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Clarient, A GE Healthcare Company, Introduces First Lab Developed Test To Assess Multiple Proteins at Single-Cell Level

GE Healthcare recently announced the introduction by Clarient Diagnostic Services, a GE Healthcare Company, of the first lab developed test using MultiOmyx™, a ground-breaking new pathology platform which uses proprietary methodology to assess multiple proteins from a single tissue section at a single-cell level. This test, now available, offers an aid to a pathologist’s diagnosis of CD30-positive lymphoma cases with difficult morphology or otherwise insufficient tissue to adequately evaluate the case.

“In many instances, suspected lymphoma cases are not straightforward, and sample tissue size inadequacy issues further complicate the matter,” said Lawrence Weiss, MD, Medical Director of Clarient. “In difficult to call diagnoses, MultiOmyx gives me great confidence in making the diagnosis and relieves me from the concern of running out of tissue. If I only have a small amount of tissue, I do not have to sacrifice or choose between important markers – I can assess them all.”

The Hodgkin Lymphoma (HL) Profile by MultiOmyx helps to assess nine unique antibodies (CD30, CD15, CD20, CD45, PAX5, OCT2, BOB1, CD3, and CD79A) on a single formalin fixed paraffin embedded tissue section to aid in differential diagnosis of Classical HL.

In clinical validation, this single slide assay called the Hodgkin Lymphoma Profile by MultiOmyx demonstrated high levels of accuracy, diagnostic reproducibility and repeatability, and high sensitivity of all immunofluorescent stains in comparison to traditional immunohistochemistry performed on the same samples. The correlation study identified unique cases where MultiOmyx demonstrated improved performance.

“Traditional pathology uses multiple slices from paraffin-fixed tumor samples and examines them slide by slide, which is less efficient and effective,” said Carrie Eglinton Manner, CEO, Clarient. “Using a single slide may save time, uses significantly less tissue and may provide a more consistent result. Since different parts of a tumor sample can act differently and because less tissue is required, pathologists can access the most accurate and broad tumor analysis available, while eliminating today’s need to prioritize tests due to limited tissue availability.”

The relevance of the MultiOmyx technology was recently confirmed in a clinical paper written by a team of scientists from GE Global Research published in Proceedings of the National Academy of Sciences (PNAS). The paper details the different ways GE is using image data to visualize cancer and the relationship between different biomarkers and the tumor environment and suggests the technology could be broadly applicable to problems in basic biological research, drug discovery and development and companion and clinical diagnostics.

“MultiOmyx provides clinicians and researchers with a novel biomarker multiplexing method to understand biological context in a way that is not possible with other technologies that disrupt the tissue histology. Once cells are removed from the context of their overall microenvironment with other methods valuable information is lost,” said Christine Kuslich, PhD, Chief Science Officer, In Vitro Diagnostics, GE Life Sciences. “MultiOmyx uniquely facilitates the ability to visualize multiple biological pathways, local immune response as well as heterogeneity of expression within regions of interest on a cell-by-cell basis from a single tissue section maintaining tissue context.”

The platform uses fluorescence to provide quantitative analysis of antibodies and allows for up to 60 proteins to be examined on a single tissue sample. It creates a “digital map” of the tumor, giving each cell an “address” and allowing for a clear graphic representation of protein expression. Matching this map to known biosignatures gives researchers a more accurate representation of the exact characteristics of the tumor and may provide clinicians with a clearer view to aid the diagnosis. It also allows them to identify patterns in the tissue by analyzing each cell and biomarker individually, or as a cluster, and thus get a level of understanding of the biological process that could not be achieved via traditional methods.

Study: Highly multiplexed single-cell analysis of formalin-fixed, paraffin-embedded cancer tissue

Source: Business Wire

Urine Biomarker Test Can Diagnose as well as Predict Rejection of Transplanted Kidneys

A breakthrough non-invasive test can detect whether transplanted kidneys are in the process of being rejected, as well as identify patients at risk for rejection weeks to months before they show symptoms, according to a study published in The New England Journal of Medicine (NEJM).

