    domain)
    207233_s_at 343 NM_000248 742 2.93E−03 1.035 MITF microphthalmia-
    associated
    transcription factor
    214070_s_at 344 AW006935 743 5.14E−03 1.036 ATP10B ATPase, Class V,
    type 10B
    219785_s_at 345 NM_024735 744 5.84E−03 1.036 FBXO31 F-box protein 31
    220684_at 346 NM_013351 745 3.34E−03 1.037 TBX21 T-box 21
    202245_at 347 AW084510 746 7.02E−03 1.037 LSS lanosterol synthase
    (2,3-oxidosqualene-
    lanosterol cyclase)
    207298_at 348 NM_006632 747 6.68E−03 1.037 SLC17A3 solute carrier family
    17 (sodium
    phosphate), member 3
    220201_at 349 NM_018835 748 3.85E−03 1.038 MNAB membrane
    associated DNA
    binding protein
    203208_s_at 350 BF214329 749 6.89E−04 1.038 CHPPR likely ortholog of
    chicken chondrocyte
    protein with a poly-
    proline region
    207033_at 351 NM_005142 750 3.42E−04 1.039 GIF gastric intrinsic
    factor (vitamin B
    synthesis)
    204929_s_at 352 NM_006634 751 6.38E−03 1.039 VAMP5 vesicle-associated
    membrane protein 5
    (myobrevin)
    209735_at 353 AF098951 752 7.05E−03 1.039 ABCG2 ATP-binding
    cassette, sub-family
    G (WHITE),
    member 2
    209234_at 354 BF939474 753 3.31E−04 1.039 KIF1B kinesin family
    member 1B
    210102_at 355 BC001234 754 5.97E−03 1.040 LOH11CR2A loss of
    heterozygosity, 11,
    chromosomal region
    2, gene A
    204114_at 356 NM_007361 755 4.45E−03 1.041 NID2 nidogen 2
    (osteonidogen)
    203344_s_at 357 NM_002894 756 1.33E−03 1.041 RBBP8 retinoblastoma
    binding protein 8
    216891_at 358 U00956 757 5.03E−03 1.042 — —
    221680_s_at 359 AF147782 758 9.08E−03 1.042 ETV7 ets variant gene 7
    (TEL2 oncogene)
    202087_s_at 360 NM_001912 759 3.63E−03 1.042 CTSL cathepsin L
    218243_at 361 NM_025158 760 6.62E−03 1.043 RUFY1 RUN and FYVE
    domain containing 1
    201980_s_at 362 NM_012425 761 5.59E−03 1.044 RSU1 Ras suppressor
    protein 1
    221280_s_at 363 NM_019619 762 4.65E−04 1.044 PARD3 par-3 partitioning
    defective 3 homolog
    (C. elegans)
    205108_s_at 364 NM_000384 763 2.36E−04 1.045 APOB apolipoprotein B
    (including Ag(x)
    antigen)
    204241_at 365 BF055171 764 6.95E−04 1.045 ACOX3 acyl-Coenzyme A
    oxidase 3, pristanoyl
    201278_at 366 N21202 765 2.71E−03 1.049 DAB2 Disabled homolog
    2, mitogen-
    responsive
    phosphoprotein
    (Drosophila)
    202067_s_at 367 AI861942 766 1.95E−03 1.050 LDLR low density
    lipoprotein receptor
    (familial
    hypercholesterolemia)
    202085_at 368 NM_004817 767 3.10E−03 1.051 TJP2 tight junction
    protein 2 (zona
    occludens 2)
    214157_at 369 AA401492 768 4.90E−03 1.053 GNAS GNAS complex
    locus
    221526_x_at 370 AF196185 769 2.72E−03 1.053 PARD3 par-3 partitioning
    defective 3 homolog
    (C. elegans)
    207738_s_at 371 NM_013436 770 2.00E−03 1.054 NCKAP1 NCK-associated
    protein 1
    204769_s_at 372 NM_000544 771 3.15E−03 1.054 TAP2 transporter 2, ATP-
    binding cassette,
    sub-family B
    (MDR/TAP)
    216693_x_at 373 AL133102 772 6.34E−03 1.055 HDGFRP3 hepatoma-derived
    growth factor,
    related protein 3
    202068_s_at 374 NM_000527 773 5.72E−03 1.057 LDLR low density
    lipoprotein receptor
    (familial
    hypercholesterolemia)
    202743_at 375 BE622627 774 7.96E−04 1.061 PIK3R3 phosphoinositide-3-
    kinase, regulatory
    subunit 3 (p55,
    gamma)
    206638_at 376 NM_000867 775 7.47E−03 1.061 HTR2B 5-
    hydroxytryptamine
    (serotonin) receptor
    2B
    31874_at 377 Y07846 776 2.32E−03 1.061 GAS2L1 growth arrest-
    specific 2 like 1
    201798_s_at 378 NM_013451 777 5.01E−03 1.062 FER1L3 fer-1-like 3,
    myoferlin (C. elegans)
    219288_at 379 NM_020685 778 6.67E−04 1.063 C3orf14 chromosome 3 open
    reading frame 14
    220167_s_at 380 NM_015369 779 5.44E−04 1.064 TP53TG3 TP53TG3 protein
    211354_s_at 381 U52913 780 1.67E−03 1.066 LEPR leptin receptor
    213317_at 382 AL049313 781 7.15E−03 1.067 CLIC5 Chloride
    intracellular channel 5
    212390_at 383 AB007923 782 8.15E−03 1.070 PDE4DIP phosphodiesterase
    4D interacting
    protein
    (myomegalin)
    212062_at 384 AB014511 783 8.65E−03 1.070 ATP9A ATPase, Class II,
    type 9A
    203337_x_at 385 NM_004763 784 6.03E−03 1.071 ITGB1BP1 integrin beta 1
    binding protein 1
    210029_at 386 M34455 785 5.97E−03 1.073 INDO indoleamine-pyrrole
    2,3 dioxygenase
    206049_at 387 NM_003005 786 8.60E−03 1.074 SELP selectin P (granule
    membrane protein
    140 kDa, antigen
    CD62)
    202949_s_at 388 NM_001450 787 6.99E−03 1.076 FHL2 four and a half LIM
    domains 2
    211864_s_at 389 AF207990 788 7.27E−03 1.076 FER1L3 fer-1-like 3,
    myoferlin (C. elegans)
    206254_at 390 NM_001963 789 5.83E−03 1.077 EGF epidermal growth
    factor (beta-
    urogastrone)
    210073_at 391 L32867 790 5.66E−04 1.077 SIAT8A sialyltransferase 8A
    (alpha-N-
    acetylneuraminate:
    alpha-2,8-
    sialyltransferase,
    GD
    209524_at 392 AK001280 791 1.03E−03 1.080 HDGFRP3 hepatoma-derived
    growth factor,
    related protein 3
    219759_at 393 NM_022350 792 8.03E−04 1.081 LRAP leukocyte-derived
    arginine
    aminopeptidase
    202112_at 394 NM_000552 793 1.22E−03 1.082 VWF von Willebrand
    factor
    219410_at 395 NM_018004 794 4.81E−03 1.083 FLJ10134 hypothetical protein
    FLJ10134
    203819_s_at 396 AU160004 795 3.58E−03 1.088 IMP-3 IGF-II mRNA-
    binding protein 3
    212730_at 397 AK026420 796 3.19E−03 1.090 DMN desmuslin
    220122_at 398 NM_024717 797 5.82E−03 1.090 MCTP1 multiple C2-
    domains with two
    transmembrane
    regions
    1
    208782_at 399 BC000055 798 2.14E−03 1.095 FSTL1 follistatin-like 1
    202468_s_at 400 NM_003798 799 1.36E−03 1.096 CTNNAL1 catenin (cadherin-
    associated protein),
    alpha-like 1
    207018_s_at 401 NM_004163 800 4.02E−03 1.101 RAB27B RAB27B, member
    RAS oncogene
    family
    210354_at 402 M29383 801 4.60E−03 1.102 — —
    201110_s_at 403 NM_003246 802 9.38E−03 1.111 THBS1 thrombospondin 1
    207808_s_at 404 NM_000313 803 2.92E−03 1.114 PROS1 protein S (alpha)
    205612_at 405 NM_007351 804 7.97E−03 1.118 MMRN1 multimerin 1
    214073_at 406 BG475299 805 2.37E−03 1.121 CTTN cortactin
    Table 1: Presented are the 406 differentiating genes given by the gene name and description, the Affymetrix probeset identification number, and a representative GenBank Accession number between BMS and typical RRMS patients. p-value - statistical significance by ANOVA; Log Fold Change = refers to the logarithms fold change between the expression level of a polynucleotide in a blood sample of a BMS subject as compared to the expression level in a blood sample of a typical RRMS subject: The (−) sign means that the polynucleotide is downregulated (decreased in level) in BMS as compared to typical RRMS subjects; and the (+) sign means that the polynucleotide is upregulated (increased in level) in BMS as compared to typical RRMS subjects.
  • Table 2 hereinbelow discloses additional polynucleotides (RNA alternative transcripts) of the above identified 406 genes which expression level is differentiating between typical RRMS and BMS.
  • TABLE 2
    SEQ
    ID
    PROBESET NO: Refseq Ids/SEQ ID NO: REFSEQ_UNIGENE REFSEQ_BAND
    216683_at 1 —/ — —
    219629_at 2 NM_017911/ C22ORF8 Hs.265018
    997
    210379_s_at 3 NM_012290/ TLK1 Hs.470586
    948
    213472_at 4 —/ — —
    219700_at 5 NM_020405/ PLXDC1 Hs.125036
    1022
    211077_s_at 6 NM_012290/ TLK1 Hs.470586
    948
    210969_at 7 —/ — —
    216298_at 8 —/ — —
    219834_at 9 NM_024744/ ALS2CR8 Hs.444982
    1051
    215262_at 10 —/ — —
    220715_at 11 —/ — —
    207164_s_at 12 NM_205768/ NM_006352/ ZNF238, Hs.69997,
    1103 1133 ZNF238, Hs.69997,
    220236_at 13 NM_017990/ PDPR Hs.461183
    999
    203939_at 14 NM_002526/ NT5E Hs.153952
    865
    216945_x_at 15 NM_015148/ PASK Hs.397891
    970
    203913_s_at 16 NM_000860/ HPGD Hs.77348
    834
    204864_s_at 17 NM_175767/ NM_002183/ IL6ST, Hs.532082,
    1088 1189 IL6ST, Hs.532082,
    215698_at 18 —/ — —
    213534_s_at 19 NM_015148/ PASK Hs.397891
    970
    210948_s_at 20 NM_016269/ LEF1 Hs.125132
    988
    220458_at 21 NM_018038/ FLJ10246 Hs.274274
    1001
    212093_s_at 22 NM_020749/ NM_001001931/ NM_001001925/ NM_001001924/ NM_001001927/ MTUS1, Hs.7946,
    1025 1114 1182 1216 1234 MTUS1, Hs.7946,
    MTUS1, Hs.7946,
    MTUS1, Hs.7946,
    MTUS1, Hs.7946,
    207120_at 23 NM_022103/ FLJ14011 Hs.433473
    1033
    204787_at 24 NM_007268/ VSIG4 Hs.8904
    939
    215512_at 25 —/ — —
    46947_at 26 —/ — —
    210012_s_at 27 —/ — —
    210192_at 28 NM_006095/ ATP8A1 Hs.435052
    918
    207603_at 29 —/ — —
    218584_at 30 NM_024549/ FLJ21127 Hs.211511
    1047
    213470_s_at 31 NM_005520/ HNRPH1 Hs.202166
    912
    210461_s_at 32 NM_006720/ NM_002313/ NM_001003407/ NM_001003408/ ABLIM1, Hs.438236,
    930 1120 1187 1232 ABLIM1, Hs.438236,
    ABLIM1, Hs.438236,
    ABLIM1, Hs.438236,
    217656_at 33 —/ — —
    215177_s_at 34 NM_000210/ ITGA6 Hs.133397
    826
    204498_s_at 35 NM_001116/ ADCY9 Hs.391860
    848
    216419_at 36 —/ — —
    204019_s_at 37 NM_015677/ SH3YL1 Hs.515951
    979
    214850_at 38 NM_207331/ LOC153561 Hs.545578
    1106
    200672_x_at 39 NM_003128/ SPTBN1 Hs.503178
    872
    220179_at 40 NM_022357/ DPEP3 Hs.302028
    1037
    208591_s_at 41 NM_000922/ PDE3B Hs.445711
    835
    219199_at 42 NM_014423/ AF5Q31 Hs.519313
    958
    216959_x_at 43 NM_005010/ NRCAM Hs.21422
    899
    215041_s_at 44 NM_015296/ DOCK9 Hs.314413
    973
    213447_at 45 —/ — —
    218532_s_at 46 NM_019000/ FLJ20152 Hs.481704
    1016
    220485_s_at 47 NM_018556/ NM_080816/ SIRPB2, Hs.50716,
    1011 1150 SIRPB2, Hs.50716,
