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TITLE
EXPRESSION PROFILES OF PERIPHERAL BLOOD MONONUCLEAR
CELLS FOR INFLAMMATORY BOWEL DISEASES
[0001] This application claims the benefit of priority from U.S. Provisional
Patent Application No. 60/687,331, filed June 6,2005, and U.S. Provisional
Patent Application No. 60/692,295, filed June 20,2005; the contents of both
applications are hereby incorporated by reference herein in their entireties.
BACKGROUND OF THE INVENTION
Field of the Invention
[0002] The invention is directed to the analysis of expression profiles of
peripheral blood mononuclear cells (PBMCs) isolated from patients with
inflammatory bowel disease and the identification of PBMC transcriptional gene
signatures capable of distinguishing between patients suffering from one of two
types of inflammatory bowel disease, i.e., Crohn's disease and ulcerative colitis.
Related Background Art
[0003] Ulcerative colitis (UC) and Crohn's disease (CD) are two common,
chronic, and relapsing inflammatory bowel diseases (IBDs) that share several
demographic and clinical characteristics. However, UC and CD present key

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differences in tissue damage, which suggests distinct etiopathogenic processes for
the two diseases. One proposed etiology of IBD in general is the inappropriate
activation of the mucosal immune system against normal intestinal luminal
bacterial flora (Podolsky (2002) N. Engl. J. Med. 347:417-29). A transmural,
granulomatous inflammatory process associated with Thl-type responses is
characteristic of CD, whereas inflammation in UC tends to be limited to the
mucosa and contains large numbers of immunoglobulin-secreting plasma cells
that appear to be associated with Th2 responses (Podolsky, supra). Both diseases
are complex disorders in which a combination of environmental and genetic
factors may determine the susceptibility of an individual to disease (Bouma and
Strober (2003) Nat. Rev. Immunol. 3:521-33).
[0004] The ability to quantitate the global expression profiles at the level of
RNA using oligonucleotide microarrays has recently been applied to investigate
transcriptional signatures present in surgically resected gastrointestinal tissue
obtained from CD and UC patients (Lawrance et al. (2001) Hum. Mol. Genet.
10:445-56; see also Warner and Dieckgraefe (2002) Inflamm. Bowel Dis. 8:140-
57). These studies identified genes involved in inflammatory responses generally
altered in IBD. Additionally, the studies showed that the gastrointestinal tissue
transcriptomes obtained from UC and CD patients are quite distinct, with gene
sets identified that appear to distinguish UC tissue from CD tissue.
[0005] In contrast to gastrointestinal tissue from surgical resections or biopsies,
peripheral blood is a much more accessible tissue source of cells that might be
used to distinguish between UC and CD. Circulating peripheral blood
mononuclear cells (PBMCs) are responsible for the comprehensive surveillance
of the body for signs of infection and disease. PBMCs may therefore serve as a
surrogate tissue for evaluation of disease-induced gene expression as a marker of
disease status or severity (for a general review see Rockett et al. (2004) Toxicol.
Appl. Pharmacol. 194:189-99). Maas and coworkers identified PBMC profiles
common to patients with autoimmune diseases such as rheumatoid arthritis,
systemic lupus erythematosus, type I diabetes, and multiple sclerosis (Maas et al.
(2002) J. Immunol. 169:5-9). Twine and coworkers have shown that, in the
context of anonautoimmune disease, PBMCs obtained from renal cell carcinoma
(RCC) patients exhibit disease-associated transcriptomes distinct from those of

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healthy volunteers (Twine et al. (2003) Cancer Res. 63:6069-75). Mannick and
coworkers recently explored expression profiles of PBMCs from seven CD
patients and five UC patients with a 2400 gene cDNA microarray and described
several genes that appear differentially expressed between these diseases
(Mannick et al. (2004) Clin. Immunol. 112:247-57); previously, other genes were
reported as regulated in peripheral blood mononuclear cells of Crohn's patients at
the mRNA level (Gijsbers et al. (2004) Eur. J. Immunol. 34:1992-2000; Hori et
al. (2002) J. Gastroenterol. Hepatol. 17:1070-77; Gonsky et al. (1998) J]
Immunol. 160: 4914-22).
[O006] Although peripheral inflammatory components are proposed to be
involved in both forms of IBD, the transcriptional gene profiles of circulating
PBMCs from, healthy patients and patients with histologically verified diagnoses
of IBD, either in the form of CD or UC, have not yet been successfully used to
develop gene classifiers that allow distinction between disorders. To date, the
ability of PBMC-associated transcriptomes to diagnose IBD and/or differentiate
between CD and UC has been unknown in the art.
[0007] The present invention solves this problem by determining whether gene
expression patterns in PBMCs of patients with CD and UC are sufficiently
distinct to enable their classification on the basis of gene expression profiles in
PBMCs alone, and by providing PBMC- and IBD-associated transcriptional gene
expression patterns that may be used to distinguish patients with IBD from
healthy subjects, and optionally, patients with CD from patients with UC. Thus,
the diagnosis, prognosis, and/or monitoring of inflammatory bowel disease,
and/or of different forms of IBD, i.e., CD and UC, may be assisted by the
relatively noninvasive methods of the invention involving the transcriptional
profiling of peripheral blood mononuclear cells from patients.
SUMMARY OF THE INVENTION
[0008] In one aspect, the present invention is based on the identification and
categorization of a number of PBMC- and IBD-associated biomarkers (e.g., the
PBMC- and IBD-associated biomarkers listed in Tables 1-4, which are
differentially expressed in 1) PBMCs of patients with inflammatory bowel
disease compared to PBMCs of subjects substantially free of IBD, e.g., healthy

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subjects, 2) PBMCs of patients with Crohn's disease compared to PBMCs of
subjects substantially free of IBD, e.g., healthy subjects, 3) PBMCs of patients
with ulcerative colitis compared to PBMCs of subjects substantially free of IBD,
e.g., healthy subjects, and 4) PBMCs of patients with Crohn's disease compared
to patients with ulcerative colitis, respectively). The PBMC- and IBD-associated
biomarkers provided by the invention and listed in Tables 1-4 are also
categorized into Group I, Group II, Group III, and Group IV, respectively, based
on whether they may be optimally used to diagnose, prognose, or monitor the
progress of 1) a patient with IBD in the form of either Crohn's disease or
ulcerative colitis (Group I biomarkers; also referred to herein as a set of
"common biomarkers"); 2) a patient with Crohn's disease (Group II biomarkers;
also referred to herein as a set of "CD biomarkers"); or 3) a patient with
ulcerative colitis (Group III biomarkers; also referred to herein as a set of "UC
biomarkers"); and/or optimally used to differentiate whether a patient with IBD
has Crohn's disease or ulcerative colitis (Group IV; also referred to herein as a
set of "CDvUC biomarkers"). In addition, the PBMC- and IBD-associated
biomarkers listed in Table 5 and categorized as Group V biomarkers (also
referred to herein as a set of "classifying biomarkers") may also be used to
distinguish a patient with Crohn's disease from a patient with ulcerative colitis.
These PBMC- and IBD-associated biomarkers may, in turn, also be components
of IBD disease pathways, and thus, may serve as novel therapeutic targets for
treatment of inflammatory bowel disease, i.e., Crohn's disease or ulcerative
colitis.
[0009] Accordingly, the present invention pertains to polynucleotides, the
polypeptides they encode, and fragments, homologs and isoforms thereof, as
PBMC- and IBD-associated biomarkers (which may be categorized as Group I,
Group II, Group III, Group IV, and/or Group V biomarkers) for inflammatory
bowel disease, Crohn's disease, and/or ulcerative colitis. The invention also
pertains to the use of antibodies directed against the PBMC- and IBD biomarkers
of the invention, arrays comprising the biomarkers of the invention, and/or assays
involving the biomarkers of the invention (e.g., microarray assays, Q-PCR
assays, nucleic reporter assays, etc.). Additionally, the present invention pertains
to the use of expression profiles of these PBMC- and IBD-associated biomarkers

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to indicate the presence of, or a risk for, inflammatory bowel disease, Crohn's
disease and/or ulcerative colitis. With respect to an inflammatory bowel disease,
Crohn's disease, and/or ulcerative colitis, these PBMC- and IBD-associated
biomarkers are also useful to correlate differences in levels of expression with a
poor or favorable prognosis. The PBMC- and IBD-associated biomarkers may
also be useful for assessing the efficacy of a treatment or therapy for an IBD.
With respect to treatment for an IBD, e.g., Crohn's disease, ulcerative colitis,
etc., the PBMC- and IBD-associated biomarkers of the invention may also be
useful to screen for test compounds capable of ameliorating an IBD, and/or as
therapeutic agents themselves.
[0010] In one aspect, the invention provides PBMC- and IBD-associated
biomarkers whose level of expression, which signifies their quantity or activity, is
correlated with the presence of inflammatory bowel disease, e.g., Crohn's disease
or ulcerative colitis. The PBMC- and IBD-associated biomarkers of the
invention may be polynucleotides (e.g., DNA, cDNA, rnRNA), the polypeptides
encoded by such polynucleotides, and fragments, homologs, and isoforms of such
polynucleotides or polypeptides. In certain embodiments, the methods of the
invention are performed by detecting the presence of a transcribed
polynucleotide, or a portion thereof, wherein the transcribed polynucleotide
comprises a PBMC- and IBD-associated biomarker. Alternatively, detection may
be performed by detecting the presence of a protein, which corresponds to (i.e., is
encoded by) the PBMC- and IBD-associated biomarker gene or RNA species.
These methods may also be performed on the protein level; that is, protein
expression levels of the PBMC- and IBD-associated biomarker proteins can be
evaluated for diagnostic, prognostic and/or monitoring purposes, or to screen test
compounds, or as therapeutic agents.
[0011] In some embodiments, panels comprising more than one PBMC- and
IBD-associated biomarker(s) are used in the methods of the invention. In one
embodiment, the invention provides a panel comprising a plurality of PBMC- and
IBD-associated biomarkers. In one embodiment, a panel of the invention
comprises at least two PBMC- and IBD-associated biomarkers. In one
embodiment, a panel of the invention comprises at least three PBMC- and IBD-
associated biomarkers. In one embodiment, a panel of the invention comprises at

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least four PBMC- and IBD-associated biomarkers. In one embodiment, a panel
of tbe invention comprises at least five PBMC- and IBD-associated biomarkers.
In one embodiment, a panel of the invention comprises at least six PBMC- and
IBD-associated biomarkers. In one embodiment, a panel of the invention
comprises at least seven PBMC- and IBD-associated biomarkers. In one
embodiment, a panel of the invention comprises at least eight PBMC- and IBD-
associated biomarkers. In one embodiment, a panel of the invention comprises at
least nine PBMC- and IBD-associated biomarkers. In one embodiment, a panel
of the invention comprises at least ten PBMC- and IBD-associated biomarkers.
In one embodiment, a panel of the invention comprises at least eleven PBMC-
and IBD-associated biomarkers. In one embodiment, a panel of the invention
comprises at least twelve PBMC- and IBD-associated biomarkers. In other
embodiments, the panel of biomarkers comprises common biomarkers, CD
biomarkers, UC biomarkers, CDvUC biomarkers, and/or classifying biomarkers.
Panels of biomarkers comprising biomarkers selected from Group I biomarkers,
Group II biomarkers, Group III biomarkers, Group IV biomarkers, and/or
Group V biomarkers are also provided. A skilled artisan will recognize that a
panel of the invention may comprise any number and any combination of PBMC-
and IBD- associated biomarkers of the invention, particularly the Group V
biomarkers of the invention. Thus, in other nonlimiting embodiments of the
invention, a panel of the invention comprises at least two, at least three, at least
four, at least five, at least six, at least seven, at least eight, at least nine, at least
ten, at least eleven, or at least twelve classifying biomarkers, e.g., the classifying
biomarkers of Group V.. For example, a nonlimiting panel of the invention may
comprise the immunoglobulin heavy constant gamma 1 and immunoglobulin
kappa constant biomarkers. Another nonlimiting panel of the invention may
comprise the human 28S ribosomal RNA 5'region, protein tyrosine phosphatase
receptor type C-associated protein, H3 histone family member K, integrin beta 3
(platelet glycoprotein Ilia, antigen CD61), and H2B histone family member Q
biomarkers. Another nonlimiting panel of the invention may comprise the
immunoglobulin heavy constant gamma 1, granzyme K, mutL homolog 3,
lipocalin 2, CXCL5, serum deprivation response phosphatidylserine binding
protein, and H3 histone family member K biomarkers. In one embodiment, a

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panel of the invention provides at least 70% accuracy (more preferably, at least
80% accuracy, most preferably at least 90% accuracy) (a) in determining whether
a patient has (1) IBD in the form of either Crohn's disease or ulcerative colitis,
(2) Crohn's disease, and/or (3) ulcerative colitis, and/or (b) in distinguishing
whether a patient with IBD has Crohn's disease or ulcerative colitis. In another
aspect of the invention, the expression levels of more than one PBMC- and IBD-
associated biomarkers of the invention are determined in a particular subject
sample for which information is desired (e.g., for diagnosis, prognosis,
monitoring the course of treatment and/or disease, etc.).
[0012] In certain embodiments, a comparison of relative levels of expression of
at least one PBMC- and IBD-associated biomarker is indicative of the severity of
inflammatory bowel disease, Crohn's disease, and/or ulcerative colitis, and such a
comparison permits for diagnostic, prognostic, and monitoring analysis. For
example, comparison of expression of PBMC- and IBD-associated biomarker
profiles of various disease progression states for IBD (and/or either UC or CD)
provides a method for long-term prognosing, including the predicted duration of
an outbreak or episode of either of these diseases. In another example, the
evaluation of a particular treatment regimen may be evaluated, including whether
a particular drug will act to improve the long-term prognosis in a particular
patient.
[0013] A PBMC- and IBD-associated biomarker may also be useful as a target
for a treatment or therapeutic agent. Therefore, without limitation as to
mechanism, some of the methods of the invention are based, in part, on the
principle that regulation of the expression of the PBMC- and IBD-biomarkers of
the invention may ameliorate an inflammatory bowel disease when they are
expressed at levels similar or substantially similar to those of PBMCs isolated
from subjects substantially free of IBD, e.g., healthy subjects. The discovery of
these differential expression patterns for individual PBMC- and IBD-associated
biomarkers, or panels of such biomarkers, allows for screening of test compounds
with the goal of regulating a particular expression pattern; for example, screening
can be done for compounds that will convert an expression profile for a poor
prognosis to one for a better or improved prognosis.

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[0014] In relation to these embodiments, some PBMC- and IBD-associated
biomarkers may comprise biomarkers that are determined to have modulated
activity or expression in response to a therapy regimen. Alternatively, the
modulation of the activity or expression of a PBMC- and IBD-associated
biomarker may be correlated with the diagnosis or prognosis of inflammatory
bowel disorder, Crohn's disease and/or ulcerative colitis. In addition, regulatory
agents of the invention, e.g., regulatory agents of at least one PBMC- and IBD-
associated biomarker (e.g., PBMC- and IBD-associated polynucleotides and/or
polypeptides, related PBMC- and IBD-associated polynucleotides and/or
polypeptides (e.g., inhibitory polynucleotides, inhibitory polypeptides (e.g., anti-
biomarkers antibodies)), small molecules, etc.) may be administered as
therapeutic drugs. In another embodiment of the invention, a regulatory agent of
the invention may be used in combination with one or more other therapeutic
compositions of the invention. Formulation of such compounds into
pharmaceutical compositions is described below. Administration of such a
therapeutic regulatory agent may regulate the aberrant expression of at least one
PBMC- and IBD-associated biomarker, and therefore may be used to ameliorate
or inhibit inflammatory bowel disease, Crohn's disease, and/or ulcerative colitis.
In another embodiment of the invention, one or more regulatory agents or other
therapeutic compositions of the invention may be used in combination with one
or more other known therapeutic agents or compositions.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] FIG. 1. Functional annotation and categories of transcripts identified as
CD-associated, UC-associated, and differentially expressed between UC and CD.
A) Shown are canonical pathways (x-axis) overrepresented in the CD versus
normal ANCOVA comparison (gray bars), the UC versus normal ANCOVA
comparison (black bars), and the UC versus CD ANCOVA comparison (white
bars). In these panels, the negative log of the p-value (y-axis) is plotted in order
to highlight more significant associations. The pathways interrogated (x-axis) are
as follows: (1) amyloid processing, (2) apoptosis signaling, (3) arginine and
proline metabolism, (4) B cell receptor signaling (normrmaunoglobulin), (5)
cardiac β-adrenergic signaling, (6) chemokine signaling, (7) death receptor

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signaling, (8) ERK7MAPK signaling, (9) fatty acid metabolism, (10) cell cycle
regulation (Gl/S), (11) cell cycle regulation (G2/M), (12) G protein-coupled
receptor signaling, (13) glutamate metabolism, (14) histidine metabolism, (15)
IGF-1 signaling, (16) IL-2 signaling, (17) IL-4 signaling, (18) inositol phosphate
metabolism, (19) insulin receptor signaling, (20) integrin signaling, (21)
interferon signaling, (22) JAK7STAT signaling, (23)NF-KB signaling, (24)
nitrogen metabolism, (25) p38 MAPK signaling, (26) PI3K/AKT signaling, (27)
PPAR signaling, (28) prostaglandin and leukotriene metabolism, (29) purine
metabolism, (30) pyrimidine metabolism, (31) starch and sucrose metabolism,
(32) T cell receptor signaling, (33) tryptophan metabolism, (34) tyrosine
metabolism, and (35) VEGF signaling. B) CD-specific transcripts in PBMCs
were functionally annotated using the Ingenuity pathway analysis system
(Ingenuity, Mountain View, CA); the relative distribution of transcripts in each of
the chosen functional categories for the CD-associated genes are presented in the
pie chart. C) UC-specific transcripts in PBMCs were functionally annotated
manually and the relative distribution of transcripts in immunoglobulin versus
nonimmunoglobulin categories is presented.
[00161 FIG. 2. Supervised class prediction of CD and UC using PBMC profiles.
A) The relative overall accuracy (■; y-axis), accuracy of CD classification (---;
y-axis), and accuracy of UC classification (▲; y-axis) for panels consisting of 2-
20 gene classifiers (x-axis) is shown. B) Shown are results of weighted voting
class assignment in the test set of samples. Confidence scores in favor of CD are
presented as positive values and confidence scores of the class assignments in
favor of UC are presented as negative values. The overall accuracy of class
assignment was 100% in the test set, where 14 of 14 Crohn's patients were
correctly classified as Crohn's, 6 of 6 UC patients were correctly classified as
UC, based solely upon expression patterns in PBMCs as obtained via microarray
analysis. The actual origins of the PBMC profiles are indicated (CD patients =
first fourteen white bars; UC patients = last six black bars).
[0017] FIG. 3. Real-time PCR confirmation of classifier transcript levels in CD
and UC sample sets. A) Shown are average fold elevation (y-axis) of gene
classifier transcripts (x-axis) detected as upregulated in CD as detected by
Affymetrix microarray hybridization (Affymetrix; white columns) or quantitative

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real time RT-PCR (TAQMAN®; black columns). B) Shown are average fold
elevation, (y-axis) of gene classifier transcripts (x-axis) detected as upregulated in
UC as detected by Affyrnetrix microarray hybridization (Affymetrix; white
columns) or quantitative real-time RT-PCR (TAQMAN®; black columns).
[00181 FIG. 4. Comparison of discrirninant and logistic analysis on
classification of patients with either Crohn's disease or Ulcerative colitis using
transcriptional profiles from Q-PCR analysis. Shown is the accuracy (y-axis) of
logistic analysis or discriminant analysis for (A) twenty training sets or
(B) twenty associated test sets.
DETAILED DESCRIPTION OF THE INVENTION
[0019] Although expression profile analysis of gastrointestinal tissue biopsies
have identified the presence of gastrointestinal-associated transcriptomes that
may be used to distinguish two inflammatory bowel diseases, i.e., Crohn's
disease (CD) or ulcerative colitis (UC), the required biopsy of gastrointestinal
tissue makes such methods of diagnosis unattractive. Compared to
gastrointestinal tissue biopsies, cells in the peripheral blood, in particular,
circulating peripheral blood mononuclear cells (PBMCs), are much more
accessible. Since PBMCs are responsible for the comprehensive surveillance of
the body for signs of infection and disease, and IBDs apparently involve
inflammatory processes, PBMCs may serve as surrogates to gastrointestinal
tissue for evaluation of tissue- and disease-associated transcriptomes that may be
useful for determining the status or severity of an IBD.
[0020] The present invention is directed to the utilization of at least one
"transcriptional gene signature" (also referred to herein as a "gene signature,"
"expression signature," "transcriptome," "profile," or "gene profile") of PBMCs,
i.e., PBMC-associated transcriptional gene signatures, i.e., expression profiles of
PBMCs, to determine whether a patient is suffering from an inflammatory bowel
disease. The present invention is also directed to the use of PBMC-associated
transcriptomes for the optional determination of whether a patient with IBD is
suffering from Crohn's disease or ulcerative colitis. The present invention is
based on the finding of PBMC-associated and IBD-associated, e.g., Crohn's
disease-associated and/or ulcerative colitis-associated, transcriptomes. In

