OxMIF as a diagnostic marker

Abstract

The present invention pertains to the recognition that a specific oxMIF form of MIF is useful as a diagnostic marker in (MIF-related) diseases, in particular for example monitoring of disease progression. The present invention also pertains to the respective use of a diagnostic kit and a respective diagnostic assay and pertains to advantageous respective antibodies.

Claims

1. A method for in vitro diagnosis of a disease related to the presence of oxMIF in a subject, said method comprising: a) contacting a sample from said subject with an anti-oxMIF antibody wherein said antibody binds oxMIF but not redMIF; wherein said antibody is selected from the group consisting of: i. a RAB4 antibody, characterized by a light chain sequence as deposited by way of plasmid deposition with deposit number DSM 25110 and a heavy chain sequence as deposited by way of plasmid deposition with deposit number DSM 25112, ii. a RAB9 antibody, characterized by a light chain sequence as deposited by way of plasmid deposition with deposit number DSM 25111 and a heavy chain sequence as deposited by way of plasmid deposition with deposit number DSM 25113, iii. a RAB0 antibody, characterized by a light chain sequence as deposited by way of plasmid deposition with deposit number DSM 25114 and a heavy chain sequence as deposited by way of plasmid deposition with deposit number DSM 25115, iv. a RAB4 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 2 and a heavy chain amino acid sequence of SEQ ID NO:6, v. a RAB9 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 1 and a heavy chain amino acid sequence of SEQ ID NO:5, vi. a RAB0 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 3 and a heavy chain amino acid sequence of SEQ ID NO:7, and b) detecting the presence of oxMIF in said sample by detecting the binding of said anti-oxMIF antibody to said sample, wherein binding of said anti-oxMIF antibody to said sample is indicative of the presence of oxMIF in said sample, and wherein the presence of a higher level of oxMIF in said sample as compared to the level of oxMIF in a healthy control is indicative of the presence of a MIF-related disease in said sample.

2. The method according to claim 1, wherein said sample is a body fluid sample of said subject.

3. The method according to claim 1, wherein said sample is a cellular sample of said subject.

4. The method of claim 1 wherein said antibody is a RAB4 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 2 and a heavy chain amino acid sequence of SEQ ID NO:6.

5. The method of claim 1 wherein said antibody is a RAB9 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 1 and a heavy chain amino acid sequence of SEQ ID NO:5.

6. The method of claim 1 wherein said antibody is a RAB0 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 3 and a heavy chain amino acid sequence of SEQ ID NO:7.

7. A composition comprising an anti-MIF antibody, wherein said antibody is selected from the group consisting of: a) a RAB4 antibody, characterized by a light chain sequence as deposited by way of plasmid deposition with deposit number DSM 25110 and a heavy chain sequence as deposited by way of plasmid deposition with deposit number DSM 25112, b) a RAB9 antibody, characterized by a light chain sequence as deposited by way of plasmid deposition with deposit number DSM 25111 and a heavy chain sequence as deposited by way of plasmid deposition with deposit number DSM 25113, and c) a RAB0 antibody, characterized by a light chain sequence as deposited by way of plasmid deposition with deposit number DSM 25114 and a heavy chain sequence as deposited by way of plasmid deposition with deposit number DSM 25115.

8. A composition comprising an anti-MIF antibody, wherein said antibody is selected from the group consisting of: a) a RAB4 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 2 and a heavy chain amino acid sequence of SEQ ID NO:6, b) a RAB9 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 1 and a heavy chain amino acid sequence of SEQ ID NO:5, and c) a RAB0 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 3 and a heavy chain amino acid sequence of SEQ ID NO:7.

9. The composition of claim 8, wherein said antibody is a RAB4 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 2 and a heavy chain amino acid sequence of SEQ ID NO:6.

10. The composition of claim 8, wherein said antibody is a RAB9 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 1 and a heavy chain amino acid sequence of SEQ ID NO:5.

11. The composition of claim 8, wherein said antibody is a RAB0 antibody, which is characterized by a light chain amino acid sequence of SEQ ID NO: 3 and a heavy chain amino acid sequence of SEQ ID NO:7.

Description

DESCRIPTION OF THE FIGURES

(1) FIG. 1: TotalMiF and oxMIF in plasma of E. coli challenged mice

(2) Plasma obtained from control mice (C) and E. coli challenged mice (E) were subjected to oxMIF (FIG. 1A) and total MIF (FIG. 1B) ELISAs.

(3) FIG. 2: oxMIF detection on the surface of granulocytes and monocytes from E. coli challenged mice

(4) Blood samples obtained at different time points from control (F) or E. coli challenged mice (E) were stained with specific cell markers to discriminate the leukocyte populations, and human anti-MIF monoclonal antibody RAB9 or human control IgG1 detected by an RPE (R-phycoerythrin, a chromogenic marker)-labeled polyclonal anti-human IgG. Histograms are showing overlays of the control antibody (thick black line) with the RAB9 specific staining (grey profile) in the granulocyte population (GR1) or the monocyte population (CD14).

(5) FIG. 3: Total MIF and oxMIF detection in plasma of bacteriemic patients

(6) Total MIF and oxMIF levels in plasma from bacteriemic patients (1 to 6, black columns), one healthy control (7, grey column) and a pool of plasma from healthy donors (8, grey column) were assessed by ELISA.

(7) FIG. 4: Detection of oxMIF in serum samples of psoriasis patients.

(8) Decrease of oxMIF levels in the circulation of the patients show correlation with the improvement of disease severity.

(9) FIG. 5: Level of oxMIF in urine from rats with glomerulonephritis.

(10) (A) Levels of oxMIF increase with disease progression from day 0 (before disease induction) to day 8 after disease induction. Treatment with anti-MIF antibody RAB9 reduces urinary levels of oxMIF on day 8. (3) Macrophage infiltration determined in the same experiment after sacrificing the animals on day 8. Reduced macrophage infiltration in the RAB9 treated group correlates with reduced oxMIF levels.

(11) FIG. 6: Level of oxMIF in urine from patients with Lupus Nephritis.

(12) (A) OxMIF levels in urine correlates with disease severity. Mean values measured for each patient group are shown. (B) Time course of oxMIF levels measured in one patient newly diagnosed with Lupus Nephritis. The patient was treated with unspecific immunosuppressive drugs and reduction of urinary oxMIF levels correlates with improved clinical situation. (C) OxMIF levels in the plasma correlates with disease severity. Mean values measured for each patient group are shown.

(13) FIG. 7: Total MIF and oxMIF in the aqueous humor from patients with diabetic retinopathy

(14) Total MIF and oxMIF levels in aqueous humor obtained from patients with cataract (CAT, n=5) or diabetic retinopathy (DR, n=5) were assessed by ELISA

(15) FIG. 8: Xenograft mouse model for prostate cancer

(16) After termination of the animal model plasma samples from the mice have been taken to measure total MIF levels (A) as well as oxMIF levels (B). Tumors have been excised and weighed (C). The figures show the mean of the values obtained for each group. Plasma samples from non-xenografted mice were also analyzed for total MIF and oxMIF (=negative control).

(17) FIG. 9: oxMIF on the surface of the PC-3 prostate cancer cell line

(18) PC-3 cells were first labelled with a control human IgG1 monoclonal antibody (grey tinted graph) and with RAB9 (black line). Detection of cell surface bound antibodies was done with an RPE-labelled rabbit anti-human IgG.

(19) FIG. 10: Absence of oxMIF on the surface of leukocytes from healthy donors

(20) Human blood cells from healthy donors were incubated with a control IgG1 human monoclonal antibody (grey tinted graph), with RAB9 (black line) or with RAB0 (black dotted line). Detection of cell surface bound antibodies was done with an RPE-labelled rabbit anti-human IgG. Electronic gating enabled us to distinguish between the granulocytes, monocytes, lymphocyte B cells (CD19.sup.+ cells) and lymphocyte T cells+Natural Killer cells (CD19.sup.neg cells).

(21) FIG. 11: oxMIF on the surface of the BxPC3 pancreatic cancer cell line

(22) BxPC3 cells were first labelled with a control human IgG1 monoclonal antibody (grey tinted graph) or with RAB0 (black line). Detection of cell surface bound antibodies was done with an RPE-labelled rabbit anti-human IgG.

(23) FIG. 12: oxMIF on the surface of the A2780 ovarian cancer cell line

(24) A2780 cells were first labelled with a control human IgG1 monoclonal antibody (grey tinted graph), with RAB9 (black line). Detection of cell surface bound antibodies was done with an RPE-labelled rabbit anti-human IgG.

(25) FIG. 13: oxMIF on the surface of human lymphoma cell line

(26) Human lymphoma cell lines were first labelled with a control human IgG1 monoclonal antibody (grey tinted graph), with RAB9 (black line in A, B and D), or with RAB0 (black line in C). Detection of cell surface bound antibodies was done with an RPE-labelled rabbit anti-human IgG. A) CA46 Burkitt's lymphoma; B) MC-CAR B lymphocyte myeloma; C) Raji Burkitt's lymphoma; D) U937 histiocytic lymphoma.

(27) FIG. 14: Levels of total MIF and oxMIF in plasma from prostate cancer patients (A) Total MIF levels were measured in plasma from different prostate cancer patients (n=14) and from healthy volunteers (n=49). Box and whiskers (5-95% percentile) are shown with median in bold. Statistics: p=0.0166, t test unpaired one tail (B) oxMIF levels were measured in plasma from different prostate cancer patients (n=14) and from healthy volunteers (n=49). Box and whiskers (5-95% percentile) are shown with median in bold. Statistics: p=0.0016, t test unpaired one tail

(28) FIG. 15: Levels of total MIF and oxMIF in plasma from breast cancer patients (A) Total MIF levels were measured in plasma from different breast cancer patients (n=15) and from healthy volunteers (n=49). Box and whiskers (5-95% percentile) are shown with median in bold. Statistics: p=0.0078, t test unpaired one tail (B) oxMIF levels were measured in plasma from different breast cancer patients (n=15) and from healthy volunteers (n=49). Box and whiskers (5-95% percentile) are shown with median in bold. Statistics: p=0.0451, t test unpaired one tail

(29) FIG. 16: Levels of total MIF and oxMIF in cerebrospinal fluid from patients with multiple sclerosis (A) Total MIF levels were measured in cerebrospinal fluids from patients diagnosed with different forms of multiple sclerosis (n=49) and from healthy volunteers (n=30). Box and whiskers (5-95% percentile) are shown with medians (bold line). Statistics: p<0.0001, t test unpaired one tail (B) oxMIF levels were measured in cerebrospinal fluids from patients diagnosed with different forms of multiple sclerosis (n=49) and from healthy volunteers (n=30). Box and whiskers (5-95% percentile) are shown with medians (bold line). Statistics: p<0.0001, t test unpaired one tail