    220442_at 48 NM_003774/ GALNT4 Hs.534374
    881
    211856_x_at 49 NM_006139/ CD28 Hs.1987
    919
    206828_at 50 NM_003328/ TXK Hs.479669
    875
    214447_at 51 NM_005238/ ETS1 Hs.369438
    907
    215244_at 52 —/ — —
    206579_at 53 NM_006298/ ZNF192 Hs.57679
    922
    205254_x_at 54 NM_201632/ NM_201634/ NM_213648/ NM_003202/ TCF7, Hs.519580,
    1099 1173 1215 1219 TCF7, Hs.519580,
    TCF7, Hs.519580,
    TCF7, Hs.519580,
    210349_at 55 NM_001744/ CAMK4 Hs.220629
    856
    208157_at 56 NM_009586/ SIM2 Hs.146186
    942
    214972_at 57 —/ — —
    207334_s_at 58 NM_003242/ TGFBR2 Hs.82028
    873
    217666_at 59 —/ — —
    215771_x_at 60 NM_020975/ NM_020630/ RET, Hs.350321,
    1026 1143 RET, Hs.350321,
    216139_s_at 61 NM_033392/ NM_015133/ MAPK8IP3, Hs.207763,
    1057 1138 MAPK8IP3, Hs.207763,
    216902_s_at 62 NM_018427/ RRN3 Hs.460078
    1010
    208265_at 63 NM_020161/ DKFZP547H025 Hs.283092
    1019
    209456_s_at 64 NM_033645/ NM_033644/ NM_012300/ FBXW11, Hs.484138,
    1059 1148 1193 FBXW11, Hs.484138,
    FBXW11, Hs.484138,
    217237_at 65 —/ — —
    217208_s_at 66 NM_004087/ DLG1 Hs.292549
    885
    221757_at 67 NM_052880/ MGC17330 Hs.26670
    1060
    213481_at 68 —/ — —
    219025_at 69 NM_020404/ CD164L1 Hs.195727
    1021
    215201_at 70 —/ — —
    205378_s_at 71 NM_000665/ NM_015831/ ACHE, Hs.154495,
    833 1139 ACHE, Hs.154495,
    219829_at 72 NM_012278/ ITGB1BP2 Hs.109999
    947
    216908_x_at 73 NM_018427/ NM_145237/ RRN3, Hs.460078,
    1010 1156 LOC94431, Hs.546468,
    217184_s_at 74 NM_206961/ NM_002344/ LTK, Hs.434481,
    1105 1121 LTK, Hs.434481,
    211181_x_at 75 NM_001001890/ NM_001754/ RUNX1, Hs.149261,
    843 1179 RUNX1, Hs.149261,
    214958_s_at 76 NM_007267/ EVER1 Hs.16165
    938
    220369_at 77 NM_017936/ KIAA2010 Hs.533887
    998
    211848_s_at 78 NM_006890/ CEACAM7 Hs.74466
    932
    221638_s_at 79 NM_003763/ NM_001001434/ NM_001001433/ STX16, Hs.307913,
    880 842 1181 STX16, Hs.307913,
    STX16, Hs.307913,
    221723_s_at 80 NM_021196/ NM_133479/ NM_133478/ NM_033323/ SLC4A5, Hs.469033,
    1028 1152 1201 1223 SLC4A5, Hs.469033,
    SLC4A5, Hs.469033,
    SLC4A5, Hs.469033,
    201380_at 81 NM_006371/ CRTAP Hs.517888
    923
    34063_at 82 NM_001003715/ NM_001003716/ NM_004259/ RECQL5, Hs.514480,
    845 1178 1191 RECQL5, Hs.514480,
    RECQL5, Hs.514480,
    214757_at 83 —/ — —
    218176_at 84 NM_022149/ MAGEF1 Hs.306123
    1034
    221977_at 85 —/ — —
    214161_at 86 —/ — —
    214857_at 87 —/ — —
    216230_x_at 88 NM_000543/ NM_001007593/ SMPD1, Hs.498173,
    829 1118 SMPD1, Hs.498173,
    205019_s_at 89 NM_004624/ VIPR1 Hs.348500
    893
    221707_s_at 90 NM_018289/ FLJ10979 Hs.461819
    1006
    208664_s_at 91 NM_001001894/ NM_003316/ TTC3, Hs.368214,
    844 1180 TTC3, Hs.368214,
    215167_at 92 —/ — —
    215437_x_at 93 NM_013449/ BAZ2A Hs.314263
    955
    210892_s_at 94 NM_001518/ NM_033001/ NM_033000/ NM_032999/ GTF2I, Hs.520459,
    854 1146 1198 1222 GTF2I, Hs.520459,
    GTF2I, Hs.520459,
    GTF2I, Hs.520459,
    212400_at 95 NM_203305/ EEIG1 Hs.460208
    1101
    215137_at 96 —/ — —
    205750_at 97 NM_004332/ BPHL Hs.10136
    888
    210628_x_at 98 NM_003573/ LTBP4 Hs.466766
    877
    218210_at 99 NM_024619/ FN3KRP Hs.31431
    1050
    216784_at 100 —/ — —
    201819_at 101 NM_005505/ SCARB1 Hs.298813
    911
    214312_at 102 —/ — —
    215556_at 103 —/ — —
    221756_at 104 NM_052880/ MGC17330 Hs.26670
    1060
    216909_at 105 —/ — —
    220249_at 106 NM_012269/ HYAL4 Hs.28673
    946
    211272_s_at 107 NM_201554/ NM_001345/ NM_201445/ NM_201444/ DGKA, Hs.524488,
    1098 1119 1211 1229 DGKA, Hs.524488,
    DGKA, Hs.524488,
    DGKA, Hs.524488,
    218651_s_at 108 NM_018357/ FLJ11196 Hs.416755
    1008
    218285_s_at 109 NM_020139/ DHRS6 Hs.124696
    1018
    217385_at 110 —/ — —
    202894_at 111 NM_004444/ EPHB4 Hs.437008
    890
    217631_at 112 —/ — —
    220487_at 113 NM_018968/ SNTG2 Hs.148819
    1015
    203579_s_at 114 NM_003983/ SLC7A6 Hs.351571
    884
    215412_x_at 115 NM_005395/ NM_001003686/ NM_001003687/ NM_174930/ NM_002679/ NM_000535/ PMS2L3, Hs.549057,
    908 1115 1183 1086 867 828 PMS2L3, Hs.549057,
    PMS2L3, Hs.549057,
    PMS2L5, Hs.397073,
    POM121, Hs.488624,
    PMS2, Hs.487470,
    212217_at 116 —/ — —
    221602_s_at 117 NM_005449/ TOSO Hs.58831
    909
    217847_s_at 118 NM_005119/ THRAP3 Hs.160211
    905
    215275_at 119 —/ — —
    221951_at 120 NM_174940/ LOC283232 Hs.448664
    1087
    213224_s_at 121 —/ — —
    218967_s_at 122 NM_030664/ NM_001001484/ PTER, Hs.444321,
    1055 1113 PTER, Hs.444321,
    208442_s_at 123 NM_138292/ NM_000051/ ATM, Hs.435561,
    1069 1109 ATM, Hs.435561,
    203675_at 124 NM_005013/ NUCB2 Hs.128686
    900
    207105_s_at 125 NM_005027/ PIK3R2 Hs.371344
    901
    219144_at 126 NM_024025/ MGC1136 Hs.8719
    1042
    212463_at 127 NM_000611/ NM_203331/ NM_203329/ NM_203330/ CD59, Hs.278573,
    831 1175 1212 1230 CD59, Hs.278573,
    CD59, Hs.278573,
    CD59, Hs.278573,
    202040_s_at 128 NM_005056/ JARID1A Hs.76272
    902
    64432_at 129 NM_016534/ FLJ39616 Hs.333120
    991
    200965_s_at 130 NM_006720/ NM_002313/ NM_001003407/ NM_001003408/ ABLIM1, Hs.438236,
    930 1120 1187 1232 ABLIM1, Hs.438236,
    ABLIM1, Hs.438236,
    ABLIM1, Hs.438236,
    205353_s_at 131 NM_002567/ PBP Hs.433863
    866
    213177_at 132 NM_033392/ NM_015133/ MAPK8IP3, Hs.207763,
    1057 1138 MAPK8IP3, Hs.207763,
    218373_at 133 NM_022476/ FTS Hs.380897
    1040
    208333_at 134 NM_022363/ LHX5 Hs.302029
    1039
    206150_at 135 NM_001242/ TNFRSF7 Hs.355307
    851
    202431_s_at 136 NM_002467/ MYC Hs.202453
    863
    207838_x_at 137 NM_020524/ PBXIP1 Hs.505806
    1023
    218325_s_at 138 NM_080797/ NM_080796/ NM_022105/ DATF1, Hs.551527,
    1062 1149 1197 DATF1, Hs.551527,
    DATF1, Hs.551527,
    218475_at 139 NM_182984/ NM_022727/ HTF9C, Hs.549133,
    1090 1144 HTF9C, Hs.549133,
    218670_at 140 NM_025215/ PUS1 Hs.507295
    1053
    205594_at 141 NM_014897/ ZNF652 Hs.463375
    967
    215411_s_at 142 NM_147200/ NM_147686/ C6ORF4, Hs.486228,
    1076 1160 C6ORF4, Hs.486228,
    203048_s_at 143 NM_014639/ KIAA0372 Hs.482868
    962
    216885_s_at 144 NM_015726/ WDR42A Hs.492236
    982
    219767_s_at 145 NM_005111/ NM_145311/ NM_145858/ CRYZL1, Hs.352671,
    903 1157 1202 CRYZL1, Hs.352671,
    CRYZL1, Hs.352671,
    219131_at 146 NM_013319/ TERE1 Hs.522933
    953
    213176_s_at 147 NM_003573/ LTBP4 Hs.466766
    877
    208661_s_at 148 NM_001001894/ NM_003316/ TTC3, Hs.368214,
    844 1180 TTC3, Hs.368214,
    208196_x_at 149 NM_172388/ NM_172389/ NM_172387/ NM_006162/ NFATC1, Hs.534074,
    1083 1164 1206 1220 NFATC1, Hs.534074,
    NFATC1, Hs.534074,
    NFATC1, Hs.534074,
    212178_s_at 150 NM_172020/ POM121 Hs.488624
    1081
    221601_s_at 151 NM_005449/ TOSO Hs.58831
    909
    222013_x_at 152 NM_152563/ NM_032916/ NM_018172/ FLJ10661, Hs.61142,
    1077 1145 1196 MGC16279, Hs.458413,
    FLJ10661, Hs.61142,
    202524_s_at 153 NM_014767/ SPOCK2 Hs.523009
    963
    212068_s_at 154 —/ — —
    202830_s_at 155 NM_001467/ SLC37A4 Hs.132760
    853
    209835_x_at 156 NM_001001391/ NM_001001390/ NM_001001389/ NM_000610/ NM_001001392/ CD44, Hs.502328,
    841 1177 1186 1231 1233 CD44, Hs.502328,
    CD44, Hs.502328,
    CD44, Hs.502328,
    CD44, Hs.502328,
    212257_s_at 157 NM_139045/ NM_003070/ SMARCA2, Hs.298990,
    1071 1124 SMARCA2, Hs.298990,
    212071_s_at 158 —/ — —
    213322_at 159 NM_145063/ C6ORF130 Hs.549281
    1075
    210645_s_at 160 NM_001001894/ NM_003316/ TTC3, Hs.368214,
    844 1180 TTC3, Hs.368214,
    202514_at 161 —/ — —
    217122_s_at 162 NM_014854/ SLC35E2 Hs.551612
    964
    218440_at 163 NM_020166/ MCCC1 Hs.47649
    1020
    210707_x_at 164 NM_174930/ NM_002679/ NM_005395/ NM_001003686/ NM_001003687/ NM_000535/ PMS2L5, Hs.397073,
    1086 867 908 1115 1183 828 POM121, Hs.488624,
    PMS2L3, Hs.549057,
    PMS2L3, Hs.549057,
    PMS2L3, Hs.549057,
    PMS2, Hs.487470,
    61734_at 165 NM_020650/ RCN3 Hs.439184
    1024
    221500_s_at 166 NM_001001434/ NM_003763/ NM_001001433/ STX16, Hs.307913,
    842 880 1181 STX16, Hs.307913,
    STX16, Hs.307913,
    219422_at 167 —/ — —
    222244_s_at 168 NM_017903/ FLJ20618 Hs.551545
    996
    212550_at 169 NM_012448/ STAT5B Hs.132864
    950
    206544_x_at 170 NM_139045/ NM_003070/ SMARCA2, Hs.298990,
    1071 1124 SMARCA2, Hs.298990,
    216380_x_at 171 NM_001031/ RPS28 Hs.546293
    847
    203408_s_at 172 NM_002971/ SATB1 Hs.517717
    870
    218258_at 173 NM_015972/ MGC9850 Hs.507584
    984
    212234_at 174 NM_015338/ ASXL1 Hs.374043
    976
    217461_x_at 175 NM_001207/ BTF3 Hs.529798
    849
    218428_s_at 176 NM_016316/ REV1L Hs.443077
    989
    215667_x_at 177 NM_002679/ NM_174930/ NM_005395/ NM_001003686/ NM_001003687/ POM121, Hs.488624,
    867 1086 908 1115 1183 PMS2L5, Hs.397073,
    PMS2L3, Hs.549057,
    PMS2L3, Hs.549057,
    PMS2L3, Hs.549057,
    220465_at 178 —/ — —
    217988_at 179 NM_021178/ NM_182852/ NM_182851/ NM_182849/ CCNB1IP1, Hs.107003,
    1027 1169 1208 1227 CCNB1IP1, Hs.107003,
    CCNB1IP1, Hs.107003,
    CCNB1IP1, Hs.107003,
    221981_s_at 180 NM_030581/ FLJ12270 Hs.280951
    1054
    212201_at 181 —/ — —
    208795_s_at 182 NM_005916/ NM_182776/ MCM7, Hs.438720,
    916 1168 MCM7, Hs.438720,
    208336_s_at 183 NM_004868/ NM_138501/ GPSN2, Hs.515642,
    898 1153 GPSN2, Hs.515642,
    221499_s_at 184 NM_001001434/ NM_003763/ NM_001001433/ STX16, Hs.307913,
    842 880 1181 STX16, Hs.307913,
    STX16, Hs.307913,
    202167_s_at 185 NM_022362/ MMS19L Hs.500721
    1038
