Methods for diagnosing Alzheimer's disease

专利摘要:
The present invention relates to methods of diagnosing, monitoring, and assessing treatment effects for Aβ amyloidosis, early in the course of clinical disease or prior to the onset of brain damage and clinical symptoms. Methods of measuring the
公开号:AU2012359020A1
申请号:U2012359020
申请日:2012-12-19
公开日:2014-07-10
发明作者:Randall Bateman；David Holtzman；Kwasi G. Mawuenyega
申请人:University of Washington；Washington University in St Louis WUSTL；
IPC主号:G01N33-53

专利说明:
WO 2013/096451 PCT/US2012/070623 METHODS FOR DIAGNOSING ALZHEIMER'S DISEASE GOVERNMENTAL RIGHTS [0001] This invention was made with government support under R-01 NS065667 awarded by The National Institutes of Health. The government has certain rights in the invention. FIELD OF THE INVENTION [0002] The invention relates to methods for the diagnosis and treatment of AP amyloidosis. BACKGROUND OF INVENTION [0003] Alzheimer's Disease (AD) is the most common cause of dementia and is an increasing public health problem. It is currently estimated to afflict 5 million people in the United States, with an expected increase to 13 million by the year 2050 (Herbert et al 2001, Alzheimer Dis. Assoc. Disord. 15(4): 169-173). AD, like other central nervous system (CNS) degenerative diseases, is characterized by disturbances in protein production, accumulation, and clearance. In AD, dysregulation in the metabolism of the protein, amyloid-beta (AP), is indicated by a massive buildup, or AP amyloidosis, of this protein in the brains of those with the disease. AD leads to loss of memory, cognitive function, and ultimately independence. It takes a heavy personal and financial toll on the patient and the family. Because of the severity and increasing prevalence of this disease in the population, it is urgent that better treatments be developed. [0004] Currently, there are some medications that modify symptoms, however, there are no disease-modifying treatments. Disease-modifying treatments will likely be most effective when given before the onset of permanent brain damage. However, by the time clinical diagnosis of AD is made, extensive neuronal loss has already occurred (Price et al. 2001, Arch. Neurol. 58(9): 1395-1402). Currently, there are no means of diagnosing individuals at risk of developing AD before the onset of 1 WO 2013/096451 PCT/US2012/070623 clinical symptoms or of effectively measuring the effects of treatments that may prevent the onset or slow the progression of the disease. [0005] A need exists, therefore, for a way to identify those at risk of developing AD. Early identification and the ability to measure the effects of drugs that target AP generation would be most helpful in preventing or delaying the onset of AD, and enhancing drug development efforts. BRIEF DESCRIPTION OF THE DRAWINGS [0006] FIG. 1 depicts a graph showing the percent labeled AP in blood over 48 hours for 6 participants. Note the rapid rise to plateau by 9 hours with a rapid clearance rate. [0007] FIG. 2 depicts a graph showing the percent labeled AP in blood over 36 hours for 6 participants (blue circles) and percent labeled AP in CSF in twelve participants (red squares). [0008] FIG. 3 depicts a graph showing that blood AD kinetics are faster than CNS AP labeling kinetics. Blood and CSF samples were collected from AD participants during and after intravenous labeling for 9 hours. Plasma AP labeling increases within 1 hour, while CSF AP labeling does not increase until 5 hours. In older participants, the half-life of blood AP is 2.1 hours, while the half-life of CNS AP is 11.6 hours. [0009] FIG. 4 depicts blood AD kinetics during and after intravenous labeling. A. Blood samples from AD participants and controls during and after 9 hours of intravenous labeling. During and after the labeling phase, the AD group has increased labeled AP over the first 15 hours. B and C.. Normalized labeled plasma Ap. Labeled plasma AP was normalized by labeled plasma leucine for each hour. (Hours 0-9 are depicted in 4B while hours 10-15 are depicted in 4C.) Increased normalized labeled plasma AP is noted from hours 5 to 15 in AD compared to control. [0010] FIG. 5 depicts AD kinetics in blood after oral labeling. A participant was given a single oral dose of labeled leucine at time zero. Blood samples were collected every hour for 48 hours. Plasma labeled AP was measured and the kinetics curve is shown. A subsequent ascending dose oral labeling study revealed that plasma 2 WO 2013/096451 PCT/US2012/070623 AP can be sufficiently labeled with small doses of oral labeled leucine. The labeled CSF AP curve is shown for comparison. Note the significantly faster half-life of blood AP and the extended time course captured to measure later secondary clearance effects. [0011] FIG. 6 depicts a graph showing AP total, 42, 40, and 38 variant quantitation over time. Because specific AP variant kinetics (e.g. Ap42) may be altered in AD, a novel method was developed to allow for the sensitive and specific measurement of labeled AP variants. AP variants were immunoprecipitated from pulse oral labeled plasma samples and quantified for kinetics (A). Note that labeled Ap42 had an increased peak and faster clearance (half-life -1 hour) compared to other AP variants (in this cognitively normal participant). AP variants were similarly processed from steady-state IV labeled CSF samples and quantified for kinetics (B). Note the similar metabolism in the CSF of this cognitively normal, PET PiB negative participant. [0012] FIG. 7 depicts AD kinetics in the CNS of 12 AD participants (red triangles) and 12 controls (blue circles). The amount of labeled Ap42 and Ap40 was measured and compared between groups to measure production and clearance rates of both AP species. Error bars indicate SEM. (A) Normalized labeled Ap42 production phase. (B) Ap42 clearance phase. (C) Normalized labeled Ap40 production phase. (D) Ap40 clearance phase. (E) Fractional synthesis rates of Ap42 and Ap40. (F) Fractional clearance rates of Ap42 and Ap40. [0013] FIG. 8 graphically depicts the ratio of AP production to clearance in AD and controls. The ratio of Ap42 production to clearance rate is balanced in controls (0.95), while it is higher in those with AD (1.35). Similarly, there is increased Ap40 production to clearance ratios in AD (1.37) compared to controls (0.99). Means + standard deviations are plotted (p<0.05 ANOVA). [0014] FIG. 9 graphically depicts average CSF (A) and Ap40 (B) concentrations. As expected CSF Ap42 concentrations were lower in the AD group compared to the control group (p<0.05). Means ± standard errors are plotted. [0015] FIG. 10 graphically depicts complete time courses of the average AD kinetics in the CNS of twelve AD participants (red triangles) and twelve controls (blue circles). The average leucine normalized labeled Ap42 (A) and Ap40 (B) time 3 WO 2013/096451 PCT/US2012/070623 course is shown for hours 1 to 18. The natural log (In) plot of labeled to unlabeled ratio of Ap42 (C) and Ap40 (D) is shown for hours 18 to 36. [0016] FIG. 11 depicts two graphs plotting the H:L ratio of 13
C
6 -Leu/ 12
C
6 Leu over time. (A) Samples from a normal person with no amyloid deposition by PIB, and (B) samples from an AD individual with positive amyloid deposition. [0017] FIG. 12 depicts a graph plotting the Ap42:Ap40 H:L ratio of 13C6 Leu/ 12
C
6 -Leu over time in 50 AD patients. [0018] FIG. 13 depicts a plot showing the relative labeling of Ap42:Ap40 H:L ratio of 13
C
6 -Leu/ 1 2
C
6 -Leu at 10 hrs. [0019] FIG. 14 depicts a plot showing the relative labeling of different AP isoforms H:L ratio of 13
C
6 -Leu/ 12
C
6 -Leu over time. [0020] FIG. 15 depicts three graphs showing that a comparison of isotopic enrichments around the midpoint on the back end of the kinetic tracer curve is able to discriminate the PIB groups highly significantly. FIG. 15A shows the ratio of Ap42 percent labeled / Ap40 percent labeled at 23 hours graphed on the y-axis and PIB staining graphed on the x-axis. A threshold ratio of 0.9 is indicated by the dashed line. FIG. 15B shows the average of the ratio of Ap42 percent labeled / Ap40 percent labeled at 23 hours and 24 hours graphed on the y-axis and PIB staining graphed on the x-axis. A threshold ratio of 0.9 is indicated by the dashed line. FIG. 15C shows the calculated values of ten times kex42 added to ratio of the rate constants for irreversible loss for Ap42 versus Ap40 (1Ox kex 4 2 + FTR ratio) plotted as a function of PIB staining. A threshold ratio of 1.75 is indicated by the dashed line. MC+ = patients with PSEN1 or PSEN2 mutations that were PIB positive by PET; MC- = patients with PSEN1 or PSEN2 mutations that were PIB negative by PET; NC = non-carrier mutation carrier sibling controls. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS [0021] A method of diagnosing, or monitoring the progression or treatment of AP amyloidosis in a subject has been developed. The invention greatly enhances the accuracy of detection of AP amyloidosis early in the course of clinical disease or prior to the onset of brain damage and clinical symptoms in patients at risk of 4 WO 2013/096451 PCT/US2012/070623 developing AD and monitoring the progression of the disease. Advantageously, as illustrated in the examples, the method allows for measuring AP dynamics in the blood without invasive spinal catheters. In addition, the method allows for specific testing of proposed disease modifying therapeutics which target AP. I. Methods for monitoring the in vivo metabolism of neurally derived biomolecules [0022] The current invention provides methods for diagnosing, or monitoring the progression or treatment of AP amyloidosis resulting from differential kinetics of amyloid-p (AP) protein and AP protein variants in a subject. Alzheimer's Disease (AD) is a debilitating disease characterized by accumulation of amyloid plaques (AD amyloidosis) in the central nervous system (CNS) resulting from increased production, decreased clearance, or both, of amyloid-p (AP) protein and AP protein variants. Non-limiting examples of symptoms associated with AP amyloidosis may include impaired cognitive function, altered behavior, abnormal language function, emotional dysregulation, seizures, impaired nervous system structure or function, and an increased risk of development of Alzheimer's disease or cerebral amyloid angiopathy. [0023] In some embodiments, comparing the level of a AP variant in a subject to the level of the AP variant in an individual with no amyloidosis, one skilled in the art may be able to diagnose AP amyloidosis in a subject before the development of symptoms associated with AP amyloidosis. In other embodiments, by comparing the level of an AP variant in a subject to the level of another AP variant in the subject, one skilled in the art may be able to diagnose AP amyloidosis in the subject before the development of symptoms associated with AP amyloidosis. In addition, the invention permits the measurement of the pharmacodynamic effects of disease-modifying therapeutics in a subject. (a) A/8 variants [0024] The method of the invention comprises measuring the in vivo levels of one or more AP variants. As used herein, the term "Ap variant" refers to total AD 5 WO 2013/096451 PCT/US2012/070623 protein, Ap40, Ap42, Ap38, or another AP isoform. In some embodiments, the in vivo levels of AP variants may be measured by measuring the in vivo levels of labeled AP variants. Non-limiting examples of AP variants whose in vivo levels may be measured may include total AP protein, Ap40, Ap42, or Ap38. In one embodiment, the in vivo levels of labeled AP protein may be measured. In another embodiment, the in vivo levels of labeled Ap40 may be measured. In yet another embodiment, the in vivo levels of labeled Ap42 may be measured. In another embodiment, the in vivo levels of labeled Ap38 may be measured. [0025] In other embodiments, the in vivo levels of AP variants may be measured by measuring the in vivo relative labeling of AP variants. As used herein, "in vivo relative labeling" refers to the percent of the variant that is labeled in vivo. Non limiting examples of AP variants whose in vivo relative labeling may be measured may include AP protein, Ap40, Ap42, or Ap38. In one embodiment, the in vivo relative labeling of AP protein may be measured. In another embodiment, the in vivo relative labeling of Ap40 may be measured. In yet another embodiment, the in vivo relative labeling of Ap42 may be measured. In another embodiment, the in vivo relative labeling of Ap38 may be measured. [0026] In some embodiments, the in vivo relative labeling of more than one AP protein or AP protein variant may be measured in vivo in the subject. In some embodiments, the in vivo relative labeling of AP protein and Ap42 may be measured. In other embodiments, the in vivo relative labeling of AP protein and Ap40 may be measured. In yet other embodiments, the in vivo relative labeling of AP protein and Ap38 may be measured. In additional embodiments, the in vivo relative labeling of Ap40 protein and Ap38 may be measured. In still other embodiments, the in vivo relative labeling of AP protein and Ap38 may be measured. In other embodiments, the in vivo relative labeling of AP protein, Ap42 and Ap40 may be measured. In yet other embodiments, the in vivo relative labeling of AP protein, Ap40 and Ap38 may be measured. In still other embodiments, the in vivo relative labeling of AP protein, Ap42 and Ap38 may be measured. In additional embodiments, the in vivo relative labeling of Ap42, Ap40 and Ap38 may be measured. In preferred embodiments, the in vivo relative labeling of Ap42 protein and Ap40 may be measured. 6 WO 2013/096451 PCT/US2012/070623 [0027] Those of skill in the art will recognize that measuring the in vitro digestion products of AD (e.g., Ap 6 -1 6 , Ap 17
-
2 8 ) may be used to determine the in vivo metabolism of the AP protein and AP variants comprising the AP in vitro digestion products. In some embodiments, the in vivo relative labeling of one or more AP variants may be measured by measuring in vitro digestion products of AD (e.g., Ap6-16, Ap1 7 -28). (b) measuring in vivo relative labeling [0028] The in vivo relative labeling of AP variants may be measured by labeling an AP variant as it is synthesized in the central nervous system in vivo, and measuring the labeling of the AP variant over time. These measurements may be used to calculate the ratio or percent labeled AP variant. i. labeling moiety [0029] An AP variant may be labeled in vivo as it is synthesized in the central nervous system using a labeled moiety. Several different moieties may be used to label the AP variant. Generally speaking, the two types of labeling moieties typically utilized in the method of the invention are radioactive isotopes and non-radioactive (stable) isotopes. In a preferred embodiment, non-radioactive isotopes may be used and measured by mass spectrometry. Preferred stable isotopes include deuterium 2 H, 13c N, 17 or 180 33, 34, or 36S, but it is recognized that a number of other stable isotope that change the mass of an atom by more or less neutrons than is seen in the prevalent native form would also be effective. A suitable label generally will change the mass of the biomolecule under study such that it can be detected in a mass spectrometer. In one embodiment, the labeled moiety is an amino acid comprising a non-radioactive isotope (e.g., 13C). Alternatively, a radioactive isotope may be used, and the labeled biomolecules may be measured with a scintillation counter rather than a mass spectrometer. One or more labeled moieties may be used simultaneously or in sequence. [0030] Those of skill in the art will appreciate that several amino acids may be used to provide the label of AP variant. Generally, the choice of amino acid is based on a variety of factors such as: (1) The amino acid generally is present in at least one 7 WO 2013/096451 PCT/US2012/070623 residue of the AP variant. (2) The amino acid is generally able to quickly reach the site of protein synthesis and rapidly equilibrate across the blood-brain barrier. Leucine is a preferred amino acid to label proteins that are synthesized in the CNS such as AP variants. (3) The amino acid ideally may be an essential amino acid (not produced by the body), so that a higher percent of labeling may be achieved. Non-essential amino acids may also be used; however, measurements will likely be less accurate. (4) The amino acid label generally does not influence the metabolism of the protein of interest (e.g., very large doses of leucine may affect muscle metabolism). And (5) availability of the desired amino acid (i.e., some amino acids are much more expensive or harder to manufacture than others). In one embodiment, 13
C
6 -phenylalanine, which contains six 13C atoms, is used to label an AP variant. In a preferred embodiment, 13
C
6 -leucine is used to label an AP variant. [0031] There are numerous commercial sources of labeled amino acids, both non-radioactive isotopes and radioactive isotopes. Generally, the labeled amino acids may be produced either biologically or synthetically. Biologically produced amino acids may be obtained from an organism (e.g., kelp/seaweed) grown in an enriched mixture of 13C, 15 N, or another isotope that is incorporated into amino acids as the organism produces proteins. The amino acids are then separated and purified. Alternatively, amino acids may be made with known synthetic chemical processes. ii. administration of the labeled moiety [0032] The method of the invention provides that the labeled moiety may be administered to the subject. The labeled moiety may be administered to a subject by several methods. Suitable methods of administration include intravenously, intra arterially, subcutaneously, intraperitoneally, intramuscularly, or orally. In a preferred embodiment, the labeled moiety is administered by intravenous infusion. In another preferred embodiment, the labeled moiety may be orally ingested. [0033] The labeled moiety may be administered slowly over a period of time or as a large single dose depending upon the type of analysis chosen (e.g., steady state or bolus/chase). To achieve steady-state levels of the labeled AP variant, the labeling time generally should be of sufficient duration so that the labeled AP variant 8 WO 2013/096451 PCT/US2012/070623 may be reliably quantified. In one embodiment, the labeled moiety is labeled leucine and the labeled leucine is administered intravenously for nine hours. In another embodiment, the labeled leucine is administered intravenously for 12 hours. In yet another embodiment, the labeled leucine is administered orally. In another embodiment, the labeled leucine is administered orally as a single bolus for pulse labeling. [0034] Those of skill in the art will appreciate that the amount (or dose) of the labeled moiety can and will vary. Generally, the amount is dependent on (and estimated by) the following factors. (1) The type of analysis desired. For example, to achieve a steady state of about 15% labeled leucine in plasma requires about 2 mg/kg/hr over 9 hr after an initial bolus of 2 mg/kg over 10 min. In contrast, if no steady state is required, a large bolus of labeled leucine (e.g., 1 or 5 grams of labeled leucine) may be given. (2) The AP variant under analysis. For example, if the AP variant is being produced rapidly, then less labeling time may be needed and less label may be needed - perhaps as little as 0.5 mg/kg over 1 hour. However, most AP variants have half-lives of hours to days and, so more likely, a continuous infusion for 4, 9 or 12 hours may be used at 0.5 mg/kg to 4 mg/kg. And (3) the sensitivity of detection of the label. For example, as the sensitivity of label detection increases, the amount of label that is needed may decrease. [0035] Those of skill in the art will appreciate that more than one label may be used in a single subject. This would allow multiple labeling of the same AP variant and may provide information on the production or clearance of that AP variant at different times. For example, a first label may be given to a subject over an initial time period, followed by a pharmacologic agent (drug), and then a second label may be administered. In general, analysis of the samples obtained from this subject would provide a measurement of metabolism before AND after drug administration, directly measuring the pharmacodynamic effect of the drug in the same subject. [0036] Alternatively, multiple labels may be used at the same time to increase labeling of the AP variant, as well as obtain labeling of a broader range of AP variants. 