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particular, the invention is based on the identification of PBMC- and IBD-
associated biomarkers, which may be categorized into five groups (Group I,
Group II, Group III, Group IV and Group V) based on their utility in the
diagnosis, prognosis, monitoring, and/or treatment of IBD, Crohn's disease
and/or ulcerative colitis.
[0021] As used herein, the term "biomarker," "gene classifier," or "PBMC- and
IBD-associated biomarker," or the like, includes a polynucleotide (e.g., gene,
transcript, EST, etc.) or polypeptide molecule that is substantially modulated (i.e.,
upregulated or downregulated) in quantity in peripheral blood mononuclear cells
of subjects with inflammatory bowel disease (i.e., Crohn's disease and/or
ulcerative colitis) as compared to a subject substantially free of IBD (e.g., a
healthy subject). In certain embodiments, the PBMC- and IBD-associated
biomarkers of the invention include the polynucleotides, their corresponding gene
products, and fragments, homologs and isoforms thereof, of Group I biomarkers
(also referred to as "common biomarkers"), Group II biomarkers (also referred to
as "Crohn's disease-associated biomarkers," "CD-associated biomarkers," "CD-
specific biomarkers," or "CD biomarkers"), Group III biomarkers (also referred
to as "ulcerative colitis-associated biomarkers," "UC-associated biomarkers,"
"UC-specific biomarkers" or "UC biomarkers"), Group IV biomarkers (also
referred to as "CDvUC biomarkers"), and Group V biomarkers (also referred to
as "classifying biomarkers").
[0022] A PBMC- and IBD-associated biomarker of the invention may be a
polynucleotide, its corresponding gene product, and fragments, homologs and
isoforms thereof, that is substantially modulated (i.e., upregulated or
downregulated) in PBMCs of patients with CD compared to PBMCs of subjects
substantially free of IBD, and/or in PBMCs of patients with UC compared to
PBMCs of subjects substantially free of IBD. In one embodiment, PBMC- and
IBD-associated biomarkers comprise the PBMC- and IBD-associated biomarkers
categorized as Group I common biomarkers.
[0023J PBMC- and IBD-associated biomarkers of the invention also include
Crohn's disease-associated biomarkers. As used herein, the term "Crohn's
disease-associated biomarker" or "CD biomarker" includes a polynucleotide, its
corresponding gene product, and fragments, homologs and isoforms thereof, that

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is substantially modulated (i.e., upregulated or downregulated) in quantity in
peripheral blood mononuclear cells of patients with Crohn's disease compared to
in PBMCs of subjects substantially free of IBD. Additionally, a CD biomarker is
not substantially modulated in peripheral blood mononuclear cells of patients
with ulcerative colitis compared to in PBMCs of subjects substantially free of
IBD. In certain embodiments, the Crohn's disease-associated biomarkers of the
invention include the PBMC- and IBD-associated biomarkers categorized as
Group II biomarkers, subsets of which may be found categorized within the lists
of Group IV and Group V biomarkers.
[0024] PBMC- and IBD-associated biomarkers of the invention also include
ulcerative colitis-associated biomarkers. As used herein, the term "ulcerative
colitis-associated biomarker" or "UC biomarker" includes a polynucleotide, its
corresponding product, and fragments, homologs and isoforms thereof, that is
substantially modulated (i.e., upregulated or downregulated) in quantity in
peripheral blood mononuclear cells of patients with ulcerative colitis compared to
PBMCs of subjects substantially free of IBD. Additionally, a UC biomarker is
not substantially modulated in quantity in peripheral blood mononuclear cells of
patients with Crohn's disease compared to PBMCs of subjects substantially free
of IBD. In certain embodiments, the ulcerative colitis-associated biomarkers of
the invention include the PBMC- and IBD-associated biomarkers categorized as
Group III biomarkers, subsets of which may be found categorized within the lists
of Group IV and Group V biomarkers.
[0025] PBMC- and IBD-associated biomarkers of the invention include CDvUC
biomarkers. As used herein, the term "CDvUC biomarker" includes a
polynucleotide, its corresponding gene product, and fragments, homologs and
isoforms thereof, that is substantially modulated (i.e., upregulated or
downregulated) in quantity in peripheral blood mononuclear cells of patients with
either ulcerative colitis or Crohn's disease, compared to PBMCs of subjects
substantially free of IBD, and that enables distinguishing peripheral blood
mononuclear cells isolated from a patient with Crohn's disease from peripheral
blood mononuclear cells isolated from a patient with ulcerative colitis. For
example, a CDvUC biomarker may be substantially modulated in subjects with
one inflammatory bowel disease, e.g., ulcerative colitis, compared to its

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expression in subjects with the other inflammatory bowel disease, e.g., Crohn's
disease. Alternatively, a CDvUC biomarker may be modulated in opposite
directions in subjects with one inflammatory bowel disease, e.g., ulcerative
colitis, compared to subjects with the other inflammatory bowel disease, e.g.,
Crohn's disease. In certain embodiments, the distinguishing CDvUC biomarkers
include the biomarkers of Group IV, a subset of which may be found categorized
within the list of Group V biomarkers.
[0026] PBMC- and IBD-associated biomarkers of the invention may be
categorized into smaller sets of CDvUC biomarkers, which are sets of classifying
biomarkers. As used herein, "a set of classifying biomarkers" includes a set of
polynucleotides, their corresponding gene products, and fragments, homologs and
isoforms thereof, that may be used to distinguish patients with Crohn's disease
and patients with ulcerative colitis. In certain embodiments, a set of classifying
biomarkers is the set categorized as Group V biomarkers.
[0027] Preferably, for the purposes of the present invention, expression levels of
the substantially modulated, i.e., upregulated or downregulated, PBMC- and
IBD-associated biomarkers of the invention are respectively increased or
decreased by an abnormal magnitude, wherein the level of expression is aberrant,
e.g., outside the standard deviation for the same PBMC- and IBD-associated
biomarker in PBMCs from healthy subjects. Most preferably, the substantially
modulated PBMC- and IBD-associated biomarker is upregulated or
downregulated relative to healthy subjects by at least an aberrant 1.5-, 2-, 3-, or
4-fold change or more.
[0028] The UniGene accession numbers, names of PBMC- and IBD-associated
biomarkers included as Group I, Group II, Group II, Group IV, and Group V
biomarkers, and the directions of their modulation (i.e., upregulation or
downregulation), are listed below in Table 1, Table 2, Table 3, Table 4, and
Table 5, respectively.

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These PBMC- and IBD-biomarkers have aberrant expression, e.g., are substantially upregulated
(t) or downregulated (4), in PBMCs of both patients with CD and patients with UC compared to
healthy patients.

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^These PBMC- and IBD-biomarkers have aberrant expression, e.g., are substantially upregulated
(t) or downregulated (I), only in PBMCs of patients with CD (i.e., not in PBMCs of patients with
UC) compared to healthy patients.

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3These PBMC- and IBD-biomarkers have aberrant expression, e.g., are substantially upregulated
(t) or downregulated (I), only in PBMCs of patients with UC (i.e., not in PBMCs of patients with
CD) compared to healthy patients.

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Table 4. PBMC- and IBD-associated Biomarkers of Group IV; CDvUC Biomarkers
Accession Name Specific to: Fold
Difference ANCOVA
p-value
Hs.90061 progesterone receptor membrane
component 1 Crohn's 2.08 2.55E-07
Hs.279843 mutL homolog 3 (E. coli) Crohn's 2.00 2.75E-08
Hs.88474 prostaglandin-endoperoxide synthase 1
(prostaglandin G/H synthase and
cyclooxygenase) Crohn's 1.93 1.18E-05
Hs.73769 folate receptor 1 (adult) Crohn's 1.93 6.82E-11
Hs.89714 chemokine (C-X-C motif) ligand 5 Crohn's 1.85 3.71E-05
Hs.83381 guanine nucleotide binding protein (G
protein), gamma 11 Crohn's 1.79 8.04E-06
Hs.2359 dual specificity phosphatase 4 Crohn's 1.76 5.30E-05
Hs.204238 lipocalin 2 (oncogene 24p3) Crohn's 1.75 4.35E-05
Hs.81564 platelet factor 4 (chemokine (C-X-C motif)
ligand 4) Crohn's 1.74 4.38E-06
Hs.l 19257 emsl sequence (mammary tumor and
squamous cell carcinoma-associated
(p80/85 src substrate) Crohn's 1.70 8.21E-05
Hs.26530 serum deprivation response
(phosphatidylserine binding protein) Crohn's 1.66 5.34E-07
Hs.303023 tubulin, beta 1 Crohn's 1.65 8.39E-05
Hs.23581 leptin receptor gene-related protein Crohn's 1.61 7.52E-05
Hs.249216 H2B histone family, member J Crohn's 1.61 6.91E-05
Hs.77439 protein kinase, cAMP-dependent,
regulatory, type II, beta Crohn's 1.59 4.09E-05
Hs.2178 H2B histone family, member Q Crohn's 1.57 8.85E-06
Hs.l 14231 C-type lectin-like receptor-2 Crohn's 1.57 8.79E-07
Hs.12813 DKFZP434J214 protein Crohn's 1.52 1.21E-05
Hs.2164 pro-platelet basic protein (chemokine (C-X-
C motif) ligand 7) Crohn's 1.51 2.90E-05
Hs.300697 immunoglobulin heavy constant gamma 3
(G3m marker) UC 3.87 9.28E-13
Hs.153261 immunoglobulin heavy constant mu UC 2.60 2.72E-05
n/a unknown EST with consensus to
immunoglobulin kappa orphon UC 2.42 5.66E-05
Hs.406565 immunoglobulin kappa constant UC 2.30 1.78E-06
n/a 28 S ribosomal KNA 5' region UC 2.11 2.95E-07
Hs.406565 immunoglobulin kappa constant UC 2.08 2.88E-08
Hs.406565 immunoglobulin kappa constant UC 2.04 3.52E-07
Hs.l 83125 killer cell lectin-like receptor subfamily F,
member 1 UC 2.02 5.45E-05
Hs.411106 perforin 1 UC 1.98 7.07E-05
Hs.153261 immunoglobulin heavy constant mu UC 1.93 3.78E-05
Hs.406565 immunoglobulin kappa constant UC 1.88 2.19E-06
Hs.406565 immunoglobulin kappa constant UC 1.87 8.32E-09
Hs.102950 coatomer protein complex, subunit gamma,
immunoglobulin lambda joining 3 UC 1.74 5.47E-05

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Table 4. PBMC- and IBD-associated Biomarkers of Group IV; CDvUC Biomarkers
Accession Name Specific to: Fold
Difference ANCOVA
p-value
Hs. 102950 coatomer protein complex, subunit gamma,
immunoglobulin lambda joining 3 UC 1.74 2.10E-05
Hs.406565 immunoglobulin kappa constant uc 1.72 2.57E-07
Hs.355888 phospholipase C, beta 2 UC 1.72 2.24E-05
Hs.8272 prostaglandin D2 synthase 21kDa (brain) uc 1.71 5.41E-05
Hs.25338 protease, serine, 23 uc 1.68 7.72E-05
Hs.381417 unknown EST with consensus to
immunoglobulin kappa light chain variable
region uc 1.67 3.86E-05
Hs-75596 interleukin 2 receptor, beta uc 1.65 7.19E-05
Hs.406565 immunoglobulin kappa constant uc 1.64 2.48E-06
Hs. 102950 coatomer protein complex, subunit gamma,
immunoglobulin lambda joining 3 uc 1.64 4.13E-05
Hs.406565 immunoglobulin kappa constant uc 1.63 4.95E-06
Hs.406565 immunoglobulin kappa constant uc 1.61 3.75E-08
Hs.380156 NK-receptor, killer cell irrununoglobulin-
like receptor, two domains, long
cytoplasmic tail, 3 uc 1.60 3.16E-08
Hs.405944 immunoglobulin lambda locus uc 1.59 1.55E-05
Hs.348935 immunoglobulin lambda-like polypeptide 1 uc 1.58 4.69E-05
Hs.84 interleukin 2 receptor, gamma (severe
combined immunodeficiency) uc 1.53 7.84E-05
Hs. 193128 homolog of C. elegans smu-1 uc 1.52 5.16E-05
Hs.238944 hypothetical protein FLJ10631 uc 1.52 3.72E-05

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Table 5: PBMC- and IBD-associated Biomarkers of Group V; Classifying Biomarkers
Classifier
Gene Class Name Unigene
ID
1 Crohn's Lipocalin 2 (oncogene 24p3) iHs.204238
2 Crohn's mutL homolog 3 (E. coli) Hs.279843
3 Crohn's serum deprivation response (phosphatidylserine binding protein) Hs.26530
4 Crohn's H2B histone family, member Q Hs.2178
5 Crohn's H3 histone family, member K Hs.70937
6 Crohn's chemokine (C-X-C motif) ligand 5 Hs.89714
7 Crohn's integrin, beta 3 (platelet glycoprotein Ilia, antigen CD61) Hs.87149
8 UC immunoglobulin heavy constant gamma 3 (G3m marker; IgHg3)
also referred to herein as immunoglobulin heavy constant
gamma 1 Hs.300697
9 UC immunoglobulin kappa constant Hs.406565
10 UC M27830 Human 28S ribosomal RNA gene 5' region n/a
11 UC protein tyrosine phosphatase, receptor type, C-associated protein Hs.155975
12 UC granzyme K (serine protease, granzyme 3; tryptase II) Hs.3066
13 UC immunoglobulin kappa constant Hs.406565
14 UC immunoglobulin kappa constant Hs.406565
Sources of PBMC- and IBD-associated Biomarkers
[0029] The polynucleotide and polypeptide of a PBMC- and IBD-associated
biomarker of the invention may be isolated from any tissue or cell of a subject
expressing the PBMC- and IBD-associated biomarker. In a preferred,
nonlimiting embodiment, the tissue is from blood (or, e.g., serum, plasma, blood
cells), lymph nodes, saliva, stomach, or intestine. The tissue samples containing
one or more of the PBMC- and IBD-associated biomarkers themselves may be
useful in the methods of the invention, and one skilled in the art will be cognizant
of the methods by which such samples may be conveniently obtained, stored
and/or preserved. However, it will be apparent to one skilled in the art that
blood, in particular, PBMCs, would serve as a preferred source from which the
expression of PBMC- and IBD-associated biomarkers of the invention are
assessed in the provided methods of diagnosing, prognosing, and/or monitoring
the progress of an IBD, i.e., CD or UC.
Isolated PBMC- and IBD-associated Biomarker Polynucleotides
[0030] The present invention provides isolated polynucleotides and polypeptides
as PBMC- and IBD-associated biomarkers. Preferred nucleotide sequences of the
invention include genomic, cDNA, mRNA, siRNA, and chemically synthesized
nucleotide sequences.

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[0031] Exemplary PBMC- and IBD-associated biomarkers of the invention are
listed in Tables 1-5. The invention encompasses the polynucleotide sequences of
the PBMC- and IBD-associated biomarkers listed in Tables 1-5. Polynucleotides
of the present invention also include polynucleotides that hybridize under
stringent conditions to the polynucleotides sequences of the PBMC- and IBD-
associated biomarkers listed in Tables 1-5, or their complements, and/or encode
polypeptides that retain substantial biological activity (i.e., active fragments) of
the PBMC- and IBD-associated biomarkers listed in Tables 1-5. Polynucleotides
of the present invention also include continuous portions of the polynucleotide
sequences of the PBMC- and IBD-associated biomarkers listed in Tables 1-5
comprising at least 21 consecutive nucleotides.
[0032] The invention further encompasses the polypeptides of the PBMC- and
IBD-associated biomarkers listed in Tables 1-5. Polypeptides of the present
invention also include continuous portions of the polypeptides of the PBMC- and
IBD-associated biomarkers listed in Tables 1-5 comprising at least 7 consecutive
amino acids. A preferred embodiment of the invention includes any continuous
portion of any of the polypeptides of the PBMC- and IBD-associated biomarkers
selected from those listed in Tables 1-5 that retains substantial biological activity
of the selected polypeptide.
[0033] The invention further encompasses polynucleotide molecules that differ
from the polynucleotide sequences of the PBMC- and IBD-associated biomarkers
listed in Tables 1-5 only due to the well-known degeneracy of the genetic code,
and which thus encode the same proteins as those encoded by the PBMC- and
IBD-associated biomarkers listed in Tables 1-5.
[0034] The polynucleotides encompassed by the present invention may be used
as hybridization probes and primers to identify and isolate nucleic acids having
sequences identical to or similar to those encoding the disclosed polynucleotides.
Hybridization methods for identifying and isolating nucleic acids include
polymerase chain reaction (PCR), Southern hybridization, in situ hybridization,
and Northern hybridization, and are well known to those skilled in the art.
[0035] Hybridization reactions can be performed under conditions of different
stringency. The stringency of a hybridization reaction includes the difficulty with
which any two nucleic acid molecules will hybridize to one another. The present

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invention also includes polynucleotides capable of hybridizing under reduced
stringency conditions, more preferably stringent conditions, and most preferably
highly stringent conditions, to polynucleotides described herein. Examples of
stringency conditions are shown in Table 6 below: highly stringent conditions are
those that are at least as stringent as, for example, conditions A-F; stringent
conditions are at least as stringent as, for example, conditions G-L; and reduced
stringency conditions are at least as stringent as, for example, conditions M-R.
Table 6. Stringency Conditions

Stringency
Condition Poly-
nucleotide
Hybrid Hybrid
Length
(bpV Hybridization Temperature and
Buffer2 Wash
Temperature and
Buffer2
A DNA.-DNA >50 65°C; lxSSC -or-
42°C; ixSSC, 50% forrnamide 65DC; 0.3xSSC
B DNA:DNA <50 TB*; IxSSC TB*; IxSSC
C DNA:RNA >50 67°C; IxSSC -or-
45°C; IxSSC, 50% forrnamide 67°C; 0.3xSSC
D DNA:KNA <50 TD*; IxSSC TD*; IxSSC
E RNA:RNA >50 70°C; IxSSC -or-
50°C; IxSSC, 50% forrnamide 70°C; 0.3xSSC
F RNA:RNA <50 V; IxSSC TF*; IxSSC
G DNA:DNA >50 65°C; 4xSSC -or-
42°C; 4xSSC, 50% forrnamide 65°C; IxSSC
H DNA:DNA <50 TH*; 4xSSC TH+; 4xSSC
I DNA:KNA >50 67°C; 4xSSC -or-
45°C; 4xSSC, 50% forrnamide 67°C; IxSSC
J DNA:RNA <50 T,*; 4xSSC T,*; 4xSSC
K RNA.-KNA >50 70°C; 4xSSC -or-
50°C; 4xSSC, 50% forrnamide 67°C; IxSSC
L KNA:KNA <50 TL*; 2xSSC TL*; 2xSSC
M DNA:DNA >50 50°C; 4xSSC -or-
40°C; 6xSSC, 50% forrnamide 50°C; 2xSSC
N DNA.-DNA <50 TN*; 6xSSC TN*; 6xSSC
0 DNA:KNA >50 55°C; 4xSSC -or-
42°C; 6xSSC, 50% forrnamide 55°C; 2xSSC
P DNA:KNA <50 TP*; 6xSSC TP*; 6xSSC
Q KNA:RNA >50 60°C; 4xSSC -or-
45°C; 6xSSC, 50% forrnamide 60°C; 2xSSC
R RNA:RNA <50 TR*; 4xSSC TR*; 4xSSC
I: The hybrid length is that anticipated for the hybridized region(s) of the hybridizing polynucleotides. When
hybridizing a polynucleotide to a target polynucleotide of unknown sequence, the hybrid length is assumed to
be that of the hybridizing polynucleotide. When polynucleotides of known sequence are hybridized, the
hybrid length can be determined by aligning the sequences of the polynucleotides and identifying the region or
regions of optimal sequence complementarity.
2: SSPE (IxSSPE is 0.15MNaCl, 10mMNaH2PO4, and 1.25mM EDTA, pH 7.4) can be substituted forSSC
(IxSSC is 0.15M NaCl and 15mM sodium citrate) in the hybridization and wash buffers; washes are
performed for 15 minutes after hybridization is complete.
TB* - TR*: The hybridization temperature for hybrids anticipated to be less than 50 base pairs in length should
be 5-10°C less than the melting temperature (TJ of the hybrid, where Tm is determined according to the
following equations. For hybrids less than 18 base pairs in length, Tm(°C) = 2(# of A + T bases) + 4(# of G +
C bases). For hybrids between 18 and 49 base pairs in length, Tm(°C) = 81.5 + l&eClogjoNa4) + 0.4I(%G+C) -
(6O0/N), where N is the number of bases in the hybrid, and Na+ is the concentration of sodium ions in the
hybridization buffer (Na+ for IxSSC = 0.165M).