    201065_s_at 186 NR_002206/ NM_001518/ NM_033001/ NM_033000/ NM_032999/ —, —,
    1107 854 1146 1198 1222 GTF2I, Hs.520459,
    GTF2I, Hs.520459,
    GTF2I, Hs.520459,
    GTF2I, Hs.520459,
    211172_x_at 187 NM_004842/ NM_138633/ NM_016377/ AKAP7, Hs.486483,
    896 1154 1194 AKAP7, Hs.486483,
    AKAP7, Hs.486483,
    218707_at 188 NM_018337/ ZNF444 Hs.24545
    1007
    206770_s_at 189 NM_012243/ SLC35A3 Hs.448979
    945
    200898_s_at 190 NM_012215/ MGEA5 Hs.500842
    943
    215519_x_at 191 NM_015705/ RUTBC3 Hs.474914
    981
    212406_s_at 192 NM_018257/ C20ORF36 Hs.473317
    1005
    210826_x_at 193 NM_133341/ NM_133339/ NM_133340/ NM_133344/ NM_133342/ NM_133343/ NM_133338/ NM_002873/ RAD17, Hs.16184,
    1066 1151 1200 1224 1237 1239 1243 1246 RAD17, Hs.16184,
    RAD17, Hs.16184,
    RAD17, Hs.16184,
    RAD17, Hs.16184,
    RAD17, Hs.16184,
    RAD17, Hs.16184,
    RAD17, Hs.16184,
    218444_at 194 NM_024105/ ALG12 Hs.526711
    1043
    221822_at 195 NM_138414/ LOC112869 Hs.460487
    1070
    220755_s_at 196 NM_016947/ C6ORF48 Hs.109798
    992
    218970_s_at 197 NM_015960/ CUTC Hs.16606
    983
    218253_s_at 198 NM_006893/ LGTN Hs.497581
    933
    221293_s_at 199 NM_022047/ DEF6 Hs.15476
    1032
    217742_s_at 200 NM_100486/ NM_016628/ NM_100264/ WAC, Hs.435610,
    1063 1140 1199 WAC, Hs.435610,
    WAC, Hs.435610,
    207127_s_at 201 NM_021644/ NM_012207/ HNRPH3, Hs.499891,
    1030 1136 HNRPH3, Hs.499891,
    217850_at 202 NM_206826/ NM_014366/ NM_206825/ GNL3, Hs.313544,
    1104 1137 1213 GNL3, Hs.313544,
    GNL3, Hs.313544,
    212505_s_at 203 NM_015329/ KIAA0892 Hs.112751
    974
    211971_s_at 204 NM_133259/ LRPPRC Hs.368084
    1065
    216387_x_at 205 NM_013269/ NM_001004420/ NM_001004419/ NM_002520/ OCIL, Hs.268326,
    952 1117 1185 1218 OCIL, Hs.268326,
    OCIL, Hs.268326,
    NPM1, Hs.519452,
    218152_at 206 NM_018200/ HMG20A Hs.69594
    1002
    201788_at 207 NM_203499/ NM_007372/ DDX42, Hs.8765,
    1102 1135 DDX42, Hs.8765,
    201922_at 208 NM_014886/ TINP1 Hs.482526
    966
    212982_at 209 NM_015336/ ZDHHC17 Hs.4014
    975
    214173_x_at 210 NM_134447/ NM_003796/ C19ORF2, Hs.466391,
    1068 1128 C19ORF2, Hs.466391,
    211937_at 211 NM_001417/ EIF4B Hs.512629
    852
    216843_x_at 212 NM_000535/ NM_174930/ NM_002679/ NM_005395/ NM_001003686/ NM_001003687/ NM_032958/ NM_032959/ PMS2, Hs.487470,
    828 1086 867 908 1115 1183 1242 1247 PMS2, Hs.397073,
    L5, Hs.488624,
    POM121, Hs.549057,
    PMS2L3, Hs.549057,
    PMS2L3, Hs.549057,
    PMS2L3, Hs.433879,
    POLR2J2, Hs.433879,
    POLR2J2,
    212854_x_at 213 NM_032264/ NM_173638/ NM_183372/ AE2, Hs.325422,
    1056 1166 1209 MGC8902, Hs.512037,
    LOC200030, Hs.515837,
    212886_at 214 NM_015621/ DKFZP434C171 Hs.132994
    978
    220607_x_at 215 NM_016397/ NM_198976/ TH1L, Hs.517148,
    990 1172 TH1L, Hs.517148,
    212132_at 216 NM_015578/ C19ORF13 Hs.407368
    977
    214042_s_at 217 NM_000983/ RPL22 Hs.515329
    839
    212660_at 218 NM_015288/ PHF15 Hs.483419
    972
    208944_at 219 —/ — —
    210011_s_at 220 NM_013986/ NM_005243/ EWSR1, Hs.374477,
    956 1130 EWSR1, Hs.374477,
    211938_at 221 NM_001417/ EIF4B Hs.512629
    852
    220408_x_at 222 NM_017569/ FAM48A Hs.435815
    994
    212114_at 223 —/ — —
    212455_at 224 NM_133370/ YT521 Hs.175955
    1067
    212299_at 225 —/ — —
    200005_at 226 NM_003753/ EIF3S7 Hs.55682
    879
    200081_s_at 227 NM_001010/ RPS6 Hs.408073
    846
    213687_s_at 228 NM_000996/ RPL35A Hs.529631
    840
    204102_s_at 229 NM_001961/ EEF2 Hs.515070
    859
    211666_x_at 230 NM_000967/ RPL3 Hs.119598
    836
    209134_s_at 231 NM_001010/ RPS6 Hs.408073
    846
    221700_s_at 232 NM_003333/ UBA52 Hs.5308
    876
    200034_s_at 233 NM_000970/ RPL6 Hs.528668
    837
    201254_x_at 234 NM_001010/ RPS6 Hs.408073
    846
    212734_x_at 235 NM_000977/ NM_033251/ RPL13, Hs.410817,
    838 1147 RPL13, Hs.410817,
    217718_s_at 236 NM_139323/ NM_003404/ YWHAB, Hs.279920,
    1073 1126 YWHAB, Hs.279920,
    208678_at 237 NM_001696/ ATP6V1E1 Hs.517338
    855
    200633_at 238 NM_018955/ UBB Hs.356190
    1014
    201318_s_at 239 NM_033546/ NM_006471/ MRLC2, Hs.464472,
    1058 1134 MRCL3, Hs.190086,
    202090_s_at 240 NM_006830/ UQCR Hs.8372
    931
    221474_at 241 NM_033546/ MRLC2 Hs.464472
    1058
    214629_x_at 242 NM_153828/ NM_207520/ NM_207521/ NM_020532/ NM_007008/ RTN4, Hs.429581,
    1080 1176 1214 1221 1236 RTN4, Hs.429581,
    RTN4, Hs.429581,
    RTN4, Hs.429581,
    RTN4, Hs.429581,
    200067_x_at 243 NM_152827/ NM_003795/ NM_152828/ SNX3, Hs.12102,
    1078 1127 1203 SNX3, Hs.12102,
    SNX3, Hs.12102,
    201899_s_at 244 NM_181762/ NM_003336/ NM_181777/ UBE2A, Hs.379466,
    1089 1125 1207 UBE2A, Hs.379466,
    UBE2A, Hs.379466,
    210968_s_at 245 NM_153828/ NM_207520/ NM_207521/ NM_020532/ NM_007008/ RTN4, Hs.429581,
    1080 1176 1214 1221 1236 RTN4, Hs.429581,
    RTN4, Hs.429581,
    RTN4, Hs.429581,
    RTN4, Hs.429581,
    200609_s_at 246 NM_005112/ NM_017491/ WDR1, Hs.128548,
    904 1142 WDR1, Hs.128548,
    208805_at 247 NM_002791/ PSMA6 Hs.446260
    868
    218571_s_at 248 NM_014169/ C14ORF123 Hs.279761
    957
    217730_at 249 NM_022152/ PP1201 Hs.98475
    1035
    218520_at 250 NM_013254/ TBK1 Hs.505874
    951
    208908_s_at 251 NM_173061/ NM_173062/ NM_173060/ NM_001750/ CAST, Hs.440961,
    1085 1165 1084 1217 CAST, Hs.440961,
    CAST, Hs.440961,
    CAST, Hs.440961,
    207467_x_at 252 NM_173061/ NM_173062/ NM_173060/ NM_001750/ CAST, Hs.440961,
    1085 1165 1084 1217 CAST, Hs.440961,
    CAST, Hs.440961,
    CAST, Hs.440961,
    201975_at 253 NM_198240/ NM_002956/ RSN, Hs.524809,
    1093 1123 RSN, Hs.524809,
    200814_at 254 NM_006263/ NM_176783/ PSME1, Hs.75348,
    920 1167 PSME1, Hs.75348,
    203090_at 255 NM_006923/ SDF2 Hs.514036
    934
    201470_at 256 NM_004832/ GSTO1 Hs.190028
    895
    212586_at 257 NM_173060/ CAST Hs.440961
    1084
    200703_at 258 NM_003746/ DNCL1 Hs.5120
    878
    217995_at 259 NM_021199/ SQRDL Hs.511251
    1029
    201346_at 260 NM_024551/ ADIPOR2 Hs.371642
    1048
    201609_x_at 261 NM_012405/ NM_170705/ ICMT, Hs.515688,
    949 1162 ICMT, Hs.515688,
    202000_at 262 NM_002490/ NDUFA6 Hs.274416
    864
    202001_s_at 263 NM_002490/ NDUFA6 Hs.274416
    864
    203880_at 264 NM_005694/ COX17 Hs.534383
    914
    218525_s_at 265 NM_017902/ HIF1AN Hs.500788
    995
    219798_s_at 266 NM_019606/ FLJ20257 Hs.178011
    1017
    208398_s_at 267 NM_004865/ TBPL1 Hs.486507
    897
    218358_at 268 NM_024324/ MGC11256 Hs.211282
    1045
    203097_s_at 269 —/ — —
    221598_s_at 270 NM_004269/ CRS98 Hs.374262
    887
    209546_s_at 271 AF323540/ GenBank Hs.114309
    811
    50400_at 272 AI743990/ GenBank Hs.24859
    812
    217752_s_at 273 NM_018235/ GenBank Hs.273230
    1003
    201931_at 274 NM_000126/ GenBank Hs.169919
    825
    218567_x_at 275 NM_005700/ GenBank Hs.22880
    915
    202056_at 276 AW051311/ GenBank Hs.169149
    816
    218907_s_at 277 NM_023942/ GenBank Hs.284135
    1041
    213726_x_at 278 AA515698/ GenBank Hs.251653
    806
    204448_s_at 279 AF031463/ GenBank Hs.9302
    808
    1405_i_at 280 M21121/ GenBank —
    823
    212864_at 281 Y16521/ GenBank Hs.24812
    1108
    209444_at 282 BC001851/ GenBank Hs.7940
    819
    208898_at 283 AF077614/ GenBank Hs.272630
    809
    202377_at 284 AW026535/ GenBank Hs.23581
    815
    209547_s_at 285 BC001043/ GenBank Hs.15075
    818
    202922_at 286 BF676980/ GenBank Hs.151393
    821
    201403_s_at 287 NM_004528/ GenBank Hs.111811
    892
    213154_s_at 288 AI934125/ GenBank Hs.17411
    814
    215676_at 289 N91109/ GenBank Hs.32935
    824
    218927_s_at 290 NM_018641/ GenBank Hs.25204
    1012
    213648_at 291 AW614427/ GenBank Hs.182877
    817
    209593_s_at 292 AF317129/ GenBank Hs.252682
    810
    203731_s_at 293 NM_014569/ GenBank Hs.110839
    960
    201234_at 294 NM_004517/ GenBank Hs.6196
    891
    214817_at 295 BE783668/ GenBank Hs.175780
    820
    201761_at 296 NM_006636/ GenBank Hs.154672
    929
    205467_at 297 NM_001230/ GenBank Hs.5353
    850
    222318_at 298 AI744673/ GenBank Hs.186970
    813
    209933_s_at 299 AF020314/ GenBank Hs.9688
    807
    200734_s_at 300 BG341906/ GenBank Hs.119177
    822
    219899_x_at 301 NM_014434/ NDOR1 Hs.512564
    959
    221563_at 302 NM_144729/ NM_144728/ NM_007207/ DUSP10, Hs.497822,
    1074 1155 1192 DUSP10, Hs.497822,
    DUSP10, Hs.497822,
    65517_at 303 NM_005498/ AP1M2 Hs.18894
    910
    205126_at 304 NM_006296/ VRK2 Hs.468623
    921
    200696_s_at 305 NM_198252/ NM_000177/ GSN, Hs.522373,
    1094 1110 GSN, Hs.522373,
    208790_s_at 306 NM_012232/ PTRF Hs.437191
    944
    205115_s_at 307 NM_016196/ RBM19 Hs.7482
    987
    213982_s_at 308 NM_014857/ RABGAP1L Hs.495391
    965
    206992_s_at 309 NM_015684/ NM_001003805/ NM_001003803/ ATP5S, Hs.438489,
    980 1116 1184 ATP5S, Hs.438489,
    ATP5S, Hs.438489,
    201060_x_at 310 NM_198194/ NM_004099/ NM_017723/ STOM, Hs.253903,
    1092 1129 1195 STOM, Hs.253903,
    FLJ20245, Hs.495541,
    209278_s_at 311 NM_006528/ TFPI2 Hs.438231
    924
    210542_s_at 312 —/ — —
    202006_at 313 NM_002835/ PTPN12 Hs.61812
    869
    210557_x_at 314 NM_172211/ NM_000757/ NM_172210/ NM_172212/ CSF1, Hs.173894,
    1082 1112 1205 1226 CSF1, Hs.173894,
    CSF1, Hs.173894,
    CSF1, Hs.173894,
    210796_x_at 315 NM_198846/ NM_198845/ NM_001245/ SIGLEC6, Hs.397255,
    1097 1171 1188 SIGLEC6, Hs.397255,
    SIGLEC6, Hs.397255,
    220825_s_at 316 NM_018240/ KIRREL Hs.272234
    1004
    202378_s_at 317 NM_017526/ LEPR Hs.23581
    993
    210241_s_at 318 NM_007233/ TP53AP1 Hs.274329
    936
