METHODS OF DETECTING SJOGREN'S SYNDROME USING SALIVARY EXOSOMES
The present disclosure is directed to methods of using salivary exosomes to detect and treat Sjögren's syndrome in a subject.
1 . A method of identifying the presence or absence of Sjögren's syndrome in a subject, the method comprising:
a) determining the expression level of at least one of seven biomarkers in microvesicular RNA isolated from a saliva sample from the subject,
wherein the seven biomarkers comprise IFIT3, OAS1, OAS2, IFIT1, TMEM60, ZNF395 and CPNE2; and
b) identifying the presence of Sjögren's syndrome in the subject based on the expression level of the at least one biomarker.
2 . The method of claim 1 , wherein identifying the presence of Sjögren's syndrome in the subject based on the expression level of the at least one biomarker comprises:
i) inputting the expression levels from step (a) into an algorithm to generate a score;
ii) comparing the score to a predetermined cutoff value; and
iii) determining the presence or absence of Sjögren's syndrome in the subject based on comparison between the score and the predetermined cutoff value.
3 . The method of claim 2 , wherein the algorithm is the product of a feature selection wrapper algorithm, a machine learning algorithm, a trained classifier built from at least one predictive classification algorithm or any combination thereof.
4 . The method of claim 3 , wherein the predictive classification algorithm, the feature selection wrapper algorithm, and/or the machine learning algorithm comprises XGBoost (XGB), random forest (RF), Lasso and Elastic-Net Regularized Generalized Linear Models (glmnet), Linear Discriminant Analysis (LDA), cforest, classification and regression tree (CART), treebag, k nearest-neighbor (knn), neural network (nnet), support vector machine-radial (SVM-radial), support vector machine-linear (SVM-linear), naïve Bayes (NB), multilayer perceptron (mlp), Boruta or any combination thereof.
5 . The method of claim 4 , wherein the algorithm is the product of a trained classifier is trained to identify Sjögren's syndrome in a subject using:
i) the expression level of the at least one biomarker in at least one biological sample from at least one subject who does not have Sjögren's syndrome; and
ii) the expression levels of the at least one biomarker in at least one biological sample from at least one subject who has Sjögren's syndrome.
6 . The method of claim 1 , wherein:
i) the at least one biomarker is at least one of IFIT3, OAS1, OAS2, IFIT1, TMEM60 and CPNE2, wherein the presence of Sjögren's syndrome in the subject is identified when the expression level of the at least one biomarker is greater than or equal to a predetermined cutoff value; and/or
ii) the at least one biomarker is ZNF395, wherein the presence of Sjögren's syndrome in the subject is identified when the expression level of the at least one biomarker is less than or equal to a predetermined cutoff value
7 . The method of any one of the preceding claims , wherein step (a) comprises determining the expression level of:
a) at least two of the seven biomarkers;
b) at least three of the seven biomarkers;
c) at least four of the seven biomarkers;
d) at least five of the seven biomarkers;
e) at least six of the seven biomarkers; or
f) each of the seven biomarkers.
8 . The method of any of the preceding claims , further comprising prior to step (a):
i) isolating a plurality of microvesicles from the saliva sample from the subject; and
ii) extracting at least one microvesicular RNA from the plurality of isolated microvesicles.
9 . The method of any of the preceding claims , wherein the at least one microvesicle is isolated from the saliva sample by contacting the saliva sample with at least one affinity agent that binds to at least one surface marker present on the surface the at least one microvesicle.
10 . The method of any of the preceding claims , wherein step (a) further comprises:
(i) determining the expression level of at least one reference biomarker;
(ii) normalizing the expression level of the at least one biomarker to the expression level of the at least one reference biomarker.
11 . The method of any of the preceding claims , wherein inputting the expression levels from step (a) into an algorithm to generate a score comprises inputting the normalized expression levels from step (a) into an algorithm to generate a score.
