1. Field of the Invention
The present invention relates to a method for determining the quantity of marinobufagenin (“MBG”) present in a body specimen, such as blood or urine, and also relates to unique compounds employable in such method.
2. Description of the Prior Art
Hypertension is a public health problem in the United States. Nearly 73 million Americans suffer from this disorder, and its incidence is rising. Fields L E, Burt V L, Cutler J A, et al., “The Burden of Adult Hypertension in the United States 1999 to 2000: A Rising Tide,” Hypertension, 2004;44:398-404. Almost one third of adults have been diagnosed with this disorder and the number of adults with hypertension increased by about 30% between the late 1980s and the early 1990s. Obesity and the aging process account for some of the increase in hypertensive patients (Cheung B M Y, Ong K L, Man Y B, et al., “Prevalence, awareness, treatment, and control of hypertension. United States National Health and Nutrition Examination Survey 2001-2002,” J. Clin. Hypertens., 2006;8:93-98), but the epidemic of diabetes, now encountered more often in teenagers, will, no doubt, continue to impact the incidence rate.
The current therapy of hypertension is based largely upon epidemiologic data. However, the basis for many treatment paradigms is the division of hypertension into two broad etiopathogenetic categories. The latter reflect the physical relationships between blood flow, blood pressure, and the resistance to flow in the vascular circuit. The expression which relates these physical elements is Q (flow)=P (pressure)/R (resistance). If one solves for pressure, one obtains the equation P=Q×R. One may perturb pressure either by altering the flow term or the resistance term or both. In mammalian species, including man, flow is a function of cardiac output (“CO”). CO, in turn, depends crucially upon venous return to the heart, and the latter is directly related to the extracellular fluid (“ECF”) volume, especially the intravascular volume. Accordingly, the flow term in the equation above can be replaced by ECF volume, leading to the recognition that there are two major pathogenetic mechanisms in the development of hypertension: 1) expansion of the ECF volume and 2) increased total peripheral resistance. If one excludes from consideration the secondary causes of hypertension, somewhere in the neighborhood of 90-95% of hypertension is characterized as “essential.” Kaplan N M, Flynn J T., “Kaplan's Clinical Hypertension, ninth edition, 2006,” Lippincott, Williams and Wilkins, Philadelphia, pp. 50-121. This term denotes the fact that specific etiologic factors remain unknown. However, it is clear that essential hypertension is a syndrome with multiple etiologies. Furthermore, if one examines the two broad etiologic categories of hypertension (1) expansion of the ECF volume and 2) increased peripheral resistance) the data suggest that the former category accounts for almost 30-40% of the “essential” hypertension, and the latter approximately 60-70%. Laragh J H, Letcher R L, Pickering T G., “Renin profiling for diagnosis and treatment of hypertension,” JAMA, 1979:41:151-156.
A prime focus of the present invention is the cause of volume expansion-mediated hypertension, which, over time, has achieved greater prominence. Current thought is that, over time, this form of hypertension may account for more than 40% of the hypertensives in the United States given the increasing number of the elderly, obese, and diabetics. Volume expansion-mediated hypertension is seen primarily in the following demographic groups: 1) African-Americans, 2) the elderly, 3) the obese, 4) a subset of Type II diabetics, and 5) Hispanics. It is anticipated that, because of the aging of the population and the increasing number of obese and diabetic persons, as well as the expected increase in the proportion of the population who are Hispanic, the 40%/160% relationship between the pathogenetic groups in essential hypertension referred to above will reverse in the next 20-30 years. In addition, although they are not essential hypertensives, it is believed that a significant number of patients with preeclampsia have, as their primary etiology, hypertension based upon excessive volume expansion.
There are urgent needs for diagnostic tests to guide the therapy of hypertension. There is also a need to develop therapeutic agents directed specifically at the underlying pathophysiology, as determined by diagnostic testing. Such a system of diagnostic/therapeutic matching would greatly improve the management of hypertensive patients, would eliminate guesswork with respect to prescriptive practices, would lead to more rapid and better control of blood pressure and, in the long run, would positively impact the ability to prevent hypertensive complications, which include heart attack and stroke. Such pretreatment testing would introduce “personalized medicine” in the management of hypertension. In addition, such developments would have a positive impact on the costs of healthcare.