9 WO 2013/096451 PCT/US2012/070623 iii. biological sample [0037] The method of the invention provides that a biological sample be obtained from a subject so that the in vivo metabolism of the labeled AP variant may be determined. Suitable biological samples include, but are not limited to, cerebral spinal fluid (CSF), blood plasma, blood serum, urine, saliva, perspiration, and tears. In one embodiment of the invention, biological samples are taken from the CSF. In an alternate embodiment, biological samples are collected from the urine. In a preferred embodiment, biological samples are collected from the blood. As used herein, "blood" refers to either blood plasma or blood serum. [0038] Cerebrospinal fluid may be obtained by lumbar puncture with or without an indwelling CSF catheter (a catheter is preferred if multiple collections are made over time). Blood may be collected by veni-puncture with or without an intravenous catheter, and processed according to methods known in the art. Urine may be collected by simple urine collection or more accurately with a catheter. Saliva and tears may be collected by direct collection using standard good manufacturing practice (GMP) methods. [0039] After administration of a labeled amino acid, one or more samples will be collected from the subject. As will be appreciated by those of skill in the art, the number of samples and when they would be taken generally will depend upon a number of factors such as: the type of analysis, type of administration, the AP variant of interest, the rate of metabolism, the type of detection, etc. In some embodiments, the invention provides that a first biological sample be taken from the subject prior to administration of the label to provide a baseline for the subject. [0040] In some embodiments, samples of blood or CSF are taken hourly for 36 hours. Alternatively, samples may be taken every other hour or even less frequently. In one embodiment, samples of CSF are taken about 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15 hours after administration of the labeled moiety. In another embodiment, samples of CSF are taken about 9, 10, or 11 hours after administration of the labeled moiety. In yet another embodiment, samples of CSF are taken about 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, or 36 hours after administration of the labeled moiety. In yet another embodiment, samples of CSF are taken about 26, 10 WO 2013/096451 PCT/US2012/070623 27, or 28 hours after administration of the labeled moiety. In a preferred embodiment, samples of CSF are taken about 10 hours after administration of the labeled moiety. In another preferred embodiment, samples of CSF are taken about 27 hours after administration of the labeled moiety. [0041] In one embodiment, blood samples are taken about 1, 2, 3, 4, 5, 6, 7, 8, or 9 hours after administration of the labeled moiety. In another embodiment, blood samples are taken about 5, 6, 7, 8, 9, 10, 11, or 12 hours after administration of the labeled moiety. In yet another embodiment, blood samples are taken about 17, 18, 19, 20, 21, 22, 23, 24, 25, or 26 hours after administration of the labeled moiety [0042] In general, biological samples obtained during the production phase may be used to determine the rate of synthesis of the AP variant, and biological samples taken during the clearance phase may be used to determine the clearance rate of the AP variant. For CSF, the production phase is typically in the first 12 hours after labeling, while the clearance phase is typically 24 to 36 hours after labeling. For blood, the production phase is typically the first three hours after labeling, while the clearance phase is typically between about 4 to about 10 hours after labeling. In an alternative embodiment, samples may be taken from an hour to days or even weeks apart depending upon the protein's synthesis and clearance rate. iv. detection [0043] The present invention provides that detection of the amount of labeled AP and the amount of unlabeled AP in the biological samples may be detected. Suitable methods for the detection of labeled and unlabeled AP can and will vary according to the type of labeled moiety used to label it. If the labeled moiety is a non radioactively labeled amino acid, then the method of detection typically should be sensitive enough to detect changes in mass of the labeled protein with respect to the unlabeled protein. In a preferred embodiment, mass spectrometry is used to detect differences in mass between the labeled and unlabeled AP. In one embodiment, gas chromatography mass spectrometry is used. In an alternate embodiment, MALDI-TOF mass spectrometry is used. In a preferred embodiment, high-resolution tandem mass spectrometry is used. 11 WO 2013/096451 PCT/US2012/070623 [0044] Additional techniques may be utilized to separate AP from other proteins and biomolecules in the biological sample. As an example, immunoprecipitation may be used to isolate and purify AP before it is analyzed by mass spectrometry. Alternatively, mass spectrometers having chromatography setups may be used to isolate proteins without immunoprecipitation, and then AP may be measured directly. In an exemplary embodiment, AP is immunoprecipitated and then analyzed by a liquid chromatography system interfaced with a tandem MS unit equipped with an electrospray ionization source (LC-ESI-tandem MS). [0045] The invention also provides that multiple AP variants in the same biological sample may be measured simultaneously. That is, both the amount of unlabeled and labeled AP may be detected and measured separately or at the same time for multiple AP variants. As such, the invention provides a useful method for screening changes in synthesis and clearance of AP variants on a large scale (i.e. proteomics/metabolomics) and provides a sensitive means to detect and measure AP variants involved in the underlying pathophysiology of AD. v. ratio of relative labeling of AG variants [0046] The amount of labeled and unlabeled AP variant in a biological sample may be used to determine the relative labeling of the AP variant in the sample. According to the invention, the relative labeling of an AP variant in a sample is the ratio of labeled AP variant to unlabeled AP variant in the sample. Those of skill in the art will recognize that the relative labeling of an AP variant in a biological sample is directly proportional to the metabolism of said AP variant in the subject. (c) ratio of relative labeling and diagnosis [0047] A method of the invention may comprise calculating the ratio of relative labeling of one AP variant relative to the relative labeling of another AP variant. Those of skill in the art will recognize that, when the relative labeling of any two AP variants are similar in a given sample, the ratio of relative labeling of said two AP variants may be about 1. Conversely, when the relative labeling of any one AP variant differs from the relative labeling of other AP variants in a given sample, the ratio of 12 WO 2013/096451 PCT/US2012/070623 relative labeling of said AP variant to another AP variant in the biological sample may be a number other than 1 (i.e. greater than 1 or less than 1). [0048] As illustrated in the examples, the inventors discovered that the relative labeling of AP variants in healthy subjects are similar in a given sample taken at a given time. Therefore, the ratio of relative labeling of any AP variant to any other AP variant in a healthy subject may be about 1. Surprisingly, the inventors also discovered that the relative labeling of Ap42 in subjects with AP amyloidosis is different from the relative labeling of other AP variants in a given sample taken at a given time. Therefore, the ratio of relative labeling of Ap42 to any other AP variant in a subject with AP amyloidosis may be a number other than one 1. In other words, a ratio of relative labeling of Ap42 to any other AP variant in a subject of about 1 indicates the absence of AP amyloidosis . Conversely, a ratio of relative labeling of Ap42 to any other AP variant in a subject is other than one 1, indicates the presence of AP amyloidosis . [0049] In some embodiments, the ratio of relative labeling of AP protein to Ap42 may be measured. In other embodiments, the ratio of relative labeling of Ap42 to AP protein may be measured. In yet other embodiments, the ratio of relative labeling of AP protein to Ap40 may be measured. In additional embodiments, the ratio of relative labeling of Ap40 to AP protein variant may be measured. In still other embodiments, the ratio of relative labeling of AP protein to Ap38 may be measured. In other embodiments, the ratio of relative labeling of Ap38 to AP protein variant may be measured. In additional embodiments, the ratio of relative labeling of Ap40 to Ap38 may be measured. In yet embodiments, the ratio of relative labeling of Ap38 to Ap40 may be measured. In still embodiments, the ratio of relative labeling of Ap42 to Ap38 may be measured. In other embodiments, the ratio of relative labeling of Ap38 to Ap42 may be measured. In some embodiments, the ratio of relative labeling of Ap40 to Ap42 may be measured. In preferred embodiments, the ratio of relative labeling of Ap42 to Ap40 may be measured. [0050] As described in the examples, the relative labeling of Ap42 in subjects with AP amyloidosis may be higher than the relative labeling of other AP variants in CSF samples taken at about 4 to about 22 hours. Therefore, the ratio of relative labeling of Ap42 to Ap40 in CSF samples taken at about 4 to about 17 hours 13 WO 2013/096451 PCT/US2012/070623 may be greater than about 1. In some embodiments, a ratio of relative labeling of Ap42 to Ap40 greater than about 1 in a CSF sample taken at about 4 to about 22 hours indicates the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to Ap40 greater than about 1 in a CSF sample taken at about 4 to about 17 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 greater than about 1 in a CSF sample taken at about 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 hours or more, indicates the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 greater than about 1 in a CSF sample taken at about 8, 9, 10, 11, 12 hours or