By measuring just three genetic molecules in a urine sample, the test accurately diagnoses acute rejection of kidney transplants, the most frequent and serious complication of kidney transplants, says the study’s lead author, Dr. Manikkam Suthanthiran, the Stanton Griffis Distinguished Professor of Medicine at Weill Cornell Medical College and chief of transplantation medicine, nephrology and hypertension at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

“It looks to us that we can actually anticipate rejection of a kidney several weeks before rejection begins to damage the transplant,” Dr. Suthanthiran says.

The test may also help physicians fine-tune the amount of powerful immunosuppressive drugs that organ transplant patients must take for the rest of their lives, says Dr. Suthanthiran, whose laboratory developed what he calls the “three-gene signature” of the health of transplanted kidney organs.

“We have, for the first time, the opportunity to manage transplant patients in a more precise, individualized fashion. This is good news since it moves us from the current one-size-fits-all treatment model to a much more personalized plan,” he says, noting that too little immunosuppression leads to organ rejection and too much can lead to infection or even cancer.

Given the promise of the test first developed in the Suthanthiran laboratory at Weill Cornell and previously reported in NEJM, the National Institutes of Health (NIH) sponsored a multicenter clinical trial of nearly 500 kidney transplant patients at five medical centers, including NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian/Columbia University Medical Center. The successful results of that trial are detailed in the July 4 issue of NEJM.

Such a test is sorely needed to help improve the longevity of kidney transplants and the lives of patients who receive these organs, says study co-author Dr. Darshana Dadhania, associate professor of medicine and medicine in surgery at Weill Cornell Medical College and associate attending physician at NewYork-Presbyterian Hospital.

Dr. Dadhania says that the primary blood test now used to help identify rejection — creatinine, which measures kidney function — is much less specific than the three-gene signature.

“Creatinine can go up for many reasons, including simple dehydration in a patient, and when this happens we then need to do a highly invasive needle-stick biopsy to look at the kidney and determine the cause. Our goal is to provide the most effective care possible for our transplant patients, and that means individualizing their post transplant care,” she says. “Using an innovative biomarker test like this will eliminate unnecessary biopsies and provide a yardstick to measure adequate immunosuppression to keep organs — and our patients — healthy.”

Although a number of researchers have tried to develop blood or urine-based tests to measure genes or proteins that signify kidney organ rejection, Dr. Suthanthiran and his research team were the first to create a gene expression profile urine test — an advance that was reported in NEJM in 2001 and, with an update also in NEJM, in 2005.

The research team measured the levels of messenger RNA (mRNA) molecules produced as genes are being expressed, or activated, to make proteins. To do this, they developed a number of sophisticated tools to measure this genetic material. “We were told we would never be able to isolate good quality mRNA from urine,” he says. “Never say never.”

He and his colleagues found that increased expression of three mRNAs can determine if an organ will be, or is being, rejected. The mRNAs (18S ribosomal (rRNA)–normalized CD3ε mRNA, 18S rRNA–normalized interferon-inducible protein 10 (IP-10) mRNA, and 18S rRNA) indicate that killer T immune cells are being recruited to the kidney in order to destroy what the body has come to recognize as alien tissue.

The signature test consists of adding levels of the three mRNAs in urine into a composite score. Tracked over time, a rising score can indicate heightened immune system activity against a transplanted kidney, Dr. Suthanthiran says. A score that stays the same suggests that the patient is not at risk for rejection.

“We were always looking for the most parsimonious model for an organ rejection biomarker test,” Dr. Suthanthiran says. “Minimizing the number of genes that we test for is just more practical and helps to give us a clearer path towards diagnosis and use in the clinic.”

Physicians can tailor a patient’s use of multiple immunosuppressive drugs by lowering the doses steadily, and monitoring the patient’s composite score over time. Any increase would suggest a somewhat higher dose of therapy is needed to keep the organ safe.

“This is akin to monitoring blood glucose in a patient with diabetes,” Dr. Suthanthiran says. “Because different people have different sensitivity to the two-to-four immunosuppressive drugs they have to take, this test offers us a very personalized approach to managing transplantations.”

Predicting rejection weeks before it happens

The clinical trial began in 2006 with participation from five medical centers — NewYork-Presbyterian/Columbia University Medical Center, the University of Pennsylvania’s Perelman School of Medicine, the Northwestern University Feinberg School of Medicine, the University of Wisconsin School of Medicine and Public Health and NewYork-Presbyterian/Weill Cornell Medical Center, which contributed 122 of the total 485 kidney transplant patients.