(30) FIG. 17: Levels of total MIF and oxMIF in plasma from ovarian cancer patients (A) Total MIF levels were measured in plasma from different ovarian cancer patients (n=42) and from healthy volunteers (n=19). Box and whiskers (5-95% percentile) are shown with median in bold. Statistics: p=0.0434, t test unpaired one tail (B) oxMIF levels were measured in plasma from different ovarian cancer patients (n=42) and from healthy volunteers (n=19). Box and whiskers (5-95% percentile) are shown with median in bold. Statistics: p=0.0663, t test unpaired one tail (C) Total MIF levels were measured in plasma from different kind of ovarian cancer patients (clear cell adenocarcinoma n=7, papillary serous cystadenocarcinoma n=14, and serous cystadenocarcinoma n=21) and from healthy volunteers (n=19). Box and whiskers (5-95% percentile) are shown with median in bold. Statistical significance was assessed using the t test (unpaired one tail) for each group against the control group: a. Controls (n=19) vs Clear Cell Adenocarcinoma (n=7): p=0.3696 b. Controls (n=19) vs Papillary Serous Cystadenocarcinoma (n=14): p=0.0721 c. Controls (n=19) vs Serous Cystadenocarcinoma (n=21): p=0.0046** (D) oxMIF levels were measured in plasma from different kind of ovarian cancer patients (clear cell adenocarcinoma n=7, papillary serous cystadenocarcinoma n=14, and serous cystadenocarcinoma n=21) and from healthy volunteers (n=19). Box and whiskers (5-95% percentile) are shown with median in bold. Statistical significance was assessed using the t test (unpaired one tail) for each group against the control group: a. Controls (n=19) vs Clear Cell Adenocarcinoma (n=7): p=0.4518 b. Controls (n=19) vs Papillary Serous Cystadenocarcinoma (n=14): p=0.0438* c. Controls (n=19) vs Serous Cystadenocarcinoma (n=21): p=0.0357*

(31) FIG. 17A: Levels of total MIF in plasma from ovarian cancer patients

(32) FIG. 17B: Levels of oxMIF in plasma from ovarian cancer patients

(33) FIG. 17C: Levels of total MIF in plasma from patients with different forms of ovarian cancer

(34) FIG. 17D: Levels of oxMIF in plasma from patients with different forms of ovarian cancer

(35) FIG. 18: Levels of total MIF and oxMIF in plasma from UC and CD patients (A) Total MIF levels were measured in plasma from different UC (n=15) and CD patients (n=21), as well as from healthy volunteers (n=19). Box and whiskers (5-95% percentile) are shown with median in bold. a. Controls vs UC: p=0.1240, t test unpaired one tail b. Controls vs CD: p=0.0207*, t test unpaired one tail (B) oxMIF levels were measured in plasma from different UC (n=15) and CD patients (n=21), as well as from healthy volunteers (n=19). Box and whiskers (5-95% percentile) are shown with median in bold. a. Controls vs UC: p=0.0417*, t test unpaired one tail b. Controls vs CD: p=0.0114*, t test unpaired one tail

(36) FIG. 18A: Levels of total MIF in plasma from patients with UC and CD

(37) FIG. 18B: Levels of oxMIF in plasma from patients with UC and CD

DEFINITIONS AND GENERAL TECHNIQUES

(38) Unless otherwise defined herein, scientific and technical terms used in connection with the present invention shall have the meanings that are commonly understood by those of ordinary skill in the art. Generally, nomenclatures used in connection with, and techniques of, cell and tissue culture, molecular biology, immunology, microbiology, genetics and protein and nucleic acid chemistry described herein are those well known and commonly used in the art. The methods and techniques of the present invention are generally performed according to conventional methods well known in the art and as described in various general and more specific references that are cited and discussed throughout the present specification unless otherwise indicated. See, e.g., Sambrook et al., Molecular Cloning: A Laboratory Manual, 2nd ed., Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y. (1989) and Ausubel et al., Current Protocols in Molecular Biology, Greene Publishing Associates (1992), and Harlow and Lane Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y. (1990), which are incorporated herein by reference.

(39) MIF or macrophage migration inhibitory factor refers to the protein, which is known as a critical mediator in the immune and inflammatory response, and as a counterregulator of glucocorticoids. MIF includes mammalian MIF, specifically human MIF (Swiss-Prot primary accession number: P14174), wherein the monomeric form is encoded as a 115 amino acid protein but is produced as a 114 amino acid protein due to cleavage of the initial methionine. MIF also includes GIF (glycosylation-inhibiting factor) and other forms of MIF such as fusion proteins of MIF. The numbering of the amino acids of MIF starts with the N-terminal methionine (amino acid 1) and ends with the C-terminal alanine (amino acid 115).

(40) oxidized MIF or oxMIF is defined for the purposes of the invention as an isoform of MIF that occurs by treatment of MIF with mild oxidizing reagents, such as Cystine. As has been shown by the present invention, recombinant oxMIF that has been treated this way comprises isoform(s) of MIF that share structural rearrangements with oxMIF that (e.g.) occurs in vivo after challenge of animals with bacteria.

(41) redMIF is defined for the purposes of this invention as reduced MIF and is MIF which does not bind to RAB0, RAB9 and/or RAB4.

(42) The anti-oxMIF antibodies described in this invention are able to discriminate between ox and red MIF, which are generated by mild oxidation or reduction, respectively, and are useful to specifically detect oxMIF. Discrimination between these conformers is assessed by ELISA (e.g. as described in example 3.4) or surface plasmon resonance.

(43) Assessing Differential Binding of the Antibodies by Biacore.

(44) Binding kinetics of oxMIF and redMIF to antibody RAB9 and RAB0 are examined by surface plasmon resonance analysis using a Biacore 3000 System. The antibodies were coated on a CM5 (=carboxymethylated dextran) chip and recombinant MIF protein, pre-incubated with 0.2% Proclin300, were injected. (Proclin300 consists of oxidative isothiazolones that stabilize the oxMIF structure by avoiding a conversion of oxMIF to redMIF). In native HES-EP buffer (=Biacore running buffer) without addition of ProClin300, none of the recombinant MIF proteins bound to RAB9, RAB0 or to the reference antibody (irrelevant isotype control antibody) used as negative (background) binding control.

(45) In a preferred embodiment, oxMIF is MIF which is differentially bound by antibody RAB9, RAB4 and/or RAB0 or an antigen-binding fragment thereof, meaning that these antibodies do bind to oxMIF while redMIF is not bound by either one of these antibodies.

(46) In other embodiments, the anti-oxMIF antibodies, e.g. the antibodies mentioned above or an antigen-binding portion thereof bind oxMIF with a K.sub.D of less than 100 nM, preferably a K.sub.D of less than 50 nM, even more preferred with a M.sub.D of less than 10 nM. Particularly preferred, the antibodies of this invention bind to oxMIF with a M.sub.D of less than 5 nM.

(47) (Non-)binding of an antibody, e.g. RAB9, RAB4 or RAB0 (to oxMIF or redMIF) can be determined as generally known to a person skilled in the art, examples being any one of the following methods: Differential Binding ELISA with recombinant MIF, or surface plasmon resonance using recombinant MIF in its reduced or oxidized state, like the well known Biacore assay, described above.

(48) A preferred method for the determination of binding is surface plasmon resonance of an antibody to e.g. rec. (ox)MIF whereupon binding is meant to be represented by a K.sub.D of less than 100 nM preferably less than 50 nM, even more preferred less than 10 nM whereas the non-binding to redMIF is characterized by a K.sub.D of more than 400 nM. Binding and specific binding is used interchangeably here to denote the above. Differential binding in the context of this application means that a compound, in particular the antibodies as described herein, bind to oxMIF (e.g. with the K.sub.D values mentioned above) while they do not bind to redMIF (with non-binding again being defined as above).

(49) An antibody refers to an intact antibody or an antigen-binding portion that competes with the intact antibody for (specific) binding. See generally, Fundamental Immunology, Ch. 7 (Paul, W., ed., 2nd ed. Raven Press, N.Y. (1989)) (incorporated by reference). The term antibody includes human antibodies, mammalian antibodies, isolated antibodies and genetically engineered forms such as chimeric, camelized or humanized antibodies, though not being limited thereto.

(50) The term antigen-binding portion of an antibody refers to one or more fragments of an antibody that retain the ability to specifically bind to an antigen (e.g. (ox)MIF). Antigen-binding portions may be produced by recombinant DNA techniques or by enzymatic or chemical cleavage of intact antibodies. Antigen-binding portions include e.g.though not limited theretothe following: Fab, Fab, F(ab)2, Fv, and complementarity determining region (CDR) fragments, single-chain antibodies (scFv), chimeric antibodies, antibodies and polypeptides that contain at least a portion of an antibody that is sufficient to confer specific antigen binding to the polypeptide, i.e. ox or redMIF. From N-terminus to C-terminus, both the mature light and heavy chain variable domains comprise the regions FR1, CDR1, FR2, CDR2, FR3, CDR3 and FR4. The assignment of amino acids to each domain is in accordance with the definitions of Kabat, Sequences of Proteins of Immunological Interest (National Institutes of Health, Bethesda, Md. (1987 and 1991)), Chothia et al. J. Mol. Biol. 196:901-917 (1987), or Chothia et al., Nature 342:878-883 (1989). An antibody or antigen-binding portion thereof can be derivatized or linked to another functional molecule (e.g., another peptide or protein). For example, an antibody or antigen-binding portion thereof can be functionally linked to one or more other molecular entities, such as another antibody (e.g., a bispecific antibody or a diabody), a detectable agent, a cytotoxic agent, a pharmaceutical agent, and/or a linking molecule.

(51) The term KD refers here, in accordance with the general knowledge of a person skilled in the art to the equilibrium dissociation constant of a particular antibody with the respective antigen. This equilibrium dissociation constant measures the propensity of a larger object (here: complex ox or red MIF/antibody) to separate, i.e. dissociate into smaller components (here: ox or redMIF and antibody).

(52) The term human antibody refers to any antibody in which the variable and constant domains are human sequences. The term encompasses antibodies with sequences derived from human genes, but which have been changed, e.g. to decrease possible immunogenicity, increase affinity, eliminate cysteines that might cause undesirable folding, etc. The term encompasses such antibodies produced recombinantly in non-human cells, which might e.g. impart glycosylation not typical of human cells.

(53) The term humanized antibody refers to antibodies comprising human sequences and containing also non-human sequences.

(54) The term camelized antibody refers to antibodies wherein the antibody structure or sequences has been changed to more closely resemble antibodies from camels, also designated camelid antibodies. Methods for the design and production of camelized antibodies are part of the general knowledge of a person skilled in the art.

(55) The term chimeric antibody refers to an antibody that comprises regions from two or more different species.

(56) The term isolated antibody or isolated antigen-binding portion thereof refers to an antibody or an antigen-binding portion thereof that has been identified and selected from an antibody source such as a phage display library or a B-cell repertoire.

(57) The production of the anti-(ox)MIF antibodies according to the present invention includes any method for the generation of recombinant DNA by genetic engineering, e.g. via reverse transcription of RNA and/or amplification of DNA and cloning into expression vectors. In some embodiments, the vector is a viral vector, wherein additional DNA segments may be ligated into the viral genome. In some embodiments, the vector is capable of autonomous replication in a host cell into which it is introduced (e.g. bacterial vectors having a bacterial origin of replication and episomal mammalian vectors). In other embodiments, the vector (e.g. non-episomal mammalian vectors) can be integrated into the genome of a host cell upon introduction into the host cell, and thereby replicated along with the host genome. Moreover, certain vectors are capable of directing the expression of genes to which they are operatively linked. Such vectors are referred to herein as recombinant expression vectors (or simply, expression vectors).