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Additional examples of stringency conditions for polynucleotide hybridization are provided in Sambrook, J.,
E.F. Fritsch, and T. Maniatis, 1989, Molecular Cloning: A Laboratory Manual, Cold Spring Harbor
Laboratory Press, Cold Spring Harbor, NY, chapters 9 and 11, and Current Protocols in Molecular Biology,
1995, F.M. Ausubel et al., eds., John Wiley & Sons, Inc., sections 2.10 and 6.3-6.4, incorporated herein by
reference.
[0036] The polynucleotides of the present invention may also be used as
hybridization probes and primers to identify and isolate homologous
polynucleotides, i.e., nucleic acids having sequences that encode polypeptides of
the invention and/or polypeptides homologous to the disclosed polypeptides.
These homologs are polynucleotides and polypeptides isolated from different
species than that of the disclosed polynucleotides and polypeptides, or within the
same species, but with significant sequence similarity to the disclosed
polynucleotides and polypeptides. Preferably, polynucleotide homologs have at
least 60% sequence identity (more preferably, at least 75% identity; most
preferably, at least 90% identity) with the disclosed polynucleotides, whereas
polypeptide homologs have at least 30% sequence identity (more preferably, at
least 45% identity; most preferably, at least 60% identity) with the disclosed
polypeptides. Preferably, homologs of the disclosed polynucleotides and
polypeptides are those isolated from mammalian species, most preferably those
isolated from humans.
[0037] The polynucleotides of the present invention may be used as
hybridization probes and primers to identify and isolate DNAs having sequences
encoding allelic variants of the polynucleotides sequences of the PBMC- and
IBD-associated biomarkers listed in Tables 1-5. Allelic variants are naturally
occurring alternative forms of the polynucleotide sequences of the PBMC- and
IBD-associated biomarkers listed in Tables 1-5 that encode polypeptides that are
identical to or have significant similarity to the polypeptides encoded by the
genes listed in Tables 1-5. Preferably, allelic variants have at least 90% sequence
identity (more preferably, at least 95% identity; most preferably, at least 99%
identity) with the disclosed polynucleotides.
[0038] Consequently, in addition to polynucleotide sequences listed in Tables
1-5, the present invention also encompasses homologs and allelic variants of the
PBMC- and IBD-associated biomarkers listed in Tables 1-5.
[0039] The polynucleotides of the present invention may also be used as
hybridization probes and primers to identify cells and tissues that express the

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polypeptides of PBMC- and EBD-associated biomarkers of the present invention
and the conditions under which they are expressed.
[0040] Additionally, the polynucleotides of the present invention may be used to
alter (i.e., regulate (e.g., enhance, reduce, or modify)) the expression of the genes
corresponding to the PBMC- and IBD-associated biomarkers of the present
invention in a cell or organism. These corresponding genes are the genomic
DNA sequences of the present invention that are transcribed to produce the
mKNAs from which the PBMC- and IBD-associated biomarker polypeptides of
the present invention are derived.
[0041] Altered expression of the PBMC- and IBD-associated biomarkers
encompassed by the present invention in a cell or organism may be achieved
through the use of various inhibitory polynucleotides, such as antisense
polynucleotides, ribozymes that bind and/or cleave the mRNA transcribed from
the genes of the invention, triplex-forming oligonucleotides that target regulatory
regions of the genes, and short interfering RNA that causes sequence-specific
degradation of target mRNA (e.g., Galderisi et al. (1999) J. Cell Physiol.
181:251-57; Sioud (2001) Curr. Mol. Med 1:575-88; Knauert and Glazer (2001)
Hum. Mol. Genet. 10:2243-51; Bass (2001) Nature 411:428-29).
[0042] The inhibitory antisense or ribozyme polynucleotides of the invention can
be complementary to an entire coding strand of a gene of the invention, or to only
a portion thereof. Alternatively, inhibitory polynucleotides can be
complementary to a noncoding region of the coding strand of a gene of the
invention. The inhibitory polynucleotides of the invention can be constructed
using chemical synthesis and/or enzymatic ligation reactions using procedures
well known in the art. The nucleoside linkages of chemically synthesized
polynucleotides can be modified to enhance their ability to resist nuclease-
mediated degradation, as well as to increase their sequence specificity. Such
linkage modifications include, but are not limited to, phosphorothioate,
methylphosphonate, phosphoroamidate, boranophosphate, morpholino, and
peptide nucleic acid (PNA) linkages (Galderisi et al., supra; Heasman (2002)
Dev. Biol. 243:209-14; Mickelfield (2001) Curr. Med Chem. 8:1157-79).
Alternatively, antisense molecules can be produced biologically using an

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expression vector into which a polynucleotide of the present invention has been
subcloned in an antisense (i.e., reverse) orientation.
[0043] In yet another embodiment, the antisense polynucleotide molecule of the
invention is an a-anomeric polynucleotide molecule. An a-anomeric
polynucleotide molecule forms specific double-stranded hybrids with
complementary RNA in which, contrary to the usual p-units, the strands run
parallel to each other. The antisense polynucleotide molecule can also comprise
a 2'-o-methylribonucleotide or a chimeric RNA-DNA analogue, according to
techniques that are known in the art.
[0044] The inhibitory triplex-forming oligonucleotides (TFOs) encompassed by
the present invention bind in the major groove of duplex DNA with high
specificity and affinity (Knauert and Glazer, supra). Expression of the genes of
the present invention can be inhibited by targeting TFOs complementary to the
regulatory regions of the genes (i.e., the promoter and/or enhancer sequences) to
form triple helical structures that prevent transcription of the genes.
[0045] In one embodiment of the invention, the inhibitory polynucleotides of the
present invention are short interfering RNA (siRNA) molecules. These siRNA
molecules are short (preferably 19-25 nucleotides; most preferably 19 or 21
nucleotides), double-stranded RNA molecules that cause sequence-specific
degradation of target mRNA. This degradation is known as RNA interference
(RNAi) (e.g., Bass (2001) Nature 411:428-29). Originally identified in lower
organisms, RNAi has been effectively applied to mammalian cells and has
recently been shown to prevent fulminant hepatitis in mice treated with siRNA
molecules targeted to Fas mRNA (Song et al. (2003) Nature Med. 9:347-51). In
addition, intrathecally delivered siRNA has recently been reported to block pain
responses in two models (agonist-induced pain model and neuropathic pain
model) in the rat (Dorn et al. (2004) Nucleic Acids Res. 32(5):e49).
[0046] The siRNA molecules of the present invention can be generated by
annealing two complementary single-stranded RNA molecules together (one of
which matches a portion of the target mRNA) (Fire et al., U.S. Patent No.
6,506,559) or through the use of a single hairpin RNA molecule that folds back
on itself to produce the requisite double-stranded portion (Yu et al. (2002) Proc.
Natl. Acad. Sci. USA 99:6047-52). The siRNA molecules can be chemically

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synthesized (Elbashir et al. (2001) Nature 411:494-98) or produced by in vitro
transcription using single-stranded DNA templates (Yu et al., supra).
Alternatively, the siRNA molecules can be produced biologically, either
transiently (Yu et al., supra; Sui et al. (2002) Proc. Natl. Acad. Set USA
99:5515-20) or stably (Paddison et al. (2002) Proc. Natl. Acad. Sci. USA
99:1443-48), using an expression vector(s) containing the sense and antisense
siRNA sequences. Recently, reduction of levels of target mRNA in primary
human cells, in an efficient and sequence-specific manner, was demonstrated
using adenoviral vectors that express hairpin RNAs, which are further processed
into siRNAs (Arts et al. (2003) Genome Res. 13:2325-32).
[0047] The siRNA molecules targeted to the polynucleotides of the present
invention can be designed based on criteria well known in the art (e.g., Elbashir
et al. (2001) EMBO J. 20:6877-88). For example, the target segment of the target
mRNA should begin with AA (preferred), TA, GA, or CA; the GC ratio of the
siRNA molecule should be 45-55%; the siRNA molecule should not contain three
of the same nucleotides in a row; the siRNA molecule should not contain seven
mixed G/Cs in a row; and the target segment should be in the ORF region of the
target mRNA and should be at least 75 bp after the initiation ATG and at least 75
bp before the stop codon. siRNA molecules targeted to the polynucleotides of
the present invention can be designed by one of ordinary skill in the art using the
aforementioned criteria or other known criteria (e.g., Reynolds et al. (2004) Nat.
Biotechnol 22:326-30).
[0048] Altered expression of the genes of PBMC- and IBD-associated
biomarkers of the present invention in a cell or organism may also be achieved
through the creation of nonhuman transgenic animals into whose genomes
polynucleotides of the present invention have been introduced. Such transgenic
animals include animals that have multiple copies of a gene (i.e., the transgene)
of the present invention. A tissue-specific regulatory sequence(s) may be
operably linked to the transgene to direct expression of a polypeptide of the
present invention to particular cells or a particular developmental stage. In
another embodiment, transgenic nonhuman animals can be produced that contain
selected systems that allow for regulated expression of the transgene. One
example of such a system known in the art is the cre/loxP recombinase system of

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bacteriophage PL Methods for generating transgenic animal via embryo
manipulation and microinjection, particularly animals such as mice, have become
conventional and are well known in the art (e.g., Bockamp et al. (2002) Physiol.
Genomics 11:115-32). In preferred embodiments of the invention, the nonhuman
transgenic animal comprises at least one PBMC- and IBD-associated biomarker.
[0049] Altered expression of the genes of the present invention in a cell or
organism may also be achieved through the creation of animals whose
endogenous genes corresponding to the polynucleotides of the present invention
have been disrupted through insertion of extraneous polynucleotides sequences
(i.e., a knockout animal). The coding region of the endogenous gene may be
disrupted, thereby generating a nonfunctional protein. Alternatively, the
upstream regulatory region of the endogenous gene may be disrupted or replaced
with different regulatory elements, resulting in the altered expression of the still-
functional protein. Methods for generating knockout animals include
homologous recombination and are well known in the art (e.g., Wolfer et al.
(2002) Trends Neurosci. 25:336-40).
Isolated PBMC- and IBD-associated Biomarker Polypeptides
[0050] Several aspects of the invention pertain to isolated PBMC- and IBD-
associated biomarker proteins, biologically active portions thereof, and
polypeptide fragments suitable for use as immunogens to raise anti- PBMC- and
IBD-associated biomarker antibodies. In one embodiment, native PBMC- and
IBD-associated biomarker proteins can be isolated from cells or tissue sources by
an appropriate purification scheme using standard protein purification techniques.
In another embodiment, PBMC- and IBD-associated biomarker proteins are
produced by recombinant DNA techniques. As an alternative to recombinant
expression, a PBMC- and IBD-associated biomarker protein or polypeptide can
be synthesized chemically using standard peptide synthesis techniques.
[0051] The PBMC- and IBD-associated biomarker proteins listed in Tables 1-5
may be recombinantly produced by operably linking the polynucleotide
sequences of the PBMC- and IBD-associated biomarkers listed in Tables 1-5 to
an expression control sequence (e.g., the pMT2 and pED expression vectors).
General methods of expressing recombinant proteins are well known in the art.

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[0052] A number of cell lines may act as suitable host cells for recombinant
expression of PBMC- and IBD-associated biomarker polypeptides of the present
invention. Mammalian host cell lines include, for example, COS cells, CHO
cells, 293T cells, A431 cells, 3T3 cells, CV-1 cells, HeLa cells, L cells, BHK21
cells, HL-60 cells, U937 cells, HaK cells, Jurkat cells, normal diploid cells, as
well as cell strains derived from in vitro culture of primary tissue and primary
explants.
[0053] Alternatively, it may be possible to recombinantly produce the
polypeptides of the present invention in lower eukaryotes, such as yeast, or in
prokaryotes. Potentially suitable yeast strains include Saccharomyces cerevisiae,
Schizosaccharomycespom.be, Kluyveromyces strains, and Candida strains.
Potentially suitable bacterial strains include Escherichia coli, Bacillus subtilis,
and Salmonella typhimurium. If the polypeptides of the present invention are
made in yeast or bacteria, it may be necessary to modify them by, for example,
phosphorylation or glycosylation of appropriate sites in order to obtain
functionality. Such covalent attachments may be accomplished using well-
known chemical or enzymatic methods.
[0054] In another embodiment of the invention, PBMC- and IBD-associated
biomarker polypeptides of the present invention may also be recombinantly
produced by operably linking the PBMC- and IBD-associated biomarker
polynucleotides of the present invention to suitable control sequences in one or
more insect expression vectors, such as baculovirus vectors, and employing an
insect cell expression system. Materials and methods for baculovirus/Sf9
expression systems are commercially available in kit form (e.g., the MAXBAC®
kit, Invitrogen, Carlsbad, CA).
[0055] Following recombinant expression in the appropriate host cell, the
polypeptides of the present invention may then be purified from culture medium
or cell extracts using well-known purification processes, such as gel filtration and
ion exchange chromatography. Purification may also include affinity
chromatography with agents known to bind the polypeptides of the present
invention. These purification processes may also be used to purify the
polypeptides of the present invention from natural sources.

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[0056] Alternatively, the PBMC- and IBD-associated biomarker polypeptides of
the present invention may also be expressed recombinantly in a form that
facilitates identification, purification and/or detection. For example, the
polypeptides may be expressed as fusions with proteins such as maltose-binding
protein (MBP), glutathione-S-transferase (GST), or thioredoxin (TRX). Kits for
expression and purification of such fusion proteins are commercially available
from New England BioLabs (Beverly, MA), Pharmacia (Piscataway, N J), and
Invitrogen (Carlsbad, CA), respectively. The polypeptides of the present
invention can also be tagged with a small epitope and subsequently identified or
purified using a specific antibody to the epitope. A preferred epitope is the
FLAG epitope, which is commercially available from Eastman Kodak (New
Haven, CT).
[0057] A signal sequence can be used to facilitate secretion and isolation of the
secreted protein or other proteins of interest. Signal sequences are typically
characterized by a core of hydrophobic amino acids that are generally cleaved
from the mature protein during secretion in one or more cleavage events. Such
signal peptides contain processing sites that allow cleavage of the signal sequence
from the mature proteins as they pass through the secretory pathway. Thus, the
invention pertains to the described polypeptides having a signal sequence, as well
as to polypeptides from which the signal sequence has been proteolytically
cleaved (i.e., the cleavage products). In one embodiment, a polynucleotide
sequence encoding a signal sequence can be operably linked in an expression
vector to a protein of interest, such as a protein that is ordinarily not secreted or is
otherwise difficult to isolate. The signal sequence directs secretion of the protein,
such as from a eukaryotic host into which the expression vector is transformed,
and the signal sequence is subsequently or concurrently cleaved. The protein can
then be readily purified from the extracellular medium by art-recognized
methods. Alternatively, the signal sequence can be linked to the protein of
interest using a sequence that facilitates purification, such as with a GST domain.
[0058] In addition to the PBMC- and IBD-associated biomarker polypeptides
listed in Tables 1-5, and allelic variants and homologs thereof, the present
invention also encompasses polypeptides that are structurally different from the
polypeptides listed in Tables 1-5 (e.g., have a slightly altered sequence), but that

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have substantially the same biochemical properties as the disclosed polypeptides
(e.g., are changed only in functionally nonessential amino acid residues). Such
molecules include, but are not limited to, deliberately engineered variants
containing alterations, substitutions, replacements, insertions, or deletions.
Techniques and kits for such alterations, substitutions, replacements, insertions or
deletions are well known to those skilled in the art.
[0059] The present invention also encompasses variants of the PBMC- and IBD-
associated biomarker proteins of the invention that function either as agonists or
as antagonists to the PBMC- and IBD-associated biomarker proteins. In certain
embodiments, an agonist of the PBMC- and IBD-associated biomarker proteins
can retain substantially the same, or a subset of, the biological activities of the
naturally occurring form of a PBMC- and IBD-associated biomarker protein, or
may enhance an activity of a PBMC- and IBD-associated biomarker protein. In
certain embodiments, an antagonist of a PBMC- and IBD-associated biomarker
protein can inhibit one or more of the activities of the naturally occurring form of
the PBMC- and IBD-associated biomarker protein by, for example, competitively
modulating an activity of a PBMC- and IBD-associated biomarker protein. Thus,
specific biological effects can be elicited by treatment with a variant of limited
function. In one embodiment, treatment of a subject with a variant having a
subset of the biological activities of the naturally occurring form of the protein
has fewer side effects in a subject relative to treatment with the naturally
occurring form of the PBMC- and IBD-associated biomarker protein. In another
preferred embodiment, an agent may serve as an agonist or an antagonist for
PBMC- and IBD-associated biomarker proteins of the invention depending on
whether up- or downregulation of a particular PBMC- and IBD-associated
biomarker protein of interest is required for treatment of IBD.
[O060J Variants of the PBMC- and IBD-associated biomarker proteins can be
generated by mutagenesis, e.g., discrete point mutation or truncation of a PBMC-
and IBD-associated biomarker protein. Alternatively, variants of PBMC- and
IBD-associated biomarker proteins that function as either PBMC- and IBD-
associated biomarker protein agonists or as PBMC- and IBD-associated
biomarker protein antagonists can be identified by screening combinatorial
libraries of mutants, e.g., truncation mutants of a PBMC- and IBD-associated

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biomaxker protein for agonist or antagonist activity. In one embodiment, a
variegated library of PBMC- and IBD-associated biomarker protein variants is
generated by combinatorial mutagenesis at the polynucleotide level and is
encoded by a variegated gene library. In certain embodiments, such, protein may
be used, for example, as a therapeutic protein of the invention. A variegated
library of PBMC- and IBD-associated biomarker protein variants can be
produced by, for example, enzymatically ligating a mixture of synthetic
oligonucleotides into gene sequences such that a degenerate set of potential
PBMC- and IBD-associated biomarker protein sequences is expressible as
individual polypeptides, or alternatively, as a set of larger fusion proteins (e.g.,
for phage display) containing the set of PBMC- and IBD-associated biomarker
protein sequences therein. There are a variety of methods that can be used to
produce libraries of potential PBMC- and IBD-associated biomarker protein
variants from a degenerate oligonucleotide sequence. Chemical synthesis of a
degenerate gene sequence can be performed in an automatic DNA synthesizer,
and the synthetic gene then ligated into an appropriate expression vector. Use of
a degenerate set of genes allows for the provision, in one mixture, of all of the
sequences encoding the desired set of potential PBMC- and IBD-associated
biomarker protein sequences. Methods for synthesizing degenerate
oligonucleotides are known in the art.
[0061] The polypeptides of the present invention may also be produced by
known conventional chemical synthesis. Methods for chemically synthesizing
the polypeptides of the present invention are well known to those skilled in the
art. Such chemically synthetic polypeptides may possess biological properties in
common with the natural, purified polypeptides, and thus may be employed as
biologically active or immunological substitutes for the natural peptides.
Antibodies Against PBMC- and IBD-associated Biomarkers
[0062] In another aspect, the invention pertains to antibodies that are specific to
proteins corresponding to, or encoded by, PBMC- and IBD-associated
biomarkers of the invention. Preferably the antibodies are monoclonal, and most
preferably, the antibodies are humanized, as described below.

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[0063] Antibody molecules to the PBMC- and IBD-associated biomarkers of the
invention (anti-biomarker antibodies) may be produced by methods well known
to those skilled in the art. For example, monoclonal antibodies can be produced
by generation of hybridomas in accordance with known methods. Hybridomas
formed in this manner are then screened using standard methods, such as
enzyme-linked immunosorbent assay (ELISA), to identify one or more
hybridomas that produce an antibody that specifically binds with the polypeptides
of the present invention. A full-length polypeptide of the present invention may
be used as the immunogen, or, alternatively, antigenic peptide fragments of the
polypeptides may be used. An antigenic peptide of a polypeptide of the present
invention comprises at least 7 continuous amino acid residues, and encompasses
an epitope such that an antibody raised against the peptide forms a specific
immune complex with the polypeptide. Preferably, the antigenic peptide
comprises at least 10 amino acid residues, more preferably at least 15 amino acid
residues, even more preferably at least 20 amino acid residues, and most
preferably at least 30 amino acid residues.
[0064] As an alternative to preparing monoclonal antibody-secreting
hybridomas, a monoclonal antibody to a PBMC- and IBD-associated biomarker
of the present invention may be identified and isolated by screening a
recombinant combinatorial immunoglobulin library (e.g., an antibody phage
display library) with a PBMC- and IBD-associated biomarker polypeptide of the
present invention to thereby isolate immunoglobulin library members that bind to
the PBMC- and IBD-associated biomarker. Techniques and commercially
available kits for generating and screening phage display libraries are well known
to those skilled in the art, as are methods and reagents particularly amenable for
use in generating and screening antibody display libraries.
[0065] Polyclonal sera and antibodies may be produced by immunizing a
suitable subj ect with a polypeptide of the present invention. The antibody titer in
the immunized subject may be monitored over time by standard techniques, such
as with ELISA using immobilized biomarker protein. If desired, the antibody
molecules directed against a polypeptide of the present invention may be isolated
from the subject or culture media and further purified by well-known techniques,
such as protein A chromatography, to obtain an IgG fraction.