    213069_at 319 —/ — —
    216034_at 320 NM_080740/ SUHW1 Hs.178665
    1061
    210793_s_at 321 NM_139131/ NM_005387/ NUP98, Hs.524750,
    1072 1131 NUP98, Hs.524750,
    207375_s_at 322 NM_002189/ NM_172200/ IL15RA, Hs.524117,
    860 1163 IL15RA, Hs.524117,
    206247_at 323 NM_005931/ MICB Hs.211580
    917
    217078_s_at 324 NM_007261/ CMRF- Hs.9688
    937 35H
    219257_s_at 325 NM_021972/ NM_182965/ SPHK1, Hs.68061,
    1031 1170 SPHK1, Hs.68061,
    204781_s_at 326 NM_152876/ NM_152877/ NM_152874/ NM_152875/ NM_152873/ NM_152871/ NM_152872/ NM_000043/ FAS, Hs.244139,
    1079 1161 1204 1225 1238 1240 1244 1245 FAS, Hs.244139,
    FAS, Hs.244139,
    FAS, Hs.244139,
    FAS, Hs.244139,
    FAS, Hs.244139,
    FAS, Hs.244139,
    FAS, Hs.244139,
    221536_s_at 327 NM_018385/ FLJ11301 Hs.518505
    1009
    209468_at 328 NM_002335/ LRP5 Hs.6347
    861
    201061_s_at 329 NM_198194/ NM_004099 STOM, Hs.253903,
    1092 1129 STOM, Hs.253903,
    203499_at 330 NM_004431/ EPHA2 Hs.171596
    889
    213324_at 331 NM_198291/ NM_005417/ SRC, Hs.195659,
    1095 1132 SRC, Hs.195659,
    221535_at 332 NM_018385/ FLJ11301 Hs.518505
    1009
    219938_s_at 333 NM_024430/ PSTPIP2 Hs.368623
    1046
    213787_s_at 334 NM_006579/ EBP Hs.522636
    926
    219592_at 335 NM_024596/ MCPH1 Hs.550532
    1049
    200637_s_at 336 NM_130440/ NM_002840/ PTPRF, Hs.272062,
    1064 1122 PTPRF, Hs.272062,
    202193_at 337 NM_005569/ NM_016733/ LIMK2, Hs.474596,
    913 1141 LIMK2, Hs.474596,
    214859_at 338 NM_015082/ FSTL4 Hs.483390
    969
    209213_at 339 NM_001757/ CBR1 Hs.88778
    857
    218945_at 340 NM_024109/ MGC2654 Hs.306380
    1044
    220471_s_at 341 NM_025107/ MYCT1 Hs.18160
    1052
    59625_at 342 NM_003946/ NOL3 Hs.513667
    883
    207233_s_at 343 NM_198158/ NM_000248/ NM_198178/ NM_198177/ NM_006722/ NM_198159/ MITF, Hs.166017,
    1091 1111 1210 1228 1235 1241 MITF, Hs.166017,
    MITF, Hs.166017,
    MITF, Hs.166017,
    MITF, Hs.166017,
    MITF, Hs.166017,
    214070_s_at 344 —/ — —
    219785_s_at 345 —/ — —
    220684_at 346 NM_013351/ TBX21 Hs.272409
    954
    202245_at 347 NM_002340/ LSS Hs.517366
    862
    207298_at 348 NM_006632/ SLC17A3 Hs.327179
    927
    220201_at 349 NM_018835/ MNAB Hs.533499
    1013
    203208_s_at 350 NM_014637/ CHPPR Hs.521608
    961
    207033_at 351 NM_005142/ GIF Hs.110014
    906
    204929_s_at 352 NM_006634/ VAMP5 Hs.172684
    928
    209735_at 353 NM_004827/ ABCG2 Hs.480218
    894
    209234_at 354 NM_015074/ KIF1B Hs.97858
    968
    210102_at 355 NM_198315/ LOH11CR2A Hs.152944
    1096
    204114_at 356 NM_007361/ NID2 Hs.369840
    941
    203344_s_at 357 NM_203292/ NM_203291/ NM_002894/ RBBP8, Hs.546282,
    1100 1174 1190 RBBP8, Hs.546282,
    RBBP8, Hs.546282,
    216891_at 358 —/ — —
    221680_s_at 359 NM_016135/ ETV7 Hs.272398
    986
    202087_s_at 360 NM_001912/ NM_145918/ CTSL, Hs.418123,
    858 1159 CTSL, Hs.418123,
    213324_at 331 NM_198291/ NM_005417/ SRC, Hs.195659,
    1095 1132 SRC, Hs.195659,
    221535_at 332 NM_018385/ FLJ11301 Hs.518505
    1009
    219938_s_at 333 NM_024430/ PSTPIP2 Hs.368623
    1046
    213787_s_at 334 NM_006579/ EBP Hs.522636
    926
    219592_at 335 NM_024596/ MCPH1 Hs.550532
    1049
    200637_s_at 336 NM_130440/ NM_002840/ PTPRF, Hs.272062,
    1064 1122 PTPRF, Hs.272062,
    202193_at 337 NM_005569/ NM_016733/ LIMK 2, Hs.474596,
    913 1141 LIMK 2, Hs.474596,
    214859_at 338 NM_015082/ FSTL4 Hs.483390
    969
    209213_at 339 NM_001757/ CBR1 Hs.88778
    857
    218945_at 340 NM_024109/ MGC2654 Hs.306380
    1044
    220471_s_at 341 NM_025107/ MYCT1 Hs.18160
    1052
    59625_at 342 NM_003946/ NOL3 Hs.513667
    883
    207233_s_at 343 NM_198158/ NM_000248/ NM_198178/ NM_198177/ NM_006722/ NM_198159/ MITF, Hs.166017,
    1091 1111 1210 1228 1235 1241 MITF, Hs.166017,
    MITF, Hs.166017,
    MITF, Hs.166017,
    MITF, Hs.166017,
    MITF, Hs.166017,
    214070_s_at 344 —/ — —
    219785_s_at 345 —/ — —
    220684_at 346 NM_013351/ TBX21 Hs.272409
    954
    202245_at 347 NM_002340/ LSS Hs.517366
    862
    207298_at 348 NM_006632/ SLC17A3 Hs.327179
    927
    220201_at 349 NM_018835/ MNAB Hs.533499
    1013
    203208_s_at 350 NM_014637/ CHPPR Hs.521608
    961
    207033_at 351 NM_005142/ GIF Hs.110014
    906
    204929_s_at 352 NM_006634/ VAMP5 Hs.172684
    928
    209735_at 353 NM_004827/ ABCG2 Hs.480218
    894
    209234_at 354 NM_015074/ KIF1B Hs.97858
    968
    210102_at 355 NM_198315/ LOH11CR2A Hs.152944
    1096
    204114_at 356 NM_007361/ NID2 Hs.369840
    941
    203344_s_at 357 NM_203292/ NM_203291/ NM_002894 RBBP8, Hs.546282,
    1100 1174 1190 RBBP8, Hs.546282,
    RBBP8, Hs.546282,
    216891_at 358 —/ — —
    221680_s_at 359 NM_016135/ ETV7 Hs.272398
    986
    202087_s_at 360 NM_001912/ NM_145918/ CTSL, Hs.418123,
    858 1159 CTSL, Hs.418123,
    210073_at 391 NM_003034/ SIAT8A Hs.408614
    871
    209524_at 392 NM_016073/ HDGFRP3 Hs.513954
    985
    219759_at 393 NM_022350/ LRAP Hs.482910
    1036
    202112_at 394 NM_000552/ VWF Hs.440848
    830
    219410_at 395 NM_018004/ FLJ10134 Hs.126598
    1000
    203819_s_at 396 NM_006547/ IMP-3 Hs.432616
    925
    212730_at 397 NM_015286/ NM_145728/ DMN, Hs.207106,
    971 1158 DMN, Hs.207106,
    220122_at 398 —/ — —
    208782_at 399 NM_007085/ FSTL1 Hs.269512
    935
    202468_s_at 400 NM_003798/ CTNNAL1 Hs.58488
    882
    207018_s_at 401 NM_004163/ RAB27B Hs.25318
    886
    210354_at 402 NM_000619/ IFNG Hs.856
    832
    201110_s_at 403 NM_003246/ THBS1 Hs.164226
    874
    207808_s_at 404 NM_000313/ PROS1 Hs.64016
    827
    205612_at 405 NM_007351/ MMRN1 Hs.268107
    940
    214073_at 406 —/ — —
  • The genes encoding RNA polymerase I transcription factor (RRN3) and leucine-rich PPR-motif containing protein (LRPRC) were found as most significantly down-regulated genes in BMS signature (Table 1, hereinabove). RRN33 (transcription initiation factor TIF-IA), a 72-kDa protein, is essential for ribosomal DNA (rDNA) transcription and acts as a bridge between RNA pol I and the committed rDNA promoter (Hirschler-Laszkiewicz I, et al., 2003; Miller G, et al., 2001; 20:1373-1382). The suppression of polymerase I regulation mechanism is confirmed by down-regulation of polymerase (RNA) I polypeptide D (POLR1D).
  • LRPPRC is a candidate gene for the French-Canadian type of Leigh syndrome, a form of cytochrome c oxidase deficiency, and plays a role in translation or stability of mitochondrially encoded cytochrome c oxidase (COX) subunits (Mootha V K, et al., 2003). The LRPPC together with POLR1D molecules comprise a complex with NFkBIB protein (Bouwmeester T, et al., 2004) that inhibits proinflammatory NFkB pathway.
  • Without being bound by any theory, the suppression of molecules involved in polymerase I related mechanism, COXI and NFkB regulation could account for the differences between BMS and typical RRMS patients. In addition, the polymerase I related mechanism can be potential drug targets for the treatment of RRMS aimed to switch RRMS to the BMS variant. One of commercially available drug that has proven effects on polymerase I mechanism is a diterpenoid triepoxide Triptolide (TPT), isolated from the Chinese herb Tripterygium wilfordii (Leuenroth S J and Crews C M. Triptolide-induced transcriptional arrest is associated with changes in nuclear substructure. Cancer Res. 2008; 68:5257-5266). Triptolide has various anti-inflammatory effects (Liu Y, et al. Triptolide, a component of Chinese herbal medicine, modulates the functional phenotype of dendritic cells. Transplantation. 2007; 84:1517-1526), it modulates T-cell inflammatory responses and ameliorates Experimental Autoimmune Encephalomyelitis (Wang Y, et al. Triptolide modulates T-cell inflammatory responses and ameliorates experimental autoimmune encephalomyelitis. J Neurosci Res. 2008; 86:2441-2449).
  • More specifically TPT demonstrated to suppress of T lymphocyte function including T cell apoptosis induction, inhibition of lymphocyte prolipheration and IFNγ production (Chen B J. 2001. Triptolide, a novel immunosuppressive and anti-inflammatory agent purified from a Chinese herb Tripterygium wilfordii Hook f. Leuk Lymphoma 42:253-265; Qiu D, Kao P N. 2003. Immunosuppressive and anti-inflammatory mechanisms of triptolide, the principal active diterpenoid from the Chinese medicinal herb Tripterygium wilfordii Hook f. Drugs R D 4:1-18; Yang Y, Liu Z, Tolosa E, Yang J, Li L. 1998. Triptolide induces apoptotic death of T lymphocyte. Immunopharmacology 40:139-149; Chan M A, Kohlmeier J E, Branden M, Jung M, Benedict S H. 1999. Triptolide is more effective in preventing T cell proliferation and interferon-gamma production than is FK506. Phytother Res 13:464-467). The TPT decreased IL2 and IL2 receptor expression by inhibiting activation of the purine box regulator of the NFkB of activated T cells (Qiu 1999). Additionally, it was demonstrated that TPT can inhibit the maturation, antigen processing, and presentation of dendritic cells and can suppress tumor necrosis factor (TNF)-a and IL-6 production by activated macrophages (Zhu K J, Shen Q Y, Cheng H, Mao X H, Lao L M, Hao G L. 2005. Triptolide affects the differentiation, maturation and function of human dendritic cells. Int Immunopharmacol 5:1415-1426; Wu Y, Cui J, Bao X, Chan S, Young D O, Liu D, Shen P. 2006. Triptolide attenuates oxidative stress, NF-kappaB activation and multiple cytokine gene expression in murine peritoneal macrophage. Int J Mol Med 17:141-150).
  • Table 3, hereinbelow, discloses the genes involved in the RNA polymerase I pathway, which are likely to be involved in typical RRMS or BMS pathology.
