Methods for diagnosing and treating inflammatory bowel disease
Biomarkers predictive of responsiveness to integrin beta7 antagonists, including anti-beta7 integrin subunit antibodies, and methods of using such biomarkers are provided. In addition, methods of treating gastrointestinal inflammatory disorders such as inflammatory bowel diseases including ulcerative colitis and Crohn's disease are provided. Also provided are methods of using such predictive biomarkers for the treatment of inflammatory bowel diseases including ulcerative colitis and Crohn's disease.
1. A method of treating a patient having a gastrointestinal inflammatory disorder, the method comprising: (a) measuring the mRNA expression level of VNN2 in a biological sample from the patient; (b) comparing the mRNA expression level of VNN2 measured in (a) to a reference level for VNN2; (c) identifying the patient as likely to have a response to a therapy comprising an integrin beta7 antagonist based on the detection of a lower level of mRNA expression of VNN2 in the biological sample as compared to the reference level for VNN2; and (d) administering to the patient the therapy.
2. The method of claim 1 , wherein 105 mg of the integrin beta7 antagonist is administered subcutaneously once every four weeks.
3. The method of claim 1 , wherein an initial dose of 210 mg of the integrin beta7 antagonist is administered subcutaneously followed by a first subsequent dose of 210 mg of the integrin beta7 antagonist administered subcutaneously two weeks after the initial dose, a second subsequent dose of 210 mg of the integrin beta7 antagonist administered subcutaneously four weeks after the initial dose, a third subsequent dose of 210 mg of the integrin beta7 antagonist administered subcutaneously eight weeks after the initial dose, and a fourth subsequent dose of 210 mg of the integrin beta7 antagonist administered subcutaneously twelve weeks after the initial dose.
4. The method of claim 1 , wherein the gastrointestinal inflammatory disorder is an inflammatory bowel disease.
5. The method of claim 4 , wherein the inflammatory bowel disease is ulcerative colitis or Crohn's disease.
6. The method of claim 5 , wherein the inflammatory bowel disease is ulcerative colitis and the response is selected from the group consisting of clinical response, mucosal healing and remission.
7. The method of claim 1 , wherein the biological sample is selected from the group consisting of intestinal tissue and peripheral whole blood.
8. The method of claim 1 , wherein the mRNA expression level is measured by an RNA sequencing method, microarray or a PCR method.
9. The method of claim 8 , wherein the PCR method comprises qPCR.
10. The method of claim 1 , wherein the measuring comprises amplifying VNN2 mRNA and detecting the amplified VNN2 mRNA, thereby measuring the level of the amplified VNN2 mRNA.
11. The method of claim 1 , wherein each of the reference levels is a median value.
12. The method of claim 1 , wherein the patient is not previously treated with an anti-TNF therapeutic agent.
13. The method of claim 6 , wherein administration of the integrin beta7 antagonist results in one or more of the following: (1) a 3-point decrease and 30% reduction from baseline in MCS and ≥1-point decrease in rectal bleeding subscore or absolute rectal bleeding score of 0 or 1, (2) an endoscopic subscore of 0 or 1, (3) MCS≤2 with no individual subscore>1.
14. The method of claim 1 , wherein the integrin beta7 antagonist is a monoclonal anti-beta7 antibody or an antigen-binding fragment thereof.
15. The method of claim 14 , wherein the anti-beta7 antibody is selected from the group consisting of a chimeric antibody, a human antibody, and a humanized antibody.
16. The method of claim 14 , wherein the anti-beta7 antibody or antigen-binding fragment thereof comprises three heavy chain hypervariable region (HVR-H1-H3) sequences and three light chain hypervariable region (HVR-L1-L3) sequences, wherein: (i) the HVR-L1 comprises the amino acid sequence set forth in SEQ ID NO:9; (ii) the HVR-L2 comprises the amino acid sequence set forth in SEQ ID NO:2; (iii) the HVR-L3 comprises the amino acid sequence set forth in SEQ ID NO:3; (iv) the HVR-H1 comprises the amino acid sequence set forth in SEQ ID NO:4; (v) the HVR-H2 comprises the amino acid sequence set forth in SEQ ID NO:5; and (vi) the HVR-H3 comprises the amino acid sequence set forth in SEQ ID NO:19.