Preeclampsia is an example of volume expansion-mediated hypertension. The present invention involves methods and compounds which facilitate early detection and possible treatment of preeclampsia. The present invention seeks to move toward the goal of prevention of this syndrome. Preeclampsia is a disorder that consists in the de novo development of hypertension and proteinuria after 20 weeks of gestation. The syndrome often includes excessive edema formation and intrauterine growth restriction (“IUGR”). Preeclampsia occurs in from 3%-10% of all pregnancies. Pridjian G, Puschett J B, “Preeclampsia, Part I: Clinical and pathophysiological considerations,” Obstet. Gyn. Survey, 2002;57:598-618. It is the second leading cause of fetal wastage, as well as maternal morbidity and mortality. Remarkably, the hypertension, proteinuria, and edema completely resolve within 12 weeks of parturition. The only definitive therapy of this disorder is the delivery of the fetus and placenta. The latter organ appears to be the offending agent. Unfortunately, because of the IUGR, and consequent prematurity, the fetus may not survive. Therapy for preeclampsia has not changed in over 40 years and remains unsatisfactory. Preeclampsia is of great interest because pregnancy represents nature's experiment in volume expansion. In fact, pregnant patients gain an additional 40%-50% of extracellular fluid, including blood volume, as pregnancy proceeds. Scott D E, “Anemia in pregnancy,” Obstet. Gynecol. Annu., 1972;1:219-244.
The present invention seeks to determine if preeclampsia could be an example of volume expansion-mediated hypertension. A review of the literature revealed a dearth of animal models, in general, and no information on the possibility that at least some forms of preeclampsia (a syndrome, not a single disease process) could be related to excessive volume expansion. Furthermore, elevated levels of marinobufagenin (“MBG”) have been reported in preeclamptic patients. Gonick H C, Ding Y, Vaziri N D, et al., “Simultaneous measurement of marinobufagenin, ouabain, and hypertension-associated protein in various disease states,” Clin. Exp. Hypertens., 1998;20:617-627 and Lopatin D A, Ailamazian E K, Dmitrieva R I, et al., “Circulating bufodienolide and cardenolide sodium pump inhibitors in preeclampsia,” Am. J. Hypertens., 1999;17:1179-1187. Volume expansion is known to stimulate MBG secretion and elaboration. Fedorova O V, Doris P A, Bagrov A Y, Endogenous marinobufagenin-like factor in acute plasma volume expansion,” Clin. Exp. Hypertens., 1998;20:581-591 and Bagrov A Y, Fedorova O V, Dmitrieva R I, et al., “Plasma marinobufagenin-like and ouabain-like immunoreactivity during saline volume expansion in anesthetized dogs,” Cardiovasc. Res., 996;31:296-305. It has been determined that MBG is produced both in the adrenal glands (Dmitrieva R I, Bagrov A Y, Lalli E, et al., “Mammalian bufadienolide is synthesized from cholesterol in the adrenal cortex by a pathway that is independent of cholesterol side-chain cleavage,” Hypertension, 2000;36:442-448 and Lichtstein D, Steinitz M, Gati I, et al., “Bufodienolides as endogenous Na, K-ATPase inhibitors: biosynthesis in bovine and rat adrenals,” Clin. Exp. Hypertens., 1998;20:573-579) and in the placenta (Hilton P J, White R W, Lord G A, et al., “An inhibitor of the sodium pump obtained from human placenta,” Lancet, 1996;348:303-305), and perhaps, also in other sites in the body, e.g., the hypothalamus. Additionally, MBG is a known vasoconstrictor that can cause hypertension. Schoner, W., “Endogenous cardiac glycosides, a new class of steroid hormones,” Eur. J. Biochem., 2002;269:2240-2448. It is also a cardiac inotrope.
Despite the foregoing knowledge, there remains a very real and substantial need to develop an effective means for ascertaining, with accuracy, and repeatability the amount of marinobufagenin in a body specimen, such as urine or blood.
The present invention has met the above-described need by providing an effective assay for determining, with precision, the amount of marinobufagenin in a body specimen to thereby facilitate an accurate evaluation of whether an individual has hypertension. The methods of the present invention also involve the use of unique compounds which facilitate such a determination of marinobufagenin concentration in a body specimen.
It is an object of the present invention to employ an accurate method for determining the amount of marinobufagenin in a body specimen in order to facilitate an evaluation regarding whether an individual is suffering from hypertension.
It is a further object of the method of the present invention to employ certain unique compounds which may be used to create conjugates for use in such method.
It is a further object of the present invention to provide a method which employs marinobufagenin linked to a protein as an immunogenic conjugate to generate polyclonal rabbit and murine monoclonal antibodies (“mab”) which may be employed in determining quantitatively the amount of marinobufagenin in a body specimen.
It is yet another object of the present invention to provide such a method which may employ an ELISA test in effecting determination of the marinobufagenin concentration.
It is yet another object of the present invention to provide a method of accurately determining the marinobufagenin concentration in a body specimen in order to ascertain whether volume expansion-mediated hypertension exists in a patient.
