The present invention relates to cell death of cancer cells, and in particular to biomarkers that maybe used to identify cancer cells that are sensitive to death receptor ligand (DRL)-induced cell death. The invention also extends to prognostic methods and kits for identifying cancer cells that are sensitive to DRL-induced cell death. The invention further extends to novel compositions and therapeutic methods using such compositions for treating cancer.

Malignant pleural mesothelioma (MPM) is a rare but invariably fatal malignancy that occurs most frequently in the pleura and is almost always associated with asbestos exposure (l, 2). Although asbestos mining and usage has been the subject of legislation in many nations, there remains evidence of increased use and production of asbestos as the trend towards global industrialisation increases (3). Given a cancer latency period of anywhere from 10-40 years, it is therefore likely that in such countries asbestos-related cancers will increase over the next five decades. Current treatment options for patients diagnosed with MPM are limited. Radical surgery, for example, offers limited benefit and the cancer is refractory to most chemotherapeutic agents (4). Indeed, the current gold standard chemotherapy regimen of pemetrexed plus cisplatin offers a median overall survival of 12.1 months and a time to progression of 5.7 months (5).

Tumour necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL/Apo2L) is a member of the TNF ligand family that induces cell death in tumour cells in vitro and in vivo but not in most normal cells. Numerous chemotherapeutic drugs have also been shown to sensitize tumour cells to TRAIL-mediated cell death. While some mesothelioma cells are sensitive to TRAIL induced cell death others are resistant to the induction of cell death in vitro and this disruption of core-cell death machinery has been implicated in the general resistance to conventional cytotoxic agents observed clinically (11).

Certain cancers are sensitive to the pro-cell death effects of known death receptor ligands, while others are not. Without knowledge of which cancers are sensitive to DRL-induced cell death, individuals with cancer must rely on treatment with nonspecific cytotoxic therapies, such as chemotherapy, with the toxicities and problems described (5). Furthermore, with no clear indication pre-treatment of whether a patient will respond or not, the benefit of such treatment is uncertain at the outset. There is thus a compelling need for more effective therapeutic interventions for the treatment of cancers that are sensitive to cell death caused by death receptor ligand (DRL)-induced cell death. There is also a need to provide a biomarker that can be used to identify cancerous cells that are sensitive to cell death caused by death receptor ligands when bound to death receptors, such as TRAIL-receptor ι & 2 (Death Receptors 4&5), TNF receptor and FAS receptor

Hence, in a first aspect of the invention, there is provided a method of determining if an individual's cancer cell is sensitive to death receptor ligand (DRL)-induced cell death, the method comprising detecting, in a biological sample taken from the individual, for:

(i) the presence of a mutant BAPi gene or mutant BAPi protein;

(ii) a reduced level of expression of a wild-type BAPi gene or a lower wild-type BAPi protein concentration compared to the level of expression or protein concentration in a reference cell that is a BAPi wildtype cell, which is resistant to DRL-induced cell death; or

(iii) reduced or non-binding of an ASXL protein to a wild-type BAPi protein compared to the level of binding in a reference cell that is a BAPi wild-type cell, which is resistant to DRL-induced cell death;

wherein the presence, in the sample, of the mutant BAPi gene or the mutant BAPi protein, or of a reduced level expression of the wild-type BAPi gene or a lower protein concentration, or reduced or non-binding of an ASXL protein to a wild-type BAPi protein, is indicative of the individual's cancer cell being sensitive to DRL- induced cell death.

Previous genetic analyses have identified several key recurrent alterations, including inactivation of CDKN2A, NF2 and BAPi, as well as frequent losses and gains of a number of chromosomal arms. More recently, the first whole exome sequence analysis of 22 malignant mesothelioma patients confirmed the importance of these three genes as probable driver events in tumour development as well as identifying recurrent non-synonymous mutations in CULi, an essential component of the SCF E3 ubiquitin ligase complex (6). BAPi is a tumour suppressor gene that is somatically mutated in a variety of cancer types including mesothelioma (7), uveal melanoma (8), renal cell carcinoma (9) and cholangiocarcinomas (10). The inventors have discovered that the expression of BAPi mutants in cancer cells causes increased sensitivity to cell death induced by death receptor ligands, which exhibit fewer off-target effects. Tumour necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), for example, induces cell death in tumour cells in vitro and in vivo but not in most normal cells. Advantageously, the invention therefore increases the likelihood that an individual with a cancer, which is associated with expression of a mutant BAPi gene or synthesis of a mutant BAPi protein, or a reduced level of expression of a wild-type BAPi gene or a lower wild- type BAPi protein concentration, will exhibit a positive outcome when treated with death receptor ligand therapy. Accordingly, the method of the invention provides a prognosis. Thus, such individuals are less likely to be treated with non-specific therapies and suffer the associated undesirable side-effects.

BAPi is a deubiquitinating enzyme encoded by the BAPi gene. It is an 8o.4kDa protein, which comprises a nuclear-localising sequence and a ubiquitin carboxy- terminal hydrolase (UCH) domain, which provides BAPi with deubiquitinase activity. The BAPi gene may be mutated in the germline or somatically in a variety of forms of cancer. The nucleotide sequence encoding one embodiment of the human wild-type BAPi gene (BAPi Whole gene sequence ^1568815595x52410105-52401004 Homo sapiens chromosome 3) is provided herein as SEQ ID No.i, as follows:

GAGCGCATGCCCGCATCTGCTGTCCGACAGGCGGAAGACGAGCCCAGAGGCGGAGCA GGGCCGTCGCGC CTTGGTGACGTCTGCCGCCGGCGCGGGCGGGTGACGCGACTGGGCCCGTTGTCTGTGTGT GGGACTGAG GGGCCCCGGGGGCGGTGGGGGCTCCCGGTGGGGGCAGCGGTGGGGAGGGAGGGCCTGGAC ATGGCGCTG AGGGGCCGCCCCGCGGGAAGATGAATAAGGGCTGGCTGGAGCTGGAGAGCGACCCAGGTG AGGAGGGGA CCGGGAGGGCCAGGGGCTGGGGAGGCCGGATGGGCCCGGGACGCGCCTGCCTGACCATCA CCCCCTCCT CTTGTCGCCCCACCCAGGCCTCTTCACCCTGCTCGTGGAAGATTTCGGTAAGAGCCTTTT CTCCCTGCC GGACCGGGGCTGTGGCGGCCCACCCCTGCGCCCTCACTCATCAGGGGCTGTCCTTCCCTA CTGCTTTCC TTTCCTCATCGCAGGTGTCAAGGGGGTGCAAGTGGAGGAGATCTACGACCTTCAGAGCAA ATGTCAGGG GTGAGTGGCTGTACACCAGGGCTGCCCCTTACACCCAGAGTGCTGGGGAAGGTCCCAGAG AACAGGGCC CCTTAGGGAAGACAGTGCCAGGAACCCTACGTTGTAAAATCTCACAGAAAGCAGCAGCCT TGCTCTCTG AGTGCCCGCTCCTGATCAAACTGATACTTTCTTTTCTCCCAAACTTTCCTTAGCGCTTCC CTTTTTGTA GCAGCCCCCTCCCCACCCCTAAGCATCCTTTGGTTCAGCTGCTTTCCTGGCCTTGCAGCG GGAAGACCC CGGTCACACAATGTCTTTTGTGCAGTTGTGTAATGTATTAATTTTAGTGTGCCCATGTGT CCTTGGCTT TAATCCTGACACAAAGTCATCCTGTATTGATTGGTTGGGGTGACAAGGCCCCTCCTGGGT GCCCACACT TAGAGTCTTTTCCCAGTGGTCCTGCAGAATAGATGTGTAAGAGAGTAGCAACAGTAGCAA CCGTGACTG AACCAAGAAGTCTACTTTAATTTCCTGGAACAAAAGAGACTGGTGTGGGTGTTCATTTGC TTTCCTGAC TGCATTGGGGCCCACAAGTGAGAAGGAGTGCCTCAGTTCCTCATCAGAGTTTTTGTTCTT GTCTTACTT TGTGTTCCTACCCTGTCCCATCCTTGGCCCTCAGTTCCAGCTTTTCTTCTCTTACCCAGA ACTATAGAC TTCATAAGGAGACTGGGTGGACTCCTGGAGCATCACAGTCAGAGGCTTATGCTTTGCTCT GCCTGTGGC AGGCCTTTGGTGTGTGAGGGCACAAGGCCACTTCAGACACAGTGTTGGGAAGAAGCCAGG GGAGAGGGG GGATCACAGCAAGGACACCTGAGTGATGACGCAGTGCAAAGGATTAATGGGAGAAAGAAG GGAATGCTG ATTGTCTTCTCCCCTTTGGCTGATCTGGCTCTGCCCCTTACTTCCCCCAGCCCTGTATAT GGATTTATC TTCCTGTTCAAATGGATCGAAGAGCGCCGGTCCCGGCGAAAGGTCTCTACCTTGGTGGAT GATACGTCC GTGATTGATGATGATATTGTGAATAACATGTTCTTTGCCCACCAGGTCTGCTGGACTCTG TGCTTTGTT TGGAGGGTGGGATGCTGCCATGTTTTTGCTTGGGAAGTGGAAATGGAGGAAGACAGGAGG AGGAGATAG GCAGATTCTAGGGGTGGTAGCTACAGAAATCCTCTGGCAGAACGAACTGAACTCTTAATT CATTAAAGG GAACAGCTTTAGAGTAGGAGGGTGTCTGAGTCCACTCTCTGTGTCCTCAGATATCCAGTG GGTATTTGG TAGGTGCTTGTTAAATGAATAAACATTAGGCAAAGATGAAAGGAGCTGAGAAGGGGAGTT GTCCAGATA TGACTGACCTGCTCTGGATCCCCATTCTTGATGTATATGGGCTTGGGGCTT GCAGTGAGGGGTGCTGTG TATGGGTGACTATTCTTGGTTTCACAGCTGATACCCAACTCTTGTGCAACT CATGCCTTGCTGAGCGTG CTCCTGAACTGCAGCAGCGTGGACCTGGGACCCACCCTGAGTCGCATGAAGGACTTCACC AAGGGTTTC AGCCCTGAGGTAGGCTGCAGTGCCTTCATCCTGGCTCACAGCCAACTGGGCAGATCTGAC CCTGAGGGC CACTGGGAATGCTACCACATGATATTGGGTACTATTAGGCTGTTTCTTTTT CAAATGATTGTTTATGTT ACATTTGACTCTTAAATAAATTGTGTAAGGCCATTGTTTTTAGATGCAGTT GCGGGGAAAGGACACAGG CCTAGGGAGGGAGGAGAGTTTCCTTAAGTCAGACCATGTCAGAACCTTCTC TGTCAGGACTTTTCCTCT CAGGCCATGTTGCTTCCTAGTGTCCACTAATTACCATGCAAGGCCAGCACAGTCCATCTC TTTGGGGCT CCAGAGCTCTTTTCTGCCCCCACCAGCCTTTTAAGAAAGTTCGTCTGTGTT CCTTCCGATTCCTGGAAT GCCTCCAGGCTGCTCTCTGAAGCTTTGCCTTCCACCCATAGTCCTACCTGAGGAGAAATT ATTCTGATA CGGCCTTATTTTCTTCCCCGTAGAGCAAAGGATATGCGATTGGCAATGCCC CGGAGTTGGCCAAGGCCC ATAATAGCCATGCCAGGTGTGTGGGAGCTGTGGGAGCTGATGTGGGGTGGGAGTAGGGGG AGTATCATT TTTTGGGCCCTGACTCTGTTTTTCCCCAGGCCCGAGCCACGCCACCTCCCT GAGAAGCAGAATGGCCTT AGTGCAGTGCGGACCATGGAGGCGTTCCACTTTGTCAGCTATGTGCCTATCACAGGCCGG CTCTTTGAG CTGGATGGGCTGAAGGTCTACCCCATTGACCATGGTAGGCACCATGAGCTGGAGGCCTGT TGGGTGTCT CTGCCTACCTCCTAGGGAGCTGGGGCTCAGGGCCCTCTGGTATGTGGTACC CAGTGGCAGGGGTTGTCG GTACCGACACCCGGCTCTGGCTGGGGTTTCACCCTACACCATATTGCCCGACCAGCTCCT GATTCCCTG GCTCAACTGCTCTTCTCTGTCTTCCTTCCCACTCCTGGCCTGCCCAAACTCAGGGTTTCC TTCTCGCTG ATTCCTTGTCTTGGTCTCCACTAGGGCCCTGGGGGGAGGACGAGGAGTGGACAGACAAGG CCCGGCGGG TCATCATGGAGCGTATCGGCCTCGCCACTGCAGGGTAAGGGCCCTGTGCCT GCCCTGTTCTACTCTCTG GAGCTGTACCTACTTTGGGAGGGACAGAGAGTATCCAGGTGATTTGTAAAT TGCAAGGCCATATGGTGA ATCTGGCAAGATCAGGCTTAGATCATGGGTTCTCAACTTGTTGTCTTATTT CCTGCCTGGGCTGCCTGT GGCCTGCTCCTGGGTGGGCTGGGGGAGGGGCAGGCCTCAGTGGAGCCTTAGGCAGCCCAG GTCTGCTGG TTCACTTCCAGATAGGCCCCTCATACAGCTTGTTGGAAGGTACCAGCTCAGGTGCCTGGC ATGTATGGC TAGTCGCTGCCTGCCTGTTGGGGTGGGGCCTATACCTACAGCTGCAGGTGT GACTGCAGGGAGCCCTGC CAGGATATCTGCCTCAACCTGATGGCGGGGCCGGGGCGGGAGCTGCTCTCACGGCTGCGG CTGTGACTG CAGGGAGCCCTACCACGACATCCGCTTCAACCTGATGGCAGTGGTGCCCGACCGCAGGAT CAAGTATGA GGCCAGGCTGCATGTGCTGAAGGTGAACCGTCAGACAGTACTAGAGGCTCT GCAGCAGGTAGGTGCCCT TTCTTCCTGGCCTCTGCCCAGCCCAACCCTCCCTGCATTCCTCCTCCCTTC CCCCACAGCATTTGTCTC TGATTCGTGAACATACTCTCTTGTAGATCTGGGCTTCAGCTAACCACATCT TTTCTTTGCCCCCATTGT GGGAAAGGTGGGACTTGGAGTGGGGAGGGAGAATAGCTTCTAAAAGGAAGT TTGGGTTTGGGTGTTTTA TTTCCCTGTGAGTGAATGGGTAGAGCCAAGGCCATTATTCCTTTAGGTCCT CAGCCCTTAGCTATTTAA GGTAGAAGCCCGGGTCTACCCTTTCTCCTCTGAGCCCTGGATTCTGTTGTTAGCTGATAA GAGTAACAC AGCCAGAGCTGATTCAGACCCACAAGTCTCAAGAGTCACAGCTGCCTGAGGAGTCCAAGT CAGCCAGCA ACAAGTCCCCGCTGGTGCTGGAAGCAAACAGGGCCCCTGCAGCCTCTGAGGGCAACCACA CAGGTACTG GGGGGTTTGGGACCTCTTGTGGACCTCAGAGCCACCCGCTAATGTCTGACATGGGAGGCC TAAACAGGG AAAGTCTTTTTCTGGGGATGTCCTTGGGCAGTGTTCTTCCCCCGTCAGAAGGTAGAGGGA GAGCAGTCC TTCCCTAAAGAAAGGCACCTGTAAAGGGCCGCTGTTACCACAGGCCCCTGGGCCCTTCTC TGTAATGTA