(58) Anti-(ox)MIF antibodies can be produced inter alia by means of conventional expression vectors, such as bacterial vectors (e.g., pBR322 and its derivatives), or eukaryotic vectors. Those sequences that encode the antibody can be provided with regulatory sequences that regulate the replication, expression and/or secretion from the host cell. These regulatory sequences comprise, for instance, promoters (e.g., CMV or SV40) and signal sequences. The expression vectors can also comprise selection and amplification markers, such as the dihydrofolate reductase gene (DHFR), hygromycin-B-phosphotransferase, and thymidine-kinase. The components of the vectors used, such as selection markers, replicons, enhancers, can either be commercially obtained or prepared by means of conventional methods. The vectors can be constructed for the expression in various cell cultures, e.g., in mammalian cells such as CHO, COS, HEK293, NSO, fibroblasts, insect cells, yeast or bacteria such as E. coli. In some instances, cells are used that allow for optimal glycosylation of the expressed protein.

(59) The anti-(ox)MIF antibody light chain gene(s) and the anti-(ox)MIF antibody heavy chain gene(s) can be inserted into separate vectors or the genes are inserted into the same expression vector. The antibody genes are inserted into the expression vector by standard methods, e.g., ligation of complementary restriction sites on the antibody gene fragment and vector, or blunt end ligation if no restriction sites are present.

(60) The production of anti-(ox)MIF antibodies or antigen-binding fragments thereof may include any method known in the art for the introduction of recombinant DNA into eukaryotic cells by transfection, e.g. via electroporation or microinjection. For example, the recombinant expression of anti-(ox)MIF antibody can be achieved by introducing an expression plasmid containing the anti-(ox)MIF antibody encoding DNA sequence under the control of one or more regulating sequences such as a strong promoter, into a suitable host cell line, by an appropriate transfection method resulting in cells having the introduced sequences stably integrated into the genome. The lipofection method is an example of a transfection method which may be used according to the present invention.

(61) The production of anti-(ox)MIF antibodies may also include any method known in the art for the cultivation of said transformed cells, e.g. in a continuous or batchwise manner, and the expression of the anti-(ox)MIF antibody, e.g. constitutive or upon induction. It is referred in particular to WO 2009/086920 for further reference for the production of anti-(ox)MIF antibodies. In a preferred embodiment, the anti-(ox)MIF antibodies as produced according to the present invention bind to oxMIF or an epitope thereof. Particularly preferred antibodies in accordance with the present invention are antibodies RAB9, RAB4 and/or RAB0 as well as RAM9, RAM4 and/or RAM0.

(62) The sequences of these antibodies are partly also disclosed in WO 2009/086920; see in addition the sequence list of the present application and the following:

(63) TABLE-US-00001 SEQIDNO:1fortheaminoacidsequence ofthelightchainofRAB9: DIQMTQSPSSLSASVGDRVTITCRSSQRIMTYLNWYQQKP GKAPKLLIFVASHSQSGVPSRFRGSGSETDFTLTISGLQP EDSATYYCQQSFWTPLTFGGGTKVEIKRTVAAPSVFIFPP SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQ ESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC, SEQIDNO:2fortheaminoacidsequence ofthelightchainofRAB4: DIQMTQSPGTLSLSPGERATLSCRASQGVSSSSLAWYQQK PGQAPRLLIYGTSSRATGIPDRFSGSASGTDFTLTISRLQ PEDFAVYYCQQYGRSLTFGGGTKVEIKRTVAAPSVFIFPP SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQ ESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC, SEQIDNO:3fortheaminoacidsequence ofthelightchainofRAB0: DIQMTQSPGTLSLSPGERATLSCRASQGVSSSSLAWYQQK PGQAPRLLIYGTSSRATGIPDRFSGSASGTDFTLTISRLQ PEDFAVYYCQQYGRSLTFGGGTKVEIKRTVAAPSVFIFPP SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQ ESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC, SEQIDNO:4fortheaminoacidsequence ofthelightchainofRAB2: DIQMTQSPVTLSLSPGERATLSCRASQSVRSSYLAWYQQK PGQTPRLLIYGASNRATGIPDRFSGSGSGTDFTLTISRLE PEDFAVYYCQQYGNSLTFGGGTKVEIKRTVAAPSVFIFPP SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQ ESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC, SEQIDNO:5fortheaminoacidsequence oftheheavychainofRAB9: EVQLLESGGGLVQPGGSLRLSCAASGFTFSIYSMNWVRQA PGKGLEWVSSIGSSGGTTYYADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCAGSQWLYGMDVWGQGTTVTVSSAS TKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWN SGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTKTYT CNVDHKPSNTKVDKRVESKYGPPCPPCPAPEFLGGPSVFL FPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGV EVHNAKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCK VSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQ VSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDG SFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLS LSLGK, SEQIDNO:6fortheaminoacidsequence oftheheavychainofRAB4: EVQLLESGGGLVQPGGSLRLSCAASGFTFSIYAMDWVRQA PGKGLEWVSGIVPSGGFTKYADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCARVNVIAVAGTGYYYYGMDVWGQG TTVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYF PEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPS SSLGTKTYTCNVDHKPSNTKVDKRVESKYGPPCPPCPAPE FLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEV QFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDW LNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPP SQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKT TPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALH NHYTQKSLSLSLGK, SEQIDNO:7fortheaminoacidsequence oftheheavychainofRAB0: EVQLLESGGGLVQPGGSLRLSCAASGFTFSWYAMDWVRQA PGKGLEWVSGIYPSGGRTKYADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCARVNVIAVAGTGYYYYGMDVWGQG TTVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYF PEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPS SSLGTKTYTCNVDHKPSNTKVDKRVESKYGPPCPPCPAPE FLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEV QFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDW LNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPP SQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKT TPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALH NHYTQKSLSLSLGK, SEQIDNO:8fortheaminoacidsequence oftheheavychainofRAB2: EVQLLESGGGLVQPGGSLRLSCAASGFTFSIYAMDWVRQA PGKGLEWVSGIVPSGGFTKYADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCARVNVIAVAGTGYYYYGMDVWGQG TTVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYF PEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPS SSLGTKTYTCNVDHKPSNTKVDKRVESKYGPPCPPCPAPE FLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEV QFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQDW LNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPP SQEEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKT TPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALH NHYTQKSLSLSLGK. SEQIDNO:9fortheaminoacidsequence ofRAM0hc: EVQLLESGGGLVQPGGSLRLSCAASGFTFSWYAMDWVRQA PGKGLEWVSGIYPSGGRTKYADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCARVNVIAVAGTGYYYYGMDVWGQG TTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYF PEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPS SSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCP APELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSNED PEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLH QDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYT LPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENN YKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHE ALHNHYTQKSLSLSPGK. SEQIDNO:10fortheaminoacidsequence ofRAM0lc: DIQMTQSPGTLSLSPGERATLSCRASQGVSSSSLAWYQQK PGQAPRLLIYGTSSRATGIPDRFSGSASGTDFTLTISRLQ PEDFAVYYCQQYGRSLTFGGGTKVEIKRTVAAPSVFIFPP SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQ ESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC. SEQIDNO:11fortheaminoacidsequence ofRAM9hc: EVQLLESGGGLVQPGGSLRLSCAASGFTFSIYSMNWVRQA PGKGLEWVSSIGSSGGTTYYADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCAGSQWLYGMDVWGQGTTVTVSSAS TKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWN SGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYI CNVNHKPSNTKVDKRVEPKSCDKTHTCPPCPAPELLGGPS VFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYV DGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEY KCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSREEMT KNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLD SDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQK SLSLSPGK. SEQIDNO:12fortheaminoacidsequence ofRAM9lc: DIQMTQSPSSLSASVGDRVTITCRSSQRIMTYLNWYQQKP GKAPKLLIFVASHSQSGVPSRFRGSGSETDFTLTISGLQP EDSATYYCQQSFWTPLTFGGGTKVEIKRTVAAPSVFIFPP SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQ ESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC. SEQIDNO:13fortheaminoacidsequence ofRAM4hc: EVQLLESGGGLVQPGGSLRLSCAASGFTFSIYAMDWVRQA PGKGLEWVSGIVPSGGFTKYADSVKGRFTISRDNSKNTLY LQMNSLRAEDTAVYYCARVNVIAVAGTGYYYYGMDVWGQG TTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYF PEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPS SSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCP APELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHED PEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLH QDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYT LPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENN YKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHE ALHNHYTQKSLSLSPGK. SEQIDNO:14fortheaminoacidsequence ofRAM4lc: DIQMTQSPGTLSLSPGERATLSCRASQGVSSSSLAWYQQK PGQAPRLLIYGTSSRATGIPDRFSGSASGTDFTLTISRLQ PEDFAVYYCQQYGRSLTFGGGTKVEIKRTVAAPSVFIFPP SDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQ ESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC.

(64) The anti-MIF antibody of the invention is preferably an isolated monoclonal antibody. The anti-MIF antibody can be an IgG, an IgM, an IgE, an IgA, or an IgD molecule. In other embodiments, the anti-MIF antibody is an IgG1, IgG2, IgG3 or IgG4 subclass. In other embodiments, the antibody is either subclass IgG1 or IgG4. In other embodiments, the antibody is subclass IgG4. In some embodiments, the IgG4 antibody has a single mutation changing the serine (serine-228, according to the Kabat numbering scheme) to proline. Accordingly, the CPSC sub-sequence in the Fc region of IgG4 becomes CPPC, which is a sub-sequence in IgG1 (Angal et al. Mol. Immunol. 1993, 30, 105-108).

(65) Additionally, the production of anti-(ox)MIF antibodies may include any method known in the art for the purification of an antibody, e.g. via anion exchange chromatography or affinity chromatography. In one embodiment the anti-(ox)MIF antibody can be purified from cell culture supernatants by size exclusion chromatography.

(66) The terms center region and C-terminal region of MIF refer to the region of human MIF comprising amino acids 35-68 and as 86-115, respectively, preferably as 50-68 and as 86 to 102 of human MIF, respectively.

(67) Particularly preferred antibodies of the present invention bind to either region as 50-68 or region as 86-102 of human MIF. This is also reflected by the binding of the preferred antibodies RAB0, RAB4 RAB2 and RAB9 as well as RAM4, RAM9 and RAM0 which bind as follows:

(68) RAB4 and RAM4: as 86-102

(69) RAB9 and RAM9: as 50-68

(70) RAB0 and RAM0: as 86-102

(71) RAB2: as 86-102

(72) The term epitope includes any protein determinant capable of specific binding to an immunoglobulin or an antibody fragment. Epitopic determinants usually consist of chemically active surface groupings of molecules such as exposed amino acids, amino sugars, or other carbohydrate side chains and usually have specific three-dimensional structural characteristics, as well as specific charge characteristics.

(73) The term vector refers to a nucleic acid molecule capable of transporting another nucleic acid to which it has been linked. In some embodiments, the vector is a plasmid, i.e., a circular double stranded DNA loop into which additional DNA segments may be ligated.