The gene-expression studies were led by Dr. Suthanthiran with his laboratory serving as the Gene Expression Monitoring (GEM) core and the clinical trial was led by Dr. Abraham Shaked, director of the PENN Transplant Institute at the Perelman School, on behalf of the Clinical Trials in Organ Transplants 04 (CTOT-04) Study Investigators. The GEM core was blinded to the clinical status of the patients including their biopsy results and the data collection and analysis were performed by an independent statistical center sponsored by NIH.

Researchers collected 4,300 urine specimens during the first year of transplantation, starting at day three post-transplantation. The urine samples were shipped to the GEM core at Weill Cornell Medical College, where analysis of the urine revealed that the three gene-based biomarkers signature could distinguish kidney recipients with biopsy confirmed rejection from those whose biopsies did not show signs of rejection or who did not undergo a biopsy because there was no clinical sign of rejection.

The researchers used the signature to derive a composite score and identify a threshold value indicative of rejection. This score accurately detected transplant rejection with a low occurrence of false-positive and false-negative results. “It is about 85 percent accurate, which is much higher than the creatinine test used today,” Dr. Suthanthiran says. Investigators then validated the diagnostic signature by obtaining similar results when they tested a set of urine samples collected in a separate CTOT clinical trial.

Dr. Suthanthiran anticipates conducting another NIH-funded clinical trial to test whether the signature test can be used to personalize individual immunosuppressive therapy. He says that NIH is also interested in submitting the test to the federal Food and Drug Administration for approval.

These studies have provided enough information that many medical centers can test their own kidney transplant patients for rejection using the publicly-available formula for the biomarker test. Dr. Suthanthiran also is working to develop a way for patients to submit samples via mail for biomarker testing, and avoid an office visit. The study was supported by NIH grants UO1AI63589 and R37AI051652, the Qatar National Research Foundation (NPRP 08-503-3-111) and by a Clinical and Translational Science Center Award (UL1TR000457, to Weill Cornell Medical College).

Study: Urinary-Cell mRNA Profile and Acute Cellular Rejection in Kidney Allografts

Source: Weill Cornell Medical College

C2N Diagnostics Announces Collaborative Research Agreement with Cambridge Isotopes

C2N Diagnostics (C2N) recently announced that it has signed a collaborative research and a global, exclusive supplier agreement with Cambridge Isotope Laboratories, Inc (CIL). The partnership guarantees C2N’s future access to mass quantities of highly enriched stable isotopes at predictable prices. These stable isotopes are key reagents to C2N’s platform of Stable Isotope Labeling Kinetic (SILK™)-based biomarkers. Such biomarkers are showing considerable promise to detect early Alzheimer’s pathology (i.e., well before the onset of clinical symptoms) as well as to measure treatment responsiveness in preclinical and clinical drug studies.

C2N gains a research partner in CIL that is the premier manufacturer in the world of stable isotopes used in clinical research and diagnostic applications. Under terms of the agreement, C2N receives from CIL an upfront payment, commercial milestone fees, future supply guarantees of stable isotopes at predictable prices, and large quantities of GMP-grade stable isotope (13C6) labeled leucine (L-Leucine). The L-Leucine will be used in future upcoming clinical validation studies involving C2N’s SILK™-based tests. CIL also commits to making significant investment in its own infrastructure and manufacturing processes. This will ensure CIL’s ability to meet the future demand of stable isotopes that will incorporate into C2N’s tests

“We spent considerable time evaluating the options available to C2N for obtaining access to stable isotopes used in our SILK™ tests. The logistics of having adequate supply of these reagents to enable disease screening on large numbers of at-risk individuals are far from trivial. We concluded that CIL is the best-positioned company in the world to meet our future expected demands in terms of both material quantity and material quality,” stated Dr. Joel B. Braunstein, C2N’s CEO. “Stable isotopes are non-radioactive, perfectly safe for people to consume and to the environment, and offer great sensitivity for tracking the in vivo metabolism of proteins implicated in diseases like Alzheimer’s. This makes them highly desirable diagnostic reagents. As we expand the use of our SILK™-based biomarkers beyond research services and into clinical diagnostic applications, CIL will be an instrumental partner to help us qualify our test kits and to produce L-Leucine under GMP scaled-up conditions.”