more, indicates the presence of AP amyloidosis. In a preferred embodiment, a ratio of relative labeling of Ap42 to Ap40 greater than about 1 in a CSF sample taken at about 10 hours, indicates the presence of AP amyloidosis. [0051] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 may be about 1.04, 1.05, 1.06, 1.07, 1.08, 1.09, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4 or above in a CSF sample taken at about 4 to about 22 hours, indicating the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to Ap40 may be about 1.01, 1.02, 1.03, 1.04, 1.05, 1.06, 1.07, 1.08, 1.09, 1.1, 1.2, 1.3, 1.4, or 1.5 in a CSF sample taken at about 4 to about 17 hours, indicating the presence of AP amyloidosis. In yet other embodiments, a ratio of relative labeling of Ap42 to Ap40 may be about 1.09, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, or 2 in a CSF sample taken at about 4 to about 22 hours, indicating the presence of AP amyloidosis. In additional embodiments, a ratio of relative labeling of Ap42 to Ap40 may be about 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, or 3.0 in a CSF sample taken at about 4 to about 22 hours, indicating the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to Ap40 may be about 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4 or above in a CSF sample taken at about 4 to about 22 hours, indicating the presence of AP amyloidosis. [0052] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, or above in a CSF sample taken at about 6 hours, indicates the presence of AD 14 WO 2013/096451 PCT/US2012/070623 amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, or above in a CSF sample taken at about 6 hours, indicates the presence of AP amyloidosis. In yet other embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.4, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, 1.49, 1.5,, 1.51, 1.52, 1.53, 1.54, 1.55, 1.56, 1.57, 1.58, 1.59, 1.6, 1.61, 1.62, 1.63, 1.64, 1.65, 1.66, 1.67, 1.68, 1.69, 1.7, 1, 1, 1.72, 1.73, 1.74, 1.75, 1.76, 1.77, 1.78, 1.79, 1.8, 1.81, 1.82, 1.83, 1.84, 1.85, 1.86, 1.87, 1.88, 1.89, 1.9, 1.91, 1.92, 1.93, 1.94, 1.95, 1.96, 1.97, 1.98, 1.99, 2, 2.1, 2.1, 2.3, 2.4, 2.5, or above in a CSF sample taken at about 6 hours, indicates the presence of AP amyloidosis. [0053] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, or above in a CSF sample taken at about 7 hours, indicates the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, or above in a CSF sample taken at about 7 hours, indicates the presence of AP amyloidosis. In yet other embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.4, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, 1.49, 1.5,, 1.51, 1.52, 1.53, 1.54, 1.55, 1.56, 1.57, 1.58, 1.59, 1.6, 1.61, 1.62, 1.63, 1.64, 1.65, 1.66, 1.67, 1.68, 1.69, 1.7, 1, 1, 1.72, 1.73, 1.74, 1.75, 1.76, 1.77, 1.78, 1.79, 1.8, 1.81, 1.82, 1.83, 1.84, 1.85, 1.86, 1.87, 1.88, 1.89, 1.9, 1.91, 1.92, 1.93, 1.94, 1.95, 1.96, 1.97, 1.98, 1.99, 2, 2.1, 2.1, 2.3, 2.4, 2.5, or above in a CSF sample taken at about 7 hours, indicates the presence of AP amyloidosis. [0054] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2,1, 2.2, 2.3, 2.4, 2.5, or above in a CSF sample taken at about 8 hours, indicates the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.2, 1.21, 1.22, 1.23, 1.24, 1.25, 1.26, 1.27, 1.28, 1.29, 1.3, 1.31, 1.32, 1.33, 1.34, 1.35, 1.36, 1.37, 1.38, 1.39, 1.4, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, 1.49, 1.5,, 1.51, 1.52, 1.53, 1.54, 1.55, 1.56, 1.57, 1.58, 1.59, 1.6, 1.61, 1.62, 1.63, 1.64, 1.65, 1.66, 1.67, 1.68, 1.69, 1.7, 1, 1, 1.72, 1.73, 1.74, 1.75, 1.76, 1.77, 1.78, 1.79, 1.8, 1.81, 1.82, 1.83, 1.84, 1.85, 1.86, 1.87, 1.88, 1.89, 1.9, 1.91, 1.92, 1.93, 1.94, 1.95, 1.96, 1.97, 1.98, 1.99, 2, 2.1, 2.1, 2.3, 15 WO 2013/096451 PCT/US2012/070623 2.4, 2.5, or above in a CSF sample taken at about 8 hours, indicates the presence of AP amyloidosis. [0055] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2,1, 2.2, 2.3, 2.4, 2.5, or above in a CSF sample taken at about 9 hours, indicates the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.2, 1.21, 1.22, 1.23, 1.24, 1.25, 1.26, 1.27, 1.28, 1.29, 1.3, 1.31, 1.32, 1.33, 1.34, 1.35, 1.36, 1.37, 1.38, 1.39, 1.4, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, 1.49, 1.5,, 1.51, 1.52, 1.53, 1.54, 1.55, 1.56, 1.57, 1.58, 1.59, 1.6, 1.61, 1.62, 1.63, 1.64, 1.65, 1.66, 1.67, 1.68, 1.69, 1.7, 1, 1, 1.72, 1.73, 1.74, 1.75, 1.76, 1.77, 1.78, 1.79, 1.8, 1.81, 1.82, 1.83, 1.84, 1.85, 1.86, 1.87, 1.88, 1.89, 1.9, 1.91, 1.92, 1.93, 1.94, 1.95, 1.96, 1.97, 1.98, 1.99, 2, 2.1, 2.1, 2.3, 2.4, 2.5, or above in a CSF sample taken at about 9 hours, indicates the presence of AP amyloidosis. [0056] In some preferred embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2 or above in a CSF sample taken at about 10 hours, indicates the presence of AP amyloidosis. In other preferred embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.2, 1.21, 1.22, 1.23, 1.24, 1.25, 1.26, 1.27, 1.28, 1.29, 1.3, 1.31, 1.32, 1.33, 1.34, 1.35, 1.36, 1.37, 1.38, 1.39, 1.4, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, 1.49, 1.5,, 1.51, 1.52, 1.53, 1.54, 1.55, 1.56, 1.57, 1.58, 1.59, 1.6, 1.61, 1.62, 1.63, 1.64, 1.65, 1.66, 1.67, 1.68, 1.69, 1.7, 1, 1, 1.72, 1.73, 1.74, 1.75, 1.76, 1.77, 1.78, 1.79, 1.8, 1.81, 1.82, 1.83, 1.84, 1.85, 1.86, 1.87, 1.88, 1.89, 1.9, 1.91, 1.92, 1.93, 1.94, 1.95, 1.96, 1.97, 1.98, 1.99, 2 or above in a CSF sample taken at about 10 hours, indicates the presence of AP amyloidosis. In yet other preferred embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.25, 1.26, 1.27, 1.28, 1.29, 1.3, 1.31, 1.32, 1.33, 1.34, 1.35, 1.36, 1.37, 1.38, 1.39, 1.4, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, 1.49, 1.5,, 1.51, 1.52, 1.53, 1.54, 1.55, 1.56, 1.57, 1.58, 1.59, 1.6, 1.61, 1.62, 1.63, 1.64, 1.65, 1.66, 1.67, 1.68, 1.69, or 1.7 in a CSF sample taken at about 10 hours, indicates the presence of AP amyloidosis. In yet other preferred embodiments, a ratio of relative labeling of Ap42 to Ap40 of about 1.3, 1.31, 1.32, 1.33, 1.34, 1.35, 1.36, 1.37, 1.38, 1.39, 1.4, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, 1.49, 1.5,, 1.51, 1.52, 1.53, 1.54, 1.55, 1.56, 1.57, 1.58, 1.59, 1.6, 1.61, 1.62, 16 WO 2013/096451 PCT/US2012/070623 1.63, 1.64, 1.65 in a CSF sample taken at about 10 hours, indicates the presence of AP amyloidosis. [0057] As described in the examples, the relative labeling of the Ap42 variant in subjects with AP amyloidosis may be lower than the relative labeling of other AP variants in CSF samples taken at about 22 to about 32 hours. Therefore, the ratio of relative labeling of Ap42 to Ap40 in CSF samples taken at about 22 to about 32 hours may be lower than about 1. [0058] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 22 to about 32 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, or 32 hours or more, indicates the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 25, 26, 27, 28, 29 hours or more indicates the presence of AP amyloidosis. In yet another embodiment, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 23, 24, 25, 26, 27, 28, 29, 30, 31 hours or more indicates the presence of AP amyloidosis. [0059] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 23 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 23 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 23 hours, indicating the presence of AP amyloidosis. 17 WO 2013/096451 PCT/US2012/070623 [0060] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 24 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 24 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 24 hours, indicating the presence of AP amyloidosis. [0061] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 25 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 25 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 25 hours, indicating the presence of AP amyloidosis. [0062] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 26 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be 18 WO 2013/096451 PCT/US2012/070623 about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 26 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 26 hours, indicating the presence of AP amyloidosis. [0063] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 28 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 28 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 28 hours, indicating the presence of AP amyloidosis. [0064] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 29 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 19 WO 2013/096451 PCT/US2012/070623 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 29 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 29 hours, indicating the presence of AP amyloidosis. [0065] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 30 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 30 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 30 hours, indicating the presence of AP amyloidosis. [0066] In some embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 31 hours indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 31 hours, indicating the presence of AP amyloidosis. In another embodiment, a 20 WO 2013/096451 PCT/US2012/070623 ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 31 hours, indicating the presence of AP amyloidosis. [0067] In preferred embodiments, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 27 hours indicates the presence of AP amyloidosis. In a preferred embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a CSF sample taken at about 27 hours, indicating the presence of AP amyloidosis. In another preferred embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a CSF sample taken at about 27 hours, indicating the presence of AP amyloidosis. [0068] In a preferred embodiment, a ratio of relative labeling of Ap42 to Ap40 less than about 1 in a CSF sample taken at about 27 hours indicates the presence of AP amyloidosis. In yet another preferred embodiment, a ratio of relative labeling of Ap42 to Ap40 may be about 0.7, 0.6, 0.5, 0.4, or about 0.3 in a CSF sample taken at about 27 hours, indicating the presence of AP amyloidosis. [0069] The relative labeling of the Ap42 variant in subjects with AP amyloidosis may be higher than the relative