CACTCCCTTTCTTGTTTTCTCTAGAGGCGGTTTTTTTTTTTTTTTTTTTTT TTTTTTTTCTTCCTGCTT CTTTTTTCCCATCTCATTCTTTGCCCTGTCTCATTGCGGGATCATGACTTAGAGCTTGCT GACTCCCAT TGCACCAGCTGGCTGGGCTGTTCTTCTCTGGGAAGTGCTGGTTCACAGGGC CGGGGAGACTGTGAGCTT TTCTTGGAGATCCTACTGGAGGTCCTGCCTGTGTTCTTGCCCTGTCTCAGATGGTGCAGA GGAGGCGGC TGGTTCATGCGCACAAGCCCCATCCCACAGCCCTCCCAACAAACCCAAGCTAGTGGTGAA GCCTCCAGG CAGCAGCCTCAATGGGGTTCACCCCAACCCCACTCCCATTGTCCAGCGGCT GCCGGCCTTTCTAGACAA TCACAATTATGCCAAGTCCCCCATGCAGGTAAGCTGGGAGCACCCTTGCAGGATTCTCTA CTTGATTCT CTTGAGAGGCTGCAACAGGCAATTTTCCCATGTGGTTCCTTGGTGTTCATC CTTGGCATGGCTGGGTCA AGCTGCCTGGGCCTGGGTTGCTAGGTTCCTCTGCCTGATATGAAAAGGCCC CCACAACAGCAGGAGCTT AGGGAGGCAGGGAGAGCTCCTTTGAATTTAATCTAGTTACGTGGCTGTGGGATTAAATGT TTAGGTCAC GCTCCTTGGTACAACTTCATGGGTTGGGTTTTACTGGCAAAATAAAGGCAT GTGTTTCAGGGCACTCTG TTTCTCTTAAAACCCCTCCGTGGGGTTCTATCCAGTGTAAGTGGGTGGCAGCCTCCCCAC AAGCCAAGG ACAGGCCATGGAACAGCTGGAGGGGTTCCGCTGACTCAGTCTGGAAAACCATGTTGGCTT TCTCTCTGG CTGTGAGTGTCTAGGCTCAGCCTGGGCCGAGCAGCACTTGTTTGTAACTGCCCTGGTCTT TGTCCCAGG AGGAAGAAGACCTGGCGGCAGGTGTGGGCCGCAGCCGAGTTCCAGTCCGCCCACCCCAGC AGTACTCAG ATGATGAGGATGACTATGAGGATGACGAGGAGGATGACGTGCAGAACACCAACTCTGCCC TTAGGTCAG CCCAGCTTTCTAAGGCTACCAGGTTCTAGGTGCTTCGGATCCCATCCTGAATATCTCAGT CTGTGTCTG AGAATGCCCTGCAGCAGATAATGTTGAGCACCTGCGGAGTTTGGGGCCCTGGGGGAGGCT GGCATGATG GGGCTGACCCCAGGTCCCCAGGAAGTTTTTGGTGGGCTGGGGGGTAAGGCTGAGCACGTA AGCTTATAT CATGTCCTATTGGAAGTGGCCTTTTAGCCAGGCCTTGAAGGATTGGTTGGGGCAGGGATG GAGGAGATG TGGGTGGTGGGGAGGCAGCTTTGCTGGAACACAGGGCATTGGCAAAAGGCCAGGAGTGGG ATGGCTGGA ATAGAGGAAGTGTCTTTTGAGGACACTTGGCTGCAGCTGTCAGAACTTGATGCCAGGCTT AGCATGGCT AGTTCAAGTTGCTTGGACCAAGTATAAGGAGTTTTAGGGTCAGCCCCTGGAGGTCGGGAT GTATTTAAG CCATTCTGGGTACTGCTGGGTATGGTCACCTGGCCCGTTCCCTTGCTTCACATCTTCTCG GGCCCCACA GGTATAAGGGGAAGGGAACAGGGAAGCCAGGGGCATTGAGCGGTTCTGCTGATGGGCAAC TGTCAGTGC TGCAGCCCAACACCATCAACGTCTTGGCTGAGAAGCTCAAAGAGTCCCAGAAGGACCTCT CAATTCCTC TGTCCATCAAGACTAGCAGCGGGGCTGGGAGTCCGGCTGTGGCAGTGCCCACACACTCGC AGCCCTCAC CCACCCCCAGCAATGAGAGTACAGACACGGCCTCTGAGATCGGCAGTGCTTTCAACTCGC CACTGCGCT CGCCTATCCGCTCAGCCAACCCGACGCGGCCCTCCAGCCCTGTCACCTCCCACATCTCCA AGGTGCTTT TTGGAGAGGATGACAGCCTGCTGCGTGTTGACTGCATACGCTACAACCGTGCTGTCCGTG ATCTGGGTC CTGTCATCAGCACAGGCCTGCTGCACCTGGCTGAGGATGGGGTGCTGAGTCCCCTGGCGC TGACAGGTG GGCCTTGGACTGGCTCACTGGCCACTTGGTGCACCCAGGAGGGAGGAGGGAAGTGGCCAA GTGACCACA AAGTGTCCTGCACTCTGATGATTTTCTTGTGACCTCTCTTCCCAGAGGGTGGGAAGGGTT CCTCGCCCT CCATCAGACCAATCCAAGGCAGCCAGGGGTCCAGCAGCCCAGTGGAGAAGGAGGTCGTGG AAGCCACGG ACAGCAGAGAGAAGACGGGGATGGTGAGGCCTGGCGAGCCCTTGAGTGGGGAGAAATACT CACCCAAGG TGAGCCTCCGTTGTGGTTTTCTCCTTTAATCCTGGCAGAGGGTAAGGCCTGAGCTCCTCC TGCCCAGGT GCCAAGTTCTTGATTGGAACTTTGGTGTGAAGATTGGTGGCTGGAGCCATGTGCCAGAAG ACTTTCTGG GTTGGGTGGTGGCAGGGGCCTTGATAGGCATGGACTCGCTGCTCATCCTTGCCTCTAGCT GCCTATTGC TCGTGGGGCTTTGTTGCTGGCCCGCCCCGATCAGAGGTGCAATGCTGGGTTTTGGCAGGA GCTGCTGGC ACTGCTGAAGTGTGTGGAGGCTGAGATTGCAAACTATGAGGCGTGCCTCAAGGAGGAGGT AGAGAAGAG GAAGAAGTTCAAGGTGGGTGATTTCTCCAGTTGCCTGATCTGGCCTCTCCCGAGGTCCAC TGGTGGCTG CTCTGGCAAGATTGGCTCCAGTGCTCTCAGTCTTCTTCTCTCCTACAGATTGATGACCAG AGAAGGACC CACAACTACGATGAGTTCATCTGCACCTTTATCTCCATGCTGGCTCAGGAAGGTGAGGGG ATGCGCTGC TGTCTTAACTGGAATGCCCTGCTGAGGGCCGTGTCCTTCAGCTCCCCTCCCCTGGCCTCT CCTGAGGCT TGAGCAGACCTTGGGGCACAGGGAGGGCCATGAGAGCCTCAGCTCCTGGCCTGAGGCAGC CAGCACCTG CTCAAGGGTCTCTACCTCTTCGCAGGCATGCTGGCCAACCTAGTGGAGCAGAACATCTCC GTGCGGCGG CGCCAAGGGGTCAGCATCGGCCGGCTCCACAAGCAGCGGAAGCCTGACCGGCGGAAACGC TCTCGCCCC TACAAGGCCAAGCGCCAGTGAGGACTGCTGGCCCTGACTCTGCAGCCCACTCTTGCCGTG TGGCCCTCA CCAGGGTCCTTCCCTGCCCCACTTCCCCTTTTCCCAGTATTACTGAATAGTCCCAGCTGG AGAGTCCAG GCCCTGGGAATGGGAGGAACCAGGCCACATTCCTTCCATCGTGCCCTGAGGCCTGACACG GCAGATCAG CCCCATAGTGCTCAGGAGGCAGCATCTGGAGTTGGGGCACAGCGAGGTACTGCAGCTTCC TCCACAGCC GGCTGTGGAGCAGCAGGACCTGGCCCTTCTGCCTGGGCAGCAGAATATATATTTTACCTA TCAGAGACA TCTATTTTTCTGGGCTCCAACCCAACATGCCACCATGTTGACATAAGTTCCTACCTGACT ATGCTTTCT CTCCTAGGAGCTGTCCTGGTGGGCCCAGGTCCTTGTATCATGCCACGGTCCCAACTACAG GGTCCTAGC TGGGGGCCTGGGTGGGCCCTGGGCTCTGGGCCCTGCTGCTCTAGCCCCAGCCACCAGCCT GTCCCTGTT GTAAGGAAGCCAGGTCTTCTCTCTTCATTCCTCTTAGGAGAGTGCCAAACTCAGGGACCC AGCACTGGG CTGGGTTGGGAGTAGGGTGTCCCAGTGGGGTTGGGGTGAGCAGGCTGCTGGGATCCCATG GCCTGAGCA GAGCATGTGGGAACTGTTCAGTGGCCTGTGAACTGTCTTCCTTGTTCTAGCCAGGCTGTT CAAGACTGC TCTCCATAGCAAGGTTCTAGGGCTCTTCGCCTTCAGTGTTGTGGCCCTAGCTATGGGCCT AAATTGGGC TCTAGGTCTCTGTCCCTGGCGCTTGAGGCTCAGAAGAGCCTCTGTCCAGCCCCTCAGTAT TACCATGTC TCCCTCTCAGGGGTAGCAGAGACAGGGTTGCTTATAGGAAGCTGGCACCACTCAGCTCTT CCTGCTACT CCAGTTTCCTCAGCCTCTGCAAGGCACTCAGGGTGGGGGACAGCAGGATCAAGACAACCC GTTGGAGCC CCTGTGTTCCAGAGGACCTGATGCCAAGGGGTAATGGGCCCAGCAGTGCCTCTGGAGCCC AGGCCCCAA CACAGCCCCATGGCCTCTGCCAGATGGCTTTGAAAAAGGTGATCCAAGCAGGCCCCTTTA TCTGTACAT AGTGACTGAGTGGGGGGTGCTGGCAAGTGTGGCAGCTGCCTCTGGGCTGAGCACAGCTTG ACCCCTCTA GCCCCTGTAAATACTGGATCAATGAATGAATAAAACTCTCCTAAGAATCTCCTGAGAAAT GAA [SEQ ID No.i]