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[0066] Additionally, recombinant anti-biomarker antibodies, such as chimeric,
humanized, and single-chain antibodies, comprising both human and nonhuman
portions, which can be made using standard recombinant DNA techniques, are
within the scope of the invention. Humanized antibodies may also be produced
using transgenic mice that are incapable of expressing endogenous
immunoglobulin heavy and light chain genes, but that can express human heavy
and light chain genes. Alternatively, humanized antibodies that recognize a
selected epitope can be generated using a technique referred to as guided
selection. In this approach, a selected nonhuman monoclonal antibody (e.g., a
murine antibody) is used to guide the selection of a humanized antibody
recognizing the same epitope.
[0067] Chimeric antibodies, including chimeric immunoglobulin chains, may be
produced by recombinant DNA techniques known in the art. For example, a gene
encoding the Fc constant region of a murine (or other species) monoclonal
antibody molecule is digested with restriction enzymes to remove the region
encoding the murine Fc, and the equivalent portion of a gene encoding a human
Fc constant region is substituted (see PCT/US86/02269; EP 184,187;
EP 171,496; EP 173,494; WO 86/01533; U.S. Patent No. 4,816,567; EP 125,023;
Better et al. (1988) Science 240:1041-43; Liu et al. (1987) Proc. Natl. Acad. Sci.
U.S.A. 84:3439-43; Liu et al. (1987) J. Immunol 139:3521-26; Sun et al. (1987)
Proc. Natl. Acad. Sci. U.S.A. 84:214-18; Nishimura et al. (1987) Cane. Res.
47:999-1005; Wood et al. (1985) Nature 314:446-49; and Shaw etal. (1988) J.
Natl. Cancer Inst. 80:1553-59).
[0068] If desired, an antibody or an immunoglobulin chain may be humanized
by methods known in the art. Humanized antibodies, including humanized
immunoglobulin chains, may be generated by replacing sequences of the Fv
variable region that are not directly involved in antigen binding with equivalent
sequences from human Fv variable regions. General methods for generating
humanized antibodies are provided by Morrison (1985) Science 229:1202-07; Oi
et al. (1986) BioTechniques 4:214-21; and U.S. Patent Nos. 5,585,089, 5,693,761
and 5,693,762, all of which are hereby incorporated by reference in their
entireties. Those methods include isolating, manipulating, and expressing the
nucleic acid sequences that encode all or part of immunoglobulin Fv variable

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regions from at least one of a heavy or light chain. Sources of such nucleic acid
are well known to those skilled in the art and, for example, may be obtained from
a hybridoma producing an antibody against a predetermined target. The
recombinant DNA encoding the humanized antibody, or fragment thereof, may
then be cloned into an appropriate expression vector.
[0069] Humanized or CDR-grafted antibody molecules or immunoglobulins may
be produced by CDR grafting or CDR substitution, wherein one, two, or all
CDRs of an immunoglobulin chain can be replaced. See, e.g., U.S. Patent No.
5,225,539; Jones et al. (1986) Nature 321:522-25; Verhoeyan et al. (1988)
Science 239:1534-36; and Beidler et al. (1988) J. Immunol 141:4053-60, all of
which are hereby incorporated by reference in their entireties. U.S. Patent No.
5,225,539 describes a CDR-grafting method that may be used to prepare
humanized antibodies of the present invention (see also, GB 218863 8 A). All of
the CDRs of a particular human antibody may be replaced with at least a portion
of a nonhuman CDR, or only some of the CDRs may be replaced with nonhuman
CDRs. It is only necessary to replace the number of CDRs required for binding
of the humanized antibody to a predetermined antigen.
[0070] Monoclonal, chimeric and humanized antibodies, which have been
modified by, e.g., deleting, adding, or substituting other portions of the antibody,
e.g., the constant region, are also within the scope of the invention. For example,
an antibody may be modified as follows: (i) by deleting the constant region; (ii)
by replacing the constant region with another constant region, e.g., a constant
region meant to increase half-life, stability or affinity of the antibody, or a
constant region from another species or antibody class; and/or (iii) by modifying
one or more amino acids in the constant region to alter, for example, the number
of glycosylation sites, effector cell function, Fc receptor (FcR) binding,
complement fixation, among others.
[0071] Methods for altering an antibody constant region are known in the art.
Antibodies with altered function (e.g., altered affinity for an effector Iigand, such
as FcR on a cell, or the CI component of complement) may be produced by
replacing at least one amino acid residue in the constant portion of the antibody
with a different residue (see, e.g., EP 388,151 Al, U.S. Patent Nos. 5,624,821
and 5,648,260, all of which are hereby incorporated by reference in their

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entireties). Similar types of alterations may also be applied to murine
immunoglobulins and immunoglobulins from other species. For example, it is
possible to alter the affinity of an Fc region of an antibody (e.g., an IgG, such as a
human IgG) for an FcR (e.g., Fc gamma Rl) or for Clq binding by replacing the
specified residue(s) with a residue(s) having an appropriate functionality on its
side chain, or by introducing a charged functional group, such as glutamate or
aspartate, or an aromatic nonpolar residue such as phenylalanine, tyrosine,
tryptophan or alanine (see, e.g., U.S. Patent No. 5,624,821).
[0072] Human antibodies to PBMC- and IBD-associated biomarkers of the
invention may additionally be produced using transgenic nonbuman animals that
are modified so as to produce fully human antibodies rather than the animal's
endogenous antibodies in response to challenge by an antigen. See, e.g., PCT
publication WO 94/02602. The endogenous genes encoding the heavy and light
immunoglobulin chains in the nonhuman host have been incapacitated, and active
loci encoding human heavy and light chain immunoglobulins are inserted into the
host's genome. The human genes are incorporated, for example, using yeast
artificial chromosomes containing the requisite human DNA segments. An.
arrimal which provides all the desired modifications is then obtained as progeny
by crossbreeding intermediate transgenic animals containing fewer than the full
complement of the modifications. One embodiment of such a nonhuman animal
is a mouse, and is termed the XENOMOUSE™ as disclosed in PCT publications
WO 96/33735 and WO 96/34096. This animal produces B cells that secrete fully
human immunoglobulins. The antibodies can be obtained directly from the
animal after immunization with an immunogen of interest, as, for example, a
preparation of a polyclonal antibody, or alternatively from immortalized B cells
derived from the animal, such as hybridomas producing monoclonal antibodies.
Additionally, the genes encoding the immunoglobulins with human variable
regions can be recovered and expressed to obtain the antibodies directly, or can
be further modified to obtain analogs of antibodies such as, for example, single
chain Fv molecules.
[0073] The binding capacity of an antibody of the invention may be measured by
the following methods: Biacore analysis, enzyme linked immunosorbent assay

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(ELISA), X-ray crystallography, sequence analysis and scanning mutagenesis,
and other methods that are known in the art.
[0074] Other protein-binding molecules may also be employed to modulate the
activity of a PBMC- and IBD-associated biomarker. Such protein-binding
molecules include small modular immunopharmaceutical (SMIP™) drugs
(Trubion Pharmaceuticals, Seattle, WA). SMIPs are single-chain polypeptides
composed of a binding domain for a cognate structure such as an antigen, a
counterreceptor or the like, a hinge-region polypeptide having either one or no
cysteine residues, and immunoglobulin CH2 and CH3 domains (see also
www.trubion.com). SMIPs and their uses and applications are disclosed in, e.g.,
U.S. Published Patent Appln. Nos. 2003/0118592,2003/0133939, 2004/0058445,
2005/0136049,2005/0175614,2005/0180970,2005/0186216,2005/0202012,
2005/0202023,2005/0202028,2005/0202534, and 2005/0238646, and related
patent family members thereof, all of which are hereby incorporated by reference
herein in their entireties.
[0075] Fragments of anti-biomarker antibodies may be produced by cleavage of
the antibodies in accordance with methods well known in the art. For example,
immunologically active F(ab') and F(ab')2 fragments may be generated by
treating the antibodies with an enzyme such as pepsin.
[0076] Anti-biomarker antibodies of the invention are also useful for isolating,
purifying, and/or detecting PBMC- and IBD-associated biomarker polypeptides
in the supernatant, cellular lysate, or on the cell surface. Antibodies disclosed in
this invention can be used diagnostically to monitor levels of PBMC- and IBD-
associated biomarker proteins as part of a clinical testing procedure, or to target a
therapeutic modulator to a cell or tissue comprising the antigen of the anti-
biomarker antibody. For example, a therapeutic of the invention, including but
not limited to a small molecule, can be linked to the anti-biomarker antibody in
order to target the therapeutic to a PBMC- and IBD-associated biomarker.
Detection of PBMC- and IBD-associated Biomarkers
[0077] The present invention provides methods for diagnosing, prognosing, and
monitoring the progress of an IBD, e.g., Crohn's disease or ulcerative colitis, in a
subject that directly or indirectly results from aberrant expression or activity

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levels of PBMC- and IBD-associated biomarkers by detecting such aberrant
expression or activity levels of PBMC- and IBD-associated biomarkers,
including, but not limited to, the use of such methods in human subjects. For
example, these methods may be performed by utilizing prepackaged diagnostic
kits comprising at least one of the group comprising PBMC- and IBD-associated
biomarker polynucleotides and fragments thereof, PBMC- and IBD-associated
biomarker polypeptides and derivatives thereof, antibodies to PBMC- and IBD-
associated biomarkers, and modulators of PBMC- and IBD-associated biomarker
polynucleotides and/or polypeptides as described herein, which may be
conveniently used, for example, in a clinical setting. In addition, one of skill in
the art would recognize that changes in expression or activity levels of one or
more PBMC- and IBD-associated biomarkers may also be detected by well-
known methods other than those described herein.
[0078] The diagnostic, prognostic, and monitoring assays of the present
invention involve detecting and quantifying PBMC- and IBD-associated
biomarker gene products in biological samples. PBMC- and IBD-associated
biomarker gene products include, but are not limited to, PBMC- and IBD-
associated biomarker mRNAs, cDNAs, and genomic DNAs, and PBMC- and
IBD-associated biomarker polypeptides; such gene products can be measured
using methods well known to those skilled in the art.
[0079] For example, mRNA of PBMC- and IBD-associated biomarkers can be
directly detected and quantified using hybridization-based assays, such as
Northern hybridization, in situ hybridization, dot and slot blots, and
oligonucleotide arrays. Hybridization-based assays refer to assays in which a
probe nucleic acid is hybridized to a target nucleic acid. In some formats, the
target, the probe, or both are immobilized. The immobilized nucleic acid may be
DNA, RNA, or other oligonucleotide or polynucleotides, and may comprise
naturally or nonnaturally occurring nucleotides, nucleotide analogs, or
backbones. Methods of selecting nucleic acid probe sequences for use in the
present invention are based on the nucleic acid sequences of the PBMC- and
IBD-associated biomarkers and are well known in the art.
[0080] Alternatively, mRNA of PBMC- and IBD-associated biomarkers may be
amplified before detection and quantitation. Such amplification-based assays are

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well known in the art and include polymerase chain reaction (PCR), reverse-
transcription-PCR (RT-PCR), PCR-enzyme-linked immunosorbent assay (PCR-
ELISA), ligase chain reaction (LCR), self-sustained sequence replication,
transcriptional amplification system, Q-beta Replicase, or any other
polynucleotide amplification method. Primers and probes for producing and
detecting amplified PBMC- and IBD-associated biomarker gene products may be
readily designed and produced without undue experimentation by those of skill in
the art based on the nucleic acid sequences of the PBMC- and IBD-associated
biomarkers listed in Tables 1-5. Amplified PBMC- and IBD-associated gene
products may be directly analyzed, for example, by gel electrophoresis; by
hybridization to a probe nucleic acid; by sequencing; by detection of a
fluorescent, phosphorescent, or radioactive signal; or by any of a variety of well-
known methods. In addition, methods are known to those of skill in the art for
increasing the signal produced by amplification of target nucleic acid sequences.
One of skill in the art will recognize that whichever amplification method is used,
a variety of quantitative methods known in the art (e.g., quantitative PCR (Q-
PCR); also referred to herein as "real time PCR", "quantitative real time PCR,"
"quantitative real time reverse transcriptase polymerase chain reaction,"
"quantitative real time RT-PCR," and the like)) may be used if quantitation of
PBMC- and IBD-associated gene products is desired.
[0081] PBMC- and IBD-associated biomarker polypeptides of the invention (or
fragments thereof) can be detected using various well-known immunological
assays employing anti-biomarker antibodies described above. Immunological
assays refer to assays that utilize an antibody (e.g., polyclonal, monoclonal,
chimeric, humanized, scFv, and fragments thereof) that specifically binds to a
PBMC- and IBD-associated polypeptide (or fragment thereof). Such well-known
immunological assays suitable for the practice of the present invention include
ELISA, radioimmunoassay (RIA), immune-precipitation, immunofluorescence,
fluorescence-activated cell sorting (FACS) and Western blotting. In addition, an
anti-biomarker antibody can be labeled with a radioactive biomarker whose
presence and location in a subject can be detected by standard imaging
techniques.

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[0082] Each PBMC- and IBD-associated biomarker may be considered
individually, although it is within the scope of the invention to provide
combinations of two or more PBMC- and IBD-associated biomarkers for use in
the methods and compositions of the invention to increase the confidence of the
analysis. In one embodiment, the invention provides panels, e.g., models, of the
PBMC- and IBD-associated biomarkers of the invention. A panel may comprise
and/or consist essentially of 2-5,5-15,15-35,35-50, 50-100, or more than 100
PBMC- and IBD-associated biomarkers. In one embodiment, a panel of the
invention comprises and/or consists essentially of at least two PBMC- and IBD-
associated biomarkers. In one embodiment, a panel of the invention comprises
and/or consists essentially of at least three PBMC- and IBD-associated
biomarkers. In one embodiment, a panel of the invention comprises and/or
consists essentially of at least four PBMC- and IBD-associated biomarkers. In
one embodiment, a panel of the invention comprises and/or consists essentially of
at least five PBMC- and IBD-associated biomarkers. In one embodiment, a panel
of the invention comprises and/or consists essentially of at least six PBMC- and
IBD-associated biomarkers. In one embodiment, a panel of the invention
comprises and/or consists essentially of at least seven PBMC- and IBD-
associated biomarkers. In one embodiment, a panel of the invention comprises
and/or consists essentially of at least eight PBMC- and IBD-associated
biomarkers. In one embodiment, a panel of the invention comprises and/or
consists essentially of at least nine PBMC- and IBD-associated biomarkers. In
one embodiment, a panel of the invention comprises and/or consists essentially of
at least ten PBMC- and IBD-associated biomarkers. In one embodiment, a panel
of the invention comprises and/or consists essentially of at least eleven PBMC-
and IBD-associated biomarkers. In one embodiment, a panel of the invention
comprises and/or consists essentially of at least twelve PBMC- and IBD-
associated biomarkers.
[0083] In another embodiment, panels of PBMC- and IBD-associated
biomarkers are selected such that the biomarkers within any one panel share
certain features. For example, the biomarkers of a first panel may each exhibit at
least a 1.5-fold increase in quantity or activity in PBMCs from patients with
inflammatory bowel disease, i.e., Crohn's disease or ulcerative colitis, as

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compared to PBMCs from a subject substantially free of IBD. Alternatively,
biomarkers of a second panel may each exhibit differential regulation as
compared to a first panel. Similarly, different panels of biomarkers may be
composed of biomarkers from different functional categories (i.e., proteolysis,
signal transduction, transcription, etc.) or samples (i.e., blood, kidney, spleen,
lymph node, brain, intestine, colon, heart, urine, etc.), or may be selected to '
represent different stages of an inflammatory bowel disease, i.e., Crohn's disease
or ulcerative colitis. In a preferred embodiment, panels of the invention comprise
biomarkers from blood, and in particular, PBMCs. Panels of the PBMC- and
IBD-associated biomarkers of the invention may be made by selecting as a panel
the biomarkers categorized as Group I biomarkers, the biomarkers categorized as
Group II biomarkers, the biomarkers categorized as Group HI biomarkers, the
biomarkers categorized as Group IV biomarkers, and/or the biomarkers
categorized as Group V biomarkers. Panels may also be made by independently
selecting biomarkers from Group I, Group II, Group III, Group IV, and/or
Group V categorized biomarkers. In a preferred embodiment, a panel comprises
and/or consists essentially of the set of PBMC- and IBD-associated biomarkers
categorized as Group V biomarkers. A skilled artisan will also recognize that a
panel of the invention may comprise and/or consist essentially of any number and
any combination of PBMC- and EBD- associated biomarkers of the invention,
particularly the Group V biomarkers of the invention. For example, a
nonlimiting panel of the invention may comprise and/or consist essentially of the
irnmunoglobulin heavy constant gamma 1 and immunoglobulin kappa constant
PBMC- and IBD- associated biomarkers. Another nonlimiting panel of the
invention may comprise and/or consist essentially of the human 28S ribosomal
RNA 5'region, protein tyrosine phosphatase receptor type C-associated protein,
H3 histone family member K, integrin beta 3 (platelet glycoprotein Ilia, antigen
CD61) and H2B histone family member Q PBMC- and IBD- associated
biomarkers. Another nonlimiting panel of the invention may comprise and/or
consist essentially of the immunoglobulin heavy constant gamma 1, granzymeK,
mutL homolog 3, lipocalin 2, CXCL5, serum deprivation response
phosphatidylserine binding protein, and H3 histone family member K PBMC-
and IBD- associated biomarkers. In one embodiment, a panel of the invention

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provides at least 70% accuracy (more preferably, at least 80% accuracy, most
preferably at least 90% accuracy) in determining whether a patient has (1) IBD in
the form of either Crohn's disease or ulcerative colitis, (2) Crohn's disease,
and/or (3) ulcerative colitis, and/or in distinguishing between whether a patient
with IBD has Crohn's disease or ulcerative colitis.
[0084] In addition to providing panels of PBMC- and IBD-associated
biomarkers, it is within the scope of the invention to provide a panel of PBMC-
and IBD-associated biomarkers conveniently coupled to a solid support. For
example, PBMC- and IBD-associated biomarker polynucleotides of the invention
may be coupled to an array (e.g., a biochip for hybridization analysis), to a resin
(e.g., a resin that can be packed into a column for column chromatography), or a
matrix (e.g., a nitrocellulose matrix for Northern blot analysis) using well-known
methods in the art. Methods of making and using such arrays, including the use
of such arrays with computer readable media (comprising PBMC- and IBD-
associated biomarkers of the invention) and/or databases, e.g., a relational
database, are well known in the art.
[0085] By providing such support, discrete analysis of the presence or activity in
a sample of each PBMC- and IBD-associated biomarker selected for the panel
may be detected. For example, in an array, polynucleotides complementary to
each member of a panel of PBMC- and IBD-associated biomarkers may be
individually attached to different known locations on the array using methods
well known in the art. The array may be hybridized with, for example,
polynucleotides extracted from a blood sample (preferably a PBMC sample) from
a subject. The hybridization of polynucleotides from the sample with the array at
any location on the array can be detected, and thus the presence or quantity of the
PBMC- and IBD-associated biomarker(s) in the sample can be ascertained. Thus,
not only tissue specificity, but also the level of expression of a panel of IBD
biomarkers in the tissue is ascertainable. In a preferred embodiment, an array
based on a biochip is employed. Similarly, ELISA analyses may be performed
on immobilized antibodies specific for different polypeptide biomarkers
hybridized to a protein sample from a subject.
[0086] In another embodiment, a reporter nucleic acid is utilized to detect the
expression of one or more PBMC- and IBD-associated biomarkers of the

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invention. Such a reporter nucleic acid can be useful for high-throughput screens
for agents that alter the expression profiles of peripheral blood mononuclear cells.
The construction and use of such reporter assays are well known.
[0087] For example, the construction of a reporter for transcriptional regulation
of a PBMC- and IBD-associated biomarker of the invention generally requires a
regulatory sequence of PBMC- and IBD-associated biomarker, typically the
promoter. The promoter can be obtained by a variety of routine methods. For
example, a genomic library can be hybridized with a labeled probe consisting of
the coding region of the nucleic acid to identify genomic library clones
containing promoter sequences. The isolated clones can be sequenced to identify
sequences upstream from the coding region. Another method is an amplification
reaction using a primer that anneals to the 5' end of the coding region of the
PBMC- and IBD-associated biomarker polynucleotide. The amplification
template can be, for example, restricted genomic nucleic acids to which anchor
bubble adaptors have been ligated.
[0088] To construct the reporter, the promoter of the selected PBMC- and IBD-
associated biomarker can be operably linked to the reporter nucleic acid, e.g.,
without utilizing the reading frame of the selected PBMC- and IBD-associated
biomarker polynucleotide. The nucleic acid construct is transformed into tissue
culture cells, e.g., peripheral blood mononuclear cells, by a transfection protocol
to generate reporter cells.
[0089] Many of the well-known reporter nucleic acids may be used. In one
embodiment, the reporter nucleic acid is green fluorescent protein. In a second
embodiment, the reporter is P-galactosidase. In other embodiments, the reporter
nucleic acid is alkaline phosphatase, p-lactamase, luciferase, chloramphenicol
acetyltransferase, or other reporter nucleic acids known in the art. The reporter
nucleic acid construct may be maintained on an episome or inserted into a
chromosome by, for example, using targeted homologous recombination.
Methods of making and using such reporter nucleic acids are well known.
Analysis with Group I-V Biomarkers
[0090] One of skill in the art will recognize that although the PBMC- and IBD-
associated biomarkers of the invention may be categorized into five different

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groups, each individual biomarker is a PBMC- and IBD-associated biomarker of
the invention. Additionally, a skilled artisan will recognize that the biomarkers
are categorized into such groups for characterization purposes only. For
example, the PBMC- and IBD-associated biomarkers of Group I have been
determined to be biomarkers differentially expressed in PBMCs of patients with
CD in common with PBMCs of patients with UC. Thus, these common
biomarkers are categorized together to convey that they conveniently may be
used together in assays of screening test compounds for treating an IBD, or may
be used together for diagnosing, prognosing, and/or monitoring an IBD, without
regard to whether the IBD is in the form of CD or UC. A skilled artisan will also
recognize that the PBMC- and IBD-associated biomarkers categorized as
Group II, Group III, Group IV, and/or Group V biomarkers may also be used to
screen test compounds for, diagnose, prognose, and/or monitor an IBD, without
regard to whether the IBD is in the form of CD or UC. However, it will be noted
that Group II biomarkers, i.e., biomarkers included in the set of CD biomarkers,
may be the optimal set to use in methods of screening test compounds for,
diagnosing, prognosing, and/or monitoring an IBD when the IBD is in the form
of CD. Conversely, Group III biomarkers, i.e., biomarkers included in the set of
UC biomarkers, may be the optimal set to use in methods of screening test
compounds for, diagnosing, prognosing, and/or monitoring an IBD when the IBD
is in the form of UC. Also, Group IV biomarkers, i.e., biomarkers included in the
set of CDvUC biomarkers, and particularly Group V biomarkers, i.e., biomarkers
included in the set of classifying biomarkers, may be the optimal set(s) to use in
methods of screening test compounds for, diagnosing, prognosing, and/or
monitoring an IBD, when it is important to distinguish patients with CD from
patients with UC.
Screening
[0091] In addition to methods of diagnosing, prognosing, and monitoring the
progression of an IBD, the PBMC- and IBD-associated biomarker
polynucleotides and polypeptides of the present invention may be used in
screening assays to identify pharmacological agents, or lead compounds for
agents, capable of regulating the activity of PBMC- and IBD-associated

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biomarkers, and thus, potentially capable of inhibiting or alleviating the
symptoms of an IBD, i.e., Crohn's disease or ulcerative colitis. Such screening
assays, including high throughput methods of screening, are well known in the
art. For example, samples from subjects diagnosed with or suspected of having
IBD, or samples containing PBMC- and IBD-associated biomarkers (either
natural or recombinant) can be contacted with one of a plurality of test
compounds (e.g., small organic molecules, biological agents), and the expression
or activity levels of PBMC- and IBD-associated biomarkers in each of the treated
samples can be compared to the expression or activity levels of PBMC- and IBD-
associated biomarkers in untreated samples or in samples contacted with different
test compounds to determine whether any of the test compounds provides: 1) a
substantially decreased level of expression or activity of at least one PBMC- and
IBD-associated biomarker, thereby indicating an inhibitor of the activity of at
least one PBMC- and IBD-associated biomarker, or 2) a substantially increased
level of expression or activity of at least one PBMC- and IBD-associated
biomarker, thereby indicating an agent that increases the activity of at least one
PBMC- and IBD-associated biomarker. In a preferred embodiment, the
identification of test compounds capable of regulating the activity of at least one
PBMC- and IBD-associated biomarker is performed using high-throughput
screening assays, such as provided by BIACORE®(Biacore International AB,
Uppsala, Sweden), or BRET (bioluminescence resonance energy transfer), and
FRET (fluorescence resonance energy transfer) assays, as well as ELISA and
cell-based assays.
[0092] In addition, the invention is further directed to a method of screening for
test compounds capable of regulating the binding of a PBMC- and IBD-
associated biomarker to a binding partner, the method carried out by combining
the test compound, the PBMC- and IBD-associated protein, and the binding
partner and determining whether binding of the binding partner and PBMC- and
IBD-associated protein occurs, and how such binding is positively or negatively
modulated by the test compound.
[0093] As mentioned above, the agent capable of regulating the activity of a
PBMC- and IBD-associated biomarker may be any of a variety of naturally
occurring or synthetic compounds, biomolecules, proteins, peptides,