(74) The term host cell refers to a cell line, which is capable to produce a recombinant protein after introducing an expression vector. The term recombinant cell line, refers to a cell line into which a recombinant expression vector has been introduced. It should be understood that recombinant cell line means not only the particular subject cell line but also the progeny of such a cell line. Because certain modifications may occur in succeeding generations due to either mutation or environmental influences, such progeny may not, in fact, be identical to the parent cell, but are still included within the scope of the term recombinant cell line as used herein.

(75) The host cell type according to the present invention is e.g. a COS cell, a CHO cell or e.g. an HEK293 cell, or any other host cell known to a person skilled in the art, thus also for example including bacterial cells, like e.g. E. coli cells. In one embodiment, the anti-MIF antibody is expressed in a DHFR-deficient CHO cell line, e.g., DXE11, and with the addition of G418 as a selection marker. When recombinant expression vectors encoding antibody genes are introduced into CHO host cells, the antibodies are produced by culturing the host cells for a period of time sufficient to allow for expression of the antibody in the host cells or secretion of the antibody into the culture medium in which the host cells are grown.

(76) Anti-(ox)MIF antibodies can be recovered from the culture medium using standard protein purification methods.

(77) A MIF-related, disease in the present context refers generally to infectious diseases, inflammation, autoimmunity, cancer, cell differentiation and atherogenesis. MIF-related diseases are e.g., type I and II-diabetes, acute lung injury, asthma, allograft-rejection, graft-versus-host-disease, wound healing disturbances and inflammatory bowel disease. Further, cancer is a MIF-related disease. In particular, MIF-related cancers are lymphoma, sarcoma, prostatic cancer and colon cancer, bladder cancer, pancreas cancer, ovarian cancer, melanoma, hepatocellular carcinoma, ovarian cancer, breast cancer and pancreatic cancer.

(78) Further, atherosclerosis is a MIF-related disease.

(79) Further MIF-related diseases are sarcoidosis, scleroderma, psoriasis, (ulcerative) colitis, as well atopic dermatitis, as well as septic shock, delayed hypersensitivity, acute respiratory distress syndrome (ARDS), multiple sclerosis, pancreatitis and ischemic cardiac injury.

(80) Immune and inflammatory disorders, which are MIF-related, are gram negative and gram positive sepsis, e.g. P. aeruginosa infections or sepsis, DTH, glomerulonephritis, arthritis, adjuvant arthritis, juvenile arthritis, (autoimmune) encephalomyelitis/encephalitis, (autoimmune) myocarditis, allergic encephalitis, gastritis, colitis; (immune)glomerulonephritis; pneumonia, toxic shock syndrome, viral infections, tuberculosis, hepatitis B, dengue fever, parasitic and helminthic MIF-related infections, in particular malaria, leishmaniasis, trypanosomiasis, toxoplasmosis, amoebiasis, schistosomiasis, cysticercosis, trichenellosis and filariasis; kidney diseases, like leukocyte-mediated renal injury, non-proliferative renal disease, proliferative renal disease, renal allograft rejection and congenital nephritic syndrome of the Finnish type, nephritis, nephropathy like uric acid nephropathies and hypertensive nephropathy, ureteric obstruction and diabetic nephropathy.

(81) Neuropathic pain is a further MIF-related disease.

(82) Most preferred diseases to be diagnosed according to the present invention are: glomerulonephritis, sepsis, lymphoma, lupus nephritis, psoriasis, ulcerative colitits and ophthalmological conditions, as well as Burkitt's lymphoma, leukemia, prostrate adenocarcinoma, pancreatic adenocarcinoma, and ovarian carcinoma.

(83) One important aspect of the present invention is directed to detection of oxMIF in a sample of a subject; this detection will allow e.g. the skilled practitioner to determine whether or not MIF is a therapeutically important component of the disease or disorder which afflicts the subject in question. This determination will aid his decision whether or not an (additional) anti-(ox)MIF treatment could be beneficial for the subject in question.

(84) OxMIF is also useful as a marker to determine a health or disease condition of a given subject in general; elevated oxMIF level will allow the finding that the subject is afflicted with a MIF related disease; oxMIF can thus also be used as a (secondary) general marker for a health/disease condition of a subject, similar e.g. to the determination of C-reactive protein (CRP) which is currently and widely used as such a (secondary) marker.

(85) A subset of in vivo protective anti-oxMIF mAbs (e.g. RAB9, RAB4 and RAB0), which are directed against the pro-inflammatory cytokine oxMIF (Macrophage Migration Inhibitory Factor) do not bind to unmodified MIF in its reduced state (designated as redMIF). By contrast, these mAbs were shown to be highly selective for a redox dependent MIF isoform (designated as oxMIF). It was shown that oxMIF is not present in blood of healthy subjects and animals. It was also shown that oxMIF is not present on cellular surfaces of healthy subjects and animals. According to the present invention, and by the methods described herein, oxMIF can only be detected after onset of a disease. oxMIF was then (i.e. after onset of disease) shown to appear in the circulation or on the surface of cells. Stated differently: it was shown by the present inventors that oxMIF is clearly increased (i.e. detectable) in the circulation in samples of human or animal patients afflicted with a MIF related disease. It was also shown that oxMIF is strongly increased (and, thus, detectable) on the surface of cells afflicted with MIF related diseases. According to the present invention, detection of oxMIF in patients provides advantageous information regarding disease progression and therapeutic intervention. Therefore, oxMIF can be used as a diagnostic marker and the herein described methods will enable the monitoring of oxMIF during MIF-related diseases, e.g. affliction of a subject, e.g. a human, with inflammatory conditions or disease states like cancer.

(86) Based on the described findings, the present invention is directed to the use of oxMIF as a marker in the diagnosis of MIF-related diseases. oxMIF is preferably MIF, which is differentially binding, as defined herein above, to antibody RAB9, RAB4 and/or RAB0. As explained above and shown in the experimental part, in particular the examples section, the present inventors showed for the first time that oxMIF is an isoform of MIF, which is encountered patient samples of MIF-related diseases, while it is not encountered, i.e. present as defined above, in normal healthy controls. Thus, oxMIF is most suitable as a marker in the diagnosis of MIF-related diseases. As it was shown by the present invention that oxMIF, in particular the amount thereof, is also correlated with the state of a disease and/or its progression; diagnosis in the context of this specification encompasses detection of a disease, evaluation of a disease state and monitoring of a disease progression, which also allows monitoring efficacy of a therapeutic treatment.

(87) In a preferred embodiment, the diagnosis of said MIF-related diseases, which uses oxMIF as a marker, will encompass the further use of compounds binding to oxMIF for the detection of oxMIF.

(88) These compounds, which differentially bind oxMIF can be antibodies or small molecules, which differentially bind to oxMIF.

(89) The diagnostic assay which can be used in the present invention can be any diagnostic assay which is well-known to a person skilled in the art. In particular, the diagnostic assay can be carried out e.g. in an ELISA format, a sandwich (ELISA) format with use of FACS, immunofluorescence, immunohistochemistry, and all further suitable methods, all of which are well-known in the art.

(90) The present invention will be in the following described by way of the examples, whereby the examples shall be considered by no means as limiting the present invention.

REFERENCE EXAMPLES

A) GCO-Assay for Antibody Screening

(91) A THP1 suspension culture is centrifuged and cells are resuspended in fresh full medium to a cell density of 10.sup.6 cells per ml. This culture is transferred into wells of a 96-well microplate (90 l/well) and a potential anti-MIF antibody is added to give a final concentration of 75 g/ml. Each antibody is tested in triplicate. After o/n incubation at 37 C. dexamethasone is added to give a concentration of 2 nM and after one hour incubation at 37 C. LPS is added (3 ng/ml final concentration). After further six hours incubation at 37 C. the supernatant is harvested and the IL-6 concentrations are determined in a commercially available ELISA. The results of the triplicates are averaged and the percentage of IL-6 secretion is determined in comparison to the control antibodies. Antibodies that result in an IL-6 secretion of less than 75% are evaluated as positive.

B) Assay for Determination of IC50 Values

(92) The experimental procedure is carried out as described for the screening assay with the exception that increasing amounts of antibody are used (typically from 1-125 nM). The resultant dose response curve is expressed as % inhibition in comparison to a negative control antibody. This curve is used for calculation of the maximum inhibitory effect of the antibody (% Inh max) and the antibody concentration that shows 50% of the maximum inhibitory effect (IC.sub.50).

C) Inhibition of Cell Proliferation

(93) Serum stimulates secretion of MIF in quiescent NIH/3T3 and MIF in turn stimulates cell proliferation. Antibodies inhibiting this endogenous MIF, therefore, decrease the proliferation of quiescent NIH/3T3 cells. The reduction of proliferation is determined by the incorporation of .sup.3H-thymidine.

(94) 1000 NIH/3T3 cells per well are incubated in a 96 well plate over the weekend at 37 C. in medium containing 10% serum. Cells are then starved over night at 37 C. by incubation in medium containing 0.5% serum. The 0.5% medium is removed and replaced by fresh medium containing 10% serum, 75 g/ml antibody and 5 Ci/ml of 3H-thymidine. After 16 hours incubation in a CO.sub.2 incubator at 37 C. cells are washed twice with 150 l of cold PBS per well. Using a multi-channel pipette 150 l of a 5% (w/v) TCA solution per well are added and incubated for 30 minutes at 4 C. Plates are washed with 150 l PBS. Per well 75 l of a 0.5M NaOH solution with 0.5% SDS are added, mixed and stored at room temperature. Samples are measured in a -counter by mixing 5 ml of Ultima Gold (Packard) and 75 l sample solution. Each determination is done in triplicate and the values are compared with the values of the control antibody by a t-test. Antibodies that significantly reduce proliferation (P<0.05) are evaluated as positive.

D) Binding Studies: Epitope Determination of Anti-MIF Antibodies

(95) Each peptide is diluted in coupling buffer to give a peptide concentration of typically 1/g/ml added to microplates (NUNC Immobilizer Amino Plate F96 Clear) and incubated over night at 4 C. (100 l/well). As controls recombinant full length MIF and PBS are used. The plate is washed 3 times with 200 l PEST and antibodies (2-4 g/ml in PBS) are added (100 l/well) and incubated for 2 hours at room temperature with gentle shaking. The plate is washed 3 times with 200 l PEST and detection antibody (e.g. Fc specific anti-human IgG/HRP labeled, Sigma) is added (100 l/well). After incubation for 1 hour at room temperature with gentle shaking, the plate is washed 3 times with 200 l PEST. Each well is incubated with 100 l TMB (3,3,5,5-tetramethylbenzidine) solution (T-0440, Sigma) for 30 minutes in the dark. Staining reaction is stopped by adding 100 l of 1.8 M H.sub.2SO.sub.4-solution per well. Samples are measured at 450 nm.

E) Affinity Determination of Fab Fragments of Anti-MIF Antibodies by Biacore

(96) Typically, 40 RU units of human recombinant MIF are immobilized on a sensor chip with a CM5 (=carboxymethylated dextran) matrix (Biacore). Fab fragments are injected at a concentration range of typically 6-100 nM diluted in HES-EP. After each cycle the chip is regenerated with 50 mM NaOH+1 M NaCl. Affinities are calculated according to the 1:1 Langmuir model.