The cDNA sequence encoding one embodiment of the human wild-type BAPi gene is provided herein as SEQ ID No.2, as follows:

ATGAATAAGGGCTGGCTGGAGCTGGAGAGCGACCCAGGCCTCTTCACCCTGCTCGTG GAAGATTTCGGT GTCAAGGGGGTGCAAGTGGAGGAGATCTACGACCTTCAGAGCAAATGTCAGGGCCCTGTA TATGGATTT ATCTTCCTGTTCAAATGGATCGAAGAGCGCCGGTCCCGGCGAAAGGTCTCTACCTTGGTG GATGATACG TCCGTGATTGATGATGATATTGTGAATAACATGTTCTTTGCCCACCAGCTGATACCCAAC TCTTGTGCA ACTCATGCCTTGCTGAGCGTGCTCCTGAACTGCAGCAGCGTGGACCTGGGACCCACCCTG AGTCGCATG AAGGACTTCACCAAGGGTTTCAGCCCTGAGAGCAAAGGATATGCGATTGGCAATGCCCCG GAGTTGGCC AAGGCCCATAATAGCCATGCCAGGCCCGAGCCACGCCACCTCCCTGAGAAGCAGAATGGC CTTAGTGCA GTGCGGACCATGGAGGCGTTCCACTTTGTCAGCTATGTGCCTATCACAGGCCGGCTCTTT GAGCTGGAT GGGCTGAAGGTCTACCCCATTGACCATGGGCCCTGGGGGGAGGACGAGGAGTGGACAGAC AAGGCCCGG CGGGTCATCATGGAGCGTATCGGCCTCGCCACTGCAGGGGAGCCCTACCACGACATCCGC TTCAACCTG ATGGCAGTGGTGCCCGACCGCAGGATCAAGTATGAGGCCAGGCTGCATGTGCTGAAGGTG AACCGTCAG ACAGTACTAGAGGCTCTGCAGCAGCTGATAAGAGTAACACAGCCAGAGCTGATTCAGACC CACAAGTCT CAAGAGTCACAGCTGCCTGAGGAGTCCAAGTCAGCCAGCAACAAGTCCCCGCTGGTGCTG GAAGCAAAC AGGGCCCCTGCAGCCTCTGAGGGCAACCACACAGATGGTGCAGAGGAGGCGGCTGGTTCA TGCGCACAA GCCCCATCCCACAGCCCTCCCAACAAACCCAAGCTAGTGGTGAAGCCTCCAGGCAGCAGC CTCAATGGG GTTCACCCCAACCCCACTCCCATTGTCCAGCGGCTGCCGGCCTTTCTAGACAATCACAAT TATGCCAAG TCCCCCATGCAGGAGGAAGAAGACCTGGCGGCAGGTGTGGGCCGCAGCCGAGTTCCAGTC CGCCCACCC CAGCAGTACTCAGATGATGAGGATGACTATGAGGATGACGAGGAGGATGACGTGCAGAAC ACCAACTCT GCCCTTAGGTATAAGGGGAAGGGAACAGGGAAGCCAGGGGCATTGAGCGGTTCTGCTGAT GGGCAACTG TCAGTGCTGCAGCCCAACACCATCAACGTCTTGGCTGAGAAGCTCAAAGAGTCCCAGAAG GACCTCTCA ATTCCTCTGTCCATCAAGACTAGCAGCGGGGCTGGGAGTCCGGCTGTGGCAGTGCCCACA CACTCGCAG CCCTCACCCACCCCCAGCAATGAGAGTACAGACACGGCCTCTGAGATCGGCAGTGCTTTC AACTCGCCA CTGCGCTCGCCTATCCGCTCAGCCAACCCGACGCGGCCCTCCAGCCCTGTCACCTCCCAC ATCTCCAAG GTGCTTTTTGGAGAGGATGACAGCCTGCTGCGTGTTGACTGCATACGCTACAACCGTGCT GTCCGTGAT CTGGGTCCTGTCATCAGCACAGGCCTGCTGCACCTGGCTGAGGATGGGGTGCTGAGTCCC CTGGCGCTG ACAGAGGGTGGGAAGGGTTCCTCGCCCTCCATCAGACCAATCCAAGGCAGCCAGGGGTCC AGCAGCCCA GTGGAGAAGGAGGTCGTGGAAGCCACGGACAGCAGAGAGAAGACGGGGATGGTGAGGCCT GGCGAGCCC TTGAGTGGGGAGAAATACTCACCCAAGGAGCTGCTGGCACTGCTGAAGTGTGTGGAGGCT GAGATTGCA AACTATGAGGCGTGCCTCAAGGAGGAGGTAGAGAAGAGGAAGAAGTTCAAGATTGATGAC CAGAGAAGG ACCCACAACTACGATGAGTTCATCTGCACCTTTATCTCCATGCTGGCTCAGGAAGGCATG CTGGCCAAC CTAGTGGAGCAGAACATCTCCGTGCGGCGGCGCCAAGGGGTCAGCATCGGCCGGCTCCAC AAGCAGCGG AAGCCTGACCGGCGGAAACGCTCTCGCCCCTACAAGGCCAAGCGCCAGTGA