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oligopeptides, polysaccharides, nucleotides or polynucleotides. The test
compound may be, e.g., a small molecule or a biological agent. As discussed
below, test compounds may be provided from a variety of libraries well known in
the art.
[00941 The test compounds of the present invention may be obtained from any
available source, including systematic libraries of natural and/or synthetic
compounds. Test compounds may also be obtained by any of the numerous
approaches in combinatorial library methods known in the art, including:
biological libraries; peptoid libraries (libraries of molecules having the
functionalities of peptides, but with novel, nonpeptide backbones that are
resistant to enzymatic degradation yet remain bioactive; see, e.g., Zuckermann et
al. (1994) J. Med. Chem. 37:2678-85); spatially addressable parallel solid phase
or solution phase libraries; synthetic library methods requiring deconvolution; the
"one-bead, one-compound" library method; and synthetic library methods using
affinity chromatography selection. The biological library and peptoid library
approaches are limited to peptide libraries, while the other four approaches are
applicable to peptide, nonpeptide oligomer or small molecule libraries of
compounds (see generally, e.g., Lam (1997) Anticancer Drug Des. 12(3): 145-67).
Methods for Diagnosing, Prognosing and Monitoring the Progress of an
Inflammatory Bowel Disease
[0095] "Diagnostic" or "diagnosing" means identifying the presence or absence
of a pathologic condition. Diagnostic methods involve detecting substantially
modulated (i.e., aberrant) expression of PBMC- and IBD-associated biomarkers
by determining a test amount of PBMC- and IBD-associated biomarker gene
products (e.g., mRNA, cDNA, or polypeptide, including fragments thereof) in a
biological sample from a subject (human or nonhuman mammal), and comparing
the test amount with the normal amount or range (i.e., an amount or range from
an individual(s) known not to suffer from IBD) for the PBMC- and IBD-
associated biomarker gene product.
[0096] In one embodiment, the levels of PBMC- and IBD-associated biomarkers
in the two samples are compared, and aberrant expression of one or more PBMC-
and IBD-associated biomarkers in the test sample indicates IBD. In other
embodiments, the aberrant expression of 2, 3,4 or more biomarkers indicates a

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severe case of IBD. In another embodiment, the aberrant expression one or more
biomarkers indicates a likelihood of IBD, and aberrant expression of 2,3,4 or
more biomarkers indicates an increased likelihood of IBD. In another aspect, the
invention provides biomarkers whose quantity or activity is correlated with
different manifestations or severity or types of IBD. For example, aberrant
expression of the PBMC- and IBD-associated biomarkers in Table 5, as
indicated, may correlate with a diagnosis of Crohn's disease or ulcerative colitis.
The subsequent level of expression may further be compared to different
expression profiles of various stages of the disorder to confirm whether the
subject has a matching profile. Although a particular diagnostic method may not
provide a definitive diagnosis of IBD, it suffices if the method provides a positive
indication that aids in diagnosis.
[0097] The present invention also provides methods for prognosing IBD by
detecting aberrant expression or activity levels of at least one PBMC- and IBD-
associated biomarker. "Prognostic" or "prognosing" means predicting the
probable development and/or severity of a pathologic condition. Prognostic
methods involve determining the test amount of at least one PBMC- and IBD-
associated biomarker gene product in a biological sample from a subject, and
comparing the test amount to a prognostic amount or range (i.e., an amount or
range from individuals with varying severities of IBD) for the PBMC- and IBD-
associated biomarker gene product. Various amounts of the PBMC- and IBD-
associated biomarker gene product in a test sample are consistent with certain
prognoses for IBD, Crohn's disease, and/or ulcerative colitis. The detection of an
amount of PBMC- and IBD-associated biomarker gene product at a particular
prognostic level provides for a prognosis for the subject. In one embodiment of
the present invention, as related to IBD (or a particular form of IBD),
substantially upregulated expression or activity of one or more PBMC- and IBD-
associated biomarkers is typically correlated with an abnormal increase. In
another embodiment of the present invention, as related to IBD (or a particular
form of IBD), substantially downregulated expression or activity of one or more
PBMC- and IBD-associated biomarkers is typically correlated with an abnormal
decrease.

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[0098] In addition, the prognostic assays described herein can be used to
determine whether a subject can be administered an agent (e.g., an agonist,
antagonist, peptidomimetic, protein, peptide, polynucleotide, small molecule, or
other drug candidate) to treat or prevent IBD associated with aberrant PBMC-
and IBD-associated biomarker expression or activity. Accordingly, regulation of
a PBMC- and IBD-associated biomarker, such as PAI-2, to normal levels (e.g.,
levels similar or substantially similar to tissue substantially free of IBD) may
allow for amelioration of IBD.
[0099] In relation to the field of gastroenterology, prognostic assays can be
devised to determine whether a subject undergoing treatment for such disorder
has a poor outlook for long-term survival or disease progression. In a preferred
embodiment, prognosis can be determined shortly after diagnosis, i.e., within a
few days. By establishing expression profiles of different stages of IBD, or of a
particular form of IBD (e.g., Crohn's disease or ulcerative colitis), from onset to
acute disease, an expression pattern may emerge to correlate a particular
expression profile to increased likelihood of a poor prognosis. The prognosis
may then be used to devise a more aggressive treatment program to avert chronic
IBD and enhance the likelihood of long-term survival and well-being.
[0100] In a preferred embodiment of the invention, the disclosed molecules and
methods are used on a biological sample to detect, in PBMC- and IBD-associated
biomarker genes, the presence of one or more genetic alterations well known to
result in aberrant expression of PBMC- and IBD-associated biomarkers. Such
detecting can be used to determine the severity of IBD or to prognosticate the
potential for IBD due to modulated expression or activity of PBMC- and IBD-
associated biomarkers. In a further specific embodiment, one or more genetic
alterations are correlated with the prognosis or susceptibility of a subject to IBD.
Genetic alterations in a PBMC- and IBD-associated biomarker gene from a
sample can be identified by well-known methods in the art, including, but not
limited to, sequencing reactions, electrophoretic mobility assays, and
oligonucleotide hybridizations.
[0101] The present invention also provides methods for monitoring the progress
or course of IBD, Crohn's disease, and/or ulcerative colitis, by monitoring the
expression or activity of PBMC- and IBD-associated biomarkers. Monitoring

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methods involve determining the test amount of a PBMC- and IBD-associated
biomarker gene product in biological samples taken from a subject at a first and
second time, and comparing the amounts. A change in the amount of a PBMC-
and IBD-associated biomarker, or changes in the amounts of PBMC- and IBD-
associated biomarkers, between the first and second time indicates a change in
the course of the IBD. Such monitoring assays are also useful for evaluating the
efficacy of a particular therapeutic intervention in patients (e.g., during clinical
trials), i.e., evaluating the modulation of PBMC- and IBD-associated biomarkers
in response to therapeutic agents provided herein.
[0102] It will be appreciated that the assay methods of the present invention do
not necessarily require measurement of absolute values of PBMC- and IBD-
associated biomarker gene products because relative values are sufficient for
many applications of these methods. It will also be appreciated that in addition to
the quantity or abundance of PBMC- and IBD-associated biomarker gene
products, variant or abnormal PBMC- and IBD-associated biomarker gene
products or their expression patterns (e.g., mutated transcripts, truncated
polypeptides) may be identified by comparison to normal gene products and
expression patterns.
Methods of Treatment
[0103] The present invention provides for both prophylactic and therapeutic
methods of treating a subject at risk for, susceptible to, or diagnosed with IBD,
Crohn's disease, and/or ulcerative colitis. Subjects at risk, susceptible to, or
diagnosed with an IBD that is caused or contributed to by aberrant PBMC- and
IBD-associated biomarker expression or activity can be identified by, for
example, any of the diagnostic or prognostic assays as described herein, or a
combination thereof. In one aspect, the invention provides prophylactic methods
for preventing, in a subject, IBD associated with aberrant PBMC- and IBD-
associated biomarker expression or activity, by administering to the subject a
PBMC- and IBD-associated biomarker protein or an agent, which regulates
PBMC- and IBD-associated biomarker protein expression or activity.
Administration of a prophylactic agent can occur prior to the manifestation of
symptoms characteristic of the differential PBMC- and IBD-associated biomarker

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protein expression, such that IBD is prevented or, alternatively, delayed in its
progression. Another aspect of the invention pertains to therapeutic methods of
regulating expression or activity levels of PBMC- and IBD-associated biomarkers
for therapeutic purposes. Accordingly, in an exemplary embodiment, this
regulatory method of the invention involves contacting cells (e.g., PBMCs) with
an agent that regulates the expression level(s) or one or more of the activities of
PBMC- and IBD-associated biomarkers.
[0104] An agent that regulates expression or activity levels of PBMC- and IBD-
associated biomarkers, i.e., a regulatory agent of at least one PBMC- and IBD-
associated biomarker, may be an agent as described herein, such as a PBMC- and
IBD-associated biomarker polynucleotide (including related PBMC- and IBD-
associated biomarker polynucleotides (e.g., inhibitory polynucleotides)), a
PBMC- and IBD-associated biomarker protein, a naturally occurring target
molecule of a PBMC- and IBD-associated biomarker protein (e.g., a PBMC- and
IBD-associated biomarker protein substrate), an anti-biomarker antibody, a
PBMC-and IBD-associated biomarker agonist, a PBMC-and IBD-associated
biomarker antagonist, or other small molecule. The appropriate agent can be
determined based on screening assays described herein.
[0105] These regulatory methods can be performed in vitro (e.g., by cidturing
PBMCs with the agent) or, alternatively, in vivo (e.g., by administering the
regulatory agent to a subject). In one embodiment, the method involves
administering a PBMC- and IBD-associated biomarker protein or polynucleotide
molecule or a PBMC- and IBD-associated agonist as therapy to compensate for
substantially reduced or aberrant PBMC- and IBD-associated biomarker protein
expression or activity. Stimulation or upregulation of PBMC- and IBD-
associated biomarker activity is desirable in situations in which PBMC- and IBD-
associated biomarker protein is substantially downregulated and/or in which
increased PBMC- and IBD-associated biomarker activity is likely to have a
beneficial effect.
[0106] In another embodiment, the method involves the administration of an
inhibitory polynucleotide or polypeptide as therapy to compensate for
substantially increased or aberrant PBMC- and IBD-associated biomarker
expression or activity. Inhibition or downregulation of PBMC- and IBD-

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associated biomarker activity is desirable in situations in which PBMC- and IBD-
associated biomarker expression or activity is substantially upregulated and/or in
which decreased PBMC- and IBD-associated biomarker activity is likely to have
a beneficial effect.
[0107] Several pharmacogenomic approaches to be considered in determining
whether to administer a regulatory agent of at least one PBMC- and IBD-
associated biomarker are well known to one of skill in the art and include
genome-wide association, candidate gene approach, and gene expression
profiling. A pharmaceutical composition of the invention is formulated to be
compatible with its intended route of administration (e.g., oral compositions
generally include an inert diluent or an edible carrier). Other nonlimiting
examples of routes of administration include parenteral (e.g., intravenous,
subcutaneous, intramuscular), oral (e.g., inhalation), rectal, transdermal (topical),
and transmucosal administration. The pharmaceutical compositions compatible
with each intended route are well known in the art.
[0108] A regulatory agent of at least one PBMC- and IBD-associated biomarker
may be used as a pharmaceutical composition when combined with a
pharmaceutically acceptable carrier(s). Such a composition may contain, in
addition to the regulatory agent of at least one PBMC- and IBD-associated
biomarker and a carrier(s), various diluents, fillers, salts, buffers, stabilizers,
sohibilizers, and other materials well known in the art. The term
"pharmaceutically acceptable" means a nontoxic material that does not interfere
with the effectiveness of the biological activity of the active ingredient(s). The
characteristics of the carrier will depend on the route of administration.
[0109] The pharmaceutical composition of the invention may also contain
cytokines, lymphokines, or other hematopoietic factors such as M-CSF, GM-
CSF, DL-1, IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-11, IL-12, IL-
14, IL-15, G-CSF, stem cell factor, and erythropoietin. The pharmaceutical
composition may also include anticytokine antibodies, thrombolytic or
antithrombotic factors such as plasminogen activator and Factor VIII, and/or
other anti-inflammatory agents. Such additional factors and/or agents may be
included in the pharmaceutical composition to produce a synergistic effect with a
regulatory agent of at least one PBMC- and IBD-associated biomarker, or to

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minimize side effects caused by the regulatory agent. In addition, a composition
of the invention may also include (in addition to a regulatory agent of at least one
PBMC- and IBD-associated biomarker of the invention) known agent(s) used to
treat IBD, e.g., sulfasalazine, 5-ASA, steroids, etc. Conversely, a regulatory
agent to at least one PBMC- and IBD-associated biomarker may be included in
formulations of the particular cytokine, lymphokine, other hematopoietic factor,
thrombolytic or antithrombotic factor, or anti-inflammatory agent to minimize
side effects of the cytokine, lymphokine, other hematopoietic factor, thrombolytic
or antithrombotic factor, or anti-inflarnmatory agent.
[0110] The pharmaceutical composition of the invention may be in the form of a
liposome in which a regulatory agent of at least one PBMC- and IBD-associated
biomarker is combined, in addition to other pharmaceutical^ acceptable carriers,
with amphipathic agents such as lipids that exist in aggregated form as micelles,
insoluble monolayers, liquid crystals, or lamellar layers in aqueous solution.
Suitable lipids for liposomal formulation include, without limitation,
monoglycerides, diglycerides, sulfatides, lysolecithin, phospholipids, saponin,
bile acids, etc. Preparation of such liposomal formulations is well known by
those of skill in the art.
[0111] As used herein, the term "therapeutically effective amount" means the
total amount of each active component of the pharmaceutical composition or
method that is sufficient to show a meaningful patient benefit, e.g., amelioration
of symptoms of, healing of, or increase in rate of healing of conditions related to
IBD, etc. When applied to an individual active ingredient, administered alone,
the term refers to that ingredient alone. When applied to a combination, the term
refers to combined amounts of the active ingredients that result in the therapeutic
effect, whether administered in combination, serially or simultaneously.
[0112] In practicing the method of treatment or use of the present invention, a
therapeutically effective amount of a regulatory agent of at least one PBMC- and
IBD-associated biomarker is administered to a subject, e.g., a mammal (e.g., a
human). A regulatory agent may be administered in accordance with the method
of the invention either alone or in combination with other therapies, such as
treatments employing cytokines, lymphokines or other hematopoietic factors, or
anti-inflarnmatory agents. When coadministered with one or more agents, a

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regulatory agent of at least one PBMC- and IBD-associated biomarker may be
administered either simultaneously with the other agent(s), or sequentially. If
administered sequentially, the attending physician will decide on the appropriate
sequence of administering, e.g., a regulatory agent of at least one PBMC- and
IBD-associated biomarker, in combination with other regulatory agents of at least
one PBMC- and IBD-associated biomarker, or in combination with other agents.
[0113] In one embodiment, the regulatory agent(s) of at least one PBMC- and
IBD-associated biomarker of the invention, e.g., pharmaceutical compositions
thereof, are administered in combination therapy, i.e., combined with other
agents, e.g., therapeutic agents, that are useful for treating pathological conditions
or disorders, such as immune and/or inflammatory disorders. The term "in
combination" in this context means that the agents are given substantially
contemporaneously, either simultaneously or sequentially. If given sequentially,
at the onset of administration of the second compound, the first of the two
compounds is preferably still detectable at effective concentrations at the site of
treatment or in the subject.
Combination Therapy
[0114] Combination therapy can include, e.g., a regulatory agent of a PBMC-
and IBD-associated biomarker coformulated with, and/or coadministered with, at
least one additional therapeutic agent. Additional agents may include at least one
cytokine inhibitor, growth factor inhibitor, immunosuppressant, anti-'
inflammatory agent, metabolic inhibitor, enzyme inhibitor, cytotoxic agent, or
cytostatic agent, as described in more detail below. Such combination therapies
may advantageously utilize lower dosages of the administered therapeutic agents,
thus avoiding possible toxicities or complications associated with the various
monotherapies. Moreover, the therapeutic agents disclosed herein act on
pathways that differ from the IBD injury pathway, and thus are expected to
enhance and/or synergize with the effects of the at least one regulatory agent of a
PBMC- and IBD-associated biomarker.
[0115] Therapeutic agents used in combination with a regulatory agent of a
PBMC- and IBD-associated biomarker may be those agents that interfere at
different stages in an inflammatory response. In one embodiment, at least one

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regulatory agent of a PBMC- and IBD-associated biomarker described herein
may be coformulated with, and/or coadministered with, at least one cytokine
and/or growth factor antagonist. The cytokine and/or growth factor antagonists
may include soluble receptors, peptide inhibitors, small molecules, ligand
fusions, antibodies (that bind cytokines or growth factors or their receptors or
other cell surface molecules), and "anti-inflarnmatory cytokines" and agonists
thereof.
[0116] Nonlimiting examples of the agents that can be used in combination with
the regulatory agents of PBMC- and IBD-associated biomarkers described herein,
include, but are not limited to, antagonists of at least one interleukin (e.g., IL-1,
IL-2, IL-6, IL-7, IL-8, IL-12, IL-13, IL-15, IL-16, IL-17, IL-18, IL-21, and
IL-22); cytokine (e.g., TNFcc, LT, EMAP-II, and GM-CSF); or growth factor
(e.g., FGF and PDGF). The agents may also include, but are not limited to,
antagonists of at least one receptor for an interleukin, cytokine, and growth
factor. Regulatory agents of PBMC- and IBD-associated biomarkers can also be
combined with inhibitors of, e.g., antibodies to, cell surface molecules such as
CD2, CD3, CD4, CD8, CD20 (e.g., the CD20 inhibitor rituximab (RITUXAN®)),
CD25, CD28, CD30, CD40, CD45, CD69, CD80 (B7.1), CD86 (B7.2), CD90, or
their ligands, including CD154 (gp39 or CD40L), or LFA-l/ICAM-1 and
VLA-4/VCAM-1 (Yusuf-Makagiansaretal. (2002) Med. Res. Rev. 22:146-67).
Other compounds that can be used in combination with regulatory agents of
PBMC- and IBD-associated biomarkers described herein may include antagonists
of the receptors for IL-1, IL-12, TNFct, IL-15, IL-17, IL-18, IL-21 and IL-22.
[0117] Examples of agents useful in combination therapies with a regulatory
agent of a PBMC- and IBD-associated biomarker include IL-12 antagonists (such
as antibodies that bind IL-12 (see e.g., WO 00/56772)); IL-12 receptor inhibitors
(such as antibodies to the IL-12 receptor); and soluble IL-12 receptor and
fragments thereof. Examples of IL-15 antagonists include antibodies against IL-
15 or its receptor, soluble fragments of the IL-15 receptor, and IL-15-binding
proteins. Examples of IL-18 antagonists include antibodies to IL-18, soluble
fragments of the IL-18 receptor, and IL-18 binding proteins (IL-18BP, Mallat et
al. (2001) Ore. Res. 89:E41-45). Examples of IL-1 antagonists include

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interleukin-1-converting enzyme (ICE) inhibitors (such as Vx740), IL-1
antagonists (e.g., IL-1RA (anakinra (KINERET™), Amgen)), sIL-lRII
(Immunex), and anti-IL-1 receptor antibodies.
[0118] Examples of TNF antagonists include antibodies to TNF (e.g., human
TNFa), such as D2E7 (human anti-TNFa antibody, U.S. Patent No. 6,258,562,
HUMIRA™, Abbott Labs); CDP-571/CDP-870/BAY-10-3356 (humanized anti-
TNFa antibodies, CelltechyPharmacia); cA2 (chimeric anti-TNFa antibody,
REMICADE™, Centocor); and anti-TNF antibody fragments (e.g., CPD870).
Other examples include soluble TNF receptor (e.g., human p55 or p75) fragments
and derivatives, such as p55 kD TNFR-IgG (55 kD TNF receptor-IgG fusion
protein, LENERCEPT™) and 75 kd TNFR-IgG (75 kD TNF receptor-IgG fusion
protein, ENBREL™ (etanercept - Immunex)). See, e.g., van der Poll et al. (1997)
Blood. 89:3727-34; Mori etal. (1996)1 Immunol. 157:3178-82. Further
examples include enzyme antagonists (e.g., TNFa converting enzyme inhibitors
(TACE) such as alpha-sulfonyl hydroxamic acid derivative (WO 01/55112) or
N-hydroxyforrnamide inhibitors (GW3333, -005, or-022, GlaxoSmithKline)
and TNF-bp/s-TNFR (soluble TNF binding protein, see, e.g., Lantz et al. (1991)
J. Clin. Invest. 88:2026-31; Kapadia et al. (1995) Amer. J. Physiol. Heart Circ.
Phys. 268:H517-25). TNF antagonists may be soluble TNF receptor (e.g., human
p55 or p75) fragments and derivatives, such as 75 kd TNFR-IgG; and TNFa
converting enzyme (TACE) inhibitors.
[0119] In other embodiments, the regulatory agents of PBMC- and IBD-
associated biomarkers described herein can be administered in combination with
at least one of the following: IL-13 antagonists, such as soluble IL-13 receptors
and/or anti-IL-13 antibodies; and IL-2 antagonists, such as IL-2 fusion proteins
(e.g., DAB 486-IL-2 and/or DAB 389-IL-2 made by Seragen, see, e.g., Sewell et
al. (1993) Arthritis Rheum. 36:1223-33) and anti-IL-2R antibodies (e.g.,
anti-Tac-H humanized antibody, Protein Design Labs, see Junghans et al. (1990)
Cancer Res. 50:1495-502). Another combination includes regulatory agents of
PBMC- and IBD-associated biomarkers in combination with nondepleting anti-
CD4 inhibitors such as IDEC-CE9.1/SB 210396 (anti-CD4 antibody,
GlaxoSmithKline). Yet other combinations include regulatory agents of PBMC-