  • TABLE 3
    Genes involved in the RNA polymerase I pathway
    SEQ Representative
    Affymetrix ID Public ID/SEQ ID
    ProbSet NO: NO: Gene Symbol Gene Title
    216902_s_at 62 AF001549/1284; RRN3 RRN3 RNA polymerase I
    NM_018427/1285 transcription factor homolog
    211971_s_at 204 AI653608/1286; LRPPRC leucine-rich PPR-motif
    NM_133259/1287 containing
    220113_x_at 1248 NM_019014/1288 POLR1B polymerase (RNA) I polypeptide
    B, 128 kDa
    207515_s_at 1249 NM_004875/1289 POLR1C polymerase (RNA) I polypeptide
    C, 30 kDa
    209317_at 1250 AF008442/1290 POLR1C polymerase (RNA) I polypeptide
    C, 30 kDa
    218258_at 173 NM_015972/1291 POLR1D polymerase (RNA) I polypeptide
    D, 16 kDa
    202725_at 1251 NM_000937/1292 POLR2A polymerase (RNA) II (DNA
    directed) polypeptide A, 220 kDa
    217420_s_at 1252 M21610/1293 POLR2A polymerase (RNA) II (DNA
    directed) polypeptide A, 220 kDa
    201803_at 1253 NM_000938/1294 POLR2B polymerase (RNA) II (DNA
    directed) polypeptide B, 140 kDa
    208996_s_at 1254 BC000409/1295 POLR2C polymerase (RNA) II (DNA
    directed) polypeptide C, 33 kDa
    214263_x_at 1255 AI192781/1296 POLR2C polymerase (RNA) II (DNA
    directed) polypeptide C, 33 kDa
    216282_x_at 1256 AJ224143/1297 POLR2C polymerase (RNA) II (DNA
    directed) polypeptide C, 33 kDa
    203664_s_at 1257 NM_004805/1298 POLR2D polymerase (RNA) II (DNA
    directed) polypeptide D
    214144_at 1258 BF432147/1299 POLR2D polymerase (RNA) II (DNA
    directed) polypeptide D
    213887_s_at 1259 AI554759/1300 POLR2E polymerase (RNA) II (DNA
    directed) polypeptide E, 25 kDa
    217854_s_at 1260 BC004441/1301 POLR2E polymerase (RNA) II (DNA
    directed) polypeptide E, 25 kDa
    209511_at 1261 BC003582/1302 POLR2F polymerase (RNA) II (DNA
    directed) polypeptide F
    202306_at 1262 NM_002696/1303 POLR2G polymerase (RNA) II (DNA
    directed) polypeptide G
    209302_at 1263 U37689/1304 POLR2H polymerase (RNA) II (DNA
    directed) polypeptide H
    212955_s_at 1264 AL037557/1305 POLR2I polymerase (RNA) II (DNA
    directed) polypeptide I, 14.5 kDa
    212782_x_at 1265 BG335629/1306 POLR2J polymerase (RNA) II (DNA
    directed) polypeptide J, 13.3 kDa
    216242_x_at 1266 AW402635/1307 POLR2J2 DNA directed RNA polymerase
    II polypeptide J-related gene
    214740_at 1267 BE676209/1308 POLR2J2 /// DNA directed RNA polymerase
    MGC13098 II polypeptide J-related gene ///
    hypothetical prote
    202634_at 1268 AL558030/1309 POLR2K polymerase (RNA) II (DNA
    directed) polypeptide K, 7.0 kDa
    202635_s_at 1269 NM_005034/1310 POLR2K polymerase (RNA) II (DNA
    directed) polypeptide K, 7.0 kDa
    202586_at 1270 AA772747/1311 POLR2L polymerase (RNA) II (DNA
    directed) polypeptide L, 7.6 kDa
    211730_s_at 1271 BC005903/1312 POLR2L polymerase (RNA) II (DNA
    directed) polypeptide L,
    7.6 kDa /// polymerase (RNA) II
    219459_at 1272 NM_018082/1313 POLR3B polymerase (RNA) III (DNA
    directed) polypeptide B
    209382_at 1273 U93867/1314 POLR3C polymerase (RNA) III (DNA
    directed) polypeptide C (62 kD)
    210573_s_at 1274 BC004424/1315 POLR3C polymerase (RNA) III (DNA
    directed) polypeptide C (62 kD)
    208361_s_at 1275 NM_001722/1316 POLR3D polymerase (RNA) III (DNA
    directed) polypeptide D, 44 kDa
    218016_s_at 1276 NM_018119/1317 POLR3E polymerase (RNA) III (DNA
    directed) polypeptide E (80 kD)
    205218_at 1277 NM_006466/1318 POLR3F polymerase (RNA) III (DNA
    directed) polypeptide F, 39 kDa
    206653_at 1278 BF062139/1319 POLR3G Polymerase (RNA) III (DNA
    directed) polypeptide G (32 kD)
    206654_s_at 1279 NM_006467/1320 POLR3G polymerase (RNA) III (DNA
    directed) polypeptide G (32 kD)
    218866_s_at 1280 AF060223/1321 POLR3K polymerase (RNA) III (DNA
    directed) polypeptide K, 12.3 kDa
    203782_s_at 1281 NM_005035/1322 POLRMT polymerase (RNA)
    mitochondrial (DNA directed)
    203783_x_at 1282 BF057617/1323 POLRMT polymerase (RNA)
    mitochondrial (DNA directed)
    202466_at 1283 NM_006999/1324 POLS polymerase (DNA directed)
    sigma
  • The measurement of RRN3, LRPPRC, POLR1D and other polymerase I mechanism related biomarkers could be used for diagnosis and prediction of BMS. Additionally those markers could be useful for typical RRMS patients to monitor the efficacy of various immunomodulatory drugs for assessment of patients with good response to treatment.
  • Measurement of BMS biomarkers can be performed on the mRNA level by the quantitative reverse-transcriptase polymerase chain reaction (QRT-PCR) method and on protein level by LUMINEX technology. Possible modification of the invention is developing biomarkers on protein level (e.g., using ELISA, Western Blot analysis and the like) in PBMC and serum.
  • Multiple sclerosis (MS) is a heterogeneous disease. To better diagnose and treat MS patients the various types of disease have to be distinguished. The teachings of the invention enable, for the first time, to distinguish between BMS and typical RRMS patients using molecular tools, which when combined with accurate clinical information enables to dissect the biological complexity of MS.
  • In the current study the use of gene expression profiling enabled to diagnose benign MS using a phenotypic approach to differentiate subtypes of the disease. The identified gene expression phenotypes also enable to better understand the biology of benign MS and to develop therapeutics strategies to treat MS.
  • The gene expression signature generated herein of benign MS enables refining MS to diagnose low risk patients versus high risk patients and accordingly suggest appropriate treatment.
  • The benign MS patients that represent low risk would not be treated while the high risk relapsing-remitting MS patients will be treated. In addition, the teachings of the invention enable to monitor response to treatment and better use of current approved medications.
  • The teachings of the invention can be used to develop a kit or device for diagnosis and prediction of typical RRMS clinical outcome, improving medical decision support systems and individualizing patient care. In addition, the teachings of the invention can be used to develop new drugs that will imitate BMS gene expression signature and will result in silencing of the active RRMS.
    • Example 2 Study Subject and Methods
  • Subjects—31 patients (age 44.5±1.5; female to male ratio 24:7) with BMS were characterized by mean EDSS 1.95±0.15, disease duration 17.0±1.3 years, annual EDSS rate 0.13±0.01, annual relapse rate 0.23±0.04. 36 patients (age 40.3±1.8; female to male ratio 8:3) with RRMS were characterized by mean EDSS 3.54±0.23, disease duration 10.9±1.4 years, annual EDSS rate 0.45±0.06, annual relapse rate 0.64±0.09.
  • RNA isolation and microarray expression profiling—Peripheral blood mononuclear cells (PBMC) were separated on ficoll-hypaque gradient. Total RNA was isolated using the TRIzol Reagent (Invitrogen, Carlsbad, Calif.), and cDNA was synthesized, labeled and hybridized to HG-U133A-2 array (Affymetrix, Inc, Santa Clara, Calif.) containing 22,215 gene-transcripts, washed and scanned (Hewlett Packard, GeneArray™ scanner G2500A) according to manufacturer's protocol Affymetrix (Inc, Santa Clara, Calif.).
  • Data Analysis—Data analysis was performed using the Partek Genomics Solution software [World Wide Web (dot) partek (dot) com]. Expression values were computed from raw CEL (cells) files by applying the Robust Multi-Chip Average (RMA) background correction algorithm. The RMA correction included: 1) values background correction; 2) quantile normalization; 3) log 2 transformation; 4) median polish summarization. The gene transcripts were filtered using Affymetrix MASS Present/Absent Detection. Thereafter, 9987 transcript that were detected as Present in 100% microarrays were used for analysis. In order to avoid the noise caused by variable set effects each set was normalized to pre-saved distribution pattern of a well balanced set used as a reference distribution. To reduce batch effect ANOVA multiple model analysis was applied. Source of variation was analyzed; nuisance batches effects such as working batch, patient age, gender and treatment were eliminated. Most informative genes (MIGs) were defined as genes that passed Falls Discovery Rate (FDR) correction with p<0.05 by ANOVA linear contrasts model. Thereafter, predictive algorithm based on two level cross validation method, Super Vector Machine (SVM) and K-Nearest Neighbor algorithms were applied to calculate MIGs classification rates. Only genes which were included in classifiers (from 1 to 10 genes) with more than 70% correct classification rates were analyzed.
  • Experimental Results
  • Identification of classification rates of genes involved in the RNA polymerase I pathway between typical RRMS and BMS disease course—Tables 4A-C presents the corrected classification rates for all combinations of RRN3, LRPPRC and POLR1D genes of the RNA polymerase I pathway for the entire BMS and typical RRMS group (Table 4A), for the BMS group (Table 4B) and for the typical RRMS group (Table 4C). The best predictive performance for each classifier is presented.
  • TABLE 4A
    Classifiers Aver. % Correct St. Err (%)
    RRN3 63.6 11.2
    LRPPRC 73.3 9.5
    POLR1D 72.7 9.5
    RRN3, POLR1D 72.7 9.5
    RRN3, LRPPRC 63.6 10.2
    POLR1D, LRPPRC 81.8 8.2
    RRN3, LRPPRC, POLR1D 77.2 8.9
    Average % correct = Average percent of correct classification between BMS and typical RRMS patients using specific classifier;
    St. Err. = standard error;
  • TABLE 4B
    Classifiers BMS % corr
    RRN3
    67
    LRPPRC 80
    POLRID 60
    RRN3, POLR1D 60
    RRN3, LRPPRC 30
    POLR1D, LRPPRC 80
    RRN3, LRPPRC, POLR1D 70
    BMS % Corr. = Average percent of correct classification for BMS patients using specific classifier;
  • TABLE 4C
    Classifiers Typical RRMS % corr
    RRN3 60
    LRPPRC 67
    POLR1D 80
    RRN3, POLR1D 83
    RRN3, LRPPRC 90
    POLR1D, LRPPRC 83
    RRN3, LRPPRC, POLR1D 83
    RRMS % corr.—Average percent of correct classification for typical RRMS patients using specific classifier.
  • The results presented in Table 4B demonstrate that for classification of BMS, each of the genes of the RNA polymerase I pathway, i.e., RRN3, LRPPRC and POLR1D exhibits a correct classification rate of 67%, 80% and 60%, respectively. The results presented in Table 4C demonstrate that for classification of typical RRMS, each of RRN3, LRPPRC and POLR1D exhibits a correct classification rate of 60%, 67% and 80%, respectively. In addition, an increased rate of correct classification of typical RRMS, which is a more complex and heterogenous condition, can be achieved using a combination of 2 or 3 genes of the RNA polymerase I pathway. For example, a correct classification rate of 83% is obtained using the combination of RRN3 and POLR1D; a correct classification rate of 83% is obtained using the combination of POLR1D and LRPPRC; and a correct classification rate of 90% is obtained using the combination of RRN3 and LRPPRC (Table 4C, above).
  • The classification for the combination of RRN3 and LRPPRC resulted in outstanding classification rate of 90% of typical RRMS (TMS) (Table 4C), while showing a low 30% classification for these 2 genes for BMS (Table 4B), further supporting the differentiations between the two disease patterns.
  • To conclude, correct classification for both groups would be achieved using more than one combination of genes of the RNA polymerase I pathway, for example LRPPRC alone or with POLR1D reached 80% classification rate for BMS and RRN3 and LRPPRC correctly classify 90% of TMS patients.
  • Identification of biomarkers for differentiation of patients with BMS or typical RRMS course of disease—BMS patients differentiated from typical RRMS by 177 MIGs (Table 5). The 17 genes with higher classification performance (Table 6) were identified from MIGs by applying predictive algorithms.