labeling of other AP variants in a blood sample taken at about 1 to about 32 hours. Therefore, a ratio of relative labeling of Ap42 to another AP variant in a blood sample taken at about 1 to about 32 hours may be more than about 1. In some embodiments, a ratio of relative labeling of Ap42 to another AP variant may be more than about 1 in a blood sample taken at about 1 to about 32 hours, indicating the presence of AP amyloidosis. In one embodiment, a ratio 21 WO 2013/096451 PCT/US2012/070623 of relative labeling of Ap42 to another AP variant may be more than about 1 in a blood sample taken at about 1 to about 4 hours, such as about 1, 2, 3, or 4 hours or more, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to another AP variant may be more than about 1 in a blood sample taken at about 10 min, 15 min, 30 min, 1 hour, 90 min, 2 hours, 2.5 hours, 3 hours, or 3.5 hours, indicating the presence of AP amyloidosis. In still another embodiment, a ratio of relative labeling of Ap42 to another AP variant may be more than about 1 in a blood sample taken between about 10 min to 60 min, 30 min to 90 min, 60 min to 2 hours, 90 min to 2.5 hours, or 2 hours to 3 hours, indicating the presence of AP amyloidosis. [0070] In some embodiments, a ratio of relative labeling of Ap42 to an AP variant may be about 1.04, 1.05, 1.06, 1.07, 1.08, 1.09, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4 or above in a blood sample taken between about 0 to about 3 hours after labeling, indicating the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to an AP variant may be about 1.01, 1.02, 1.03, 1.04, 1.05, 1.06, 1.07, 1.08, 1.09, 1.1, 1.2, 1.3, 1.4, or 1.5 in a blood sample taken between about 0 to about 3 hours, indicating the presence of AP amyloidosis. In yet other embodiments, a ratio of relative labeling of Ap42 to an AP variant may be about 1.09, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, or 2 in a blood sample taken between about 0 to about 4 hours, indicating the presence of AP amyloidosis. In additional embodiments, a ratio of relative labeling of Ap42 to an AP variant may be about 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, or 3.0 in a blood sample taken between about 0 to about 3 hours, indicating the presence of AP amyloidosis. In other embodiments, a ratio of relative labeling of Ap42 to an AP variant may be about 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4 or above in a blood sample taken between about 0 to about 3 hours, indicating the presence of AP amyloidosis. [0071] In some embodiments, a ratio of relative labeling of Ap42 to another AP variant may be less than about 1 in blood samples taken between about 4.5 hours to about 10 hours, indicating the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to another AP variant may be less than 22 WO 2013/096451 PCT/US2012/070623 about 1 in blood samples taken at about 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, or 32 hours or more after labeling, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to another AP variant may be less than about 1 in blood samples taken at about 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, or 9.5 hours or more, indicating the presence of AP amyloidosis. [0072] In some embodiments, a ratio of relative labeling of Ap42 to an AP variant of less than about 1 in a blood sample taken between about 5 to about 9 hours after labeling indicates the presence of AP amyloidosis. In one embodiment, a ratio of relative labeling of Ap42 to an AP variant may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5, 0.49, 0.48, 0.47, 0.46, 0.45, 0.44, 0.43, 0.42, 0.41, 0.4, 0.39, 0.38, 0.37, 0.36, 0.35, 0.34, 0.33, 0.32, 0.31, 0.3, 0.29, 0.28, 0.27, 0.26, 0.25, 0.24, 0.23, 0.22, 0.21, 0.2, 0.1, or less in a blood sample taken at about 5 to about 9 hours, indicating the presence of AP amyloidosis. In another embodiment, a ratio of relative labeling of Ap42 to an AP variant may be about 0.9, 0.89, 0.88, 0.87, 0.86, 0.85, 0.84, 0.83, 0.82, 0.81, 0.8, 0.79, 0.78, 0.77, 0.76, 0.75, 0.74, 0.73, 0.72, 0.71, 0.7, 0.69, 0.68, 0.67, 0.66, 0.65, 0.64, 0.63, 0.62, 0.61, 0.6, 0.59, 0.58, 0.57, 0.56, 0.55, 0.54, 0.53, 0.52, 0.51, 0.5 or less in a blood sample taken at about 5 to about 9 hours, indicating the presence of AP amyloidosis. [0073] In one exemplary embodiment, the in vivo relative labeling of Ap42 and Ap40 are measured by administering labeled leucine to a subject and collecting one or more biological samples at regular intervals over 36 hours. The biological sample may be collected from blood plasma or CSF. The amount of labeled and unlabeled AP in the biological samples is typically determined by immunoprecipitation followed by LC ESI-tandem MS. From these measurements, a ratio of labeled to unlabeled AP may be calculated to determine the relative labeling of Ap42 and Ap40. A ratio of relative labeling of Ap42 to relative labeling of Ap40 may then be calculated in a given biological sample. A ratio of relative labeling of Ap42 to relative labeling of Ap40 in a given sample other than 1 indicates the presence of AP amyloidosis. 23 WO 2013/096451 PCT/US2012/070623 II. Kits for diagnosing or monitoring the progression or treatment of neurological and neurodegenerative diseases [0074] The current invention provides kits for diagnosing or monitoring the progression or treatment of AP amyloidosis by measuring the ratio of relative labeling of two AP variants in a subject. Generally, a kit comprises a labeled amino acid, means for administering the labeled amino acid, means for collecting biological samples over time, and instructions for detecting and determining the ratio of labeled to unlabeled protein so that the ratio of relative labeling of the two AP variants may be calculated. A ratio of relative labeling of the two AP variants of about one indicates the absence of AP amyloidosis, whereas a ratio of relative labeling of the two AP variants other than one indicates the absence of AP amyloidosis. These comparisons may enable a practitioner to predict the advent of AD, diagnose the onset of AD, monitor the progression of AP amyloidosis, or verify the effectiveness of a treatment for AP amyloidosis. In a preferred embodiment, the kit comprises 13C 6 -leucine or 13
C
6 -phenylalanine, the AP variants to be measued are Ap42 and Ap40, and the disease to be assessed is AD. DEFINITIONS [0075] Unless defined otherwise, all technical and scientific terms used herein have the meaning commonly understood by a person skilled in the art to which this invention belongs. The following references provide one of skill with a general definition of many of the terms used in this invention: Singleton et al., Dictionary of Microbiology and Molecular Biology (2nd ed. 1994); The Cambridge Dictionary of Science and Technology (Walker ed., 1988); The Glossary of Genetics, 5th Ed., R. Rieger et al. (eds.), Springer Verlag (1991); and Hale & Marham, The Harper Collins Dictionary of Biology (1991). As used herein, the following terms have the meanings ascribed to them unless specified otherwise. [0076] "Isotope" refers to all forms of a given element whose nuclei have the same atomic number but have different mass numbers because they contain different numbers of neutrons. By way of a non-limiting example, 12 C and 13 C are both stable isotopes of carbon. 24 WO 2013/096451 PCT/US2012/070623 [0077] "Lag time" generally refers to the delay of time from when the biomolecule is first labeled until the labeled biomolecule is detected. [0078] "Metabolism" refers to any combination of the synthesis, transport, breakdown, modification, or clearance rate of a biomolecule. [0079] "Metabolic index" refers to a measurement comprising the fractional synthesis rate (FSR) and the fractional clearance rate (FCR) of the biomolecule of interest. Comparison of metabolic indices from normal and diseased individuals may aid in the diagnosis or monitoring of neurological or neurodegenerative diseases. [0080] "Neurally derived cells" includes all cells within the blood-brain barrier including neurons, astrocytes, microglia, choroid plexus cells, ependymal cells, other glial cells, etc. [0081] "Steady state" refers to a state during which there is insignificant change in the measured parameter over a specified period of time. [0082] "Synthesis rate" refers to the rate at which the biomolecule of interest is synthesized. [0083] In metabolic tracer studies, a "stable isotope" is a nonradioactive isotope that is less abundant than the most abundant naturally occurring isotope. [0084] "Subject" as used herein means a living organism having a central nervous system. In particular, the subject is a mammal. Suitable subjects include research animals, companion animals, farm animals, and zoo animals. The preferred subject is a human. EXAMPLES [0085] The following examples are included to demonstrate preferred embodiments of the invention. Example 1. AP turnover in blood [0086] Genetic, biochemical, and animal model studies strongly support the hypothesis that amyloid-p (AP) plays a central role in AD: more specifically that accumulation and conformational change of AP in toxic forms are major contributors to AD pathogenesis. 