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and IBD-associated biomarkers with CD80 (B7.1) and CD86 (B7.2)
costimulatory pathway antagonists (such as antibodies, soluble receptors, or
antagonistic ligands); P-selectin glycoprotein ligand (PSGL) and PSGL-1
inhibitors (such as antibodies to PSGL and/or PSGL-1 and small molecule
inhibitors); T cell- and B cell-depleting agents (such as anti-CD4 or anti-CD22
antibodies), and anti-inflammatory cytokines and agonists thereof (e.g.,
antibodies). The anti-inflammatory cytokines may include IL-4 (e.g., Schering-
Plough Biopharma); IL-10 (e.g., SCH 52000, recombinant IL-10, Schering-
Plough Biopharma); IL-11; IL-13; and TGF|5 or agonists thereof (e.g., agonist
antibodies).
[0120] In other embodiments, at least one regulatory agent of a PBMC- and
IBD-associated biomarker can be coformulated with, and/or coadministered with,
at least one anti-inflammatory drug, immunosuppressant, metabolic inhibitor, and
enzymatic inhibitor. Nonlirniting examples of the drugs or inhibitors that can be
used in combination with the regulatory agents of PBMC- and IBD-associated
biomarkers described herein include, but are not limited to, at least one of:
nonsteroidal anti-inflammatory drugs (NS AIDs) (including, but not limited to,
aspirin, salsalate, diflunisal, ibuprofen, ketoprofen, nabumetone, piroxicam,
naproxen, diclofenac, indomethacin, sulindac, tolmetin, etodolac, ketorolac,
oxaprozin, tenidap, meloxicam, piroxicam, aceclofenac, tolmetin, tiaprofenic
acid, nimesulide, etc.); sulfasalazine; corticosteroids (such as prednisolone);
cytokine suppressive anti-inflarnmatory drugs (CSAIDs); inhibitors of nucleotide
biosynthesis (such as inhibitors of purine biosynthesis (e.g., folate antagonist
such as methotrexate)); and inhibitors of pyrimidine biosynthesis, e.g., a
dihydroorotate dehydrogenase (DHODH) inhibitor such as leflunomide (see, e.g.,
Kraan et al. (2004) Ann. Rheum. Dis. 63:1056-61). Therapeutic agents for use in
combination with regulatory agents of at least one PBMC- and IBD-associated
biomarker may include one or more NSAIDs, CSAIDs, DHODH inhibitors (such
as leflunomide), and folate antagonists (such as methotrexate).
(0121] Examples of additional agents that may be used in combination with
regulatory agents of PBMC- and IBD-associated biomarkers include at least one
of: corticosteroid (oral, inhaled and local injection); immunosuppressant (such as
cyclosporin and tacrolimus (FK-506)); an mTOR inhibitor (such as sirolimus

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(rapamycin) or a rapamycin analog anaVor derivative, e.g., ester rapamycin
derivative such as CCI-779 (see, e.g., Elit (2002) Curr. Opin. Investig. Drugs
3:1249-53; Huang et al. (2002) Curr. Opin. Investig. Drugs 3:295-304)); an agent
which interferes with the signaling of proinflammatory cytokines such as TNFoc
and IL-1 (e.g., an IRAK, NIK, IKK, p38 or MAP kinase inhibitor); TPL-2, Mk-2
and NFKD inhibitors; COX-2 inhibitors (e.g., celecoxib, rofecoxib, etc., and
variants thereof); phosphodiesterase inhibitors (such as Rolipram); phospholipase
inhibitors (e.g., an inhibitor of cytosolic phospholipase 2 (cPLA2) such as
trifluoromethyl ketone analogs (U.S. Patent No. 6,350,892)); inhibitors of
vascular endothelial cell growth factor (VEGF); inhibitors of the VEGF receptor;
inhibitors of angiogenesis; RAGE and soluble RAGE; estrogen receptor beta
(ERB) agonists, ERB-NFxb antagonists; interferon-p (for example, IFNp-la and
IFNp-lb); Copaxone; and corticosteroids.
[0122] Other useful therapeutic agents that may be combined with one or more
regulatory agent(s) of a PBMC- and IBD-associated biomarker include:
budenoside; epidermal growth factor; aminosalicylates; 6-mercaptopurine;
azathioprine; metronidazole; lipoxygenase inhibitors; mesalamine; olsalazine;
balsalazide; antioxidants; thromboxane inhibitors; growth factors; elastase
inhibitors; pyridinyl-imidazole compounds; glucuronide- or dextran-conjugated
prodrugs of prednisolone; dexamethasone or budesonide; ICAM-1 antisense
phosphorothioate oligodeoxynucleotides (ISIS 2302; Isis Pharmaceuticals, Inc.);
soluble complement receptor 1 (TP10; T Cell Sciences, Inc.); slow-release
mesalazine; antagonists of platelet activating factor (PAF); ciprofloxacin;
lignocaine; cyclosporin A; hydroxychloroquine (PLAQUENIL™); minocycline
(MNOCIN™); and anakinra (KTNERET™).
[0123] Choosing a particular therapeutic agent for administration in combination
with regulatory agents of PBMC- and IBD-associated biomarkers of the
invention will largely depend on factors such as the particular subject, the desired
target, and chosen length of treatment. Such decisions are well within the skill
and knowledge of one skilled in the art.
[0124] Additional examples of therapeutic agents that can be combined with a
regulatory agent of a PBMC- and IBD-associated biomarker include one or more

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of: 6-mercaptopurines (6-MP); azathioprine; sulfasalazine; mesalazine;
olsalazine; chloroquine, hydroxychloroquine (PLAQUENIL®); penicillamine;
aurothiornalate (intramuscular and oral); azathioprine; colchicine; beta-2
adrenoreceptor agonists (salbutamol, terbutaline, salmeterol); xanthines
(theophylline, aminophylline); cromoglycate; nedocromil; ketotifen; ipratropium
and oxitropium; mycophenolate mofetil; adenosine agonists; antithrombotic
agents; complement inhibitors; and adrenergic agents.
[0125] In one embodiment, a regulatory agent of a PBMC- and IBD-associated
biomarker can be used in combination with one or more antibodies directed at
other targets involved in regulating immune responses. Nonlimiting examples of
agents for treating or preventing immune responses with which a regulatory agent
of a PBMC- and IBD-associated biomarker of the invention can be combined
include the following: antibodies against other cell surface molecules, including
but not limited to CD25 (interleukin-2 receptor-a), CD1 la (LFA-1), CD54
(ICAM-1), CD4, CD45, CD28, CTLA4, ICOSL, ICOS, CD80 (B7.1), and/or
CD86 (B7.2). In yet another embodiment, a regulatory agent of a PBMC- and
IBD-associated biomarker is used in combination with one or more general
immunosuppressive agents, such as cyclosporins A or FK506. In another
embodiment, a regulatory agent of a PBMC- and IBD-associated biomarker is
used in combination with a CTLA4 agonist, e.g., (e.g., CTLA4 Ig - abatacept
(ORENCIA®)).
[0126] A pharmaceutical composition of the invention is formulated to be
compatible with its intended route of administration. Methods to accomplish the
administration are known to those of ordinary skill in the art. It may also be
possible to obtain compositions which may be topically or orally administered, or
which may be capable of transmission across mucous membranes.
Administration of a modulator of the invention used in the pharmaceutical
composition to practice Hie method of the present invention can be carried out in
a variety of conventional ways, such as oral ingestion, inhalation, cutaneous,
subcutaneous, intravenous injection, rectal enema, insertion of a suppository, etc.
[0127] Solutions or suspensions used for intradermal or subcutaneous
application typically include one or more of the following components: a sterile
diluent such as water for injection, saline solution, fixed oils, polyethylene

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glycols, glycerine, propylene glycol or other synthetic solvents; antibacterial
agents such as benzyl alcohol or methyl parabens; antioxidants such as ascorbic
acid or sodium bisulfite; chelating agents such as ethylenediaminetetraacetic acid;
buffers such as acetates, citrates or phosphates; and agents for the adjustment of
tonicity such as sodium chloride or dextrose. The pH can be adjusted with acids
or bases, such as hydrochloric acid or sodium hydroxide. Such preparations may
be enclosed in ampoules, disposable syringes or multiple dose vials made of glass
or plastic.
[0128] Pharmaceutical compositions suitable for injection include sterile
aqueous solutions or dispersions and sterile powders for the extemporaneous
preparation of sterile injectable solutions or dispersion. For intravenous
administration, suitable carriers include physiological saline, bacteriostatic water,
CREMAPHORE™ EL (BASF, Parsippany, NJ) or phosphate buffered saline
(PBS). In all cases, the composition must be sterile and should be fluid to the
extent that easy syringability exists. It must be stable under the conditions of
manufacture and storage and must be preserved against the contaminating action
of microorganisms such as bacteria and fungi. The carrier can be a solvent or
dispersion medium containing, for example, water, ethanol, polyol (for example,
glycerol, propylene glycol, and liquid polyethylene glycol, and the like), and
suitable mixtures thereof. The proper fluidity can be maintained, for example, by
the use of a coating such as lecithin, by the maintenance of the required particle
size in the case of dispersion, and by the use of surfactants. Prevention of the
action of microorganisms can be achieved by various antibacterial and antifungal
agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal,
and the like. In many cases, it will be preferable to include isotonic agents, for
example, sugars, polyalcohols such as mannitol, sorbitol, and sodium chloride, in
the composition. Prolonged absorption of the injectable compositions can be
brought about by including in the composition an agent which delays absorption,
for example, aluminum monostearate and gelatin.
[0129] When a therapeutically effective amount of a regulatory agent of at least
onePBMC- and IBD-associated biomarker is administered orally, the binding
agent will be in the form of a tablet, capsule, powder, solution or elixir. When
administered in tablet form, the pharmaceutical composition of the invention may

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additionally contain a solid carrier such as a gelatin or an adjuvant. The tablet,
capsule, and powder contain from about 5 to 95% binding agent, and preferably
from about 25 to 90% binding agent When administered in liquid form, a liquid
carrier such as water, petroleum, oils of animal or plant origin such as peanut oil
(albeit keeping in mind the frequency of peanut allergies in the population),
mineral oil, soybean oil, or sesame oil, or synthetic oils may be added. The liquid
form of the pharmaceutical composition may further contain physiological saline
solution, dextrose or other saccharide solution, or glycols such as ethylene glycol,
propylene glycol, or polyethylene glycol. When administered in liquid form, the
pharmaceutical composition contains from about 0.5 to 90% by weight of the
binding agent, and preferably from about 1 to 50% by weight of the binding
agent.
[0130] When a therapeutically effective amount of a regulatory agent of at least
one PBMC- and IBD-associated biomarker is administered by intravenous,
cutaneous or subcutaneous injection, the regulatory agent will be in the form of a
pyrogen-free, parenterally acceptable aqueous solution. The preparation of such
parenterally acceptable protein solutions, having due regard for pH, isotonicity,
stability, and the like, is within the skill of those in the art. A preferred
pharmaceutical composition for intravenous, cutaneous, or subcutaneous
injection should contain, in addition to the regulatory agent of at least one
PBMC- and IBD-associated biomarker, an isotonic vehicle such as sodium
chloride injection, Ringer's injection, dextrose injection, dextrose and sodium
chloride injection, lactated Ringer's injection, or other vehicle as known in the art.
The pharmaceutical composition of the present invention may also contain
stabilizers, preservatives, buffers, antioxidants, or other additive known to those
of skill in the art.
[0131] The amount of a regulatory agent of at least one PBMC- and IBD-
associated biomarker in the pharmaceutical composition of the present invention
will depend upon the nature and severity of the condition being treated, and on
the nature of prior treatments that the patient has undergone. Ultimately, the
attending physician will decide the amount of the regulatory agent of at least one
PBMC- and IBD-associated biomarker with which to treat each individual
patient. Initially, the attending physician will administer low doses of the

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regulatory agent of at least one PBMC- and IBD-associated biomarker and
observe the patient's response. Larger doses of the regulatory agent of at least
one PBMC- and IBD-associated biomarker may be administered until the optimal
therapeutic effect is obtained for the patient, and at that point the dosage is not
generally increased further. It is contemplated that the various pharmaceutical
compositions used to practice the method of the present invention should contain
about 0.1 jag to about 100 mg per kg body weight.
[0132] The duration of intravenous (i.v.) therapy using a pharmaceutical
composition of the present invention will vary, depending on the severity of the
disease being treated and the condition and potential idiosyncratic response of
each individual patient. It is contemplated that the duration of each application of
the regulatory agent of at least one PBMC- and IBD-associated biomarker may
be in the range of 12 to 24 hours of continuous i.v. administration, or some other
appropriate period. Also contemplated is subcutaneous (s.c), suppository, etc.
therapy using a pharmaceutical composition of the present invention. These
therapies can be administered daily, weekly, or, more preferably, biweekly, or
monthly. It is also contemplated that where the regulatory agent of at least one
PBMC- and IBD-associated biomarker is a small molecule, the therapies may be
administered daily, twice a day, three times a day, etc. Ultimately the attending
physician will decide on the appropriate duration of therapy, or therapy with a
small molecule, and the timing of administration of the therapy, using the
pharmaceutical composition of the present invention.
Kits
[0133] The invention also provides kits for determining the prognosis for long-
term survival or well-being in a subject having an inflammatory bowel disease,
the kit comprising reagents for assessing expression of the biomarkers of the
invention. Kits for diagnosis and monitoring are also contemplated. Preferably,
the reagents may comprise one or more anti-biomarker antibody or fragment
thereof, wherein the antibody or fragment thereof specifically binds with a
protein corresponding to a PBMC- and IBD-associated biomarker. Optionally,
the kits may comprise a polynucleotide probe wherein the probe specifically
binds with a transcribed polynucleotide corresponding to a PBMC- and IBD-

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associated biomarker listed in Tables 1-5. The kits may also include a panel of
PBMC- and IBD-associated biomarkers, which may be arranged as an array on a
biochip, such as, for example, a GENECHTP®.
[0134] The invention further provides kits for assessing the suitability of each of
a plurality of compounds for inhibiting an inflammatory bowel disease in a
subject. Such kits include a plurality of compounds to be tested, and a reagent
(i.e., an antibody specific to corresponding proteins, or a probe or primer specific
to corresponding polynucleotides) for assessing expression of a PBMC- and IBD-
associated biomarker listed in Tables 1-5.
[0135] Modifications to the above-described compositions and methods of the
invention, according to standard techniques, will be readily apparent to one
skilled in the art and are meant to be encompassed by the invention.
[0136] This invention is further illustrated by the following examples, which
should not be construed as limiting. The contents of all references, patents and
patent applications cited throughout this application are hereby incorporated by
reference herein.
EXAMPLES
[0137] The Examples which follow are set forth to aid in the understanding of
the invention but are not intended to, and should not be construed to, limit its
scope in any way. The Examples do not include detailed descriptions of
conventional methods, such as isolation of peripheral blood mononuclear cells
from healthy volunteers and patients afflicted with inflammatory bowel disease.
Such methods are well known to those of ordinary skill in the art.
EXAMPLE 1
Materials and Methods
Example 1.1: Patient Information and Clinical Assessments
[0138] Blood samples for pharmacogenomic analysis were collected at North
American and European clinical sites from a total of 42 apparently healthy
individuals, 59 CD patients and 26 UC patients. Each clinical site's Institutional
Review Board or Ethics Committee approved this study, and no procedures were
performed prior to obtaining informed consent from each patient

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[0139] A comparison of the demographic characteristics of individuals in the
present study is presented in Table 7.
Table 7: Demographic characteristics of normal disease-free individuals (C) and
subjects with IBP, in the form of Crohn's disease (CD) or ulcerative colitis (UC)

1: p-value calculated using two-sided t-test with, t-statistic based on AKOVA error estimate.
2: p-value calculated using Likelihood Ratio chi-square test comparing male to female frequencies
among groups.
3: p-value calculated using Likelihood Ratio chi-square test comparing Caucasian to non-
Caucasian frequencies among groups.
[0140] Healthy subjects (24 males, 18 females) were predominantly Caucasian
and ranged in age from 25 to 60 years. CD patients (21 males, 38 females) were
predominantly Caucasian and ranged in age from 20 to 65 years, with Crohn's
disease activity index scores (CDAI) ranging between 220 and 400, and with an
abdominal pain rating of >25 and/or a diarrhea rating of >25. Diagnosis of CD
for at least 6 months was confirmed by radiological studies, endoscopy with
histological examination, or surgical pathology; patients with a diagnosis of
Crohn's disease were included if the diagnosis was confirmed by a biopsy. UC
patients (8 males, 18 females) were predominantly Caucasian and ranged in age
from 25 to 73 years, and had scores from the Physician's Global Assessment of
the Mayo Ulcerative Colitis Scoring System (MUCSS) ranging from mild to
moderate (scores of 1 or 2). The diagnosis of left-sided UC was provided by
endoscopy with biopsy, in addition to standard clinical criteria.
[0141] Proportions of females to males were significantly different between the
healthy and IBD populations, but not distinct between the two IBD populations;
neither race (Caucasian vs. non-Caucasian) nor age differed significantly between
healthy and IBD populations, or between the two IBD populations (all at the

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p<0.05 level). Investigation of concomitant medication usage between the two
IBD populations indicated that neither 5-ASA nor any of Hie other less frequently
used drugs reported as concomitant medications confounded the comparisons in
this study.
Example 1.2: Blood Sampling and Processing
[0142] Blood (8 ml) was collected from each person into a Vacutainer cell
preparation tube (CPT; Becton Dickinson, Franklin Lakes, NJ) at the clinical site
and shipped overnight to a central processing lab for PBMC isolation according
to manufacturer's recommendations. All PBMCs analyzed in this study were
processed within 24 hours after the blood draw. Prior to RNA purification,
complete cell counts were performed on purified PBMCs using an ABX Pentra
60 C+ Hematology Analyzer (Irvine, CA) to record absolute counts and
percentages of neutrophils, lymphocytes, monocytes, eosinophils, and basophils.
Cell counts for one PBMC sample from a UC patient were not performed, and
this profile was "therefore excluded from the ANCOVA analyses described below.
Expression, data from this patient were included when developing and testing
prediction models. Total RNA was purified from PBMCs using the RNeasy mini
column protocol (Qiagen, Valencia, CA).
Example 1.3: Oligonucleotide Array Hybridization and Data Reduction
[0143] Total RNA (2 p.g) was converted to biotinylated cRNA according to the
Affymetrix protocol (Affymetrix, Santa Clara, CA). Labeled cRNA (10(j,g) was
fragmented and prepared for hybridization as previously described (Twine et al.,
supra). Biotinylated cRNA was hybridized to the Affymetrix HG-U133A human
GENECHTP® array as described in the Affymetrix Technical Manual. Eleven
biotinylated control transcripts ranging in abundance from 1:300,000 (3 ppm) to
1:1000 (1000 ppm) were spiked into each sample prior to hybridization to
function as a standard curve (Hill et al. (2001) Genome Biol.
2(12):research0055.1-0055.13). GENECHIP® MAS 5.0 software was used to
evaluate the specific hybridization intensity, compute a signal value for each
probe set and make an absent/present call. The signal value for each probe set
was then converted to a frequency value representative of the number of
transcripts present in 106 transcripts by reference to the standard curve (Hill et al.,

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supra). Each transcript was evaluated and included in the study if it met the
following two constringent criteria: called 'present' and at or above a frequency
value of 10 (10 ppm) in at least one of the samples (healthy, UC or CD). 7,908
sequences met these filtering criteria and were used in the analysis.
Example 1.4: Analysis of Variance (ANOVA) and Analysis of Covariance
(ANCOVA)
[0144] Analysis of covariance (ANCOVA) methods were used to adjust for
differences in PBMC cell type composition when testing for differences in mean
expression among disease groups. Separate ANCOVAs were, run for each
transcript, using log-transformed frequency as the response measure. The
ANCOVA model included terms for disease group, gender, neutrophil percent,
monocyte percent, and eosinophil percent. In the ANCOVA, for each cell type a
slope describing the linear relationship between the percent of the cell type and
the expression level for a particular gene was estimated, and a t-test was done to
determine whether the slope was significantly different from 0 (where a slope of
0 indicates that there is no linear relationship between cell type percent and
expression level).
[0145] The choice of cell types to include in the ANCOVA model was driven by
consideration of 1) the degree of correlation between cell types, 2) the degree of
difference among disease types in the distribution of each cell type, and 3) the
magnitude of percents for each cell type. Covariates in an ANCOVA should not
be highly correlated to each other. Lymphocyte percents were strongly inversely
correlated with monocyte percents and with neutrophil percents, and for that
reason were not included in the ANCOVA.
[0146] In addition to the overall tests for treatment group differences and cell
type regression effects, pairwise comparisons of disease group means adjusted for
differences in cell type percents were performed using two-sided t-tests, with the
denominator of the t-statistics derived from the ANCOVA error term. Finally,
because the relative distribution of females and males was also significantly
distinct among the disease groups, gender was included in the ANCOVAs.
[0147] No adjustments of the raw p-values produced by the analyses described
above were done to account for the large number of statistical tests performed. A

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fold-change filter (1.5 fold) combined with a conservative significance level of
a=0.0001 were used to reduce the incidence of false-positive determinations.
Example 1.5: Gene Selection and Supervised Class Prediction using Microarray
Expression Data
[0148] Gene selection and supervised class prediction were performed using
GeneCluster version 2.0, which has been previously described (Golub et al.
(1999) Science 286:531-37) and is available at
wvvw.broad.mit.edu/cancer/software/software.htrnl. In these analyses only 4228
transcripts meeting a stringent data reduction filter (at least 50% present calls in
Crohn's or UC samples, and at least 50% of the Crohn's or UC samples with
frequencies greater than 10 ppm) were used. Samples within each group were
randomly selected for membership in a data set (data set MB) consisting of a
training set (75%) or a test set (25%) of profiles. Gene selection was performed
using the training set of samples, and the classifier with the fewest genes that
exhibited the highest overall accuracy of class assignment in the training set was
identified by leave-one-out and four-fold cross-validation. The predictive
classification model was then evaluated on samples in the test set, and the overall
accuracy of class assignment for samples in the test set was reported.
[0149] For gene selection, all expression data in both the training set and test set
were log transformed prior to analysis. In the training set of data, models
containing increasing numbers of features (transcript sequences) were built using
a two-sided approach (equal numbers of features in each class) with a S2N
similarity metric that used median values for the class estimate. PBMC profiles
from CD patients and UC patients were compared using a binary approach.
Predictive gene classifiers containing between 2 and 200 genes in steps of 2 were
evaluated by leave-one-out and four-fold cross-validation to identify the smallest
predictive model yielding the most accurate class assignments. Prediction of
class membership was performed using a weighted voting algorithm.
Example 1.6: Ingenuity Pathway Analysis
[0150] The Ingenuity Pathway Analysis (IP A) tool (Ingenuity, Mountain View,
CA) was used to annotate IBD-associated genes, CD-specific genes and UC-
specific genes obtained from ANCOVA analyses. Annotations on canonical

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pathways and functional categories were retrieved for these gene lists from the
Gene-By-Gene View and/or using the Search IPKB (Ingenuity Pathways
Knowledge Base) feature.
Example 1.7: Quantitative Real Time Polymerase Chain Reaction (Q-PCR)
Confirmation of Microarray Results
[0151] Two 96-well plates containing peripheral blood mononuclear cell
(PBMC) RNA samples from 59 patients with Crohn's Disease (CD) and 26
patients with ulcerative colitis (UC) were analyzed by Q-PCR. A total of 45 ng
of each PBMC RNA sample was transferred into 96-well plates in a manner that
preserved the original order of the sample. PBMC RNA samples from two
patients with CD and one patient with UC did not contain sufficient RNA;
subsequently, the samples from these patients were excluded from Q-PCR
analysis. Each RNA sample was reverse-transcribed in a 100-ul reaction using
the High Capacity cDNA Archive kit (Applied Biosystems, San Diego CA). The
reaction was incubated at 25°C for 10 minutes and then 37°C for 2 hours and
stored at -80°C until amplification. Predesigned gene-specific TAQMAN®
probe and primer sets (TAQMAN® gene expression assays, Applied Biosystems)
corresponding to the GENBANK accession numbers for genes in the 12-gene
classifier (i.e., the UniGene ID numbers found in Table 5, above) were used to
amplify and quantitate the relative expression levels of classifying biomarkers.
Also amplified and quantitated for each RNA sample were the expression levels
of four housekeeping genes: (1) p2-microglobulin (P2M), (2) p-actin, (3) 18S
ribosomal RNA (18S), and (4) glyceraldehydes-phosphate dehydrogenase
(GAPDH). Applied Biosystems (ABI) IDs of TAQMAN® probes and primers
used for each transcript of interest are indicated in Table 8.