  • TABLE 5
    MIGs discriminating between BMS and typical RRMS patients
    p-value Log Fold
    BMS Change
    Affymetrix Represen- vs (BMS vs Gene
    ProbSet SEQ tative SEQ ID typical typical Sym-
    ID NO ID: Public ID NO: RRMS RRMS) bol Gene description
    216902_s_at 62 AF001549 468 2.12E−08 −2.01 RRN3 RRN3 RNA
    polymerase I
    transcription factor
    homolog (yeast)
    210502_s_at 1410 AF042386 1534 2.30E−08 −1.28 PPIE peptidylprolyl
    isomerase E
    (cyclophilin E)
    211615_s_at 1418 M92439 1512 2.44E−08 −1.20 LRPPRC leucine-rich PPR-motif
    containing /// leucine-
    rich PPR-motif
    containing
    37950_at 1500 X74496 1526 1.05E−06 1.19 PREP prolyl endopeptidase
    218258_at 173 NM_015972 984 1.92E−06 −1.18 POLR1D polymerase (RNA) I
    polypeptide D, 16 kDa
    214439_x_at 1453 AF043899 1535 2.24E−06 −1.62 BIN1 bridging integrator 1
    214450_at 1454 NM_001335 1629 3.82E−06 −1.45 CTSW cathepsin W
    (lymphopain) ///
    cathepsin W
    (lymphopain)
    214470_at 1455 NM_002258 1615 3.83E−06 −1.77 KLRB1 killer cell lectin-like
    receptor subfamily B,
    member 1 /// killer cell
    lectin-li
    205789_at 1373 NM_001766 1627 4.32E−06 1.62 CD1D CD1D antigen, d
    polypeptide /// CD1D
    antigen, d polypeptide
    206584_at 1378 NM_015364 1650 5.84E−06 1.59 LY96 lymphocyte antigen 96
    212252_at 1425 AA181179 1660 6.14E−06 1.62 CAMKK2 calcium/calmodulin-
    dependent protein
    kinase kinase 2, beta
    212748_at 1431 AB037859 1583 7.92E−06 1.18 MKL1 megakaryoblastic
    leukemia
    (translocation) 1
    211654_x_at 1419 M17565 1519 9.99E−06 2.75 HLA- major
    DQB1 histocompatibility
    complex, class II, DQ
    beta 1 /// major
    histocompatibili
    204860_s_at 1370 AI817801 1673 1.21E−05 1.62 BIRC1 baculoviral IAP repeat-
    containing 1
    211971_s_at 204 AI653608 606 1.62E−05 −1.14 LRPPRC leucine-rich PPR-motif
    containing
    202832_at 1347 NM_014635 1601 2.21E−05 −1.33 GCC2 GRIP and coiled-coil
    domain containing 2
    40446_at 1502 AL021366 1537 2.62E−05 −1.39 PHF1 PHD finger protein 1
    210136_at 1404 AW070431 1676 2.71E−05 −1.76 MBP Myelin basic protein
    202441_at 1342 AL568449 1691 3.92E−05 1.37 C10orf69 chromosome 10 open
    reading frame 69
    213241_at 1442 AF035307 1532 4.12E−05 1.55 PLXNC1 Plexin C1
    212978_at 1435 AU146004 1686 4.13E−05 1.56 TA- T-cell activation
    LRRP leucine repeat-rich
    protein
    220005_at 1490 NM_023914 1591 4.55E−05 2.43 P2RY13 purinergic receptor
    P2Y, G-protein
    coupled, 13 ///
    purinergic receptor
    P2Y, G-pr
    218304_s_at 1473 NM_022776 1645 4.89E−05 1.58 OSBPL11 oxysterol binding
    protein-like 11
    218932_at 1480 NM_017953 1652 5.00E−05 −1.27 FLJ20729 hypothetical protein
    FLJ20729
    213106_at 1440 AI769688 1670 5.57E−05 −1.51 ATP8A1 ATPase,
    aminophospholipid
    transporter (APLT),
    Class I, type 8A,
    member 1
    219892_at 1489 NM_023003 1648 5.63E−05 1.86 TM6SF1 transmembrane 6
    superfamily member 1
    219666_at 1486 NM_022349 1585 6.07E−05 1.81 MS4A6A membrane-spanning 4-
    domains, subfamily A,
    member 6A
    206120_at 1376 NM_001772 1631 6.26E−05 1.58 CD33 CD33 antigen (gp67)
    209970_x_at 1403 M87507 1523 6.51E−05 1.33 CASP1 caspase 1, apoptosis-
    related cysteine
    protease (interleukin 1,
    beta, convertase)
    200980_s_at 1330 NM_000284 1654 8.59E−05 −1.27 PDHA1 pyruvate
    dehydrogenase
    (lipoamide) alpha 1
    200610_s_at 1326 NM_005381 1613 8.97E−05 −1.17 NCL nucleolin
    213418_at 1445 NM_002155 1609 8.99E−05 2.73 HSPA6 heat shock 70 kDa
    protein 6 (HSP70B′)
    212421_at 1429 AB023147 1545 9.22E−05 1.66 C22orf9 chromosome 22 open
    reading frame 9
    210201_x_at 1407 AF001383 1531 9.59E−05 −1.59 BIN1 bridging integrator 1
    207000_s_at 1381 NM_005605 1600 9.72E−05 −1.32 PPP3CC protein phosphatase 3
    (formerly 2B), catalytic
    subunit, gamma
    isoform (calcineur
    203139_at 1352 NM_004938 1623 0.000102879 1.78 DAPK1 death-associated
    protein kinase 1
    211368_s_at 1416 U13700 1527 0.000107311 1.36 CASP1 caspase 1, apoptosis-
    related cysteine
    protease (interleukin 1,
    beta, convertase)
    212820_at 1433 AB020663 1582 0.000108529 1.70 RC3 rabconnectin-3
    216945_x_at 15 U79240 421 0.000111457 −1.86 PASK PAS domain containing
    serine/threonine kinase
    209337_at 1395 AF063020 1540 0.000112781 −1.35 PSIP1 PC4 and SFRS1
    interacting protein 1
    201756_at 1337 NM_002946 1599 0.000114388 −1.41 RPA2 replication protein A2,
    32 kDa
    221565_s_at 1493 BC000039 1602 0.00011473 1.50 FAM26B family with sequence
    similarity 26, member
    B
    117_at 1325 X51757cds #N/A 0.000116998 2.01 HSPA6 heat shock 70 kDa
    protein 6 (HSP70B′)
    43544_at 1503 AA314406 1661 0.000118986 −1.65 THRAP5 thyroid hormone
    receptor associated
    protein 5
    219132_at 1483 NM_021255 1621 0.000121966 1.36 PELI2 pellino homolog 2
    (Drosophila)
    57715_at 1507 W72694 1657 0.000123909 1.35 FAM26B family with sequence
    similarity 26, member
    B
    220066_at 1491 NM_022162 1569 0.000125076 1.53 CARD15 caspase recruitment
    domain family,
    member 15
    212414_s_at 1428 D50918 1528 0.000139145 −1.53 SEPT6 septin 6
    213902_at 1448 AI379338 1666 0.000139994 1.32 ASAH1 N-acylsphingosine
    amidohydrolase (acid
    ceramidase) 1
    212998_x_at 1436 AI583173 1667 0.000143667 2.26 HLA- major
    DQB1 histocompatibility
    complex, class II, DQ
    beta 1 /// major
    histocompatibili
    202931_x_at 1350 NM_004305 1584 0.000148834 −1.55 BIN1 bridging integrator 1
    204112_s_at 1361 NM_006895 1619 0.00014954 1.81 HNMT histamine N-
    methyltransferase
    205467_at 297 NM_001230 850 0.000150498 1.44 CASP10 caspase 10, apoptosis-
    related cysteine
    protease
    209199_s_at 1394 N22468 1656 0.000157534 1.51 MEF2C MADS box
    transcription enhancer
    factor 2, polypeptide C
    (myocyte enhancer
    factor
    211676_s_at 1421 AF056979 1578 0.000157969 1.40 IFNGR1 interferon gamma
    receptor 1 /// interferon
    gamma receptor 1
    203492_x_at 1355 AA918224 1664 0.000163582 −1.22 KIAA0092 translokin
    211776_s_at 1423 BC006141 1577 0.000164075 3.18 EPB41L3 erythrocyte membrane
    protein band 4.1-like 3
    /// erythrocyte
    membrane protein ba
    56919_at 1505 AI806628 1672 0.000173847 1.32 KIAA1449 WD repeat endosomal
    protein
    202521_at 1344 NM_006565 1616 0.0001784 −1.14 CTCF CCCTC-binding factor
    (zinc finger protein)
    211727_s_at 1422 BC005895 1576 0.000179886 −1.49 COX11 COX11 homolog,
    cytochrome c oxidase
    assembly protein
    (yeast) /// COX11
    homolog,
    204222_s_at 1363 NM_006851 1628 0.00018487 1.54 GLIPR1 GLI pathogenesis-
    related 1 (glioma)
    204839_at 1369 NM_015918 1603 0.000185062 −1.21 POP5 processing of precursor
    5, ribonuclease P/MRP
    subunit (S. cerevisiae)
    39729_at 1501 L19185 1524 0.000185886 −1.62 PRDX2 peroxiredoxin 2
    221078_s_at 1492 NM_018084 1646 0.000188529 1.49 KIAA1212 KIAA1212
    35156_at 1499 AL050297 1548 0.000196739 −1.24 LOC203069 Hypothetical protein
    LOC203069
    219630_at 1485 NM_005764 1606 0.000198793 1.94 MAP17 membrane-associated
    protein 17
    202662_s_at 1345 NM_002223 1625 0.00020557 1.34 ITPR2 inositol 1,4,5-
    triphosphate receptor,
    type 2
    210212_x_at 1409 BC002600 1571 0.000219441 −1.27 MTCP1 mature T-cell
    proliferation 1
    217925_s_at 1471 NM_022758 1610 0.000224904 −1.21 C6orf106 chromosome 6 open
    reading frame 106
    218739_at 1477 NM_016006 1643 0.000228499 1.75 ABHD5 abhydrolase domain
    containing 5
    56197_at 1504 AI783924 1671 0.000231008 −1.24 PLSCR3 phospholipid
    scramblase 3
    208653_s_at 1388 AF263279 1561 0.00023174 1.46 CD164 CD 164 antigen,
    sialomucin
    213292_s_at 1444 AA908770 1663 0.00023191 1.54 SNX13 sorting nexin 13
    201194_at 1331 NM_003009 1608 0.000240228 −1.36 SEPW1 selenoprotein W, 1
    201619_at 1336 NM_006793 1596 0.000250445 1.27 PRDX3 peroxiredoxin 3
    203569_s_at 1356 NM_003611 1640 0.000272476 −1.45 OFD1 oral-facial-digital
    syndrome 1
    213979_s_at 1450 BF984434 1689 0.00027541 −3.22 — —
    203814_s_at 1359 NM_000904 1635 0.000281273 1.67 NQO2 NAD(P)H
    dehydrogenase,
    quinone 2
    215118_s_at 1462 AW519168 1680 0.000302493 −2.77 MGC27165 Hypothetical protein
    MGC27165
    203624_at 1357 NM_005088 1607 0.000330513 −1.38 DXYS155E DNA segment on
    chromosome X and Y
    (unique) 155 expressed
    sequence
    206999_at 1380 NM_001559 1588 0.000344019 2.07 IL12RB2 interleukin 12 receptor,
    beta 2
    205842_s_at 1374 AF001362 1538 0.000351718 1.85 JAK2 Janus kinase 2 (a
    protein tyrosine kinase)
    210166_at 1405 AF051151 1536 0.000353968 1.63 TLR5 toll-like receptor 5
    219714_s_at 1487 NM_018398 1612 0.000364622 2.39 CACNA2D3 calcium channel,
    voltage-dependent,
    alpha 2/delta 3 subunit
    212311_at 1426 AA522514 1662 0.000370292 −1.36 KIAA0746 KIAA0746 protein
    213830_at 1447 AW007751 1675 0.000370999 −1.69 TRD@ T-cell receptor delta
    chain HE/801 /// T cell
    receptor delta locus
    213005_s_at 1438 D79994 1614 0.000376513 2.26 ANKRD15 ankyrin repeat domain
    15
    202944_at 1351 NM_000262 1639 0.000376931 1.68 NAGA N-
    acetylgalactosaminidase,
    alpha-
    206011_at 1375 AI719655 1668 0.000379898 1.49 CASP1 caspase 1, apoptosis-
    related cysteine
    protease (interleukin 1,
    beta, convertase)
    204332_s_at 1365 M64073 1516 0.000382893 −1.22 AGA aspartylglucosaminidase
    215592_at 1463 AU147620 1687 0.000385413 −1.91 — Transcribed locus,
    weakly similar to
    XP_375099.1
    hypothetical protein
    LOC283585
    201798_s_at 378 NM_013451 777 0.000387903 2.24 FER1L3 fer-1-like 3, myoferlin
    (C. elegans)
    212069_s_at 1424 AK026025 1566 0.000388281 −1.17 KIAA0515 KIAA0515
    206255_at 1377 NM_001715 1597 0.000395152 −1.72 BLK B lymphoid tyrosine
    kinase
    221932_s_at 1497 AA133341 1658 0.000396589 −1.42 C14orf87 chromosome 14 open
    reading frame 87
    203246_s_at 1353 NM_006545 1611 0.000402598 −1.33 TUSC4 tumor suppressor
    candidate 4
    213534_s_at 19 D50925 425 0.000408073 −1.73 PASK PAS domain containing
    serine/threonine kinase
    219045_at 1481 NM_019034 1604 0.000412198 −1.33 RHOF ras homolog gene
    family, member F (in
    filopodia)
    202347_s_at 1340 AB022435 1550 0.000414497 −1.16 HIP2 huntingtin interacting
    protein 2
    212636_at 1430 AL031781 1543 0.000420707 1.61 QKI quaking homolog, KH
    domain RNA binding
    (mouse)
    202392_s_at 1341 NM_014338 1598 0.000423758 1.26 PISD phosphatidylserine
    decarboxylase
    216950_s_at 1467 X14355 1509 0.000437652 2.62 FCGR1A Fc fragment of IgG,
    high affinity Ia,
    receptor for (CD64)
    214511_x_at 1457 L03419 1515 0.000447516 2.83 LOC440607 Fc-gamma receptor I
    /// B2 /// Fc fragment of
    FCGR1A IgG, high affinity Ia,
    receptor for (C
    219316_s_at 1484 NM_017791 1641 0.000472922 1.68 C14orf58 chromosome 14 open
    reading frame 58
    220122_at 398 NM_024717 797 0.000473634 3.36 MCTP1 multiple C2-domains
    with two
    transmembrane regions
    1
    64883_at 1508 AI744083 1669 0.000478581 1.51 MOSPD2 motile sperm domain
    containing 2
    203279_at 1354 NM_014674 1644 0.000479669 −1.24 EDEM1 ER degradation
    enhancer, mannosidase
    alpha-like 1
    208891_at 1390 BC003143 1573 0.000483009 1.98 DUSP6 dual specificity
    phosphatase 6
    205715_at 1372 NM_004334 1636 0.000490107 1.60 BST1 bone marrow stromal
    cell antigen 1
    214085_x_at 1451 AI912583 1674 0.000510466 1.67 HRB2 HIV-1 rev binding
    protein 2
    215000_s_at 1461 AL117593 1553 0.000515959 1.24 FEZ2 fasciculation and
    elongation protein zeta
    2 (zygin II)
    202194_at 1339 AL117354 1556 0.000523169 1.36 CGI- CGI-100 protein
    100
    210202_s_at 1408 U87558 1530 0.000532952 −1.46 BIN1 bridging integrator 1
    218181_s_at 1472 NM_017792 1560 0.000547382 1.13 MAP4K4 mitogen-activated
    protein kinase kinase
    kinase kinase 4
    204023_at 1360 NM_002916 1595 0.000553752 −1.48 RFC4 replication factor C
    (activator 1) 4, 37 kDa
    207872_s_at 1384 NM_006863 1551 0.000561178 1.58 LILRA1 leukocyte
    immunoglobulin-like
    receptor, subfamily A
    (with TM domain),
    member 1
    202878_s_at 1349 NM_012072 1622 0.000583921 1.42 C1QR1 complement
    component 1, q
    subcomponent,
    receptor 1
    201285_at 1333 NM_013446 1649 0.000593976 −1.21 MKRN1 makorin, ring finger
    protein, 1 /// makorin,
    ring finger protein, 1
    211612_s_at 1417 U62858 1529 0.000613797 1.80 IL13RA1 interleukin 13 receptor,
    alpha 1 /// interleukin
    13 receptor, alpha 1
    219117_s_at 1482 NM_016594 1647 0.000616534 −1.61 FKBP11 FK506 binding protein
    11, 19 kDa
    215761_at 1464 AK000156 1557 0.000618215 2.26 RC3 rabconnectin-3
    200800_s_at 1328 NM_005345 1642 0.000625103 1.65 HSPA1A heat shock 70 kDa
    /// protein 1A /// heat
    HSPA1B shock 70 kDa protein
    1B
    202816_s_at 1346 AW292882 1679 0.000641212 1.44 SS18 synovial sarcoma
    translocation,
    chromosome 18
    209440_at 1397 BC001605 1572 0.000646328 −1.25 PRPS1 phosphoribosyl
    pyrophosphate
    synthetase 1
    204221_x_at 1362 U16307 1587 0.000654803 1.51 HRB2 HIV-1 rev binding
    protein 2
    57082_at 1506 AA169780 1659 0.000658787 −1.41 ARH LDL receptor adaptor
    protein
    201887_at 1338 NM_001560 1589 0.000679598 1.52 IL13RA1 interleukin 13 receptor,
    alpha 1
    215933_s_at 1465 Z21533 1510 0.000692626 1.47 HHEX hematopoietically
    expressed homeobox
    208774_at 1389 AV700224 1685 0.000699738 1.20 CSNK1D Casein kinase 1, delta
    201478_s_at 1334 U59151 1533 0.000707429 −1.18 DKC1 dyskeratosis congenita
    1, dyskerin
    208918_s_at 1391 AI334128 1665 0.000708781 1.38 FLJ13052 NAD kinase
    208158_s_at 1386 NM_018030 1581 0.000726407 1.37 OSBPL1A oxysterol binding
    protein-like 1A ///
    oxysterol binding
    protein-like 1A
    202838_at 1348 NM_000147 1651 0.00073801 1.43 FUCA1 fucosidase, alpha-L- 1,
    tissue
    205039_s_at 1371 NM_006060 1633 0.000754874 2.05 ZNFN1A1 zinc finger protein,
    subfamily 1A, 1
    (Ikaros)
    204834_at 1368 NM_006682 1626 0.000760238 1.74 FGL2 fibrinogen-like 2
    200701_at 1327 NM_006432 1592 0.000763959 1.41 NPC2 Niemann-Pick disease,
    type C2
    204254_s_at 1364 NM_000376 1617 0.00077458 1.64 VDR vitamin D (1,25-
    dihydroxyvitamin D3)
    receptor
    217922_at 1470 AL157902 1562 0.000779841 −1.34 MAN1A2 Mannosidase, alpha,
    class 1A, member 2
    218888_s_at 1479 NM_018092 1586 0.000801694 1.39 NETO2 neuropilin (NRP) and
    tolloid (TLL)-like 2
    210947_s_at 1414 J04810 1514 0.000810544 1.30 MSH3 mutS homolog 3 (E.