EXAMPLES

(97) The present examples relate to the finding that several specific antibodies only bind to oxMIF, but do not bind to unmodified MIF in a reduced state. This was shown by the detection of oxidized MIF by ELISA after mild oxidation of recombinant MIF by chemicals using a mock preparation, reduced MIF and untreated MIF as controls; this experiment was carried out in vitro and clearly showed that oxMIF was bound by specific antibodies, while control MIFs were not.

(98) Anti-oxMIF antibodies RAB4, RAB9 and RAB0 were shown to be incapable of binding to MIF in its reduced state at physiologically relevant concentrations. In contrast, it was shown in vitro, that mild oxidation of MIF (e.g. with L-Cystine) can convert the MIF molecule into the antibody-binding isoform. Antibody-based screenings for oxMIF forms in vertebrate systems and cell lines (e.g. immortalized cell lines, plasma from mice, urine from rats, and plasma and urine from human donors) revealed, that the occurrence of such antibody-reactive MIF isoforms is linked to disease related processes (e.g. inflammation and neoplasia). This is why these antibodies can be used as tools for e.g. the diagnostic detection of native occurring disease-related oxMIF forms and for monitoring disease progression.

(99) The present inventors have also shown for the first time that false positive results for oxMIF can be obtained. It is assumed that MIF protein can be converted to oxMIF by redox-active iron and heme in hemolytic blood samples and that MIF can be converted to oxMIF in biosamples, when oxidizing agents are added.

(100) It is thus proposed according to a preferred embodiment for avoiding false positive results to avoid the addition of e.g. oxidizing agents and to de-activate redox-active iron and heme.

(101) For example, a special sample procedure for the analysis of MIF circulating in blood is required. For the analysis of total and oxMIF, citrated plasma is preferred; to avoid false positive signals the samples in a preferred embodiment have to be prepared by the following steps:

(102) Citrated plasma from fresh blood (stored at +4 C. not longer than 12 h) has to be centrifuged at 40 g for 5 min. The supernatant has to be transferred into a new tube and centrifuged again at 2000 g for 3 min. The cell free supernatant has to be transferred again into a new tube and centrifuged at 16000 g for 3 min. After the three centrifuge steps, the cell free supernatant can be stored at 80 C. or directly used for the analysis of (ox)MIF.

(103) If sera should be analyzed regarding (ox)MIF, cells and insoluble fragments preferably have also to be removed by the same three centrifugation steps prior storage by freezing or prior running the MIF ELISA.

(104) Sediments in urine samples also preferably have to be removed by a centrifugation step (16000 g for 5 min) prior to use in the MIF ELISAs. Generally, cells and other common particles occurring in biological fluids (e.g. tear fluid, saliva) have to be removed prior by a centrifugation step and then stored for testing of (ox)MIF.

(105) Furthermore, the present inventors could show that MIF which is denatured is recognized by antibodies which specifically bind to oxMIF. Therefore, it is of utmost importance that for analysis of oxMIF, the MIF protein has to be kept in its native conformation during sample preparation (e.g. during the isolation and preparation of body fluids); therefore denaturating conditions/steps such as for example boiling, immobilization (on membranes, plastic (plate) or chips) and chemical treatments (e.g. with reducing agents, oxidizing agents and organic solvents), have to be avoided in order to keep the MIF protein in its native conformation and to avoid false positive/negative results during the analysis.

(106) For analysis of oxMIF on cellular surfaces, preferably a flow cytometry assay is used. It is particularly important that the samples do not undergo hemolysis during sample preparation. Therefore, all samples for the present flow cytometry analysis have been prepared without any step which would lead to a hemolysis of the cells within the sample.

Example 1: Preparation of oxMIF Specific Antibodies (e.g. RAB0- or RAB4-Antibody)

(107) The antibodies are produced in mammalian cells, preferentially in CHO cells, preferentially in CHO cells where the gene encoding for MIF (endogenous CHO-MIF) has been knocked out genetically. In the knock-out cells the contamination of the antibody with endogenous CHO-MIF can be abolished, which is desirable as sensitivity of the assays can be enhanced.

(108) Typically, oxMIF specific antibodies were produced in a batch fermentation process using a disposal bioreactor (wave system) up to 25 L volume. Stable CHO cell lines harboring the genes encoding for the heavy and light chain of the produced antibody, respectively, were seeded into an PowerCHO medium (Invitrogen Inc.) and incubated at 37 C. and 5% CO.sub.2.

(109) In one exemplary production process, a CHO knock out cell line was used which comprised plasmids as deposited under DSM 25114 and DSM 25115.

(110) During the cultivation, the respective human antibodies were continuously expressed into the cell culture medium. At the end of cultivation (viability<50%) the cells were separated by common centrifugation and filtration steps. The clarified cell culture supernatant (ccs) was concentrated by ultrafiltration and used for the purification of antibodies.

(111) The human antibodies were purified from the concentrated ccs by Protein A affinity chromatography (MabSelect Sure, GE Healthcare). After equilibration of the Protein A material with 5 column-volumes (cv) of 20 mM sodium phosphate running buffer, pH 7 the concentrated supernatant of the isotype control was completely applied to the affinity column. Impurities or undesirable proteins were washed out with the running buffer. The antibodies were eluted by a pH shift using 100 mM glycine, pH 3 and dialyzed against 250 mM glycine buffer, pH 5.

(112) Alternatively, the concentrated cell culture supernatant was applied to the Protein A column prior equilibrated with 5 cv of 20 mM Tris/HCl buffer including 150 mM sodium chloride buffer and 0.1% Tween 80, pH 7. Impurities were washed out by two washing steps: 1.) addition of 1 M NaCl in the equilibration buffer and 2.) 100 mM sodium phosphate including 0.1% Tween 80, pH 5. The RAB0 antibodies were eluted by 100 mM glycine buffer, pH 3 including 0.1% Tween 80 and then dialyzed against 250 mM glycine buffer, pH 5.

Example 2: Preparation of Polyclonal and Affinity Purified Polyclonal Rabbit Anti-Hu MIF Antibodies

(113) 1.) Production of Recombinant Human MIF (huMIF)

(114) Recombinant huMIF was produced in E. coli cells including an expression system with the human MIF sequence. Fresh thaw cells were cultivated in Luria Bertani medium supplemented with Ampicillin (LB/Amp) over night at +37 C. At the next day, the bacterial cell culture was diluted with an equal volume of fresh LB/Amp medium and the expression induced by addition of IPTG (final concentration: 1.0 mM) at 30 C. for 4 hours. The bacterial pellet was harvested by centrifugation and stored at 15 C.

(115) For further purification of the intracellular human MIF proteins the frozen bacterial pellet was resuspended in 20 mM Tris/HCl buffer, pH 7.8 and cells were disrupted mechanically by glass beads. Cell debris was removed by centrifugation and filtration using a common 0.2 m filter. The supernatant was directly applied to an anion exchange chromatography column (HiTrap 26/16 DEAE FF, GE Healthcare, Waukesha, USA) and MIF was purified by a passive binding mode. The flow through was rebuffered in 20 mM Bis/Tris pH 6.3 and further purified by a cation exchange chromatography (Source 30S, GE). Highly pure human MIF was eluted by a salt gradient of 50 mM NaCl in 20 mM Bis/Tris buffer, pH 6.3. Finally, the purified human MIF was rebuffered against PBS concentrated by ultrafiltration and characterized of purity and functionality.

(116) 2.) Immunization Procedure of Polyclonal Rabbit Anti huMIF Antibodies in New Zealand White Rabbits

(117) For the initial immunization, 25 g of rec. human MIF diluted in 100 l PBS was mixed with 100 l CFA (Complete Freunds Adjuvants). 200 l (450 41) of the mixture was applied s.c. to different body portions of each rabbit. After 2-3 weeks after the initial immunization a first boost with 25 g of the rec. human MIF (suspended in 100 l PBS) was mixed with 100 l IFA (Incomplete Freunds Adjuvants). Again, 200 l (450 l) of the mixture was applied s.c. to different body portions of each rabbit. A second boost was performed 2-3 weeks after the first boost, 25 g of the rec. human MIF (suspended in 100 l PBS) was mixed with 100 l IFA (Incomplete Freunds Adjuvants). Again, 200 l (450 l) of the mixture was applied s.c. to different body portions of each rabbit. The immunization procedure was terminated 2 weeks after the second boost. Typically, plasma from multiple rabbits was pooled and used for the isolation of the anti MIF antibodies.

(118) 3.) Protein a Purification and huMIF-Affinity Purification Procedure of Polyclonal Rabbit Anti huMIF Antibodies

(119) The isolation of rabbit anti huMIF antibodies from immunized plasma was typically done by two affinity chromatography steps. At first the plasma was purified by a Protein A affinity column (MabSelect Sure, GE Healthcare). To that avail, the rabbit plasma was diluted 1:3 with 20 mM Na.sub.2HPO.sub.4 buffer, pH 7.0 and applied to the affinity column. After a washing step (5 column volumes with 20 mM Na.sub.2HPO.sub.4 buffer, pH 7.0) the elution of total rabbit IgG was done with 100 mM glycine, pH 2.8. The eluate was pooled and neutralized to pH 7.0 using 1 M Tris/HCl. For hu-MIF affinity purification the total rabbit IgG was again diluted 1:3 with 20 mM Na.sub.2HPO.sub.4 buffer, PH 7.0 and applied to the 5 ml NHS-affinity column (GE Healthcare) coupled with 25 mg rhuMIF as recommended by the supplier. After a washing step (5 column volumes with 20 mM Na.sub.2HPO.sub.4 buffer, pH 7.0) the elution of the specific rabbit anti huMIF antibodies was effected with 100 mM glycine, pH 2.8. The eluate was pooled and neutralized to pH 7.0 using 1 M Tris/HCl. Finally, the hu-MIF affinity purified specific rabbit anti human MIF antibodies (in the following anti-human Mid affinity purified polyclonal antibody) were dialyzed against PBS and stored at 20 C.

Example 3: Detection of oxMIF in Samples Obtained from Patients or from Animal Disease Models

I. Sepsis

Example 3.1: oxMIF in Plasma of E. coli-Challenged Mice

(120) We sought to look for systemic oxMIF forms in plasma samples of peritonitic mice that had been challenged with 2000 cfu (colony forming units) of the gram negative pathogenic E. coli strain O111:B4. Blood samples of healthy mice (treated with PBS) and diseased mice were taken 21 h after challenge and plasma has been analyzed for oxMIF.

(121) Method

(122) Microtiter plates were coated with anti oxMIF antibodies RAB0 or RAB4. MIF was detected with an affinity purified polyclonal rabbit anti-mouse MIF antibody and a commercial HRP conjugated goat anti rabbit IgG The antibodies were obtained similarly as described in Example 2, but in contrast to the Example 2 the rabbit anti moMIF antibodies were produced by rabbit immunization with recombinant moMIF and purified by affinity chromatography against Protein A and MIF (same procedures as described in Example 2). For quantification of reactive MIF from plasma samples, oxMIF standards are prepared by mixing untreated recombinant moMIF with a buffer (=ELISA dilution buffer) that contains 0.2% of the biocide Proclin300 (Sigma Aldrich). Proclin300 consists of oxidative isothiazolones that induce/conserve the binding oxMIF structure. All plates were developed with TMB (Sigma-Aldrich) and OD was measured in an ELISA reader after stopping the reaction with 3M H.sub.2SO.sub.4.