25 WO 2013/096451 PCT/US2012/070623 [0087] A pioneering approach was recently developed to directly measure AP metabolism in the central nervous system of living humans. This method requires participants be admitted to a research hospital room, and have two IV catheters and a lumbar spinal catheter placed so that hourly samples of blood and cerebral-spinal fluid can be obtained. Using this method, recent studies have demonstrated that AP has a rapid metabolism (half-life of 8-10 hours) in the human brain and cerebral-spinal fluid (CSF). We have recently measured the dose-related effects of a proposed disease modifying treatment for AD, a gamma-secretase inhibitor, and have demonstrated direct inhibition of the production of AP in the human central nervous system. In addition, preliminary data suggest that patients with even very mild AD have disturbed AP metabolism in the central nervous system versus age matched controls. [0088] These findings are important to the understanding of the causes of AD and the development of treatments; however, blood AP dynamics are not well understood as there previously was not yet a method to measure labeled AP within blood. If such a method were available, the physiology (and pathophysiology) of AP could be better understood as a quantitative measure of AP production in the brain, transport to blood and cerebral-spinal fluid, and clearance from blood. A blood labeled AP assay would allow for the physiology and pathophysiology of AP to be measured without invasive spinal catheters, and also allow for the large scale investigation of a diagnostic test for AD, and specific testing of proposed disease modifying therapeutics which target AP. [0089] A stable isotope labeling kinetics immunoprecipitation-mass spectrometry approach was developed to measure labeled blood AP. This provides the ability to measure blood AP production, transport between compartments, and clearance rates in humans. [0090] The half-life of blood/plasma AP is distinctly different than in the CNS/CSF, with a t1/2 of 2 to 3 hours in production (FIG. 1). This contrasts with a half life of 9 to 10 hours as measured in CSF (Bateman et. al 2006). For FIG. 1, subjects were administered a labeled amino acid (13C6 leucine; infused over 9 hours with a 10 minute primed infusion of 2 mg/kg, followed by 2 mg/kg/hour for 8 hours and 50 minutes) and then blood samples were taken every hour for 0 - 15 hr, then every odd 26 WO 2013/096451 PCT/US2012/070623 hour till hour 35, then at 36 & 48 hours. Twenty-eight samples were taken in total. The samples were stored frozen. Then, samples were thawed and a protease inhibitor cocktail was added. Samples were centrifuged and then pooled from two samples of plasma (2 mls total) at every time point. Next, AP was immunoprecipitated from the samples as described below: Day 1: 1. Thaw samples slowly on ice (approx 1 hr). 2. When thawed, add 20 pl of Complete Protease Inhibitors 3. Centrifuge at 14,000 RPM in the Allegra centrifuge at 4'C for 15 minutes to remove particulates. 4. Pool the supernatant from 2 samples together (2 ml in 15 ml tubes). 5. Dilute media standards - 50 pl into 2 ml PBS. 6. Wash HJ5.1 (AD specific antibody) beads twice with 1x PBS with 0.02% azide. Make 50% bead slurry at the end. 7. Add 220 pl 5M guanidine hydrochloride solution. 8. Add 20 pl Tween-20 (5% in PBS for 0.05% final) 9. Add 5 pl of ISTD (N15- AD 40/42). 10. Add 30 pl antibody- beads (50% slurry enough for -20ng AP). 11. Incubate overnight at 4'C. Day 2: 12. Centrifuge beads at 4500 RPM for 5 minutes. 13. Remove supernatant into a new tube and save (plasma only). 14. Add 1 ml 0.5M guanidine hydrochloride solution 15. Add 10 pl of 5% for 0.05% final Tween-20. 16. Once re-suspended transfer beads to 1.5 ml Axygen tube. 17. Centrifuge beads at 4500 RPM for 5 minutes. 18. Discard supernatant using the aspirator-vacuum system, using a crimped pipette tip. 19. Wash the beads two times as follows: 27 WO 2013/096451 PCT/US2012/070623 a. 1ml 1X AmBiC rinse b. 4500 RPM for 5 minutes c. Discard supernatant d. 1ml 1X AmBiC rinse e. 4500 RPM for 5 minutes f. Discard the supernant and dry beads 20. Add 50 pl (bead volume) 98% formic acid (elution solution) and centrifuge beads at 4500 RPM for 2 minutes and remove supernatant with crimped filter gel loading tip and place in 1.5 ml Axygen tubes. 21. Dry the elution solution in a speedvac for 1 hour to remove formic acid (370C, 60 min, 60 min). 22. Make 25mM AmBiC solution by with HPLC grade water. 23. Add 1 ml of 25mM AmBiC solution to trypsin to a final concentration of 20 ng/pl. 24. Re-suspend the proteins in 10 pl solution of 25 mM AmBiC. 25. Add 10 pl of the 20 ng/pl trypsin solution to the beads for digestion. 26. Digest O/N (16 hrs) at 370C in the incubator. DAY 3: 27. Perform a short spin of the samples to let condensate settle at the bottom of tube. 28. Add 2 pl of formic acid to the digest (to precipitate proteins) 29. Place the rack of samples on the vortex and mix for 30 seconds. 30. Centrifuge the tryptic digest at 14,000 RPM in the Allegra centrifuge at 40C for 15 minutes. 31. Transfer to autosampler vials then spin down samples using the speedvac and keep in the refrigerator at 40C. [0091] The samples were then analyzed by mass spectrometry as follows: [0092] The amino acid sequence of AD 1-42 is DAEFRHDSGYEVHH QKLVFFAEDVGSNKGAIIGLMVGGVVIA (SEQ ID NO:1), AD 1-40 is DAEFRHDSGYEVHHQKLVFFAEDVGSNKGAIIGLMVGGVV (SEQ ID NO:2), and AD 1 38 is DAEFRHDSGYEVHHQKLVFFAEDVGS NKGAIIGLMVGG (SEQ ID NO:3). When 28 WO 2013/096451 PCT/US2012/070623 it is digested with a protease like trypsin, four smaller peptides are generated as AP 1-5 DAEFR(SEQ ID NO:4), AD 6-16 HDSGYEVHHQK(SEQ ID NO:5), AD 17-28 LVFFAEDVGSNK(SEQ ID NO:6), and AD 29-42 GAIIGLMVGGVVIA(SEQ ID NO:7). Only two of these peptides are of relevance for quantitation using the SILK technology (Stable Isotope Labeling Kinetics - Bateman et. al 2009) with leucine labeling because their sequence includes a leucine residue that can be labeled in vivo. These peptides are AD 17-28 LVFFAEDVGSNK(SEQ ID NO:6), and AD 29-42 GAIIGLMVGGVVIA(SEQ ID NO:7), but we use only the AD 17-28 LVFFAEDVGSNK(SEQ ID NO:6) peptide because it represents the total amounts of AP in the blood and produces a higher signal. Of course, it may be useful to also quantify the c-terminal (AD 29-42 GAIIGLMVGGVVIA (SEQ ID NO:7) or AD 29-40 GAIIGLMVGGVV(SEQ ID NO:8)) or n-terminal fragments in the blood as well. In general, any amino acid label can be used, any endoprotease can be used (or none at all) to label AP & quantify the label in the blood. The blood AP metabolism may directly reflect a disequilibrium of AP metabolism that indicates Alzheimer's disease or predisposition to Alzheimer's disease. [0093] Experiments were performed on a TSQ Vantage mass spectrometer coupled to a nanoflow ESI source and a nano-2D liquid chromatography (NanoLC-2D). The samples were maintained at a temperature of 40C in the autosampler tray. Samples were injected onto a home-made nano column (150-mm diameter) with a pulled tip, packed to 15 cm with Ace 5 C18 AR column packing material (MAC-MOD Analytical, Chadds Ford, PA). Peptides were separated by the Nano2D-LC (Eksigent, Inc. Ultra NanoLC-2D) at a flow rate of 1 mL/ min. Solvent A was 0.1% formic acid in water and solvent B was 0.1% formic acid in acetonitrile. The gradient was 15% B to 25% B in 10 min followed by 25% B to 95% B in 5 min, then, ramped down to 15% B in 2 min and the column re-equilibrated for 3 min while the autosampler was picking another sample for injection. [0094] The TSQ Vantage mass spectrometer (MS) was operated in positive ion mode using a spray voltage of 1.2 kV, with optimized parameters from tuning with peptides. Data was acquired in Multiple Reaction Monitoring (MRM) mode. During this MRM experiments, the mass of the peptide was first detected in the first dimension, or as MS1. While MS1 is used to perform quantitation the technique suffers 29 WO 2013/096451 PCT/US2012/070623 from lack of specificity especially in very complex matrices like blood and that many peptides have the same intact mass. The peptide ions were fragmented and detected in the mass spectrometer and this second dimension of MS fragmentation (MS2) provided unique fragments. The combination of the specific precursor mass and the unique fragment ions were used to selectively monitor the peptide to be quantified. In this case, multiple fragment ions (also known as reactions) were selectively monitored to quantitate AD 17-28, resulting in a unique MRM experiment. AD 17-28 has a precursor mass (MS1) with a charge to mass ratio of 663.340 for the endogenous peptide and 666.340 for the label incorporated peptide. Three each of their fragment ions were monitored after the MS2 fragmentation. The fragment ions also known as transition ions monitored have a mass to charge ratios of 819.38, 966.45 and 1113.52. The MRM experiments are detected and plotted as single chromatographic peaks which were processed by Xcalibur, which is the instrument control software. [0095] Results are described in FIG. 2. Note the rapid rise to plateau by 9 hours with a rapid clearance rate in blood, while CSF does not approach plateau until 18 hours or later. Also note the much more rapid clearance of blood AP compared to CSF Ap. There also may be a second peak of labeled AP in blood from 20 to 30 hours (peak -26 hours). Example 2. As blood kinetics [0096] In order to determine blood AD kinetics, a method was developed to measure 13
C
6 -leucine labeled AP in plasma. Prior studies in animal models demonstrate faster AP turnover in the periphery compared to the CNS. The new method required a state-of-the-art mass spectrometer with levels of quantitation in the low attomole (10-18) range. The first measurements of blood AD kinetics are shown compared to CSF AD kinetics in FIG. 3. [0097] These results demonstrate blood AD kinetics are distinct from CNS AD kinetics and can be utilized in multi-compartment models to calculate the rates of formation, transport, and breakdown of AP both in the CNS and body. 30 WO 2013/096451 PCT/US2012/070623 [0098] In order to compare the kinetics of blood AP in AD versus controls, we measured labeled plasma AP in blood samples from 12AD and 8 control participants and compared as shown in FIG. 4. [0099] In order to provide key additional kinetic information on blood AD kinetics which has a much faster turnover rate, and to potentially better distinguish AD from controls, an alternative oral pulse labeling protocol was developed (FIG. 5). The pulse labeling provides additional information on AP transport and clearance and enables evaluation of the secondary slower clearance rates that can distinguish models of AP transport. Further, the pulse oral labeling method is simplified as a single oral drink to enable straightforward implementation of blood AD kinetics as a clinical test for treatment trials or as a diagnostic test. [0100] To expand understanding of specific AP variants which may be uniquely altered in AD (e.g. Ap42), we have developed a method to measure AP c terminal variants in the same sample (FIG. 6). This novel quantitative approach allows us to evaluate the major AP variants in the same sample. Example 3. Decreased clearance of CNS P-amyloid in Alzheimer's disease [0101] Alzheimer's disease (AD) is characterized by increased amounts