[SEQ ID No.2] The amino acid sequence of one embodiment of human wild-type BAPi is referred to herein as SEQ ID No. 3, as follows:

MNKGWLELESDPGLFTLLVEDFGVKGVQVEE IYDLQSKCQGPVYGF IFLFKWIEERRSRRKVSTLVDDT SVIDDDIVNNMFFAHQLIPNSCATHALLSVLLNCSSVDLGPTLSRMKDFTKGFSPESKGY AIGNAPELA KAHNSHARPEPRHLPEKQNGLSAVRTMEAFHFVSYVPITGRLFELDGLKVYPIDHGPWGE DEEWTDKAR RVIMERIGLATAGEPYHDIRFNLMAVVPDRRIKYEARLHVLKVNRQTVLEALQQLIRVTQ PELIQTHKS QESQLPEESKSASNKSPLVLEANRAPAASEGNHTDGAEEAAGSCAQAPSHSPPNKPKLVV KPPGSSLNG VHPNPTPIVQRLPAFLDNHNYAKSPMQEEEDLAAGVGRSRVPVRPPQQYSDDEDDYEDDE EDDVQNTNS ALRYKGKGTGKPGALSGSADGQLSVLQPNTINVLAEKLKESQKDLS IPLS IKTSSGAGSPAVAVPTHSQ PSPTPSNESTDTASEIGSAFNSPLRSPIRSANPTRPSSPVTSHISKVLFGEDDSLLRVDC IRYNRAVRD LGPVI STGLLHLAEDGVLSPLALTEGGKGSSPS IRPIQGSQGSSSPVEKEVVEATDSREKTGMVRPGEP LSGEKYSPKELLALLKCVEAE IANYEACLKEEVEKRKKFKIDDQRRTHNYDEF ICTF I SMLAQEGMLAN LVEQNI SVRRRQGVS IGRLHKQRKPDRRKRSRPYKAKRQ