It is yet another object of the present invention to provide such a method for determining the quantity of marinobufagenin in a body specimen, so as to facilitate an accurate determination regarding whether essential hypertension exists in order to facilitate an appropriate course of treatment for the patient.
These and other objects of the present invention will be more fully understood in the following detailed description of the invention on reference to the illustrations appended hereto.
As employed herein, the term “body specimen” refers to blood, urine, or tissue extracts from a human being.
Marinobufagenin (
Any of a number of suitable linkers bearing CH2, C(O), O, or N atoms can be employed to provide an appropriate tether length between the hapten and the carrier protein or the hapten and biotin to enable generation of an immune response and generate antibodies or for use as a tracer (=labeled antigen) in the ELISA assay, respectively. The ranges given refer to the number of atoms that separate the hapten and the carrier protein or biotin. The linkers employed preferably include CH2, C(O), O, or N atoms and can vary in length from 5 to 20 atoms but preferably are 7 to 12 atoms in length.
It is an object of the present invention to provide sensitivity of the method of the invention to the desired level of pg/ml (picograms per milliliter). The method of the present invention preferably employs an ELISA assay which may be relatively standard, but which is unique in the chemical process it employs for attaching marinobufagenin to a protein. The design of the conjugate is also reflected in the specificity of the antibodies which are produced, i.e., their capacity to discriminate almost perfectly between MBG and RBG.
As a first step in the present process, marinobufagenin derivatives are readied for conjugation to proteins. An antibody to MBG was previously generated using an antigen prepared directly from MBG (
The derived carboxyl acid derivative was then coupled to the surface lysine groups of the carrier protein bovine serum albumin (“BSA”) by the activated N-hydroxysuccinimidyl ester method (Hosoda H, Sakai Y, Yoshida H, et al., “The Preparation of Steroid N-hydroxysuccinimide Esters and Their Reactivities with Bovine Serum Albumin,” T. Chem. Pharm. Bull., 1979;2:742-746). While the generated antibodies exhibited low cross-reactivity with some other bufodienolide natural products and cardenolides 6 (
The next step is the synthesis of immunogenic bovine serum albumin (“BSA”)-marinobufagenin and β-lactoglobulin (“BLG”)-marinobufagenin conjugates. To develop an antibody with high specificity and affinity, the excellent potential utility of a commercially available bufodienolide, cinobufotalin 3 (CINO,
An example of the preparation of the BSA-marinobufagenin antigen will be considered. To prepare the BSA-MBG antigen, the hapten 9 (
ELISA strategies, other than directly binding MBG to protein, serve as a coating reagent for ELISA plates. The other possible format of competitive ELISA for a small molecule like MBG is that the tracer is biotinylated MBG.
An example of the preparation of the marinobufagenin (CINO)-biotin conjugate 13 will be considered. To prepare the MBG (CINO)-biotin conjugate 13, the NHS ester activated MBG hapten 10 (
In order to “scale-up” the assay, so that large numbers of samples can be analyzed, synthesis of MBG will be required as a control for the assay. This may be accomplished by converting cinobufotalin (“CINO”) to MBG by a deoxygenation process. There are several mild methods which can be employed, and given the ready availability of CINO, a short sequence for deoxygenation of CINO to deliver 10's of milligrams of MBG can be provided.
While there are several methods for radical deoxygenation including those pioneered by Barton (Hartwig W., “Modern Methods for the Radical Deoxygenation of Alcohols,” Tetrahedron, 1983;39:2609-2645), a more recent use of tris(trimethylsilyl) methane (TMS)-(CH) as a tin-free reducing agent by Perchyonok (Perchyonok V T, “On the Use of (TMS) 3CH as Novel Tin-Free Radical Reducing Agent,” Tetrahedron Letters, 2006;47:5163-5165), and mild conditions reported by Wood will also be explored (Spiegel D A, Wiberg K B, Schacherer L N, et al., “Deoxygenation of Alcohols Employing Water as the Hydrogen Atom Source,” J. Am. Chem. Soc., 2005;127:12513-12515). These processes typically involve conversion to a suitable radical precursor 14 (
The ELISA assay involved the following:
Four Balb/c mice were immunized six times with gradually decreasing doses of the BSA-MBG conjugate (
In order to narrow the number of cell lines to a manageable shortlist of monoclonal antibodies (“mabs”) with the highest affinity for MBG, a two-step process was followed.
In a first step (results not shown), each of the hybridoma supernatants were assayed for their mouse IgG content. By knowing the exact antibody content, a comparison of all antibodies for their tracer binding capacity at identical antibody concentration could be made.