Table 8: ABI IDs of TAQMAN probes and primers for each targeted gene.
ABI ID Gene Name Symbol Unigene ID
Hs99999901_s1 18SrRNA 18S
Hs00194353 ml lipocalin 2 (oncogene 24p3) LCN2 Hs.204238
Hs00271778 ml mutL homolog 3 (E. coli) MLH3 Hs.279843
Hs00190538 ml serum deprivation response
(phosphatidylserine binding
protein) SDPR Hs.26530
Hs00269023_s1 histone 2, H2be HIST2H2BE Hs.2178
Hs00740275_s1 histonel,H3h HIST1H3H Hs.70937

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Table 8: ABI IDs of TAQMAN probes and primers for each targeted gene.
ABI ID Gene Name Symbol Unigene ID
Hs00171085 ml chemokine (C-X-C motif) ligand
5 CXCL5 Hs.89714
HsOO 173978 ml integrin, beta 3 (platelet
glycoprotein Ilia, antigen CD61) ITGB3 Hs.87149
Hs00415042 ml immunoglobulin kappa constant IGKC Hs.406565
Hs00174778 ml protein tyrosine phosphatase,
receptor type, C-associated
protein PTPRCAP Hs. 155979
HsOOl57878 ml granzyme K (serine protease,
granzyme 3; tryptase II) GZMK Hs.3066
HsOOl87842 ml beta-2-microglobuIin B2M
Hs99999903 ml actin, beta ACTB
Hs99999905 ml glyceraldehyde-3 -phosphate
dehydrogenase GAPDH
Hs00413854 gl immunoglobulin heavy constant
gamma 1 (Glm marker) IGHG1
Hs00203983 ml mitochondrial ribosomal protein
S28 MRPS28
[0152] Quantitative real time PCR for each transcript of interest was performed
in 96-well fast block optical reaction plates in a 25-ul reaction volume
(containing IX TAQMAN® Fast Universal Master Mix, IX TAQMAN® gene
expression assay, and 2.25 ng of cDNA) using an ABI 7900HT sequence
detection system (Applied Biosystems, San Francisco, CA). Negative control
samples of DEPC water only (no template control; NTC) and positive control
samples of human leukopack RNA were included on each 96-well plate and for
each gene-specific TAQMAN® probe and primer set. Default ABI 7900HT fast
block cycle conditions were as follows: 95°C for 20 seconds, 40 cycles of 95°C
for 1 second, and 60°C for 20 seconds. The classifying biomarkers assayed in
this manner are listed in Table 9.

Table 9. Target genes assayed
[gHgl Immunoglobulin heavy constant gamma 1 (also IgHg3)
[gKc Immunoglobulin kappa constant
28S Human 28S ribosomal RNA 5' region
PTP, C-assoc Protein tyrosine phosphatase, receptor type, C-associated
protein

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Table 9. Target genes assayed
GranzymeK Granzyrne K (Serine protease, granzyme 3; tryptase II)
tmitL homolog 3 mutL homolog 3 (E. coli)
Lipocalin-2 Lipocalin 2 (oncogene 24p3)
CXCL5 Chemokine (C-X-C motif) ligand 5
serum dep response Serum deprivation response (phosphatidylserine binding
protein)
Histone 3K H3 histone family, member K
Integrin beta-3 Integrin, beta 3 (platelet glycoprotein Ilia, antigen CD 61)
Histone 2BQ H2B histone family, member Q
[0153] Acceptance criteria were: (1) undetectable amplification in NTC samples
for each primer pair of interest, and (2) detectable gene-specific amplification in
leukopack RNA positive control samples for each primer pair of interest. Cycle
threshold (Ct) values for each amplification reaction were recorded for each
classifying biomarker and each of the four housekeeping genes. To normalize,
the differences between cycle thresholds for target genes and each of the four
housekeeping genes (ACt) in each of the PBMC samples were calculated, and the
average fold change in expression between UC and CD was calculated by the
following formula: average fold difference = 2(ACtUC-ACtCD> or 2(ACtCD-ActUC) as
appropriate.
Example 1.8: Supervised Class Prediction using Q-PCR Expression Values
[0154] Parametric (linear), nonparametric k=3 nearest neighbor, and
nonparametric k=10 nearest neighbor class assignment methods of discriminant
analysis were applied to each of three data sets each divided into a training and a
test subset (Data set MB (described above in Example 1.5) and two alternative
random allocations of the same data to training and test subsets (Data set 1, and
Data set 2)) of classifying biomarker expression levels (i.e., cycle threshold
values) normalized with each of four housekeeping genes as obtained from Q-
PCR (described above in Example 1.7). In all three data sets, RNA expression
levels from PBMC samples from 57 patients with Crohn's Disease (CD) and 25
patients with ulcerative colitis (UC) were analyzed (43 CD plus 19 UC samples

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were used for training, and 14 CD plus 6 UC samples for testing). Similarly, full
model, backward, forward, and stepwise methods of logistic analysis with
significance levels set at p = 0.05 or p = 0.15 were performed on the three data
sets of classifying biomarker expression levels normalized with the housekeeping
gene 18S. Training set and test set accuracy, sensitivity, specificity, positive
perspective value (PPV), and negative perspective value (NPV) of the
classifications were calculated and compared using SAS® 8.2 (Cary, NC) and
SPOTFIRE® DECISIONSITE™ 8.0 (Somerville, MA) software. Finally,
accuracy of classifiers generated using linear discriminant analysis of the ACts
for the 12 classifying biomarkers normalized by the cycle threshold of the
housekeeping gene 18S was compared to accuracy of classifiers generated using
logistic analysis of the same ACts for twenty data sets with random allocations to
training and test subsets (each containing 43 CD plus 19 UC samples for training,
and 14 CD plus 6 UC samples for testing).
EXAMPLE 2
Example 2.1: Cellular Composition of Purified PBMC Samples from Healthy
Subjects, Crohn's Disease Patients, and Ulcerative Colitis Patients
[0155] Prior to the expression-profiling portion of the study, the cellular
compositions of the purified PBMC pellets from subjects in all three groups
(healthy subjects, patients with CD, and patients with UC) were measured before
RNA isolation. Table 10 shows the percentages of basophils, eosinophils,
lymphocytes, monocytes and neutrophils in the PBMC samples.

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Table 10: The number of samples taken from patients with IBD, in the form of
Crohn's disease (CD) or ulcerative colitis (UC), and normal disease-free
individuals (C) and average percent (%) cell types in samples

Type CD UC ';.;-C: C vs. IBD
p-value1 CDvs.UC
p-value1
Number of
Samples 59 25 42
Basophil % 0.33 0.30 1.05 0.012 0.93
Eosinophil % 1.10 0.91 0.37 0.0003 0.37
Lympjiocyte % 52.20 59.58 78.90 O.0001 0.056
Monocyte % 29.41 27.63 14.65 O.0001 0.52
Neutrophil % 14.96 10.58 5.00 <0.0001 0.035
1: p-value calculated using a two-sided t-test, with t-statistic based on ANOVA error estimate.
[0156] The cellular composition of PBMC samples was significantly different
(p<0.05) in the comparison of PBMCs from healthy subjects to those from IBD
patients. The overall percentages of basophils and lymphocytes were
significantly lower in PBMCs from patients with IBD, while the percentages of
eosinophils, monocytes and neutrophils were significantly elevated in PBMCs
from IBD patients. Previous studies have noted elevations in neutrophils via
similar purification processes, which are due to changes in sedimentation density
that appear to be related to alterations in their activation state in the peripheral
blood of advanced cancer patients (Schmielau and Finn (2001) Cancer Res.
61:4756-60). The selective elevation in eosinophils, monocytes and neutrophils
may be a disease-related activation event captured by the CPT-based PBMC
isolation process, since cell compositions of whole blood was not significantly
different between groups (data not shown).
[0157J In contrast, basophil, eosinophil, and monocyte proportions were not
significantly distinct (p<0.05) between CD and UC PBMC samples. In the
comparison of the two IBD groups, only neutrophils were significantly different
(11% vs. 15%, p=0.035).
Example 2.2: Expression Level Differences in PBMCs from All IBD Patients
Compared to Healthy Controls
[0158] To identify disease-associated genes that are not apparently associated
with differences in cell composition, an analysis of covariance (ANCOVA) was
used to identify differentially expressed transcripts while taking into account
variation in cell composition among the PBMC samples. ANCOVAs were run

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for the 7908 transcripts that passed the standard expression level filter and the
percentage of eosinophils, monocytes, and neutrophils were included as
covariates.
[0159] The choice of which cell types to include was governed in part by the fact
that covariates in an ANCOVA should not be highly correlated to each other.
Lymphocyte percents were strongly inversely correlated with monocyte percents
and with neutrophil percents, and for that reason were not included in the
ANCOVA. For each cell type, a slope describing the linear relationship between
the percent of the cell type and the expression level for a particular gene was
estimated, and a t-test was done to determine whether the slope was significantly
different from. 0 (where a slope of 0 indicates that there is no linear relationship
between cell type percent and expression level). Finally, because the relative
distribution of females and males was also significantly distinct among the
disease groups, gender was included in the ANCOVAs to identify transcripts that
appeared gender-specific rather than related to disease status.
[0160] By the ANCOVA analysis, the levels of 220 transcripts were greater than
1.5 fold different between Crohn's disease and healthy PBMCs and possessed an
unadjusted p-value in the pairwise comparison based on the ANCOVA of less
than 0.0001, and the levels of 120 transcripts were significantly different between
UC and healthy PBMCs using the same criteria as above. Forty-five of these
sequences were differentially expressed in both UC and CD PBMCs, and these
common PBMC- and IBD-associated transcripts changed in the same direction in
both diseases compared to healthy levels (Table 1, above).
[0161] An additional filter was applied to the remaining gene sets to identify
PBMC transcripts that appear differentially expressed in only one disease state.
Of the 220 transcripts that were CD-associated (>1.5 fold change, p<0.0001), a
total of 67 sequences were not significantly altered in the UC PBMCs versus
healthy comparison (p>0.05) and therefore appear to be CD-specific. The 67
CD-specific PBMC sequences, i.e., CD biomarkers, are presented in Table 2,
above. Of the 120 transcripts that were UC-associated (>l .5 fold change,
p<0.0001), a total of 22 sequences were not significantly altered in the CD
PBMCs versus the healthy comparison (p>0.05) and therefore appear to be UC-.

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specific. The 22 UC-specific PBMC sequences, i.e., UC biomarkers, are
presented in Table 3, above.
[0162] The canonical gene pathways bearing the greatest likelihood of
significant overrepresentation are summarized for each comparison in FIG. 1A.
In this analysis, transcripts involved in the canonical category of prostaglandin
metabolism were significantly overrepresented in the CD gene signature, while
transcripts encoding proteins involved in the canonical categories of apoptosis
and B cell signaling appear overrepresented in the UC gene signature. FIG. IB
summarizes the diverse functional categories encompassed by the transcripts
differentially expressed in Crohn's disease relative to healthy controls. Major
functional categories upregulated in CD PBMCs included enzymes involved in
prostaglandin metabolism, transcription regulators and transmembrane receptors,
including several integrin isoforms. Finally, FIG. 1C summarizes the abundant
overrepresentation of immunoglobulin constant regions that was unique to the
UC PBMC gene expression signature.
Example 2.3: Identification of Gene Signatures Discriminating Crohn's Disease
and Ulcerative Colitis
[0163] Since the main goal in the present study was to determine whether gene
expression patterns in PBMCs of patients with CD and UC were sufficiently
distinct to enable classification on the basis of gene expression profiles in
PBMCs alone, a direct comparison of gene expression signatures between the
two diseases was performed. ANCOVA comparison of CD versus UC PBMC
profiles identified 49 transcripts that were present at significantly different levels
between PBMCs of CD and UC patients (>L5 fold difference, p<0.0001). These
CDvUC biomarkers are listed in Table 4, above.
[0164] Based on the ANCOVA results indicating significant differences in direct
comparison of CD and UC PBMC gene signatures, a supervised class prediction
approach was employed to identify the smallest set of informative sequences
capable of disease-specific classification. PBMC samples from the IBD patients
were randomized into a training set composed of 44 CD and 20 UC profiles and a
test set composed of 15 CD and 6 UC profiles. The relative overall accuracy,
accuracy of CD classification, and accuracy of UC classification for a panel of
gene classifiers of increasing size was determined (FIG. 2A). As shown in

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FIG. 2A, a panel consisting of two gene classifiers (i.e., lipocalin 2 and IgHg3)
provided 64% accuracy as evaluated by four-fold cross validation (FIG. 2A).
The smallest predictive model with the highest overall accuracy (91%) that
distinguished between UC and CD PBMC profiles, as evaluated by four-fold
cross-validation of the training set (FIG. 2A), was a 14-sequence (12-gene)
classifier (Table 5, above). The 14-sequence classifier had a 94% overall
accuracy as evaluated by leave-one-out cross validation (data not shown). The
gene classifiers in Table 5 are listed in descending order of signal-to-noise ratio;
i.e., of the classifying biomarkers upregulated in patients with Crohn's disease
and listed in Table 5, lipocalin 2 (classifier gene no. 1) had the highest signal-to-
noise ratio and integrin beta-3 (classifier gene no. 7) had the lowest signal-to-
noise ratio, and of the classifying biomarkers upregulated in patients with
ulcerative colitis and listed in Table 5, IgHgl (classifier gene no. 8) had the
highest signal-to-noise ratio and IgKc (classifier gene no. 14) had the lowest
signal-to-noise ratio. Increasing the size of the classifier set did not increase
accuracy above this level (FIG. 2A). This 12-gene classifier was used to assign
class membership to the 14 CD profiles and 6 UC profiles withheld for the test
set (FIG. 2B). Using this predictive model, all samples in the test set were
correctly classified as clinically diagnosed. Only one individual in each group
possessed a confidence score of less than 0.2 using this classifier, indicating the
relatively high confidence with which these calls were made by the weighted
voting algorithm. These results demonstrate the potential applicability of
utilizing PBMC expression profiles to aid in the molecular diagnosis of CD and
UC.
Example 2.4: Quantitative Real Time Reverse Transcriptase Polymerase Chain
Reaction (Q-PCR) Confirmation of Microarray Observations
[0165] Despite the classifier set's accuracy for nearest-neighbor-based class
assignment in a data set of expression levels obtained from microarray analysis,
the average fold changes of transcripts in the CD/UC classifiers were relatively
low. Therefore, quantitative real time PCR (Q-PCR) was performed to confirm
the relative expression observed by Arrymetrix microarray technology for CD
and UC samples in this study. Four separate housekeeping genes for
normalization of the target genes were used: p2-microglobulin ((32M), p-actin,

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GAPDH, and 18S ribosomal RNA (18S). All CD and UC RNA samples in the
study were converted to cDNA using the same reverse-transcription cocktail and
procedure. Comparison of average fold changes calculated by microarray and
real-time PCR using p2-microglobulin are presented in FIG. 3, and relative fold
changes for all 12 classifying genes using each of the four housekeeping genes as
normalizers were extremely concordant (Table 11).

Table 11: Relative fold changes after normalization.
Elevated in UC (Compared to CD):
Test Normalization iRHfil IsKc 28S FTP,
C-assoc Granzyme K

Any Scaled
Frequency 3.87 2.30 2.11 1.43 1.35

Q-PCR P2M 3.11 2.04 1.32 1.47 1.85
p-actin 3.05 2.00 1.30 1.44 1.81
GAPDH 2.83 1.86 1.21 1.34 1.69
18S 2.68 1.98 1.31 1.40 1.86
Elevated in CD (Compared to UC):
Test Normalization mutL3 Lipocalin-
2 CXCL5 serum
dep
response Histone 3K Integrin
beta-3 Histone
2BQ

Afiy Scaled
Frequency 2.01 1.75 1.85 1.66 1.65 1.62 1.57

Q-PCR [32M 1.93 1.84 2.28 1.49 1.32 1.49 1.27
p-actin 1.97 1.88 2.33 J 1.52 1.35 1.52 1.29
GAPDH 2.12 2.02 2.50 1.64 1.45 1.64 1.39
18S 2.13 1.96 2.44 1.59 1.47 1.61 1.36
[0166] On the basis of these results, of the 12 transcripts originally identified as
CD/UC discriminator genes (i.e., classifying biomarkers), only the 28S rRNA
fragment appears to have been significantly overestimated by microarray
hybridization.
Example 2.5: Accurate Class Prediction using Expression Values Obtained by
Q-PCR
[0167] Linear discriminant analysis (LDA) of ACts for the twelve classifying
biomarkers (listed in Tables 5 and 8) normalized with each of four housekeeping
genes (|J2M, P-actin, GAPDH, and 18S) was compared to k-NN discriminant
analysis of the same ACts for three data sets (data set MB, data set 1, data set 2)

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consisting of 43 PBMC RNA samples isolated from patients with CD and 19
PBMC RNA samples isolated from patients with UC in the training set, and 14
PBMC RNA samples isolated from patients with CD and 6 PBMC RNA samples
isolated from patients with UC in the test set.
[0168] The accuracy, sensitivity, specificity, PPV, and NPV measures of
classification performance for parametric (linear), nonparametric k=3 nearest
neighbor, or nonparametric k?=10 nearest neighbor methods of cUscriminant
analysis for the three data sets (data set MB, data set 1, data set 2) of expression
levels of classifying biomarkers normalized to each of the four housekeeping
(p2-microglobulin (p2M), p-actin, GAPDH, and 18S ribosomal RNA (18S))
genes are shown in Table 13.