    coli)
    208923_at 1392 BC005097 1575 0.000816109 1.41 CYFIP1 cytoplasmic FMR1
    interacting protein 1
    209429_x_at 1396 AF112207 1555 0.000818155 −1.22 — —
    204566_at 1366 NM_003620 1593 0.000823091 1.67 PPM1D protein phosphatase 1D
    magnesium-dependent,
    delta isoform
    218854_at 1478 NM_013352 1630 0.000823847 1.47 SART2 squamous cell
    carcinoma antigen
    recognized by T cells 2
    213198_at 1441 AL117643 1554 0.000836 1.33 ACVR1B activin A receptor, type
    IB
    218642_s_at 1476 NM_024300 1618 0.000849263 −1.21 CHCHD7 coiled-coil-helix-
    coiled-coil-helix
    domain containing 7
    203645_s_at 1358 NM_004244 1632 0.000851877 1.60 CD163 CD163 antigen
    208117_s_at 1385 NM_031206 1653 0.000852389 −1.32 FLJ12525 hypothetical protein
    FLJ12525 ///
    hypothetical protein
    FLJ12525
    218519_at 1474 NM_017945 1594 0.000854014 1.30 SLC35A5 solute carrier family
    35, member A5
    217764_s_at 1469 AF183421 1563 0.000871159 1.30 RAB31 RAB31, member RAS
    oncogene family
    214765_s_at 1459 AK024677 1564 0.000919505 1.50 ASAHL N-acylsphingosine
    amidohydrolase (acid
    ceramidase)-like
    212799_at 1432 BE217875 1682 0.00093697 1.31 — Clone 23570 mRNA
    sequence
    204744_s_at 1367 NM_013417 1624 0.000961709 −1.24 IARS isoleucine-tRNA
    synthetase
    218526_s_at 1475 NM_014185 1559 0.000964651 −1.22 RANGNRF RAN guanine
    nucleotide release
    factor
    211139_s_at 1415 AF045452 1539 0.000972219 1.40 NAB1 NGFI-A binding
    protein 1 (EGR1
    binding protein 1)
    213958_at 1449 AW134823 1677 0.000977101 −1.39 CD6 CD6 antigen /// CD6
    antigen
    221695_s_at 1494 AF239798 1558 0.000979214 1.37 MAP3K2 mitogen-activated
    protein kinase kinase
    kinase
    2 /// mitogen-
    activated protein k
    210176_at 1406 AL050262 1549 0.000989413 1.62 TLR1 toll-like receptor 1
    212314_at 1427 AB018289 1542 0.00099 −1.34 KIAA0746 KIAA0746 protein
    209882_at 1402 AF084462 1544 0.000992617 1.42 RIT1 Ras-like without
    CAAX 1
    214500_at 1456 AF044286 1541 0.00102256 1.51 H2AFY H2A histone family,
    member Y
    213088_s_at 1439 BE551340 1684 0.00104481 −1.17 DNAJC9 DnaJ (Hsp40)
    homolog, subfamily C,
    member 9
    200821_at 1329 NM_013995 1638 0.00104551 1.22 LAMP2 lysosomal-associated
    membrane protein 2
    210732_s_at 1411 AF342816 1574 0.00106818 1.84 LGALS8 lectin, galactoside-
    binding, soluble, 8
    (galectin 8)
    201224_s_at 1332 AU147713 1688 0.00107129 −1.23 SRRM1 serine/arginine
    repetitive matrix 1
    202444_s_at 1343 NM_006459 1634 0.00107236 1.72 C10orf69 chromosome 10 open
    reading frame 69
    206707_x_at 1379 NM_015864 1580 0.00107472 −1.24 C6orf32 chromosome 6 open
    reading frame 32
    221839_s_at 1496 AK026088 1567 0.00107916 −1.34 UBAP2 ubiquitin associated
    protein 2
    213279_at 1443 AL050217 1547 0.00108194 1.21 DHRS1 dehydrogenase/reduc-
    tase (SDR family)
    member 1
    214974_x_at 1460 AK026546 1568 0.00109223 2.67 CXCL5 chemokine (C-X-C
    motif) ligand 5
    209583_s_at 1399 AF063591 1570 0.00109644 1.65 CD200 CD200 antigen
    209870_s_at 1401 AW571582 1681 0.00112322 −1.39 APBA2 amyloid beta (A4)
    precursor protein-
    binding, family A,
    member 2 (X11-like)
    201494_at 1335 NM_005040 1605 0.0011371 1.27 PRCP prolylcarboxypeptidase
    (angiotensinase C)
    219806_s_at 1488 NM_020179 1637 0.00113985 1.36 FN5 FN5 protein
    208651_x_at 1387 M58664 1513 0.00119019 −1.38 CD24 CD24 antigen (small
    cell lung carcinoma
    cluster 4 antigen)
    216191_s_at 1466 X72501 1522 0.00132593 −1.84 TRDD3 /// T cell receptor delta
    TRD @ diversity 3 /// T cell
    receptor delta locus
    217143_s_at 1468 X06557 1511 0.00187286 −1.83 TRDD3 /// T cell receptor delta
    TRD @ diversity 3 /// T cell
    receptor delta locus
    Table 5. vs. = versus.
  • TABLE 6
    Genes which when included in classifiers of no more than 10 genes exhibit at
    least 70% correct classification rates between BMS and typical RRMS patients
    SEQ Gene P BMS Sequence SEQ Full Length SEQ
    Probeset ID Sym- value vs Derived ID Ref. ID
    ID NO: bol (min) RRMS From NO: Gene Title Sequences NO:
    222204_s_at 1498 RRN3 2.1*10−8 (−) AL110238 1552 RNA NM_018427 1010
    polymerase I
    transcription
    factor RRN3
    221714_s_at 1495 LOC94431 BC006441 1579 similar to RNA NM_145237 1156
    polymerase I
    transcription
    factor RRN3
    211615_s_at 1418 LRPPRC 2.4*10−8 (−) M92439 1512 leucine-rich NM_133259 1065
    PPR-motif
    containing
    protein
    211971_s_at 204 LRPPRC AI653608 606 leucine-rich NM_133259 1065
    PPR-motif
    containing
    protein
    218258_at 173 POLR1D 1.9*10−6 (−) NM_015972 984 hypothetical NM_152705 1695
    protein
    MGC9850
    205789_at 1373 CD1D 4.3*10−6 (+) NM_001766 1627 CD1D antigen, NM_001766 1627
    d polypeptide
    212999_x_at 1437 HLA- 9.9*10−6 (+) AW276186 1678 major NM_002123 1699
    DQB1 histocompatibili-
    ty complex,
    class II, DQ
    beta
    1 precursor
    209823_x_at 1400 HLA- M17955 1518 major NM_002123 1699
    DQB1 histocompatibili-
    ty complex,
    class II, DQ
    beta 1 precursor
    209480_at 1398 HLA- M16276 1521 major NM_002123 1699
    DQB1 histocompatibili-
    ty complex,
    class II, DQ
    beta
    1 precursor
    211656_x_at 1420 HLA- M32577 1520 major NM_002123 1699
    DQB1 histocompatibili-
    ty complex,
    class II, DQ
    beta
    1 precursor
    211654_x_at 1419 HLA- M17565 1519 major NM_002123 1699
    DQB1 histocompatibili-
    ty complex,
    class II, DQ
    beta
    1 precursor
    210747_at 1412 HLA- M24364 1525 major NM_002123 1699
    DQB1 histocompatibili-
    ty complex,
    class II, DQ
    beta
    1 precursor
    206584_at 1378 LY96 5.8*10−6 (+) NM_015364 1650 lymphocyte NM_015364 1650
    antigen 96; //
    MD-2 protein
    207359_at 1383 CAMKK2 6.1*10−6 (+) NM_006549 1590 calcium/calmod- NM_006549 1590
    ulin-dependent
    protein kinase
    kinase
    2, beta
    isoform
    1
    214209_s_at 1452 CAMKK2 BE504895 1683 calcium/calmod- NM_006549 1590
    ulin-dependent
    protein kinase
    kinase
    2, beta
    isoform
    1
    213812_s_at 1446 CAMKK2 AK024748 1565 calcium/calmod- NM_006549 1590
    ulin-dependent
    protein kinase
    kinase
    2, beta
    isoform
    1
    210787_s_at 1413 CAMKK2 AF140507 1546 calcium/calmod- NM_006549 1590
    ulin-dependent
    protein kinase
    kinase
    2, beta
    isoform
    1
    212252_at 1425 CAMKK2 AA181179 1660 calcium/calmod- NM_006549 1590
    ulin-dependent
    protein kinase
    kinase
    2, beta
    isoform
    1
    214643_x_at 1458 BIN1 2.2*10−6 (−) BG034080 1690 bridging NM_004305 1693
    integrator 1 // //1694
    isoform 8 NM_139343
    210202_s_at 1408 BIN1 U87558 1530 bridging NM_004305 1693
    integrator 1 // //1694
    isoform 8 NM_139343
    //
    214439_x_at 1453 BIN1 AF043899 1535 bridging NM_004305 1693
    integrator 1 // //1694
    isoform 8 NM_139343
    //
    202931_x_at 1350 BIN1 NM_004305 1584 bridging NM_004305 1693
    integrator 1 // //1694
    isoform 8 NM_139343
    //
    210201_x_at 1407 BIN1 AF001383 1531 bridging NM_004305 1693
    integrator 1 // //1694
    isoform 8 NM_139343
    //
    214450_at 1454 CTSW 3.8*10−6 (−) NM_001335 1629 cathepsin W NM_001335 1629
    preproprotein
    214470_at 1455 KLRB1 3.8*10−6 (−) NM_002258 1615 killer cell lectin- NM_002258 1615
    like receptor
    subfamily B,
    member 1
    212748_at 1431 MKL1 7.9*10−9 (+) AB037859 1583 megakaryoblastic NM_020831 1696
    leukemia
    (translocation) 1
    209072_at 1393 MBP 2.7*10−5 (−) M13577 1517 myelin basic NM_002385 1620
    protein
    210136_at 1404 MBP AW070431 1676 myelin basic NM_002385 1620
    protein
    207323_s_at 1382 MBP NM_002385 1620 myelin basic NM_002385 1620
    protein
    212978_at 1435 TA- 4.1*10−5 (+) AU146004 1686 T-cell activation NM_015350 1700
    LRRP leucine repeat-
    rich protein
    212976_at 1434 TA- R41498 1655 T-cell activation NM_015350 1700
    LRRP leucine repeat-
    rich protein
    117_at 1325 HSPA6 8.9*10−5 (+) X51757 1692 heat shock NM_002 1609
    70 kDa protein 6 155
    (HSP70B′)
    213418_at 1445 HSPA6 NM_002155 1609 heat shock NM_002 1609
    70 kDa protein 6 155
    (HSP70B′)
    200610_s_at 1326 NCL 8.9*10−5 (−) NM_005381 1613 nucleolin NM_005 1613
    381
    216191_s_at 1466 TRD @ 3.7*10−4 (−) X72501 1522 T cell receptor — #N/A
    delta locus
    217143_s_at 1468 TRD @ X06557 1511 T cell receptor — #N/A
    delta locus
    213830_at 1447 TRD @ AW007751 1675 T cell receptor — #N/A
    delta locus
    213005_s_at 1438 KANK 3.7*10−4 (+) D79994 1614 kidney ankyrin NM_015158 // 1698
    repeat- NM_153186 //1697
    containing
    protein
    Table 6. Presented are 38 gene transcripts which correspond for 17 human genes which classify BMS and typical RRMS patients. Genes given by the gene name and description, the Affymetrix probeset identification number, and a representative GenBank Accession numbers. The (−) sign means that the polynucleotide is downregulated (decreased in level) in BMS as compared to typical RRMS subjects; and the (+) sign means that the polynucleotide is upregulated (increased in level) in BMS as compared to RRMS subjects.
  • Examples of classifiers are presented as following:
  • NCL, MKL1, CTSW, KLRB1 and LRPPRC which results in correct classification rate of 79% of BMS and typical RRMS; and NCL, MKL1, CTSW, KLRB1, POLR1D, CD1D, and CAMKK2 which results in correct classification rate of 77% of BMS and typical RRMS.
    • Example 3 Testing the Effect of an Anti MS Drug in Experimental Allergic Encephalomyelitis (EAE) Animal MS Model
  • Animal model for multiple sclerosis—EAE is induced in female Lewis rats (N=15; 6-8 weeks old, body weight 180-200 g) by hind footpad subcutaneous inoculation with emulsion of 25 mg guinea-pig MBP (myelin basic protein) in CFA containing 40 mg of Mycobacterium tuberculosis (Difco, Detroit, Mich.) in 0.1 ml oil. Control rats (N=15) are injected with the same emulsion where saline solution replaces MBP. The EAE is scored as follows: 0—No obvious changes in motor function on of the rats in comparison to non-immunized rats; 1—Limp tail; 2—Limp tail and weakness of hind legs; 3—Limp tail and complete paralysis of hind legs, or limp tail with paralysis of one front and one hind leg. Or all of: walking only along the edges of the cage, pushing against the cage wall, pushing against the cage wall, spinning when picked up by the tail; 4—Limp tail, complete hind leg and partial front leg paralysis; 5—Complete hind and complete front leg paralysis, no movement around the cage, or mouse is spontaneously rolling in the cage, mouse is found dead due to paralysis.