[SEQ ID N0.3]

Tumours arise due to mutations in proto-oncogenes or tumour suppressor genes. A gain-of-function mutation in a proto-oncogene converts it into an oncogene, which causes tumourigenesis. Such gain-of-function mutations are usually missense mutations in the DNA bases, which confer a change in the amino acid sequence, or a gain of copy number of the gene. A loss-of-function mutation in a tumour suppressor gene will also lead to tumourigenesis. A loss-of-function mutation in a tumour suppressor however is not restricted to the change of a few amino acids. Any change in an amino acid which impairs the function of the protein, results in a loss-of- function mutation. Hence, unlike oncogenes, it is not always possible to identify a specific mutation which results in the loss of function of a tumour suppressor gene. Loss-of-function truncating mutations of tumour suppressors are therefore typically identified throughout the coding exons of a gene.

BAPi is a tumour suppressor gene. According to the invention, a mutant BAPi gene is one that comprises a mutation. The mutant BAPi gene is a gene that encodes a nonfunctional or enzymatically inactive BAPi protein, or a BAPi protein that exhibits reduced binding to an ASXL protein compared to the level of binding in a reference cell, which is resistant to DRL-induced cell death. Thus, a mutant BAPi protein is one that is non-functional or enzymatically inactive or incapable of binding to an ASXL protein or exhibits reduced binding to an ASXL protein compared to the level of binding in a reference cell, which is resistant to DRL-induced cell death. As described in the Examples (see Figure 7d), BAPi has surprisingly been shown to form a complex with ASXLi, ASXL2 or ASXL3. These proteins will be collectively referred to herein as an ASXL protein. BAPi-ASXL complexes have been shown to

deubiquitinate Histone 2A, and other substrates. Inhibiting the formation of this complex renders BAPi non-functional or enzymatically inactive.

The mutant BAPi protein may be a full-length protein with mutations at specific loci. The mutant BAPi protein may be a partial or complete deletion or mutation of the wild-type BAPi protein. Partial deletion or mutation may occur in the nuclear localisation sequence (NLS), the active site of wild-type BAPi, the binding site of ASXL, or at any place in the gene that would result in the loss of function of BAPi. Mutation may include one or more point mutations. Point mutations maybe a substitution, an insertion, a deletion or a frameshift mutation.

A reduced level of expression of a wild-type BAPi gene compared to the level of expression in a reference cell may result in a lower wild-type BAPi protein

concentration compared to the protein concentration in the same reference cell. The reduced level of expression of the wild-type BAPi gene maybe at least a io%, 15%, 25%, 35%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or a 100% reduction compared to the reference cell. Similarly, the lower concentration of wild- type BAPi protein may be lower by at least 10%, 15%, 25%, 35%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or 100% compared to the reference cell. The skilled person would know how to detect the extent of the reduction in BAPi gene expression or lower BAPi protein expression. Lower expression of wild-type BAPi protein may be caused by epigenetic silencing, methylation or low levels of BAPi gene expression. The term "non-functional BAPi protein" can refer to but is not limited to a BAPi protein that does not exhibit deubiquitinase (enzyme) activity. The skilled person would appreciate that standard assays for measuring deubiquitinase activity include, but are not limited to, fluorescence assays using a fluorogenic substrate, such as ubiquitin- amidomethylcoumarin; and HPLC assays using ubiquitin ethyl ester or ubiquitin fusion peptides as model substrates to monitor deubiquitinating activity.

In one embodiment, the amino acid sequence of a mutant BAPi gene (p.R6oQ) referred to herein as SEQ ID No. 4, as follows:

1 mnkgwleles dpglftllve dfgvkgvqve eiydlqskcq gpvygfifIf kwieerrsrq 61 kvstlvddts vidddivnnm ffahqlipns cathallsvl lncssvdlgp tlsrmkdftk 121 gfspeskgya ignapelaka hnsharpepr hlpekqngls avrtmeafhf vsyvpitgr1 181 feldglkvyp idhgpwgede ewtdkarrvi meriglatag epyhdirfnl mavvpdrrik 241 yearlhvlkv nrqtvlealq qlirvtqpel iqthksqesq lpeesksasn ksplvleanr 301 apaasegnht dgaeeaagsc aqapshsppn kpklvvkppg sslngvhpnp tpivqrlpaf 361 ldnhnyaksp mqeeedlaag vgrsrvpvrp pqqysddedd yeddeeddvq ntnsalrykg 421 kgtgkpgals gsadgqlsvl qpntinvlae klkesqkdls iplsiktssg agspavavpt 481 hsqpsptpsn estdtaseig safnsplrsp irsanptrps spvtshiskv Ifgeddsllr 541 vdcirynrav rdlgpvistg llhlaedgvl splalteggk gsspsirpiq gsqgssspve 601 kevveatdsr ektgmvrpge plsgekyspk ellallkcve aeianyeacl keevekrkkf 661 kiddqrrthn ydefictfis mlaqegmlan lveqnisvrr rqgvsigrlh kqrkpdrrkr 721 srpykakrq

[SEQ ID N0.4]