Dr. Joel Bradley, CIL’s CEO, commented, “By focusing on ways to diagnose and treat early Alzheimer’s disease, C2N is tackling one of the most important challenges in modern medicine. The company is making encouraging progress toward its ultimate goal of offering a convenient screening test for early Alzheimer’s that can be administered in the ambulatory setting. At CIL, we acknowledge the social and commercial impact of C2N’s efforts. For this reason, CIL is privileged and delighted to assist C2N with its development activities and to become C2N’s exclusive supplier of stable isotopes.”

Source: C2N Diagnostics

University Hospitals Case Medical Center and Case Western Reserve University Announce Licensing Agreement for the Development of Diagnostic Tests for HIV Drug Resistance

Case Western Reserve University has signed an exclusive worldwide licensing agreement granting University Hospitals (UH) Case Medical Center rights to a series of diagnostic tests to determine drug resistance and co-receptor tropism in human immunodeficiency virus (HIV).

The phenotypic and genotypic HIV tests (or assays) were invented by Eric Arts, PhD, Professor of Medicine in the Division of Infectious Diseases, Department of Medicine at Case Western Reserve School of Medicine, and Miguel Quiñones-Mateu, PhD, Assistant Professor, Department of Pathology at the School of Medicine and Scientific Director at the University Hospitals Translational Laboratory (UHTL, www.uhtl.org).

The HIV assays provide a platform of diagnostic tests used by physicians and researchers to monitor the success of anti-HIV treatment by determining drug resistance and the ability of the virus to infect different cells within the patient. The HIV assays also can be used by academic and corporate researchers to develop novel strategies to block HIV replication.

In July 2011, UH Case Medical Center created the UHTL with the goal of advancing and further developing new molecular diagnostic methodologies originally conceived in the academic and clinical laboratories at UH Case Medical Center and Case Western Reserve. UHTL’s main objective is to facilitate the development of translational research into commercial assays or products, including characterization, verification, and validation in a College of American Pathologists and Clinical Laboratory Improvement Act (CAP/CLIA) certified environment under a Good Laboratory Practice (GLP) framework.

The UHTL occupies 4,200 sq.ft. of office and laboratory space, including BSL-2+, in the Baker Electric Building (MidTown, Cleveland, OH) and was recently CAP accredited. The first series of cell-based and molecular HIV diagnostic tests will be offered by the UHTL during the second quarter of this year.

“The UHTL has provided us with an exciting opportunity to develop new molecular diagnostic tests, and the collaboration of Drs. Quiñones-Mateu and Arts has been particularly fruitful for developing these new tests that will benefit patients by allowing individually targeted selection of therapies for HIV infection,” said Clifford V. Harding, MD, PhD, the Joseph R. Kahn, MD Professor of Pathology and Chair of Department of Pathology, Case Western Reserve and UH Case Medical Center.

“A personalized, four-in-one integrated assay has been launched to provide a highly advanced way to ensure optimal care for HIV infected patients. New collaborations between Case Western Reserve and UH are in process to provide enhanced care for patients with hepatitis and cancer,” said Dr. Arts.

“The UHTL allows UH Case Medical Center to remain on the leading-edge of molecular diagnostic testing. It clearly demonstrates our commitment to our mission: ‘To heal, To teach and To discover,” said Ronald E. Dziedzicki, Chief Operating Officer at UH Case Medical Center. “This new capability will clearly benefit patients with HIV infection in a more targeted manner, thereby impacting the quality of their life. UHTL also provides a platform to assist with the movement of other new and novel testing modalities from a concept to reality. The establishment of this lab and new testing modalities also demonstrates the value of the relationship between UH Case Medical Center and Case Western Reserve University and our quest to improve patient care with new leading edge technologies.”

Dr. Quiñones-Mateu joined UH Case Medical Center as Scientific Director of the UHTL after leading the technical and commercial development of novel molecular and cell-based HIV diagnostic tests at Diagnostic Hybrids, Inc., A Quidel Company. “Our HIV phenotypic (VIRALARTS™HIV and VERITROP™) assays and the novel all-inclusive HIV genotyping and coreceptor tropism test (DEEPGEN™HIV) based on next-generation sequencing will allow us to enhance the care and treatment of HIV-infected individuals not only in Northeast Ohio but nationally as well as worldwide.