  • Treatment with an anti MS drug or with an agent which downregulates at least one gene of the RNA polymerase pathway—A therapeutically effective amount of a drug or an agent which downregulates the expression level of a gene involved in the RNA polymerase I pathway (e.g., TPT) is administered to the animal on the day of EAE induction and blood samples are drawn before and after treatment, at predetermined time points which include baseline=Time 0, Day 12—peak disease, Day 17 and day 21.
  • Testing the level of expression of genes involved in the RNA polymerase I pathway—Blood samples, obtained from the control and treated animals, are tested using Q-RT-PCR for bio-markers of benign multiple sclerosis (e.g., RRN3, POLR1D and LRPPRC). Control animals are compared to animals on the peak of EAE disease and to animals treated by the anti MS drug (e.g., TPT).
    • Example 4 In Vitro Testing Efficacy of a Drug In Vitro Using Cells of a Multiple Sclerosis Subject
  • Peripheral blood samples are obtained from female subjects with typical RRMS disease course. All patients are free of immunomodulatory or corticosteroid treatments at least 30 days before blood withdrawal. PBMC are extracted from peripheral blood, separated by Ficoll-Hypaque gradient. 15 ml of peripheral blood from patients is diluted 1:1 with Phosphate Buffered Saline (PBS) (without Ca2+/Mg2+). Blood samples are underlied with 10 ml of Ficoll-Lymphoprep (Axis Chield, Norway) and spinned (Eppendorf centrifuge, Germany) at 2300 RPM for 30 minutes. PBMCs are collected, washed with PBS and counted and incubated at 37° C. in a humidified CO2 incubator with or without anti MS drugs. After incubation, total RNA is extracted using both Trizol (Invitrogen, USA) and Phase-Lock-Gel columns (Eppendorf, Germany) including a DNase digestion step. RNA integrity is assessed by RNA Experion automated electrophoresis system.
  • Treatment with an anti MS drug or with an agent which downregulates at least one gene of the RNA polymerase pathway—A therapeutically effective amount of a drug or an agent which downregulates the expression level of a gene involved in the RNA polymerase I pathway (e.g., TPT) is incubated during 3 hours with the PBMC (of the subject having typical RRMS) and compared with PBMC (of the subject having typical RRMS) incubated during 3 hours without drug or with placebo excluding therapeutic component.
  • Testing the level of expression of genes involved in the RNA polymerase I pathway—Total RNA samples, obtained from PBMC of a subject having typical RRMS trayed in-vitro with anti-RNA polymerase I agents (e.g. TPT), are tested using Q-RT-PCR for bio-markers of benign multiple sclerosis (e.g., RRN3, POLR1D and LRPPRC). The results compared with PBMC from same patients incubated without drag or with placebo.
  • Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims.
  • All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety 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. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention. To the extent that section headings are used, they should not be construed as necessarily limiting.
    • REFERENCES Additional References are Cited in Text
    • 1. Hirschler-Laszkiewicz I, Cavanaugh A H, Mirza A et al. Rrn3 becomes inactivated in the process of ribosomal DNA transcription. J Biol Chem. 2003; 278:18953-18959;
    • 2. Miller G, Panov K I, Friedrich J K et al. hRRN3 is essential in the SL1-mediated recruitment of RNA Polymerase I to rRNA gene promoters. Embo J. 2001; 20:1373-1382;
    • 3. Achiron A, Gurevich M, Snir Y et al. Zinc-ion binding and cytokine activity regulation pathways predicts outcome in relapsing-remitting multiple sclerosis. Clin Exp Immunol. 2007; 149:235-242;
    • 4. Mootha V K, Lepage P, Miller K et al. Identification of a gene causing human cytochrome c oxidase deficiency by integrative genomics. Proc Natl Acad Sci USA. 2003; 100:605-610;
    • 5. Bouwmeester T, Bauch A, Ruffner H et al. A physical and functional map of the human TNF-alpha/NF-kappa B signal transduction pathway. Nat Cell Biol. 2004; 6:97-105;
    • 6. Leuenroth S J, Crews C M. Triptolide-induced transcriptional arrest is associated with changes in nuclear substructure. Cancer Res. 2008; 68:5257-5266;
    • 7. Liu Y, Chen Y, Lamb J R, Tam P K. Triptolide, a component of Chinese herbal medicine, modulates the functional phenotype of dendritic cells. Transplantation. 2007; 84:1517-1526;
    • 8. Wang Y, Mei Y, Feng D, Xu L. Triptolide modulates T-cell inflammatory responses and ameliorates experimental autoimmune encephalomyelitis. J Neurosci Res. 2008; 86:2441-2449;
    • 9. Pittock S J, Rodriguez M. Benign multiple sclerosis: a distinct clinical entity with therapeutic implications. Curr Top Microbiol Immunol. 2008; 318:1-17;
    • 10. L Costelloe, A Thompson, C Walsh, N Tubridy, and M Hutchinson Long-term clinical relevance of criteria for designating multiple sclerosis as benign after 10 years of disease J. Neurol. Neurosurg. Psychiatry, November 2008; 79: 1245-1248.

Claims (29)

1. A method of classifying a subject as being more likely to have benign multiple sclerosis (BMS) or as being more likely to have typical relapsing remitting multiple sclerosis (RRMS), the method comprising comparing a level of expression of at least one gene involved in the RNA polymerase I pathway in a cell of the subject to a reference expression data of said at least one gene obtained from a cell of at least one subject pre-diagnosed as having BMS and/or from a cell of at least one subject pre-diagnosed as having typical RRMS, thereby classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS.
2. A method of diagnosing a subject pre-diagnosed with multiple sclerosis (MS) as having benign multiple sclerosis (BMS) or typical relapsing remitting multiple sclerosis (RRMS), the method comprising:
(a) classifying the subject as being more likely to have BMS or as being more likely to have typical RRMS according to the method of claim 1,
(i) wherein when the subject is classified as being more likely to have said BMS then the subject is diagnosed as having BMS;
(ii) wherein when the subject is classified as being more likely to have said typical RRMS, then the subject is diagnosed as having typical RRMS; and
(c) informing the subject of the diagnosis,
thereby diagnosing the subject pre-diagnosed with the MS as having the BMS or the typical RRMS.
3. A method of monitoring an efficiency of an anti multiple sclerosis (MS) drug in treating a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS) course, the method comprising:
(a) treating the subject with the anti MS drug; and
(b) comparing a level of expression of least one gene involved in the RNA polymerase I pathway in a cell of the subject following said treating with the anti MS drug to a level of expression of said at least one gene in a cell of the subject prior to said treating the subject with the anti MS drug,
(i) wherein a decrease above a predetermined threshold in said level of expression of said at least one gene following said treating with the anti MS drug relative to said level of expression of said at least one gene prior to said treating with the anti MS drug indicates that the anti MS drug is efficient for treating the subject;
(ii) wherein an increase above a predetermined threshold in said level of expression of said at least one gene following said treating with the anti MS drug relative to said level of expression of said at least one gene prior to said treating with the anti MS drug indicates that the anti MS drug is not efficient for treating the subject; or
(iii) wherein when a level of expression of said at least one gene following said treating with the anti MS drug is identical or changed below a predetermined threshold as compared to prior to said treating with the anti MS drug then the treatment is not efficient for treating the subject
thereby monitoring the efficiency of the anti multiple sclerosis (MS) drug in treating the subject diagnosed with the typical RRMS course.
4. An in vitro method of predicting an efficiency of an anti multiple sclerosis (MS) drug for treatment of a subject diagnosed with a typical relapsing remitting multiple sclerosis (RRMS), the method comprising:
(a) contacting cells of the subject with a therapeutically effective amount of the anti MS drug; and
(b) comparing a level of expression in said cells of at least one gene involved in the RNA polymerase I pathway following said contacting with the anti MS drug to a level of expression of said at least one gene in said cells prior to said contacting with the anti MS drug,
(i) wherein a decrease above a predetermined threshold in said level of expression of said at least one gene following said contacting with the anti MS drug relative to said level of expression of said at least one gene prior to said contacting with the anti MS drug indicates that the treatment is efficient for treating the subject;
(ii) wherein an increase above a predetermined threshold in said level of expression of said at least one gene following said contacting with the anti MS drug relative to said level of expression of said at least one gene prior to said contacting with the anti MS drug indicates that the treatment is not efficient for treating the subject; or
(iii) wherein when a level of expression of said at least one gene following said contacting with the anti MS drug is identical or changed below a predetermined threshold as compared to prior to said contacting with the anti MS drug then the treatment is not efficient for treating the subject
thereby predicting the efficiency of the anti MS drug for treatment of the subject diagnosed with the typical RRMS.
5. A method of treating a subject diagnosed with multiple sclerosis, the method comprising
(a) classifying the subject as being more likely to have BMS or typical RRMS according to the method of claim 1,
(b) selecting a treatment regimen based on classification results of step (a); thereby treating the subject diagnosed with multiple sclerosis.
6. A method of treating a subject diagnosed with multiple sclerosis, the method comprising:
(a) diagnosing a typical relapsing remitting multiple sclerosis (RRMS) according to the method of claim 2,
(b) administering to the subject a therapeutically effective amount of diterpenoid triepoxide Triptolide (TPT) or a derivative thereof, thereby treating the subject.
7. A probeset comprising a plurality of oligonucleotides and no more than 50 oligonucleotides, wherein an oligonucleotide of said plurality of oligonucleotides specifically recognizes a polynucleotide of at least one gene involved in the RNA polymerase pathway.
8. A kit for classifying a disease course in a subject diagnosed with multiple sclerosis (MS), comprising the probeset of claim 7.
9. A method of selecting a drug for treating a typical relapsing remitting multiple sclerosis (RRMS) in a subject, the method comprising:
contacting cells of a subject classified as having a typical RRMS with a plurality of drug molecules,
identifying at least one drug molecule which downregulates a level of expression of at least one gene involved in the RNA polymerase I pathway, said at least one drug molecule is suitable for treating the typical RRMS in the subject,
thereby selecting the drug for treating the typical RRMS in the subject.
10. The method of claim 1, wherein a decrease above a predetermined threshold in said level of expression of said at least one gene in said cell of the subject relative to said reference expression data of said at least one gene obtained from said at least one subject having said typical RRMS classifies the subject as being more likely to have the BMS.
11. The method of claim 1, wherein an increase above a predetermined threshold in said level of expression of said at least one gene in said cell of the subject relative to said reference expression data of said at least one gene obtained from said at least one subject having said BMS classifies the subject as being more likely to have the typical RRMS.
12. The method of claim 1, wherein when a level of expression of said at least one gene in said cell of the subject is identical or changed below a predetermined threshold as compared to said reference expression data of said at least one gene obtained from said at least one subject having said BMS, then the subject is classified as being more likely to have the BMS.
13. The method of claim 1, wherein when a level of expression of said at least one gene in said cell of the subject is identical or changed below a predetermined threshold as compared to said reference expression data of said at least one gene obtained from said at least one subject having said typical RRMS, then the subject is classified as being more likely to have the typical RRMS.
14. The method of claim 5, wherein when the subject being more likely to have typical RRMS then said treatment regimen comprises administering to the subject an agent which downregulates the level of expression of said at least one gene involved in said RNA polymerase I pathway.
15. The method of claim 1, wherein said at least one gene involved in said RNA polymerase 1 pathway is selected from the group consisting of POLR1D, LRPPRC, RRN3 and NCL.
16. The method of claim 1, wherein said at least one gene involved in said RNA polymerase 1 pathway comprises the POLR1D, LRPPRC, RRN3 and NCL genes.
17. The method of claim 6, wherein said agent is selected from the group consisting of an siRNA, an antisense, an antibody and a small molecule.
18. The method of claim 17, wherein said small molecule is Cycloheximide.
19. The method of claim 6, wherein said at least one gene is RRN3, and whereas said downregulating is effected using diterpenoid triepoxide Triptolide (TPT) or a derivative thereof.
20. The method of claim 6, wherein said at least one gene is RRN3, and whereas said downregulating is effected using Cycloheximide.
21. The kit of claim 8, further comprising a positive control for an expression level of said at least one gene involved in the RNA polymerase pathway.
22. The probeset of claim 7, wherein each of said plurality of oligonucleotides is bound to a solid support.
23. The probeset wherein said plurality of oligonucleotides are bound to said solid support in an addressable location.
24. The method of claim 1, wherein said level of expression is determined using an RNA detection method.
25. The method of claim 1, wherein said level of expression is determined using a protein detection method.
26. The method of claim 1, wherein said cell is a blood cell.
27. The method of claim 5, further comprising administering to the subject a therapeutically effective amount of an anti MS agent.
28. The method of claim 3, wherein said anti-MS agent is selected from the group consisting of Diterpenoid triepoxide Triptolide (TPT), Adderall, Ambien, Avonex, Baclofen, Beta interferon, Betaseron, Celexa, Clonazepam, Copaxone, Corticosteroids, Cymbalta, Cytoxan, Dexamethasone, Effexor, Elavil, Gabapentin, Hydrocodone, Lexapro, Lyrica, Mitoxantrone, Naltrexone, Neurontin, Novantrone, Prednisone, Provigil, Rebif, Solumedrol, Symmetrel, Topamax, Tysabri, Wellbutrin, Xanax, Zanaflex, Zoloft, fingolimod, laquinimod, Mylinax (cladribine), teriflunomide, BG-12 (Biogen Idec's), firategrast (GSK/Mitsubishi Tanabe Pharma), ibudilast (MediciNova's), and CDP323 (Biogen/UCB).
29. The probeset of claim 7, wherein said at least one gene involved in said RNA polymerase 1 pathway comprises the POLR1D, LRPPRC, RRN3 and NCL genes.
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