Therefore, the amino acid sequence of the mutant BAPi protein may be encoded by SEQ ID NO. 4 or a fragment or variant thereof. In one embodiment, the nucleotide sequence of a mutant BAPi gene is referred to herein as SEQ ID No. 5, as follows: ATGAATAAGGGCTGGCTGGAGCTGGAGAGCGACCCAGGCCTCTTCACCCTGCTCGTGGAA GATTTCGGT GTCAAGGGGGTGCAAGTGGAGGAGATCTACGACCTTCAGAGCAAATGTCAGGGCCCTGTA TATGGATTT ATCTTCCTGTTCAAATGGATCGAAGAGCGCCGGTCCCGGCAAAAGGTCTCTACCTTGGTG GATGATACG TCCGTGATTGATGATGATATTGTGAATAACATGTTCTTTGCCCACCAGCTGATACCCAAC TCTTGTGCA ACTCATGCCTTGCTGAGCGTGCTCCTGAACTGCAGCAGCGTGGACCTGGGACCCACCCTG AGTCGCATG AAGGACTTCACCAAGGGTTTCAGCCCTGAGAGCAAAGGATATGCGATTGGCAATGCCCCG GAGTTGGCC AAGGCCCATAATAGCCATGCCAGGCCCGAGCCACGCCACCTCCCTGAGAAGCAGAATGGC CTTAGTGCA GTGCGGACCATGGAGGCGTTCCACTTTGTCAGCTATGTGCCTATCACAGGCCGGCTCTTT GAGCTGGAT GGGCTGAAGGTCTACCCCATTGACCATGGGCCCTGGGGGGAGGACGAGGAGTGGACAGAC AAGGCCCGG CGGGTCATCATGGAGCGTATCGGCCTCGCCACTGCAGGGGAGCCCTACCACGACATCCGC TTCAACCTG ATGGCAGTGGTGCCCGACCGCAGGATCAAGTATGAGGCCAGGCTGCATGTGCTGAAGGTG AACCGTCAG ACAGTACTAGAGGCTCTGCAGCAGCTGATAAGAGTAACACAGCCAGAGCTGATTCAGACC CACAAGTCT CAAGAGTCACAGCTGCCTGAGGAGTCCAAGTCAGCCAGCAACAAGTCCCCGCTGGTGCTG GAAGCAAAC AGGGCCCCTGCAGCCTCTGAGGGCAACCACACAGATGGTGCAGAGGAGGCGGCTGGTTCA TGCGCACAA GCCCCATCCCACAGCCCTCCCAACAAACCCAAGCTAGTGGTGAAGCCTCCAGGCAGCAGC CTCAATGGG GTTCACCCCAACCCCACTCCCATTGTCCAGCGGCTGCCGGCCTTTCTAGACAATCACAAT TATGCCAAG TCCCCCATGCAGGAGGAAGAAGACCTGGCGGCAGGTGTGGGCCGCAGCCGAGTTCCAGTC CGCCCACCC CAGCAGTACTCAGATGATGAGGATGACTATGAGGATGACGAGGAGGATGACGTGCAGAAC ACCAACTCT GCCCTTAGGTATAAGGGGAAGGGAACAGGGAAGCCAGGGGCATTGAGCGGTTCTGCTGAT GGGCAACTG TCAGTGCTGCAGCCCAACACCATCAACGTCTTGGCTGAGAAGCTCAAAGAGTCCCAGAAG GACCTCTCA ATTCCTCTGTCCATCAAGACTAGCAGCGGGGCTGGGAGTCCGGCTGTGGCAGTGCCCACA CACTCGCAG CCCTCACCCACCCCCAGCAATGAGAGTACAGACACGGCCTCTGAGATCGGCAGTGCTTTC AACTCGCCA CTGCGCTCGCCTATCCGCTCAGCCAACCCGACGCGGCCCTCCAGCCCTGTCACCTCCCAC ATCTCCAAG GTGCTTTTTGGAGAGGATGACAGCCTGCTGCGTGTTGACTGCATACGCTACAACCGTGCT GTCCGTGAT CTGGGTCCTGTCATCAGCACAGGCCTGCTGCACCTGGCTGAGGATGGGGTGCTGAGTCCC CTGGCGCTG ACAGAGGGTGGGAAGGGTTCCTCGCCCTCCATCAGACCAATCCAAGGCAGCCAGGGGTCC AGCAGCCCA GTGGAGAAGGAGGTCGTGGAAGCCACGGACAGCAGAGAGAAGACGGGGATGGTGAGGCCT GGCGAGCCC TTGAGTGGGGAGAAATACTCACCCAAGGAGCTGCTGGCACTGCTGAAGTGTGTGGAGGCT GAGATTGCA AACTATGAGGCGTGCCTCAAGGAGGAGGTAGAGAAGAGGAAGAAGTTCAAGATTGATGAC CAGAGAAGG ACCCACAACTACGATGAGTTCATCTGCACCTTTATCTCCATGCTGGCTCAGGAAGGCATG CTGGCCAAC CTAGTGGAGCAGAACATCTCCGTGCGGCGGCGCCAAGGGGTCAGCATCGGCCGGCTCCAC AAGCAGCGG AAGCCTGACCGGCGGAAACGCTCTCGCCCCTACAAGGCCAAGCGCCAGTGA

[SEQ ID N0.5]

Therefore, the nucleotide sequence of the mutant BAPi gene may be encoded by SEQ ID NO. 5 or a fragment or variant thereof.

Reduced or non-binding between an ASXL protein (ASXLi, ASXL2 or ASXL3) and a wild-type BAPi protein maybe at least a 10%, 15%, 25%, 35%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or a 100% reduction compared to a reference cell in which binding between a wild-type BAPi protein and an ASXL protein occurs. The skilled person would know how to detect the extent of the reduction in wild-type BAPi protein binding to an ASXL protein. Standard assays for measuring binding between a wild-type BAPi protein and an ASXL protein include but are not limited to protein complex immunoprecipitation or fluorescence resonance energy transfer (FRET).

The term "DRL-induced cell death" can refer to, but is not limited to, apoptosis and other types of cell death caused by a death receptor ligand (DRL), such as necroptosis and necrosis. Thus, the term "death receptor ligand" refers to any agent that binds to a cellular receptor and induces death of the cell on which the receptor is located. The term "cell death" can refer to cellular apoptosis, necrosis and necroptosis. Preferably, it refers to cellular apoptosis. Apoptosis refers to programmed cell death caused by activation of an apoptotic signal transduction pathway. This may be achieved through the binding of a DRL to a death receptor. Death receptor ligands maybe TRAIL, TNFalpha, FAS ligand (FASL), recombinant TRAIL (dulanermin), antibodies to death receptors, especially antibodies to death receptors of the ligand TRAIL (such as mapatumuab, drozitumumab, conatumumab, lexatumumab, tigatuzumab, LBY-135), or a combination thereof.

The DRL maybe an agonist molecule such as Medi-3039 or any agent that activates an apoptotic signal transduction pathway. An extrinsic apoptotic signal transduction pathway may be the FAS ligand pathway, the TNFalpha pathway or the TRAIL pathway.

The term "express(ed) or expression" can refer to a transcribed gene (i.e. DNA), or corresponding RNA that has been translated into a polypeptide or protein.

Expression of a BAPi mutant gene or BAPi polypeptide maybe detected in any compartment of the cell (e.g. in the nucleus, cytosol, the Endoplasmic Reticulum, the Golgi apparatus or the intracellular surface of the plasma membrane).

Detecting according to (i), (ii) or (iii) of the first aspect may comprise the use of any one of the following assays for detecting the presence of a gene or its corresponding protein in a sample: polymerase chain reaction (PCR); northern blotting;

hybridisation-based detection techniques; flow cytometry; immunoassays, such as enzyme-linked immunosorbent assays (ELISAs), an enzyme immunoassay (EIAs), radioimmunoassay (RIAs), Western Blots, immuno-precipitation or immunohistochemistry; immunofluorescence; chromogenic (enzyme activity) assays; fluorometric imaging plate reader (FLIPR) assay; high performance liquid

chromatography (HPLC) tandem mass spectrometry (MS/MS).