DEEPGEN™HIV is a first-in-class assay based on the latest technology developed to rapidly detect variants and mutations in any given genome with high sensitivity. Current tests are able to detect drug resistant viruses with a sensitivity of 20 percent, while DEEPGEN™HIV is able to detect these mutant viruses at frequencies as low as 1 percent. This will give the opportunity to the physicians to “see” the mutant viruses many months in advance and decide whether or not change the treatment before the patient begins to fail HIV therapy.

According to Quiñones-Mateu, “With the collaboration of Dr. Christine Schmotzer, UHTL Medical Director and Assistant Professor of Pathology at the School of Medicine, we are ready to introduce our unique products and services to HIV physicians, pharmaceutical drug companies developing the next generation of effective drugs, and national laboratory service organizations that interact with both groups.”

Source: University Hospitals

Metabolon Announces Findings From Two Major Diabetes Outcomes Studies For its Quantose Prediabetes Test

Metabolon, Inc. a pioneering leader of advanced metabolomics, announced outcome results recently from two large-cohort studies evaluating the clinical utility of Quantose, the company’s blood test for prediabetes. The studies provided further evidence that the Quantose test identifies individuals at risk for type 2 diabetes earlier and more accurately than traditional risk factors alone.

The performance of Quantose was measured among 3,841 participants from the Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) and Botnia Prospective Study cohorts. Notably, among initially healthy participants in the RISC study with 3-year follow-up data:

  • Quantose biomarkers α-hydroxybutyrate (α-HB) and linoleoyl-glycerophosphocholine (L-GPC) independently and significantly predicted worsening glycemic control, and;
  • Quantose outperformed traditional risk measures such as fasting insulin, fasting glucose, BMI, and HOMA-IR in predicting insulin resistance and progression to impaired glucose tolerance.

In the Botnia Prospective Study with 9.5 year follow-up data:

  • Quantose biomarkers were found to predict incident type 2 diabetes independent of familial diabetes, sex, age, BMI, and fasting glucose.

These findings were published in two recent articles:

“Early Metabolic Markers of the Development of Dysglycemia and Type 2 Diabetes and Their Physiological Significance”, Diabetes; Ferrannini, Gall, et.al.; 2013; 62(5): 1730.

“A Novel Fasting Blood Test for Insulin Resistance and Prediabetes” Journal of Diabetes Science and Technology; Ferrannini, Cobb, et.al.; 2013; 7(1): 100.

The Quantose test reflects insulin resistance and detects progression to prediabetes and diabetes earlier than traditional glycemic measures such a hemoglobin A1C. The test is particularly useful in identifying prediabetic patients at greatest risk of disease progression and for whom drug, or other interventional therapy, may be appropriate. Diagnostic assessment with the Quantose test is well-aligned with the American Diabetes Association guidelines which recommend that physicians consider pharmaceutical intervention in high-risk prediabetics.

Beyond its immediate impact on the treatment of prediabetes, Quantose offers convincing evidence of the maturation of the field of metabolomics — and of the potential influence the discovery of novel metabolomic biomarkers will have on personalized medicine. Metabolon is committed to utilizing its systematic metabolomics discovery approach to develop diagnostics in the areas of metabolic, cancer and cardiovascular disease and provide biomarker research services by employing their high-throughput, advanced metabolomics platform.

“These studies are clear affirmation of Quantose value to predict early those individuals at risk for eventual onset of Type 2 diabetes which may provide clinicians the opportunity for treatment interventions that may reverse the prediabetic state.”, Eric Button, Senior Vice President of Diagnostics, Metabolon commented. Eric and other biomarker discovery experts from Metabolon will be present on July 22-24th at the 73rd Scientific Sessions of the American Diabetes Association. Visit booth #776 for more information regarding these studies or schedule an appointment with an expert to learn more about the Quantose test.

Study: Early Metabolic Markers of the Development of Dysglycemia and Type 2 Diabetes and Their Physiological Significance

Study: A Novel Fasting Blood Test for Insulin Resistance and Prediabetes

Source: Metabolon