of soluble and insoluble P-amyloid (AP), predominantly in the form of Ap42 in amyloid plaques and Ap40 in amyloid angiopathy. The amyloid hypothesis proposes that AD is caused by an imbalance between AP production and clearance (1), resulting in increased amounts of AP in various forms such as monomers, oligomers, insoluble fibrils, and plaques in the central nervous system (CNS). High levels of AP then initiate a cascade of events culminating in neuronal damage and death manifesting as progressive clinical dementia of the Alzheimer's type (2). [0102] In rare cases of AD, genetic alterations increase the production of AD (3). However, AP dysregulation in the far more common late-onset "sporadic" AD is less well understood. Possible mechanisms of increased AP production for late-onset AD include alterations in gamma or beta secretase activity. Alternatively, impaired clearance of AP may also cause late-onset AD through interactions with ApoE4, 31 WO 2013/096451 PCT/US2012/070623 decreased catabolism of AP via reduced proteolysis, impaired transport across the blood-brain barrier, or impaired cerebrospinal fluid (CSF) transport. [0103] To measure the production and clearance of AP in AD, we developed a method to measure human CNS AP production and clearance (4) and compared Ap42 and Ap40 production and clearance rates in individuals with symptomatic AD and in cognitively normal persons to determine whether either or both are altered in AD. [0104] We plotted the average time course results of labeled Ap42 and Ap40 for the production phase (hours 5 to 14) and the clearance phase (hours 24 to 36) (FIG. 7). The production and clearance rates were calculated for each participant and compared by group status (AD versus control). The average Ap42 production rate did not differ between the control (6.7%/hour) and AD (6.6%/hour) groups (P = 0.96), nor did Ap40 production rate differ between groups (6.8%/hour for controls and 6.8%/hour for the AD group; P = 0.98). The average clearance rate of Ap42 was slower for AD individuals compared with that for cognitively normal controls (5.3%/hour versus 7.6%/hour, P = 0.03), as was the average clearance rate of Ap40 (5.2%/hour for AD individuals versus 7.0%/hour for controls; P = 0.01) [0105] To determine the balance of AP production to clearance rates in AD versus controls, we measured the ratios of production to clearance (FIG. 8). The ratio of Ap42 production to clearance rates was balanced for cognitively normal participants (0.95); however, because of decreased clearance in the AD participants, there was an imbalance in the Ap42 production to clearance ratio (1.35). Similarly, we observed an imbalance in the AD Ap40 production to clearance ratio (1.37) compared with the ratio in cognitively normal participants (0.99). [0106] The technique of measuring AP production and clearance has been used to measure effects of drugs that target AP generation, demonstrating decreases in production (5). We found that late-onset AD is associated with a 30% impairment in the clearance of both Ap42 and Ap40, indicating that AP clearance mechanisms may be critically important in the development of AD (6). Estimates based on a 30% decrease in AP clearance rates suggest that brain AP accumulates over about 10 years in AD. The impaired clearance of both Ap40 and Ap42 is consistent with prior findings of deposition 32 WO 2013/096451 PCT/US2012/070623 of Ap40 and Ap42 in parenchymal amyloid plaques and the substantial deposition of Ap40 in cerebral amyloid angiopathy in about 80% of cases of AD (7). [0107] Limitations of this study include the relatively small numbers of participants (12 in each group) and the inability to prove causality of impaired AP clearance for AD. In addition to decreased CNS AP clearance, CSF Ap42 concentrations are decreased in AD compared with those in controls (FIG. 9). Taken together, these may be consistent with decreased Ap42 clearance (efflux) from the brain to the CSF. However, the relationship between decreased concentrations of CSF Ap42 and decreased CNS clearance of labeled AD (FIG. 10) is not fully understood. Additional possibilities include more than one pool of AP in CSF, undetected pools of AP in CSF by enzyme-linked immunosorbent assay (e.g., oligomers), or a combined increase in AP production with impaired efflux from parenchyma to CSF. Overall, these results suggest impaired metabolism of AP in AD compared with that in controls. Materials and methods for Example 3 [0108] Research participants were enrolled from the Washington University Alzheimer's Disease Research Center. The inclusion criteria were age >60 years, cognitively normal (Clinical Dementia Rating or CDR 0), very mild AD (CDR 0.5) or mild AD (CDR 1). Exclusion criteria were other primary diagnosis of dementia or significant medical co-morbidity including stroke, bleeding diathesis, anticoagulation, and active infectious process. Full verbal and written informed consent was obtained from all participants. Twenty-four participants were clinically evaluated and rated as either very mild to mild dementia of the Alzheimer type (n=12, average age 77 +/- 7.3 years, range 61 to 85; Apolipoprotein E (ApoE) genotype 4/4 n=2, 3/4 n=4, 3/3 n=5, 2/3 n=1; gender 9 men, 3 women), or as cognitively normal (n=1 2 average age 70.6 years +/- 6.2, range 65 to 84; ApoE genotype 3/4 n=6, 3/3 n=5, 2/3 n=1; gender 4 men, 8 women). Following CSF sampling, three subjects had headaches and one required a blood patch. One participant discontinued the study because of pre-existing confusion at night. [0109] Participants were admitted to the Washington University Clinical Research Unit at 7AM. Two intravenous and one lumbar intrathecal catheters were 33 WO 2013/096451 PCT/US2012/070623 placed as previously described (Bateman et. al 2006). After baseline blood and CSF samples were collected, a primed bolus of 13C6- Leucine was infused at 2 mg/kg over 10 minutes, followed by 2 mg/kg/hr for the remaining 8 hours and 50 minutes. During and after infusion, CSF and blood samples were collected for a total of 36 hours and frozen at -70C. Twelve hours after the lumbar catheter was removed, participants were discharged from the research unit. [0110] All samples were processed and measured in a blinded fashion with data results and individual analysis completed before unblinding to participant's disease state. Ap42 and then Ap40 were serially immunoprecipitated from CSF samples using c-terminal specific antibodies, 21f12 and 2g3. The purified AP was then digested with trypsin and 13
C
6 -leucine abundance in these tryptic fragments quantified using tandem mass spectrometry as previously described (8, 9). [0111] 13
C
6 -leucine labeled media enrichment standards and CSF samples were analyzed using the Stable Isotope Labeling Tandem Mass Spectrometry (SILT MS) method (10) using SILTmass (11). Each tandem mass spectrometry scan was searched against the AP FASTA sequence database to identify peptides and assign a score. SILTmass summed the signal intensity for tandem mass spectrometry ions that matched the theoretical b and y ions for AP tryptic fragments and saved results as part of a pepXML file. A set of pepXML files for each subject was then analyzed to calculate the ratio of labeled AP to unlabeled AP by dividing the total labeled and unlabeled signal intensities. The percent 13
C
6 -leucine labeled AP was calculated as the ratio of 13C leucine-Ap17-28 divided by natural isotope abundance Ap17-28. Results were exported to Microsoft Excel, normalized by the slope of the standard curve and leucine labeling ratio (1 C 6 -Leu/ 12
C
6 -Leu) (12). [0112] Calculation of the Fractional Synthesis Rate (FSR) and Fractional Clearance Rate (FCR) were performed as previously described (9) in a blinded fashion to dementia status. After calculations and measurements were made, the dementia status of each participant was used for statistical comparison. Comparison of FSR and FCR between cognitively normal and AD groups were made by two-tailed t-test with significance set at p<0.05 (Graphpad 5.03). 34 WO 2013/096451 PCT/US2012/070623 References for Example 3 1. J. Hardy, D. J. Selkoe, The amyloid hypothesis of Alzheimer's disease: Progress and problems on the road to therapeutics. Science 297, 353 (2002). 2. J. L. Cummings, Alzheimer's disease. N. Engl. J. Med. 351, 56 (2004). 3. D. Scheuner et al., Secreted amyloid beta-protein similar to that in the senile plaques of Alzheimer's disease is increased in vivo by the presenilin 1 and 2 and APP mutations linked to familial Alzheimer's disease. Nat. Med. 2, 864 (1996). 4. R. J. Bateman et al., Human amyloid-beta synthesis and clearance rates as measured in cerebrospinal fluid in vivo. Nat. Med. 12, 856 (2006). 5. R. J. Bateman et al., A gamma-secretase inhibitor decreases amyloid-beta production in the central nervous system. Ann. Neurol. 66, 48 (2009). 6 R. B. DeMattos et al., ApoE and clusterin cooperatively suppress Abeta levels and deposition: evidence that ApoE regulates extracellular Abeta metabolism in vivo. Neuron 41, 193 (2004). 7. R. J. Ellis et al., Cerebral amyloid angiopathy in the brains of patients with Alzheimer's disease: the CERAD experience, Part XV. Neurology 46, 1592 (1996). 8. R. J. Bateman et al., Ann Neurol, (Mar 18, 2009). 9. R. J. Bateman et al., Nat Med 12, 856 (Jul, 2006). 10. R. J. Bateman, L. Y. Munsell, X. Chen, D. M. Holtzman, K. E. Yarasheski, J Am Soc Mass Spectrom 18, 997 (Jun, 2007). 11. D. L. Elbert, K. G. Mawuenyega, E. A. Scott, K. R. Wildsmith, R. J. Bateman, J Proteome Res 7, 4546 (Oct 3, 2008). 12. K. E. Yarasheski, K. Smith, M. J. Rennie, D. M. Bier, Biol Mass Spectrom 21, 486 (Oct, 1992). Example 4. Ap42 metabolism is altered in CNS samples [0113] In our latest data analysis of the late-onset Alzheimer's disease AP metabolism, we are finding distinct patterns of Ap42 metabolism compared to the other variants. The relative labeling (H:L ratio of 13
C
6 -Leu/ 12
C
6 -Leu) was calculated for various AP variants in CSF samples taken from a normal individual with no amyloid deposition by PIB (FIG. 11A), and an AD patient which has been shown to have 35 WO 2013/096451 PCT/US2012/070623 amyloid deposition by PIB (FIG. 11B). These results show that Ap42 metabolism is altered in AD individuals. The clearance portion of the Ap42 curve seems to be consistently altered. [0114] The same analysis was expanded to include data from 50 AD patients. The relative labeling (H:L ratio of 13