In the second step of the process, each monoclonal antibody (“mab”) could be incubated at two different concentrations (1 ng/ well and 0.1 ng/well, respectively) with the same concentration of biotinylated MBG referred to as “the tracer;” see
This growth process takes about 2 weeks before there are again enough cells to test by ELISA which subclones are monoclonal and secrete the desired mab. Once this has been determined, it takes about another 2 weeks to expand these subclones to where they are cryogenically stored again (multiple freezers and multiple copies). This was followed by testing which of those mabs yielded the most sensitive assay using the assay format shown in
In addition to synthesizing the marinobufagenin antigens and conjugating them with proteins in order to effectively induce an immune response antibody action, included within the present invention are the compounds designated 5 (
In a preferred practice of the invention, the antibodies produced may be stored in frozen condition until such time as they are to be used, at which time they may be thawed and employed in the ELISA test.
In an alternative approach, rabbits were immunized with the BSA-MBG conjugate for the production of polyclonal antisera. Six New Zealand White rabbits were immunized with the BSA-MBG conjugate according to routine lab protocols using decreasing immunogen doses in order to promote affinity maturation. The resulting polyclonal sera were assessed for the presence of MBG-specific antibodies by ELISA (
Four Balb/c mice were immunized six times with gradually decreasing doses of the BSA-MBG conjugate, in order to promote affinity maturation of the immune response. The conjugate was emulsified in RIBI adjuvant [1 mg Lipid A, monophosphorylated from E. coli F583 (Sigma), 1 mg Trehalose 6, 6′-dimycolate from Mycobacterium tuberculosis (Sigma, S t. Louis, M O), 0.4% (v/v) Tween-80 (Sigma), 4.5% (v/v) squalene in 2 mL MQ-water] prior to immunization. The titer of anti-MBG antibodies was monitored by testing the mice sera in an ELISA against BSA-MBG, after blocking the anti-BSA antibodies with an excess of BSA. Bound anti-MBG antibodies were detected using a peroxidase-conjugated anti-mouse IgG and the TMB substrate system. Following the last immunization step, the mice were sacrificed and their splenocytes were harvested. Splenocytes from the mouse with the best anti-MBG titer were fused with Sp2/0 myeloma cells (ATCC, Manassas, Va.) by electrofusion. Splenocytes and myeloma cells were counted, and the number of cells needed to achieve a splenocyte:myeloma ratio of 3:1 was determined. Splenocytes and myeloma cells were then mixed and treated with dispase (EMD Biosciences, San Diego, Calif.) at 10 μg/ml, for 5 min at room temperature. Cells were washed three times with electrofusion buffer (0.255 M sucrose, 0.2 mM CaCl2, 0.2 mM MgCl2, sterile-filtered), then resuspended in 0.5 ml electrofusion buffer, and gently spread on the electrofusion slide. The electrofusion chamber (Meander Fusion Chamber, Harvard Apparatus, Holliston, Mass.) was then connected to the Electro Cell Manipulator® ECM 2001 (Harvard Apparatus). Using an AC current at 6V and for 30 sec, the cells were first aligned in a pearl line fashion. One high-voltage pulse (DC current at 60V, 15 μsec) then caused adjacent cells to fuse. Following fusion, cells were allowed to sit in the chamber for 30 min at room temperature, and were then transferred to a reservoir containing fusion medium (Complete DMEM growth medium, Mediatech, Manassas, Va.) with addition of cytokines to sustain single cell growth. Cells were gently mixed into the medium, and transferred into two 96-well plates (Nunc, Rochester, N.Y.). To eliminate non-fused myeloma cells, selection with HAT media supplement (Sigma) was then applied for seven days. Hybridoma cells were maintained in Complete DMEM growth medium containing HT media supplement (Sigma). Two weeks post-fusion, one hundred different hybridomas were selected for expansion and cryogenic storage. These hybridomas produced specific anti-MBG antibodies, as ascertained by a maximal anti-MBG ELISA response, as well as by partial to complete inhibition of the obtained signal by addition of excess MBG.
Whereas particular embodiments of the present invention have been described herein for purpose of illustration, it will be evident to those skilled in the art that numerous variations of the details may be made without departing from the invention as set forth in the appended claims.
The present application claims the benefit of U.S. Provisional patent application Ser. No. 61/294,272, filed Jan. 12, 2010, and entitled, “METHOD FOR DETERMINATION OF MARINOBUFAGENIN LEVELS AND COMPOUNDS EMPLOYABLE IN SUCH METHOD,” which is herein incorporated by reference in its entirety.
Number | Date | Country | |
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61294272 | Jan 2010 | US |