12 . The method of any of the preceding claims , wherein determining the expression level of a biomarker comprises quantitative PCR (qPCR), quantitative real-time PCR, semi-quantitative real-time PCR, reverse transcription PCR (RT-PCR), reverse transcription quantitative PCR (qRT-PCR), digital PCR (dPCR), microarray analysis, sequencing, next-generation sequencing (NGS), high-throughput sequencing, direct-analysis or any combination thereof.
13 . The method of claim 12 , wherein determining the expression level of a biomarker comprises sequencing, next-generation sequencing (NGS), high-throughput sequencing or any combination thereof, wherein at least about 70%, or at least about 75%, or at least about 80%, or at least about 85%, or at least about 90%, or at least about 95%, or at least about 99%, or at least about 99.5% of the sequencing reads obtained by the sequencing, next-generation sequencing (NGS), high-throughput sequencing, direct-analysis or any combination thereof correspond to subject's transcriptome.
14 . The method of any of the preceding claims , wherein the predetermined cutoff value has a negative predictive value of at least about 80%, or at least about 85%, or at least about 90%, or at least about 95%, or at least about 99%, or at least about 99.9%.
15 . The method of any of the preceding claims , wherein the predetermined cutoff value has a positive predictive value of at least about 80%, or at least about 85%, or at least about 90%, or at least about 95%, or at least about 99%, or at least about 99.9%.
16 . The method of any of the preceding claims , wherein the predetermined cutoff value has a sensitivity of at least about 80%, or at least about 85%, or at least about 90%, or at least about 95%, or at least about 99%, or at least about 99.9%.
17 . The method of any of the preceding claims , wherein the predetermined cutoff value has a specificity of at least about 80%, or at least about 85%, or at least about 90%, or at least about 95%, or at least about 99%, or at least about 99.9%.
18 . The method of any of the preceding claims , wherein the predetermined cutoff value is calculated using at least one receiver operating characteristic (ROC) curve.
19 . The method of any of the preceding claims , wherein measuring expression levels in step (a) further comprises selectively enriching for at least one biomarker.
20 . The method of any of the preceding claims , wherein the at least one biomarker is selectively enriched by hybrid-capture, preferably wherein:
i) the hybrid-capture substantially enriches nucleic acid transcripts that correspond to the human transcriptome such that at least about 70%, or at least about 75%, or at least about 80%, or at least about 85%, or at least about 90%, or at least about 95%, or at least about 99%, or at least about 99.5% of enriched nucleic acid transcripts correspond to the human transcriptome; and/or
ii) the hybrid-capture results in a significant depletion in microbial nucleic acids
21 . The method of any of the preceding claims , further comprising administering at least one treatment to a subject identified as having Sjögren's syndrome.
22 . The method of claim 23 , wherein the at least one treatment comprises:
i) administering at least one therapeutically effective amount of an cevimeline (Evoxac®) pilocarpine (Salagen®), a supersaturated calcium phosphate rinse (e.g. NeutraSal®), cyclosporine (including ophthalmic emulsions, e.g. Restasis® and Cequa™), tacrolimus eye drops, abatacept (Orencia®), rituximab (Rituxan®), tocilizumab (Actemra®), hydroxypropyl cellulose (Lacrisert®), lifitegrast (including ophthalmic solutions, e.g. Xiidra®), LO2A eye drops, rebamipide eye drops, topical autologous serum, intravenous immunoglobulins, dexamethasone eye drops (Maxidex™), an immunosuppressive medication, a nonsteroidal anti-inflammatory medication, an arthritis medication, an antifungal medication, hydroxychloroquine (Plaquenil), methotrexate (Trexall), LOU064, INCB050465 or any combination thereof,
ii) surgery, preferably wherein the surgery comprises sealing the tear ducts of the subject; or
iii) a combination thereof.
23 . The method of any of the preceding claims , wherein the saliva sample is collected at the subject's home through the use of a sample home-collection device.