(123) Results

(124) FIG. 1A (FIG. 1B).

(125) Analyses of plasma from seven different animal experiments have revealed considerable differences of total MIF and oxMIF levels. However, no oxMIF has ever been detected in plasma of PBS treated control mice (healthy controls), whereas oxMIF was almost always detected in plasma from septic mice. Range values from seven different experiments have been summarized in Table 1.

(126) TABLE-US-00002 TABLE 1 Ranges of measured total MIF and oxMIF in mice (n = 7 expts.) Total MIF [ng/ml] oxMIF [ng/ml] Control mice 8-64 n.d. E. coli challenged mice 2-112 n.d.-36

(127) FIG. 1 shows one representative experiment in which oxMIF was detected only in septic mice with variations in oxMIF levels between mice (FIG. 1A). In this experiment total MIF level was elevated in the plasma of one mouse only and a significant portion of the total MIF in this mouse is oxMIF (FIGS. 1A and 1B, mouse E6), thus confirming that oxMIF is a better diagnostic marker for acute septicaemia than total MIF.

(128) Conclusion

(129) Total MIF is present in both healthy control mice and bacteriemic mice, but oxMIF levels correlate better to the stage of the disease than levels of total MIF.

Example 3.2: oxMIF on the Cellular Surface of Cells from E. coli-Challenged Mice

(130) Immune cells from peritonitic mice (or control mice injected with PBS only) have been analyzed for oxMIF by flow cytometry.

(131) Methods

(132) Blood from PBS- or E. coli-challenged mice was stained in Cell Staining Buffer (Biologend) with either Alexa700-labeled anti-CD3 (for T cells) and PerCP-Cy5.5-labeled anti-Ly6G (for granulocytes) or APC-labeled anti-CD14 (for monocytes) and PE-Cy7-labeled anti-CD19 (for B cells) in parallel with 300 nM RAB9 or control IgG. After washing, the human antibodies were detected using the goat R-PE-labeled anti-human IgG antibodies. After washing, the red blood cells were lysed with the BD FACS Lysing solution (Becton Dickinson, Franklin Lakes, USA). Data acquisition was performed using a FACS Canto II (Becton Dickinson) with the DIVA software (software version 6; Becton Dickinson) and the data were analyzed using the FlowJo software (Treestar, Ashland, Oreg., USA).

(133) Results

(134) The presence of oxMIF on the surface of the blood cells from peritonitic mice was analysed. Blood was harvested by cardiac puncture after 1, 3 or 21 h post-challenge, i.e. PBS for the control group and 2000 CFU E. coli for the peritonitic mice. The staining with RAB9 was performed on full blood and red cells were lysed before the analysis. FIG. 2 shows the histograms for the control mice (F) and challenged mice (E) at the different time points over a control IgG antibody (black line). In control mice, positive cells were not significantly detected with RAB9 for both, granulocytes-monocytes population and lymphocytes. oxMIF was not detected on the surface of lymphocytes but was present on the surface of both granulocytes (GR1 marker) and monocytes (CD14 marker), as soon as 1 h after challenge and up to 21 h.

(135) Summary and Conclusion

(136) In a peritonitis model in the mouse, we have been able to show the presence of oxMIF on the surface of granulocytes and monocytes during the time of infection and we have shown that oxMIF was not found in PBS-treated animals. These results demonstrate that oxMIF is a marker which appears in the course of an infection but is not present in healthy individuals.

Example 3.3: Detection of oxMIF in Sera of Bacteriemic Patients

(137) Plasma samples from citrated blood were obtained from bacteriemic patients treated in intensive care unit (ICU) and have been analyzed for their content in MIF and oxMIF

(138) Material and Methods

(139) Both total MIF and oxMIF were detected using the same ELISA set up: microtiter plates were coated with the human anti-MIF monoclonal antibody RAB0 and detection was done with an affinity purified polyclonal rabbit antibody anti-human MIF. Finally, the read-out of the ELISA was done after incubation of goat anti-rabbit, HRP conjugated (BioRad, Cat.: 171-6516) (any other goat anti-rabbit as known in the art could be used here as well) and TMB substrate (a chromogenic substrate, as defined above; any other suitable substrate could also be used, as known to a person skilled in the art) at 450 nm. The calibration of the ELISA was done with a recombinant human oxMIF which was freshly produced by an oxidation step of redMIF by adding of 0.2% ProClin300. The standards were diluted in 0.5% fish gelatin/PBS including 0.2% ProClin300 and 4% human control plasma. The range of the calibration curve is 10 ng/ml to 0.156 ng/ml. The tested human serum samples were diluted 1:25 in 0.5% fish gelatin/PBS, pH 7.2 for oxMIF ELISA, or in the presence of Proclin300 for the total MIF ELISA in order to transform every reduced MIF molecules present in the plasma in oxMIF.

(140) Results

(141) Plasma samples from citrated blood have been obtained from patients treated in an ICU for septicaemia (n=6). Gender, age, infectious germs and treatments are all different. FIG. 3 shows the levels of total MIF and oxMIF detected in the plasma of the patients as well as in one healthy donor or from a pool of 50 plasma samples from healthy donors. Total MIF is present in every sample but oxMIF is detected only in 2 out of 6 bacteremic patients.

(142) Conclusion

(143) oxMIF can be detected in the plasma of some of the bacteremic patients tested (2 out of 6), but not in the plasma of healthy donors. OxMIF can be used as a marker for septicaemia.

II. Psoriasis

Example 3.4: Detection of oxMIF in Sera of Psoriasis Patients

(144) Sera samples collected from psoriatic patients have been analyzed for their content in oxMIF. The sera were taken from patients with systemic anti-psoriatic therapy at different time points (start, 12 weeks and 24 weeks).

(145) Material and Methods

(146) Measurement of oxMIF in Serum by a Sandwich ELISA:

(147) Microtiter plates were coated with the monoclonal fully human anti-oxMIF antibody RAB0. The human serum samples were diluted 1:25 in 0.5% fish gelatin/PBS, pH 7.2. The calibration of the ELISA was done with a recombinant human oxMIF which was freshly produced by adding of 0.2% ProClin300. The standards were diluted in 0.5% fish gelatin/PBS including 0.2% ProClin300 and 4% human control plasma (i.e. a pool of serum samples from 50 healthy donors). The range of the calibration curve was 10 ng/ml to 0.156 ng/ml. After washing of the plate, oxMIF captured by the coating antibody was detected by an affinity purified polyclonal rabbit anti-human MIF antibody (rabbit anti-huMIF, does not distinguish between redMIF and oxMIF) and HRP labelled goat anti-rabbit antibodies. TMB was used as chromogenic substrate, chromogenic reaction was stopped with H.sub.2SO.sub.4 and the ELISA plate was measured at 450 nm. All samples, standards and controls, were done in duplicate.

(148) Results

(149) We were able to detect increased levels of oxMIF in serum of patients with psoriasis. During treatment with systemic immunomodulators levels of oxMIF decreased correlating with an improvement of the patient's condition (FIG. 4).

(150) Conclusion

(151) oxMIF levels have been detected in serum samples of psoriatic patients. This means that oxMIF is very sensitive in chronic or acute inflammatory skin diseases like psoriasis and can also be used as a marker for the severity of the disease and to monitor disease development during systemic anti-psoriatic therapy.

III. Nephritis

Example 3.5: oxMIF in the Urine of Rats after Establishment of Proliferative Glomerulonephritis

(152) Material and Methods

(153) Rat Model for Proliferative Glomerulonephritis:

(154) OxMIF levels were analyzed in urine of Wistar Kyoto (WKY) rats after induction of proliferative glomerulonephritis by application of a single intravenous injection of rabbit anti-rat glomerular basement membrane serum (=nephrotoxic serum, NTS) (Tam FWK, Nephrol Dial Transplant, 1999, 1658-1666). The urine samples were collected using metabolic cages before induction of the disease. Four and six days after induction of disease rats were treated with a human control antibody, or different doses of the human anti-oxMIF antibody RAB9. The second urine sampling was done before sacrificing the animals on day 8 for histological evaluation. OxMIF levels measured in the urine were correlated with other disease parameters like proteinuria or histology data of the kidney (crescent formation and macrophage infiltration).

(155) Measurement of oxMIF in Urine by a Sandwich ELISA

(156) Microtiter plates were coated with the monoclonal fully human anti-oxMIF antibody RAB0. The urine samples were diluted 1:10 in 2% BSA/TBST pH 7.2. For the standard calibration curve, recombinant moMIF protein was modified by adding 0.2% ProClin300 and the standards were diluted in 2% BSA/TBST including 0.2% ProClin300. Detection was achieved by an affinity purified polyclonal anti-mouse MIF antibody (rabbit anti-moMIF, as described in Example 3.1) and a HRP-conjugated goat anti-rabbit antibodies. TMB was used as chromogenic substrate, chromogenic reaction was stopped with H.sub.2SO.sub.4 and the ELISA plate was measured at 450 nm. All samples, standards and controls, were done in duplicate.

(157) Results

(158) Before disease induction the mean level of oxMIF was not significantly above 0. Four days after disease induction significant levels of oxMIF became detectable. During disease progression the urinary oxMIF levels increased in the untreated control group on day 8 up to 333 ng/day (mean 130 ng/day). On day 8 the mean level of oxMIF in the anti-MIF antibody treated group was by approx. 70% decreased in comparison to the non treated group (see FIG. 5A). The reduced level of oxMIF in the treated group correlated with reduced disease parameters such as proteinuria and macrophage infiltration (FIG. 5B).

(159) Conclusion

(160) The level of oxMIF in urine correlates with the disease state in an animal model for proliferative glomerulonephritis. After administration of anti-oxMIF antibody RAB0, oxMIF levels were significantly reduced. Therefore, we conclude that measurement of oxMIF is suitable as a diagnostic marker to monitor disease progression and treatment effectiveness of Nephritis.

Example 3.6: oxMIF in Urine and Plasma of Lupus Nephritis Patients

(161) Urine and plasma samples were collected from Lupus Nephritis patients at different stages of disease. Each sample was stored frozen at 20 C. and shipped on dry ice.

(162) Material and Methods

(163) Preparation of oxMIF Specific Antibodies:

(164) The same antibody preparations were used as described in Example 1.

(165) Measurement of oxMIF in Urine by a Sandwich ELISA:

(166) Microtiter plates were coated with the monoclonal fully human anti-oxMIF antibody RAB0. The human urine samples were diluted 1:10 in 0.5% fish gelatine/PBS, pH 7.2. The calibration of the ELISA was done with a recombinant human oxMIF which was freshly produced by adding of 0.2% ProClin300. The standards were diluted in 0.5% fish gelatin/PBS including 0.2% ProClin300 and 10% human control urine (i.e. a pool of urine samples from >10 healthy donors). After washing of the plate, oxMIF captured by the coating antibody was detected by an affinity purified polyclonal rabbit anti-human MIF antibody (rabbit anti-huMIF, does not distinguish between redMIF and oxMIF) and HRP labelled goat anti-rabbit antibodies. TMB was used as chromogenic substrate, chromogenic reaction was stopped with H.sub.2SO.sub.4 and the ELISA plate was measured at 450 nm. All samples, standards and controls, were done in duplicate.