17. The method of claim 16 , wherein the anti-beta7 antibody or antigen-binding fragment thereof comprises a variable light chain comprising the amino acid sequence set forth in SEQ ID NO:31 and a variable heavy chain comprising the amino acid sequence set forth in SEQ ID NO:32.
18. The method of claim 17 , wherein the anti-beta7 antibody is etrolizumab.
19. The method of claim 1 , further comprising:
(i) measuring the mRNA expression level of at least one, at least two, or at least three Low Expression Predictive Genes (“LEPG”) selected from the group consisting of SLC8A3, TNFSF15, BEST2, CCL2, CCL3, CCL3L1/3, CPA3, FGF7, HAMP, IL1A, IL18RAP, INHBA, LIF, LMO4, LRRC4, MLK7.AS1, MT1M, MUCL1, MX1, PMCH, REM2, SSTR2, TM4SF4, TMEM154, UROS, and VNN3 in the biological sample;
(ii) comparing the mRNA expression level of each of the LEPG measured in (i) to a reference level for each of the respective LEPG (“respective LEPG reference level”); and
(iii) predicting that the patient will likely respond to the therapy when the mRNA expression level of VNN2 measured in (a) is below the reference level for VNN2, and the mRNA expression level of each of the LEPG measured in (i) is below the respective LEPG reference level.
20. The method of claim 1 , further comprising:
(aa) measuring the mRNA expression level of at least one, at least two, at least three, or at least four High Expression Predictive Genes (“HEPG”) selected from the group consisting of GZMA, KLRB1, FOXM1, CCDC90A, CCL4, CPA2, CXCR6, DDO, ECH1, FAM125B, FASLG, FGF9, GPR15, GZMB, KCNMA1, PHF14, TIFAB, TMEM200A, TMIGD2, and SLC8A3 in the biological sample;
(ab) comparing the mRNA expression level detected (aa) to a reference level for each of the respective HEPG (“respective HEPG reference level”); and
(ac) predicting that the patient will likely respond to the therapy when the mRNA expression level of VNN2 measured in (a) is below the reference level for VNN2, and the mRNA expression level of each of the HEPG measured in (aa) is above to the respective HEPG reference level.
21. The method of claim 20 , wherein the respective HEPG reference level is a median value.
22. The method of claim 19 , wherein the measuring comprises amplifying one or more of SLC8A3, TNFSF15, BEST2, CCL2, CCL3, CCL3L1/3, CPA3, FGF7, HAMP, IL1A, IL18RAP, INHBA, LIF, LMO4, LRRC4, MLK7.AS1, MT1M, MUCL1, MX1, PMCH, REM2, SSTR2, TM4SF4, TMEM154, UROS, and VNN3 mRNA and detecting the amplified mRNA, thereby measuring the level of the amplified mRNA.
23. The method of claim 20 , wherein the at least one, at least two, at least three, or at least four HEPG are selected from the group consisting of GZMA, KLRB1, FOXM1, SLC8A3, and ECH1.
24. The method of claim 19 , wherein the at least one, at least two, or at least three LEPG are selected from the group consisting of SLC8A3, TNFSF15, BEST2, and CCL2.
25. The method of claim 20 , wherein the measuring comprises amplifying one or more of GZMA, KLRB1, FOXM1, CCDC90A, CCL4, CPA2, CXCR6, DDO, ECH1, FAM125B, FASLG, FGF9, GPR15, GZMB, KCNMA1, PHF14, TIFAB, TMEM200A, TMIGD2, SLC8A3 mRNA, and detecting the amplified mRNA, thereby measuring the level of the amplified mRNA.
26. The method of claim 19 , wherein the respective LEPG reference level is a median value.