Table 13:
Housekeeping
Gene Data set Method Accuracy Sensitivity Specificity PPV NPV
P2M set MB parametric 0.833 1.000 0.667 0.875 1.000
32M set MB K-NN k=3 0.762 0.857 0.667 0.857 0.667
P2M set MB K-NN k=10 0.750 1.000 0.500 0.824 1.000
P-actin set MB parametric 0.833 1.000 0.667 0.875 1.000
3-actin set MB K-NN k=3 0.798 0.929 0.667 0.867 0.800
P-actin set MB K-NN k=10 0.750 1.000 0.500 0.824 1.000
GAPDH set MB parametric 0.750 1.000 0.500 0.824 1.000
GAPDH set MB K-NN k=3 0.762 0.857 0.667 0.857 0.667
GAPDH 1 set MB K-NN k=10 0.750 1.000 0.500 0.824 1.000
18S set MB parametric 0.917 1.000 0.833 0.933 1.000
18S set MB K-NN k=3 0.845 0.857 0.833 0.923 0.714
18S set MB K-NN k=10 0.917 1.000 0.833 0.933 1.000
32M setl parametric 0.964 0.929 1.000 1.000 0.857
32M setl K-NN k=3 0.821 0.643 1.000 1.000 0.545
32M setl K-NNk=10 0.798 0.929 0.667 0.867 0.800
p-actin setl parametric 0.964 0.929 1.000 1.000 0.857
P-actin setl K-NN k=3 0.821 0.643 1.000 1.000 0.545
3-actin setl K-NNk=10 0.845 0.857 0.833 0.923 0.714
GAPDH setl parametric 0.929 0.857 1.000 1.000 0.750
GAPDH setl K-NN k=3 0.786 0.571 1.000 1.000 0.500
GAPDH setl K-NN k=10 0.845 0.857 0.833 0.923 0.714
18S setl parametric 0.845 0.857 0.833 0.923 0.714
18S setl K-NN k=3 0.810 0.786 0.833 0.917 0.625
18S setl K-NNk=10 0.845 0.857 0.833 0.923 0.714
32M set 2 parametric 0.774 0.714 0.833 0.909 0.556
32M set 2 K-NN k=3 0.738 0.643 0.667 0.818 0.444
32M set 2 K-NN k=10 0.881 0.929 0.833 0.929 0.833
3-actin set 2 parametric 0.774 0.714 0.833 0.909 0.556

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Table 13:
Housekeeping
Gene Data set Method Accuracy Sensitivity Specificity PPV NPV
p-actin . set 2 K-NN k=3 0.702 0.571 0.833 0.889 0.455
p-actin set 2 K-NN k=10 0.762 0.857 0.667 0.857 0.667
GAPDH set 2 parametric 0.810 0.786 0.833 0.917 0.625
GAPDH set 2 K-NN k=3 0.667 0.500 0.833 0.875 0.417
GAPDH set 2 K-NN k=10j 0.810 0.786 0.833 0.9171 0.625
18S set 2 parametric 0.845 0.857 0.833 0.923 0.714
18S set 2 K-NN k=3 0.810 0.786 0.833 0.917 0.625
18S set 2 K-NN k=10 0.845 0.857 0.833 0.923 0.714
[0169] The discriminant classification worked best on data set MB regardless of
the method used, suggesting that performance of each method is related to each
data set analyzed (Table 13). Both parametric and nonparametric with k=l 0
nearest neighbor methods worked similarly, although on average both worked
better than nonparametric with k=3 nearest neighbor method (Table 13).
[0170] Classifying biomarkers normalized with 18S showed a systematic
difference in performance among the three data sets. 18S outperformed the other
housekeeping genes to some degree; analysis of classifying biomarkers
normalized with 18S consistently had higher values and smaller variabilities in
accuracy, sensitivity, and specificity (Table 13).
[0171] Since 18S appeared to outperform the other housekeeping genes tested,
logistic analysis of the expression levels of classifying biomarkers normalized
with only 18S was then performed. The choice among full model, backward,
forward, or stepwise selection methods of logistic analysis had little impact on
classification (data not shown). The full model method worked as well or better
than the other reduced models on data set MB and data set 1 (data not shown). In
the case of data set 2, models with two or three classifying biomarkers
normalized with 18S (both including MLH3 and IgKC) selected by forward or
stepwise methods with the significance level set to p = 0.05 had better class
prediction (data not shown). This finding may have been due to the fact that
most of the biomarkers with atypical expression levels were included in the test
set for data set 2, while the model from the forward or stepwise selection did not
contain those abnormally expressed biomarkers. This variance in inclusion of
biomarkers may also explain why the full model was not the best performing

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logistic method and why a poorer classification resulted from discriminant
analysis with a model including all 12 qualifiers. The accuracy, sensitivity, and
specificity of different selection methods for logistic analysis indicate that
different logistic selection methods performed similarly (data not shown). For
example, if one method showed better classification on the training set than the
test set of a data set, or vice versa, then the results with all three other methods
showed the same property.
[0172] Classification by logistic analysis using a full model was then compared
to classification by linear discrirninant analysis using the parametric method.
While data set variations between the two methods were observed, both analyses
adequately performed class prediction. The class prediction using data set MB,
data set 1 and data set 2 resulted in accuracy between 0.833 and 0.917, sensitivity
between 0.786 and 1.000, and specificity between 0.667 and 1.000 (Table 14).
However, a difference between the two methods appeared when 20 data sets were
compared (Figure 4). The logistic analysis with the full model worked better on
cross-validation, whereas the discrirninant analysis did better on test set
classification.
Table 14

data set analysis method sensitivity specificity PPV NPV accuracy
MB Discriminant 0.786 1.000 1.000 0.667 0.893
MB Logistic 1.000 0.667 0.875 1.000 0.833
setl Discriminant 0.857 0.833 0.923 0.714 0.845
setl Logistic 1.000 0.833 0.933 1.000 0.917
set 2 Discriminant 0.786 1.000 1.000 0.667 0.893
set 2 Logistic 0.857 0.833 0.923 0.714 0.845
EXAMPLE 3
Discussion
[0173] The focus of the present study was an attempt to determine (1) both the
commonalities and specificities of gene expression patterns in PBMCs associated
with CD and UC and (2) whether disease-specific expression signatures could
contribute to a molecular diagnosis of disease. Several dozen genes appear to be
differentially expressed in profiles for both CD and UC patients compared with
profiles for healthy subjects. Many of these genes encode nuclear proteins such

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as transcription regulators, and most are downregulated. Examples include
NFKB2, RNA-binding factors CUGBP1 and CUGBP2, COPEB, and ELK3.
Disregulated inflammatory processes common to UC and CD may be a
consequence of modulation of the activity of these transcriptional regulators.
[0174] The most highly expressed gene commonly elevated in both
inflammatory bowel diseases was the protease inhibitor SERPINB2 (also called
PAI, plasminogen activator inhibitor, type II). Increased plasminogen activator
levels have been reported in mucosal lesions of IBD patients (de Bruin et al.
(1988) Tfiromb. Haemost. 60:262-66) and increased PAI-1 was found in IBD
patient plasma. Although distinct from PAI-1, PAI-2 shares enzyme specificity
to both u-PA and to a lesser degree, t-TA, and elevated PAI-2 levels are reported
in rheumatoid arthritis synovial fluid (Kruithof et al. (1995) Blood 86:4007-24).
These findings suggest changes in components of the fibrinolytic and coagulation
system(s) may contribute to an increased risk for thromboembolic complications
and possibly to colitis and bleeding seen in IBD patients (de Jong et al. (1989)
Gut 30:188-94). A role for PAI-2 in IBD has not been reported, but this study
suggests that elevated PAI-2 RNA levels in PBMCs are associated with disease.
[0175J Multiple functional classes of transcripts appear specifically upregulated
in PBMCs of CD patients, including prostaglandin metabolizing enzymes,
chemokines, and transcriptional regulators. The CD-specific PBMC gene profile
exhibited a proinflammatory gene expression profile that was not apparent in the
UC-specific PBMC gene profile. Genes involved in prostaglandin and
leukotriene metabolism, e.g., arachidonate 12-lipoxygenase (ALOX12) and
prostaglandin endoperoxide synthase 1 (PTGS1, cyclooxygenase 1), were
significantly increased in PBMCs from CD patients, while prostaglandin D2
synthase (PTGDS) was decreased. These effects on the prostaglandin synthetic
pathway would be expected to result in increased conversion of arachidonic acid
into select prostaglandins. Although prostaglandin content is elevated in lesions
of IBD patients (Schmidt et al. (1996) Hepatogastroenterology 43:1508-12), very
recent evidence suggests that levels of at least one prostaglandin (PGE2) are
actually decreased in mononuclear cells of patients with CD (Trebble et al.
(2004) Clin. Nutr. 23:647-55). It is unclear whether the relative elevations in
transcripts encoding arachidonic acid metabolizing enzymes in PBMCs of CD

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patients are functionally linked to this observation, but PGE2 has been
documented as an important modulator of cytokine release from T lymphocytes
derived from the gastrointestinal tract (Barrera et al. (1996) J. Cell. Physiol.
166:130-37). The upregulation of PG metabolic pathways in circulating PBMCs
of Crohn's disease patients may represent alterations in cells entering / exiting the
lamina propria of the intestine in this disease.
[0176] Several chemokines (C-X-C ligands 4 and 7, platelet factor 4 variant 1)
were upregulated in CD. Overall there was surprisingly little overlap between
transcripts identified as upregulated in the present set of CD PBMCs and those
reported as upregulated in the seven CD patients analyzed by Marmick and
colleagues (Mannick et al.3 supra). It is unknown whether this is attributable to
the larger number of patients explored herein, the larger number of genes
interrogated, differences in gene nomenclature, or some other confounding factor
between these studies. However, the most strongly upregulated transcript in CD
reported by Mannick and coworkers encoded a transforming growth factor
(TGF)-p-inducible transcript (Mannick et al., supra). Here, TSC-22, a distinct
TGF-p-inducible transcript, was also identified as upregulated in CD PBMCs.
These observations show that upregulation of TGF-p1 signal transduction appears
to be evident in CD PBMCs. Constitutive elevation in this pathway could result
in downregulation of Smad-dependent pathways, which subsequently may result
in the inhibited ability of TGF-p* to terminate immune responses and in turn play
a causal role in the pathogenesis of CD (Mannick et al., supra).
[0177] It is possible that a portion of the Crohn's-associated disease signature
gene profile may be platelet-derived. Recent evidence has demonstrated that
platelets can participate in chronic intestinal inflammation (Danese et al. (2004)
Am. J. Gastroenterol. 99:938-45) and platelets copurified to a greater extent with
the PBMCs isolated from CD patients in this study (data not shown). Thus, the
detection of platelet factor 4 and platelet factor 4 variant 1 in the CD-associated
gene signature could be attributable to elevated levels of copurified platelets in
isolated PBMCs. However, other transcripts among the top 10 nonmitochondrial
transcripts reported in platelets (Gnatenko et al. (2003) Blood 101:2285-93) do
not appear in the present CD-associated list of transcripts, suggesting that the

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levels of these anucleate cells are not the sole source of these transcripts. All of
the transcripts in the CD disease signature that have been previously associated
with platelets are also expressed at significant levels in purified T cells, B cells,
and/or monocytes (data not shown), which suggests that transcripts previously
associated with platelets can originate from the mononuclear cells that were
isolated and profiled in this study.
[0178] The UC-specific gene set was dominated by overexpression of
immunoglobulin encoding sequences, reminiscent of the active IgG plasma cell
component observed in UC patients (Farrell et al. (2002) Lancet 359:331-40).
This finding is consistent with studies on B-cell receptor gene usage that have
demonstrated that infiltrating lymphocytes in UC mucosa are of peripheral, rather
than mucosal origin (Dunn-Walters et al. (1999) Gut 44:382-86; Thoree et al.
(2002) Gut 51:44-50). IgGl and IgG4 antibodies predominate in UC, whereas
IgG2 antibodies are increased in CD (Kett and Brandtzaeg (1987) Gut 28:1013-
21). The prevalence of the IgGl type has recently been explored and shown to be
specific to UC and to lead to greater opsonization of mucosal bacteria and a feed-
forward maintenance of the polymorphonuclear leukocyte respiratory burst in UC
(Furrie et al. (2004) Gut 53:91-98). One of the transcripts most significantly
elevated in UC PBMCs in this study was annotated as immunoglobulin heavy
constant gamma 3 (IgHG3). The region encompassed by this IgHG3 qualifier on
the Affymetrix chip actually maps (i.e., shares 100% nucleotide identity by
BLAST) to several sequences ascribed to immunoglobulin heavy constant
gamma 1 (Glm marker) and has been identified as a marker of inflamed UC
gastrointestinal epithelium (Warner and Dieckgraefe, supra; Lawrance et al.,
supra). Analysis of the expression level of IgHG3 transcripts in the peripheral
blood profiles of individual patients showed that their levels may serve as a
distinctive biomarker between UC and CD (data not shown). However, these
results are also consistent with the previous observation that IgGl levels in serum
are significantly increased in UC patients relative to serum levels of IgGl in CD
patients (Gouni-Berthold et al. (1999) Hepatogastroenterology 46:1720-23).
[0179] A significant subset of patients with inflammatory bowel disease cannot
be classified by current procedures and constitute cases of "indeterminate IBD"
(Winther et al. (1998) Drugs Today (Bare). 34:935-42; Bentley et al. (2002) J.

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Clin. Pathol 55:955-60; Guindi andRiddell (2004) J. Clin. Pathol. 57:1233-44).
Therefore, one of the main goals of the present study was to determine whether
PBMC profiles in patients with UC and CD were sufficiently distinct to enable
classification of these diseases. Results of class prediction analysis indicate that a
gene signature in PBMCs can accurately discriminate UC and CD samples.
Transcriptional differences are not due to cellular composition, since cellular
compositions of PBMCs from patients appear quite similar.
[0180] Although prospective validation in a larger population would likely be
performed, the disease-specific patterns identified by the invention may provide
the basis of a molecular diagnosis of UC and CD, and may contribute to the
diagnosis of patients classified as suffering from indeterminate IBD. It is quite
possible that the proposed Thl and Th2 natures of CD and UC, respectively, are
mainly responsible for the differences in this study, and that other Thl- and Th2-
based inflammatory diseases may bear similar signatures to those identified for
CD and UC. Nonetheless, the PBMC profile identified herein appears to have
clinical utility in IBD, because the gene classifier enables discrimination between
these closely related disorders that are often difficult to distinguish and
sometimes indistinguishable.
[0181] This study indicates that transcriptional profiles in circulating monocytes,
T cells, and B cells may serve as a sensitive monitor of an organism's
physiological state in the context of IBD. As these cells traverse various tissues,
one component of the cellular reaction to the microenvironment is a
transcriptional response; such a response can be quantitated through profiling.
Expression patterns may reflect disease mechanism(s) of primary or secondary
responses to disease pathophysiology. PBMCs, due to their transit through the
body, may serve as an accessible surrogate monitor of tissues and systems that
are not easily surveyed, such as though tissues and systems affected by IBD.

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WHATIS CLAIMED IS:
1. A method of diagnosing inflammatory bowel disease in a patient, the
method comprising the steps of:
a. isolating a sample from the patient; and
b. detecting in the sample the normal or aberrant expression of at least
one PBMC- and IBD-associated biomarker,
wherein the aberrant expression of at least one PBMC- and IBD-associated
biomarker indicates that the patient may be afflicted with inflammatory bowel
disease.
2. The method of claim 1, wherein the sample is a collection of peripheral
blood mononuclear cells.
3. The method of claim 1, wherein the detecting step is performed with a
hybridization-based assay.
4. The method of claim 1, wherein the detecting step is performed with an
immunological assay.
5. The method of claim 1, wherein the detecting step is performed with a
polymerase chain reaction.
6. The method of claim 5, wherein the polymerase chain reaction is a
quantitative polymerase chain reaction.
7. The method of claim 1, wherein the detecting step detects the expression of
a panel of PBMC- and IBD-associated biomarker s.
8. The method of claim 7, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one common biomarker.
9. The method of claim 8, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one Group I biomarker.

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10. The panel of claim 9, wherein the panel of PBMC- and IBD-associated
biomarkers includes PAI-2.
11. The method of claim 7, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one CD biomarker.
12. The method of claim 11, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one Group II biomarker.
13. The method of claim 11, wherein the panel of PBMC- and IBD-associated
biomarkers includes ALOX12.
14. The method of claim 11, wherein the panel of PBMC- and IBD-associated
biomarkers includes PTGDS.
15. The method of claim 11, wherein the panel of PBMC- and IBD-associated
biomarkers includes lipocalin 2.
16. The method of claim 7, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one UC biomarker.
17. The method of claim 16, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one Group HI biomarker.
18. The method of claim 17, wherein the panel of PBMC- and IBD-associated
biomarkers includes IgHG3.
19. The method of claim 7, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one CDvUC biomarker.
20. The method of claim 19, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one Group IV biomarker.

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21. The method of claim 7, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one classifying biomarker.
22. The method of claim 21, wherein the panel of PBMC- and IBD-associated
biomarkers comprises at least one Group V biomarker.
23. The method of claim 7, wherein the panel of PBMC- and IBD-associated
biomarkers comprises a set of biomarkers selected from the group consisting of the
set of Group I biomarkers, the set of Group II biomarkers, the set of Group III
biomarkers, the set of Group IV biomarkers, and the set of Group V biomarkers.
24. A method of diagnosing ulcerative colitis in a patient, the method
comprising the steps of:
a. isolating a sample from the patient; and
b. detecting in the sample the normal or aberrant expression of at least
one ulcerative colitis-associated biomarker,
wherein the aberrant expression of at least one ulcerative colitis-associated
biomarker indicates that the patient may be afflicted with ulcerative colitis.
25. The method of claim 24, wherein the sample is a collection of peripheral
blood mononuclear cells.
26. The method of claim 24, wherein the at least one ulcerative colitis-
associated biomarker is selected from the group consisting of the PBMC- and IBD-
associated biomarkers categorized as Group III biomarkers.
27. The method of claim 26, wherein the at least one ulcerative colitis-
associated biomarker includes IgHG3.
28. The method of claim 24, wherein the detecting step is performed with a
hybridization-based assay.
29. The method of claim 24, wherein the detecting step is performed with an
immunological assay.

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3 0. The method of claim 24, wherein the detecting step is performed with a
polymerase chain reaction.
31. The method of claim 30, wherein the polymerase chain reaction is a
quantitative polymerase chain reaction.
32. The method of claim 24, wherein the detecting step detects the expression
of a panel of PBMC- and IBD-associated biomarkers.
33. A method of diagnosing Crohn's disease in a patient, the method
comprising the steps of:
a. isolating a sample from the patient; and
b. detecting in the sample the normal or aberrant expression of at least
one Crohn's disease-associated biomarker,
wherein the aberrant expression of at least one Crohn's disease-associated
biomarker indicates that the patient may be afflicted with Crohn's disease.
34. The method of claim 33, wherein the sample is a collection of peripheral
blood mononuclear cells.
35. The method of claim 33, wherein the at least one Crohn's disease-
associated biomarker is selected from the group consisting of the PBMC- and IBD-
associated biomarkers categorized as Group II biomarkers.
36. The method of claim 33, wherein the detecting step is performed with a
hybridization-based assay.
3 7. The method of claim 3 3, wherein the detecting step is performed with an
immunological assay.
38. The method of claim 33, wherein the detecting step is performed with a
polymerase chain reaction.

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39. The method of claim 38, wherein the polymerase chain reaction is a
quantitative polymerase chain reaction.
40. The method of claim 33, wherein the detecting step detects the expression
of a panel of PBMC- and IBD-associated biomarkers.
41. A method of distinguishing between a diagnosis of ulcerative colitis and a
diagnosis of Crohn's disease in a patient, the method comprising the steps of:
a. isolating a sample from the patient; and
b. detecting in the sample the normal or aberrant expression of at least
one classifying biomarker,
wherein the aberrant expression of at least one classifying biomarker
associated with distinguishing patients with Crohn's disease indicates that the
patient may be afflicted with Crohn's disease, or
wherein the aberrant expression of at least one classifying biomarker
associated with distinguishing patients with ulcerative colitis indicates that the
patient may be afflicted with ulcerative colitis.
42. The method of claim 41, wherein the sample is a collection of peripheral
blood mononuclear cells.
43. The method of claim 41, wherein the at least one classifying biomarker is
selected from the group consisting of the classifying biomarkers categorized as
Group V biomarkers.
44. The method of claim 41, wherein the detecting step is performed with a
hybridization-based assay.
45. The method of claim 41, wherein the detecting step is performed with an
immunological assay.
46. The method of claim 41, wherein the detecting step is performed with a
polymerase chain reaction.

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47. The method of claim 46, wherein the polymerase chain reaction is a
quantitative polymerase chain reaction.
48. The method of claim 41, wherein the detecting step comprises detecting in
the sample the normal or aberrant expression of a panel of classifying biomarkers,
and wherein the panel of classifying biomarkers comprises the immunoglobulin
heavy constant gamma 1, immunoglobulin kappa constant, human 28S ribosomal
RNA 5'region, protein tyrosine phosphatase receptor type C-associated protein,
granzyme K, mutL homolog 3, lipocalin 2, CXCL5, serum deprivation response
phosphatidylserine binding protein, H3 histone family member K, integrin beta 3
(platelet glycoprotein Ilia, antigen CD 61), and H2B histone family member Q
biomarkers.
49. The method of claim 41, wherein the detecting step comprises detecting in
the sample the normal or aberrant expression of a panel of classifying biomarkers,
and wherein the panel of classifying biomarkers comprises at least 2 classifying
biomarkers selected from the group consisting of the immunoglobulin heavy
constant gamma 1, immunoglobulin kappa constant, human 28 S ribosomal RNA
5'region, protein tyrosine phosphatase receptor type C-associated protein,
granzyme K, mufL homolog 3, lipocalin 2, CXCL5, serum deprivation response
phosphatidylserine binding protein, H3 histone family member K, integrin beta 3
(platelet glycoprotein ITIa, antigen CD 61), and H2B histone family member Q
biomarkers.
50. The method claim 41, wherein the detecting step comprises detecting in the
sample the normal or aberrant expression of a panel of classifying biomarkers, and
wherein the panel of classifying biomarkers comprises at least eight classifying
biomarkers selected from the group consisting of the immunoglobulin heavy
constant gamma 1, immunoglobulin kappa constant, human 28S ribosomal RNA
5 'region, protein tyrosine phosphatase receptor type C-associated protein,
granzyme K, mutL homolog 3, lipocalin 2, CXCL5, serum deprivation response
phosphatidylserine binding protein, H3 histone family member K, integrin beta 3

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(platelet glycoprotein Ilia, antigen CD 61), and-H2B histone family member Q
biomarkers.

The present invention is directed to the identification of PBMC- and IBD- associated biomarkers that may be used
to diagnose inflammatory bowel disease, and optionally, distinguish between PBMCs isolated from a patient with Crohn's disease
and PBMCs isolated from a patient with ulcerative colitis. The present invention is further directed to methods of screening, including high throughput methods of screening, for regulatory agents capable of regulating the activity of PBMC- and IBD-associated biomarkers. Provided are compositions of PBMC- and IBD-associated biomarkers, including regulatory agents of at least one
PBMC- and IBD-associated biomarker for methods of diagnosis, prognosis, therapeutic intervention and prevention of an inflammatory bowel disease, e.g., Crohn's disease and ulcerative colitis. Moreover, the present invention is also directed to methods that
can be used to assess the efficacy of test compounds and therapies in the treatment inflammatory bowel disease, i.e., Crohn's disease
or ulcerative colitis.