(167) Measurement of oxMIF in Plasma by a Sandwich ELISA:

(168) Microtiter plates were coated with the monoclonal fully human anti-oxMIF antibody RAB0. The human plasma samples were diluted 1:20 in 0.5% fish gelatin/PBS, pH 7.2. The calibration of the ELISA was done with a recombinant human oxMIF which was freshly produced by adding of 0.2% ProClin300. The standards were diluted in 0.5% fish gelatine/PBS including 0.2% ProClin300 and 5% human control plasma (i.e. a pool of plasma samples from 150 healthy donors). The range of the calibration curve was 10 ng/ml to 0.156 ng/ml. After washing of the plate, oxMIF captured by the coating antibody was detected by an affinity purified polyclonal rabbit anti-human MIF antibody (rabbit anti-huMIF, does not distinguish between redMIF and oxMIF) and HRP labelled goat anti-rabbit antibodies. TMB was used as chromogenic substrate, chromogenic reaction was stopped with H.sub.2SO.sub.4 and the ELISA plate was measured at 450 nm. All samples, standards and controls, were done in duplicate.

(169) Results

(170) The data depicted in FIG. 6A show a clear correlation between the amount of oxMIF detected in the urine and the state (stage) of the disease. The mean level of oxMIF determined in the urine of healthy controls was not significantly above 0. However, the more severe the disease state, the higher the mean oxMIF concentration determined in the urine.

(171) OxMIF levels of an acute patient diagnosed with Lupus Nephritis was measured at first observation day, 9 days and 35 days post diagnosis. Constant reduction in oxMIF levels correlated with improved clinical symptoms (FIG. 63). OxMIF levels in plasma were also measured and the results were comparable to the urinary levels. However, correlation with partly remission, remission or smoldering disease were less pronounced most probably because oxMIF in the circulation reflects overall the activity of the underlying disease (SLE) and not only the situation in the kidney (FIG. 6C).

(172) Conclusion

(173) Measurement of oxMIF in urine of lupus nephritis patients is suitable to monitor for disease progression as well as treatment efficiency. OxMIF in the circulation also correlates with disease severity although the result probably reflects the overall situation of the patients regarding SLE and not only the situation in the kidney (LN).

IV. Diabetic Retinopathy

Example 3.7

(174) Aqueous humor samples taken from patients with diabetic retinopathy (DR) and cataract as controls were assayed for the presence of MIF and oxMIF by ELISA.

(175) Material and Methods

(176) Total MIF and oxMIF were detected with the same ELISA set up described in examples 3.3 and 3.4.

(177) Results

(178) As shown on FIG. 7, total MIF is detected in the samples from DR or cataract patients, but oxMIF is only detected in DR samples.

(179) Conclusion

(180) OxMIF can be used as a marker in diabetic retinopathy.

V. Prostate Cancer

Example 3.8: OxMIF in Mouse Plasma after Establishment of a Human Prostate Cancer

(181) Plasma samples were collected at the time of termination of a xenograft mouse prostate cancer model. oxMIF as well as total MIF levels were measured and correlated with tumor growth in isotype control and anti-MIF treated mice.

(182) Material and Methods

(183) Xenograft Model for Prostate Cancer.

(184) PC-3 cells were harvested from exponentially growing cultures and mixed with growth factor-depleted BD matrigel matrix. The suspension was inoculated subcutaneously into the right flank of MF1 nude mice (210.sup.6 cells in 250 l matrigel per mice, 10 mice per group). One day after tumour induction, antibody treatment with RAB0 was started (5 and 15 mg/kg) and the antibodies were injected i.p. every second day for 2 weeks. Blood was collected by heart puncture and plasma was prepared for measurement the day of circulating MIF levels. Plasma samples from non-xenografted mice were also analyzed for total MIF and oxMIF (=negative control). In addition, tumour weight was measured.

(185) Measurement of Total MIF in Plasma by a Sandwich ELISA:

(186) Microtiter plates were coated with an affinity purified polyclonal rabbit anti-mouse MIF antibody (rabbit anti-moMIF, as described in Example 2). The tested plasma samples were diluted 1:25 in 0.5% fish gelatin/PBS, pH 7.2. The calibration of this ELISA was done by a recombinant full length mouse MIF protein. The standards were diluted in 0.5% fish gelatin/PBS including 4% control plasma. Detection of captured MIF was achieved by an affinity purified and biotinylated polyclonal rabbit anti-mouse MIF antibody (biot. rabbit anti-moMIF). All samples, standard and controls were done in duplicates

(187) Measurement of oxMIF in Plasma by a Sandwich ELISA:

(188) Microtiter plates were coated with the monoclonal fully human anti-oxMIF antibody RAB0. The plasma samples were diluted 1:25 in 2% BSA/TEST pH 7.2. For the standard calibration curve, recombinant moMIF protein was modified by adding 0.2% ProClin300 and the standards were diluted in 2% BSA/TEST including 0.2% ProClin300 and 4% control plasma. Detection of captured oxMIF was achieved by an affinity purified polyclonal anti-mouse MIF antibody (rabbit anti-moMIF, as described in Example 3.1) and a HRP-conjugated goat anti-rabbit antibodies. TMB was used as chromogenic substrate, chromogenic reaction was stopped with H.sub.2SO.sub.4 and the ELISA plate was measured at 450 nm. All samples, standards and controls, were done in duplicate.

(189) Results

(190) The median of total MIF in the isotype control treated group did not differ significantly from the anti-MIF antibody treated animals. Levels of total MIF were found to be increased in tumour bearing animals when compared to non-xenografted mice (=negative control in FIG. 8A). However, oxMIF levels in healthy animals are not detectable by the methods applied (=negative control in FIG. 8B; see also example 3.8). But as depicted in FIG. 8B, oxMIF levels were clearly detectable in tumor bearing mice. In addition, oxMIF levels were significantly reduced after treatment with an anti-MIF antibody. The median oxMIF level in the control group was found to be 8.6 ng/mL and was reduced in the two treatment groups. The dose dependent reduction of oxMIF levels also correlated with the reduction in tumor growth, thus with the therapeutic effect achieved (FIG. 8C).

(191) Conclusion

(192) In the PC-3 prostate cancer xenograft model, levels of total MIF were found to be increased in tumor bearing mice. However, oxMIF is not detected in non-xenografted control mice and concentration of oxMIF, but not of total MIF, correlates with tumor growth in MF1 nude mice. OxMIF is therefore much more suitable as a diagnostic marker for monitoring disease progression and therapeutic effects than total MIF.

Example 3.9: oxMIF on the Cellular Surface of a Prostate Cancer Cell Line

(193) The human prostate cancer cell line PC-3 (prostate adenocarcinoma, ATCC CRL-1435) has been tested by flow cytometry for the expression of oxMIF on its surface.

(194) Methods

(195) Cells were stained in Cell Staining Buffer (Biolegend) with 300 nM antibody RAB9 or RAB0 and Control 1, (irrelevant isotype control antibody) as the negative control, and antibodies were detected with the R-PE anti-human IgG (Sigma).

(196) Human blood from healthy donors was also analyzed to assess the presence of oxMIF on the surface of leukocytes in a normal situation. Heparinized blood was first incubated with anti-human Fc Receptors (anti-CD16, anti-CD32 and anti-CD64) to block unspecific binding of the antibody through their Fc domain to the cells. Cells were then incubated with a control IgG1 human monoclonal antibody, with RAB9 or with RAB0. Detection of cell surface bound antibodies was done with an R-PE-labelled rabbit anti-human IgG. In order to differentiate the different leukocyte subpopulations, cells were also labelled with a Pacific Blue-labelled anti-CD45 (pan-leukocyte marker) and an APC-labelled anti-CD19 (B cell marker). Acquisition is done after lysing the red blood cells. Using the size and complexicity parameters as well as the CD19 staining, we are able to distinguish between the granulocytes, monocytes, lymphocyte B cells (CD19+ cells) and lymphocyte T cells+Natural Killer cells (CD19neg cells). The acquisition of the data was carried out with a FACS CANTO II (Becton Dickinson) and data were analyzed with the FlowJo software (Treestar).

(197) Results

(198) oxMIF can be found on the surface of human prostate cancer cell line PC-3 (FIG. 9). Leukocytes from healthy donors (neg. control) do not show any oxMIF on their cell surface (FIG. 10).

(199) Conclusion

(200) The presence of oxMIF on the surface of human prostate cancer cells shows that oxMIF can be used as a marker for detection of cancerous cells.

VI. Pancreatic Cancer

Example 3.10: oxMIF on the Cellular Surface of Pancreatic Cancer Cell Line

(201) The human pancreatic cancer cell line BxPC-3 (Human primary pancreatic adenocarcinoma, Health Protection Agency (HPA) #93120816) has been tested by flow cytometry for the expression of oxMIF on its surface.

(202) Methods

(203) Cells were stained in Cell Staining Buffer (Biolegend) with 300 nM antibody RAB9 or RAB0 and Control 1 (irrelevant isotype control antibody), as the negative control, and antibodies were detected with the R-PE anti-human IgG (Sigma). The acquisition of the data was carried out with a FACS CANTO II (Becton Dickinson) and data were analyzed with the FlowJo software (Treestar).

(204) Results

(205) oxMIF can be found on the surface of human pancreatic cancer cell line BxPC-3 (FIG. 11). Leukocytes from healthy donors (neg. control) do not show any oxMIF on their cell surfaces (FIG. 10).

(206) Conclusion

(207) The presence of oxMIF on the surface of human pancreatic cancer cells shows that oxMIF can be used as a marker for detection of cancerous cells.

VII. Ovarian Cancer

Example 3.11: oxMIF on the Cellular Surface of Ovarian Cancer Cell Line

(208) The human ovarian cancer cell line A2780 (Human ovarian carcinoma, HPA #93112519) has been tested by flow cytometry for the expression of oxMIF on its surface.

(209) Methods

(210) Cells were stained in Cell Staining Buffer (Biolegend) with 300 nM antibody RAB9 or RAB0 and Control 1 (irrelevant isotype control antibody), as the negative control, and antibodies were detected with the R-PE anti-human IgG (Sigma). The acquisition of the data was carried out with a FACS CANTO II (Becton Dickinson) and data were analyzed with the FlowJo software (Treestar).

(211) Results

(212) oxMIF can be found on the surface of human ovarian cancer cell line A2780 (FIG. 12), but mainly with the monoclonal antibody RAB0. Leukocytes from healthy donors (neg. control) do not show any oxMIF on their cell surfaces (FIG. 10).

(213) Conclusion

(214) The presence of oxMIF on the surface of human ovarian cancer cells shows that oxMIF can be used as a marker for detection of cancerous cells.

VIII. Lymphoma

Example 3.12: oxMIF on the Cellular Surface of Lymphoma Cancer Cell Line

(215) Different immortalized human lymphoma cell lines (Table 2) have been tested by flow cytometry for the expression of oxMIF on their surfaces.