C
6 -Leu/ 12
C
6 -Leu) was calculated for various Ap42 and Ap40 variants, and the ratio of Ap42:Ap40 relative labeling was calculated in CSF with 95% confidence interval bands grouped by amyloid status (PET PIB scans) for each timepoint in CSF (FIG. 12). Note there is highly significant difference by groups in most hours (higher in hours 6 to 15, and lower in hours 24 to 30). In FIG. 12 and when plotted individually (FIG. 13), hours 10 and 27 are significant. Example 5. Ap42 metabolism is altered in blood samples [0115] The same analysis as in Example 5 may be performed using blood samples from the 50 AD patients. The relative labeling (H:L ratio of 13
C
6 -Leu/ 12
C
6 -Leu) may be calculated for various Ap42 and Ap40 variants, and the ratio of Ap42:Ap40 relative labeling may be calculated in blood with 95% confidence interval bands grouped by amyloid status (PET PIB scans) for each timepoint in blood. For instance, see FIG. 14. Example 6. Additional in vivo data using the SILK method [0116] It was hypothesized that simple measures that summarize some aspect of the SILK tracer curve of amyloid beta (AP) may provide diagnostic or prognostic information about patients with AD, at risk of AD, or suspected of having AD. To test the above hypothesis, discrimination between three groups of patients was attempted based on the ratio of the percent of Ap42 labeling to the percent of Ap40 percent calculated during the downturn of the AP SILK tracer curve. In vivo SILK studies were performed in patients with PSENI or PSEN2 mutations that were PIB positive by PET (MC+), patients with PSENI or PSEN2 mutations that were PIB negative by PET (MC-), and non-carrier mutation carrier sibling controls (NC) as described elsewhere (Bateman RJ et al 2006 Nature Medicine 12(7):856 and US 7892845) unless otherwise noted. Briefly, subjects were administered isotope-labeled leucine ( 13
C
6 -leucine) for 9 36 WO 2013/096451 PCT/US2012/070623 hours via intravenous infusion. CSF samples (6 mL/sample) were collected 23 hours and 24 hours after the start of the infusion of labeled amino acid. Quantitative measurements of labeled and unlabeled Ap42 and Ap40 were obtained by tandem mass spectrometry, and the ratio of labeled:unlabeled Ap42 and labeled:unlabeled Ap40 was calculated for each timepoint. These ratios represent the percent labeled of each AP isoform at 23 hours and 24 hours post infusion. [0117] A diagnostic threshold of 0.9 was defined in these experiments, such that a ratio of Ap42 percent labeled / Ap40 percent labeled below 0.9 classified a subject as AD positive and a ratio of Ap42 percent labeled / Ap40 percent labeled above 0.9 classified a subject as AD negative. To determine whether the ratio of Ap42 percent labeled / Ap40 percent labeled at 23 hrs post infusion was differentiated between the three groups of patients, the ratio obtained for each patient was graphed versus PIB staining. As can be seen in FIG. 15A, a threshold of 0.9 for this ratio clearly differentiates the majority of MC+ subjects from the NC subjects (6/7 MC+ subjects were below the threshold, while 11/12 NC subjects were above the threshold). Within the MC- group, 3/4 of the subjects were below the threshold. It is possible, however, that subjects in the MC- group were in the early stages of AD. Similarly, the average of the 23 hour and 24 hour labeling percentages may be compared as a ratio between Ap42 and Ap40. Ap42 percent labeled / Ap40 percent labeled at 23 hrs post infusion and 24 hrs was differentiated between the three groups of patients, the ratio obtained for each patient was graphed versus PIB staining. As can be seen in FIG. 15B, with this measure, 7/7 MC+ subjects are below the threshold, while 11/12 NC are above the threshold. For the MC- group, 2/4 subjects are below the threshold. [0118] These data may be compared to a simple measure that uses the results from the full kinetic model. In this case, the parameter kex42, which describes the rate of entry of Ap42 into the exchange compartment, is multiplied by 10 and then added to the ratio of the rate constants for irreversible loss for Ap42 versus Ap40. As shown in FIG. 15C, a threshold of 1.75 shows that 6/7 of the MC+ subjects are above the threshold, with 12/12 of the NC subjects below the threshold. For the MC- group, 2/4 subjects are below the threshold. 37 WO 2013/096451 PCT/US2012/070623 [0119] These examples indicate that simple measures that summarize some aspect of the SILK tracer curve may be diagnostic of AD. This also indicates that short term collection of CSF may be sufficient to diagnose changes in Ap42 kinetics. [0120] Having described the invention in detail, it will be apparent that modifications and variations are possible without departing from the scope of the invention defined in the appended claims. Those of skill in the art should, however, in light of the present disclosure, appreciate that many changes could be made in the specific embodiments that are disclosed and still obtain a like or similar result without departing from the spirit and scope of the invention, therefore all matter set forth herein is to be interpreted as illustrative and not in a limiting sense. 38

权利要求:
Claims (21)
[1] 1. A method of diagnosing or monitoring the progression or treatment of AP amyloidosis in a subject, the method comprising measuring the in vivo relative labeling of AP variants, including Ap38, Ap40 or Ap42 in a biological sample from the subject, and calculating the ratio of relative labeling of the Ap42 protein variant to the relative labeling of another AP protein variant, wherein a ratio other than 1 indicates the presence of AP amyloidosis.
[2] 2. The method of claim 1, wherein the in vivo relative labeling of AD, Ap38, Ap40 or Ap42 is measured by: a. administering a labeled moiety to the subject, the labeled moiety being capable of incorporating into AP as the AP is synthesized in the subject; b. obtaining a biological sample from the subject, the biological sample comprising an AP variant fraction labeled with the moiety and an AP variant fraction not labeled with the moiety; and c. detecting the amount of labeled AP variant and the amount of unlabeled AP variant, wherein the ratio of labeled AP variant to unlabeled AP variant represents the relative labeling of said AP variant in the subject.
[3] 3. The method of claim 2, wherein the biological sample is selected from the group consisting of cerebral spinal fluid, blood, urine, saliva, and tears.
[4] 4. The method of claim 2, wherein the relative labeling of AP variants are measured in a CSF biological sample.
[5] 5. The method of claim 4, wherein the relative labeling of AP variants are measured at 10 hours after administering a labeled moiety to the subject. 39 WO 2013/096451 PCT/US2012/070623
[6] 6. The method of claim 5, wherein a ratio of relative labeling of Ap42 to an AP variant, measured at 10 hours, of more than 1 at indicates the presence of AP amyloidosis.
[7] 7. The method of claim 6, wherein the relative labeling of AP variants are measured at 27 hours after administering a labeled moiety to the subject.
[8] 8. The method of claim 7, wherein a ratio of relative labeling of Ap42 to an AP variant, measured at 27 hours, of less than 1 indicates the presence of AP amyloidosis.
[9] 9. The method of claim 2, wherein the ratio of relative labeling of Ap42 to an AP variant is measured in a blood biological sample.
[10] 10. The method of claim 2, wherein the labeled moiety is an atom, or a molecule with a labeled atom.
[11] 11. The method of claim 10, wherein the atom is a radioactive isotope.
[12] 12. The method of claim 10, wherein the atom is a non-radioactive isotope.
[13] 13. The method of claim 13, wherein the non-radioactive isotope is selected from the group consisting of 2 H, 13c, 15 N, 170, 180, 33 S 34 S, and 36 S.
[14] 14. The method of claim 13, wherein the non-radioactive isotope is a component of or attached to an amino acid.
[15] 15. The method of claim 14, wherein the amino acid is leucine, the non-radioactive isotope is 13C, and the protein is an AP variant. 40 WO 2013/096451 PCT/US2012/070623
[16] 16. The method of claim 2, wherein the labeled moiety is administered to the subject intravenously, intra-arterially, subcutaneously, intraperitoneally, intramuscularly, or orally.
[17] 17. The method of claim 2, further comprising purifying the labeled protein fraction and the unlabeled protein fraction from the biological sample.
[18] 18. The method of claim 16, wherein the protein is separated by immunoprecipitation.
[19] 19. The method of claim 2, wherein the amount of labeled AP variant and the amount of unlabeled AP variant is detected by mass spectrometry.
[20] 20. The method of claim 1, wherein the subject is human.
[21] 21. A method of diagnosing or monitoring the progression or treatment of AP amyloidosis in a subject, the method comprising measuring the in vivo relative labeling of an AP variant, including Ap38, Ap40 or Ap42 in a biological sample from the subject, and comparing the labeling to a control sample, wherein a difference in amount of label indicates the presence of AP amyloidosis. 41

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法律状态:
2015-09-03| DA3| Amendments made section 104|Free format text: THE NATURE OF THE AMENDMENT IS: AMEND THE NAME OF THE INVENTOR TO READ HOLTZMAN, DAVID; BATEMAN, RANDALL AND MAWUENYEGA, KWASI G. |

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2017-08-10| FGA| Letters patent sealed or granted (standard patent)|

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2020-07-16| MK14| Patent ceased section 143(a) (annual fees not paid) or expired|

优先权:

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申请号 | 申请日 | 专利标题

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US201161577439P| true| 2011-12-19|2011-12-19||

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US61/577,439||2011-12-19||

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PCT/US2012/070623|WO2013096451A2|2011-12-19|2012-12-19|Methods for diagnosing alzheimer's disease|

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