(216) TABLE-US-00003 TABLE 2 Cell lines that have been positively tested for active MIF by flow cytometry Name Reference Origin CA46 ATCC CRL-1648 Burkitt's Lymphoma MC/CAR ATCC CRL-8083 B lymphocyte, plasmacytoma myeloma Raji ATCC CCL-86 Burkitt's Lymphoma U-937 ATCC CRL-1593.2 Histiocytic Lymphoma
Methods

(217) Cells have been stimulated (or not) with 25 g/ml LPS and 50 g/ml Dextran sulfate for 24 h up to 72 h. Cells were stained in Cell Staining Buffer (Biolegend) with 300 nM antibody RAB9 or RAB0 or RAB4 and Control 1 (irrelevant isotype control antibody), as the negative control, and antibodies were detected with the R-PE anti-human IgG (Sigma). The acquisition of the data was carried out with a FACS CANTO II (Becton Dickinson) and data were analyzed with the FlowJo software (Treestar).

(218) Results

(219) oxMIF can be found on the surface of human lymphoma cell lines (FIG. 13), whereas leukocytes from healthy donors (neg. control) do not show any oxMIF on their cell surfaces (FIG. 10).

(220) Conclusion

(221) The presence of oxMIF on the surface of human lymphoma cells shows that oxMIF can be used as a marker for detection of cancerous cells.

IX. Solid Tumour

Prostate and Breast Cancer

Example 3.13: oxMIF in the Plasma from Cancer Patients

(222) EDTA plasma samples from patients having different kinds of solid tumors (prostate and breast) were obtained from a commercial vendor. The total MIF and oxMIF concentrations were analyzed by sandwich ELISA.

(223) Material and Methods

(224) Both total MIF and oxMIF were detected using the same ELISA set up: microtiter plates were coated with human anti-MIF monoclonal antibody RAM0 and detection of MIF was done with an affinity purified, polyclonal rabbit anti-human MIF antibody. The read-out of the ELISA was done after incubation of the plate with an goat anti-rabbit, HRP conjugated antibody (BioRad, Cat.: 171-6516) (any other goat anti-rabbit could be used here as well) and TMB (chromogenic substrate; any other suitable chromogenic substrate could also be used, as known to a person skilled in the art) in an ELISA reader at 450 nm. The calibration of the ELISA was done with recombinant human MIF which was incubated with 0.2% ProClin300 (Proclin300 induces the formation of oxMIF epitopes within MIF). The standards were diluted in 0.5% fish gelatin/PBS including 0.2% ProClin300 and 5% human control plasma. The range of the calibration curve was 10 ng/ml to 0.156 ng/ml. The tested human plasma samples were diluted 1:20 either in 0.5% fish gelatin/PBS, pH 7.2 for the oxMIF ELISA, or in 0.5% fish gelatin/PBS/0.2% Proclin300 for the total MIF ELISA.

(225) Results

(226) EDTA plasma samples derived from patients diagnosed with prostate cancer (n=14) and breast cancer (n=15) have been purchased from a commercial vendor. EDTA plasma from healthy volunteers (n=49) was used as control. In FIGS. 14A and 14B levels of total MIF and oxMIF of control samples and prostate cancer samples are shown. As described in the literature, MIF was detected in the plasma from healthy individuals and a significant increase of total MIF in the plasma from prostate cancer patients (t test, p=0.0166) was observed. However, oxMIF was not detected in the plasma of healthy donors, whereas oxMIF was detected in the plasma samples from the prostate cancer patients (t test, n=0.0016). A similar pattern was observed in breast cancer samples (FIG. 15) with a significant elevation of total MIF (p=0.0078) and oxMIF (p=0.0451) in the plasma samples derived from breast cancer patients compared to the healthy controls and no oxMIF detection in healthy controls.

(227) Conclusion

(228) Elevated levels of total MIF and oxMIF can be detected in the plasma of patients with prostate and breast cancer. However, total MIF is also present in the plasma derived from healthy donors, whereas oxMIF cannot be detected in healthy controls. Therefore, oxMIF can be considered as a more specific biomarker to indicate a disease state than total MIF.

X. Multiple Sclerosis

Example 3.14: oxMIF in the CSF of Multiple Sclerosis Patients

(229) Cerebrospinal fluid samples derived from patients with different forms of multiple sclerosis were obtained from a commercial vendor. The total MIF and oxMIF concentrations were measured by sandwich ELISA.

(230) Material and Methods

(231) Both total MIF and oxMIF were detected using the same ELISA set up: microtiter plates were coated with human anti-MIF monoclonal antibody RAM0 and detection of MIF was done with an affinity purified polyclonal rabbit anti-human MIF antibody. The read-out of the ELISA was done after incubation of the plate with an goat anti-rabbit, HRP conjugated antibody (BioRad, Cat.: 171-6516) (any other goat anti-rabbit could be used here as well) and TMB (chromogenic substrate, as defined above; any other suitable chromogenic substrate could also be used, as known to a person skilled in the art) in an ELISA reader at 450 nm.

(232) For the CSF samples, the calibration of the ELISA was done with recombinant human MIF which was incubated with 0.2% ProClin300 (Proclin300 induces the formation of oxMIF epitopes within MIF). The standards were diluted in 20 mM Tris/TBST buffer pH 7.2 including 0.2% ProClin300. The range of the calibration curve is 10 ng/ml to 0.156 ng/ml. The tested human CSF samples were diluted 1:10 in 20 mM Tris/TEST, for the oxMIF ELISA, or in the presence of Proclin300 for the total MIF ELISA.

(233) Results

(234) In the cerebrospinal fluid (CSF) samples as used in this example (FIGS. 16 A and 16B), oxMIF was not detectable in the CSF from healthy controls, whereas high levels were found in the CSF of MS patients (p<0.0001). Also the levels of total MIF were strongly increased in samples from MS patients (n=49) as compared to the controls (n=30) (p<0.0001), but to a certain extent, total MIF was also found in samples from healthy controls.

(235) Conclusion

(236) Elevated levels of total MIF and oxMIF can be detected in the CSF of MS patients. However, total MIF is also present in the CSF derived from healthy donors, whereas oxMIF cannot be detected in healthy controls. Therefore, oxMIF can be considered as an excellent biomarker for multiple sclerosis and as a more specific biomarker than total MIF.

XI. Ovarian Cancer

Example 3.15: oxMIF in the Plasma from Ovarian Cancer Patients

(237) EDTA plasma samples were commercially obtained from patients having different kind of ovarian cancers (clear cell adenocarcinoma, papillary serous adenocarcinoma and serous adenocarcinoma). Their content in total MIF and oxMIF was analyzed by sandwich ELISA.

(238) Material and Methods

(239) Both total MIF and oxMIF were detected using the same ELISA set up: microtiter plates were coated with human anti-MIF monoclonal antibody RAM0 and detection of MIF was done with an affinity purified polyclonal rabbit anti-human MIF antibody. The read-out of the ELISA was done after incubation of the plate with an goat anti-rabbit, HRP conjugated antibody (BioRad, Cat.: 171-6516) (any other goat anti-rabbit as known in the art could be used here as well) and TMB (chromogenic substrate, as defined above; any other suitable chromogenic substrate could also be used, as known to a person skilled in the art) in an ELISA reader at 450 nm. The calibration of the ELISA was done with recombinant human MIF which was incubated with 0.2% ProClin300 (Proclin300 converts MIF to oxMIF). The standards were diluted in 0.5% fish gelatin/PBS including 0.2% ProClin300 and 5% human control plasma. The range of the calibration curve is 10 ng/ml to 0.156 ng/ml. The tested human plasma samples were diluted 1:20 in 0.5% fish gelatin/PBS, pH 7.2 for the oxMIF ELISA, or in the presence of Proclin300 for the total MIF ELISA.

(240) Results

(241) Plasma samples from EDTA blood have been purchased from patients diagnosed with ovarian cancer (n=42). EDTA plasma from healthy volunteers (n=19) was used as control. In FIGS. 17A and 17B levels of total MIF and oxMIF of control samples and ovarian cancer samples are shown. As described in the literature, MIF was detected in the plasma from healthy individuals and a significant increase of total MIF in the plasma from ovarian cancer patients (t test, p=0.0434) was observed. However, no oxMIF was detected in the plasma of healthy donors, whereas oxMIF was detected in the plasma samples from the ovarian cancer patients (t test, p=0.0663). When the statistical analysis is run on specific subtypes of ovarian cancer, a significant increase of MIF in plasma from serous cystadenocarcinoma over the controls (p=0.0046), as well as a significant increase of oxMIF in papillary serous cystadenocarcinoma (p=0.0438) and serous cystadenocarcinoma (p=0.0357) over the controls was observed.

XII: Ulcerative Colitis and Crohn'S Disease

Example 3.16: oxMIF in the Plasma from Patients with Ulcerative Colitis and Crohn's Disease

(242) EDTA plasma samples were commercially obtained from patients having different ulcerative colitis (UC) or Crohn's Disease (CD). Their content in total MIF and oxMIF was analyzed by sandwich ELISA.

(243) Material and Methods

(244) Both total MIF and oxMIF were detected using the same ELISA set up: microtiter plates were coated with human anti-MIF monoclonal antibody RAM0 and detection of MIF was done with an affinity purified polyclonal rabbit anti-human MIF antibody. The read-out of the ELISA was done after incubation of the plate with an goat anti-rabbit, HRP conjugated antibody (BioRad, Cat.: 171-6516) (any other goat anti-rabbit as known in the art could be used here as well) and TMB (chromogenic substrate, as defined above; any other suitable chromogenic substrate could also be used, as known to a person skilled in the art) in an ELISA reader at 450 nm. The calibration of the ELISA was done with recombinant human MIF which was incubated with 0.2% ProClin300 (Proclin300 converts MIF to oxMIF). The standards were diluted in 0.5% fish gelatin/PBS including 0.2% ProClin300 and 5% human control plasma. The range of the calibration curve is 10 ng/ml to 0.156 ng/ml. The tested human plasma samples were diluted 1:20 in 0.5% fish gelatin/PBS, pH 7.2 for the oxMIF ELISA, or in the presence of Proclin300 for the total MIF ELISA.

(245) Results

(246) Plasma samples from EDTA blood have been purchased from patients diagnosed with UC (n=15) or CD (n=21). EDTA plasma from healthy volunteers (n=19) was used as control. In FIGS. 18A and 18B levels of total MIF and oxMIF of control samples and UC and CD samples are shown. As described in the literature, MIF was detected in the plasma from healthy individuals and a significant increase of total MIF was detected in the plasma from CD patients (t test, p=0.0207), but not in UC samples (p=0.1240). However, no oxMIF was detected in the plasma of healthy donors, whereas oxMIF was detected in the plasma samples from both UC and CD patients (t test, p=0.0417 and p=0.0114, respectively when compared to controls).

(247) Conclusion

(248) For both ulcerative colitis and Crohn's disease patients, it was possible to detect a significant higher amount of oxMIF in the plasma as compared to healthy volunteers. These results show that oxMIF can be used as a biomarker in these diseases