The biological sample is preferably a cancerous bodily sample taken from a test individual. Detection for the presence of a BAPi mutant gene or mutant BAPi protein in the sample is therefore preferably carried out in vitro. The sample may comprise tissue, blood, plasma, serum, spinal fluid, urine, sweat, saliva, sputum, tears, breast aspirate, prostate fluid, seminal fluid, vaginal fluid, stool, cervical scraping, amniotic fluid, intraocular fluid, mucous, moisture in breath, animal tissue, cell lysates, tumour tissue, hair, skin, buccal scrapings, nails, bone marrow, cartilage, prions, bone powder, ear wax, or combinations thereof. The sample may be a biopsy. In another embodiment, the sample may be contained within the test subject, which maybe an experimental animal (e.g. a mouse or rat) or a human, wherein the method is an in vivo based test. Alternatively, the sample may be an ex vivo sample or an in vitro sample. Therefore, the cells being tested may be in a tissue sample (for ex vivo based tests) or the cells maybe grown in culture (an in vitro sample). Preferably, the biological sample is an ex vivo sample.

The inventors have developed a prognostic kit for determining a subject's sensitivity or otherwise to DRL-induced cell death. According to a second aspect, there is provided a kit for determining if an individual's cancer cell is sensitive to DRL-induced cell death, the kit comprising detection means for detecting the expression of a mutant BAPi gene or mutant BAPi protein, or for detecting a reduced level of expression of a wild-type BAPi gene or a lower wild-type BAPi protein concentration compared to the level of expression or protein

concentration in a reference cell that is resistant to DRL-induced cell death, or for detecting non-binding or reduced binding of an ASXL protein to a BAPi protein compared to the level of binding in a reference cell that is a BAPi wild-type cell that is resistant to DRL-induced cell death, wherein the presence, in the sample, of the mutant BAPi gene or the BAPi protein, or of a reduced level expression of the wild- type BAPi gene or a lower wild-type BAPi protein concentration, or reduced or non- binding of an ASXL protein to a wild-type BAPi protein, is indicative of the individual's cancer cell being sensitive to DRL-induced cell death. Preferably, the kit is used to provide a prognosis for an individual being treated with a death receptor ligand (DRL) or any agents activating the apoptotic pathways. A death receptor ligand maybe TRAIL, TNFalpha, FAS ligand (FASL), recombinant TRAIL (dulanermin), death receptor antibodies (such as mapatumuab,

drozitumumab, conatumumab, lexatumumab, tigatuzumab), death receptor agonists, such as Medi-3038 or Medi-3039, or a combination thereof.

Preferably, the kit comprises at least one control or reference sample. The kit may comprise a negative control and/or a positive control. A negative control may comprise a wild-type BAPi protein that is resistant to DRL-induced cell death. A positive control may comprise a mutant BAPi mRNA, or mutant BAPi protein, or a blank sample. The skilled person will appreciate that the level of mRNA in a sample is indicative of the level of gene expression in a cell.

The detection means is preferably configured to detect the expression or the concentration of a mutant BAPi protein or mRNA, or wild-type BAPi mRNA or BAPi protein in the biological sample taken from the test individual. The presence of the mutant BAPi mRNA or mutant BAPi protein, or reduced level of expression of wild- type BAPi mRNA or lower protein expression to the control, in the sample, is indicative that the test sample is sensitive to DRL-induced cell death. The level of expression of the wild-type BAPi mRNA or concentration of BAPi protein in the biological sample may be reduced or lower compared to the concentration or level of expression of the wild-type BAPi mRNA or protein in a negative control. The reduction in expression may be at least a 10%, 15%, 25%, 35%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or 100% reduction compared to the negative control. Similarly, the concentration of the wild-type BAPi protein in the biological sample maybe lower by at least a 10%, 15%, 25%, 35%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95% or 100%. Conversely, the absence of a mutant BAPi gene or protein, or normal to high expression of the wild-type BAPi gene or protein, in the sample, is indicative that the sample is insensitive to DRL-induced cell death.

Detection of a mutation in a BAPi gene or protein can be achieved using a number of sequencing approaches. In one approach, whole exome or targeted gene sequencing is undertaken with massively parallel sequencing of tumour DNA with target genes enriched using commercially available RNA baits. In another embodiment, a capillary sequencing approach is utilised with PCR primers designed to each of the exons in the BAPi gene footprint. Thus, the detection means may be a primer.

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 12 (chr3:52438255-524388i7F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 6 as follows:

acctagaacctggtagccttag

[SEQ ID No. 6]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 8 (01^3:52440631-52441138?) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 7 as follows:

gtacagctccagagagtagaac

[SEQ ID No. 7]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 1 (chr3:52443044-52444094F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 8 as follows:

tcttaccgaaatcttccacgag

[SEQ ID No. 8]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 3 (chr3:52443356-52443839F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 9 as follows:

ctgctgctttctgtgagatttt

[SEQ ID No. 9] In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 6 (chr3:52436404-52430905F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 10 as follows:

agggcattccagttaagacag

[SEQ ID No. 10] In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 17 (chr3:52436i05-52436652F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 11 as follows:

caagagtgggctgcagag

[SEQ ID No. 11]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 6 (0^3:52441201-52441691?) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 12 as follows:

actaaggccattctgcttctc

[SEQ ID No. 12]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 4 (0^3:52442276-52442837?) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 13 as follows:

atcccaccctccaaacaaag

[SEQ ID No. 13]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 13a (chr3:524372i8-52437786F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 14 as follows:

caccaagtggccagtgag

[SEQ ID No. 14] In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 13b (chr3:52437388-52437956F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 15 as follows:

ggctgtcatcctctccaaaa

[SEQ ID No. 15]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 13c (chr3:52437558-52438i25F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 16 as follows:

gagggctgcgagtgtgtg

[SEQ ID No. 16] In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 14 (chr3:52430940-52437529F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 17 as follows:

ctctgccaggattaaaggagaa

[SEQ ID No. 17]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 9 (chr3152440055-52440607?) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 18 as follows:

gaatgcagggagggttgg

[SEQ ID No. 18]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 5 (chr3:5244i76o-524423o8F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 19 as follows:

acccaatatcatgtggtagcat

[SEQ ID No. 19]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 2 (chr3:524435i6-52443974F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 20 as follows:

aaggacagcccctgatga

[SEQ ID No. 20]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 7 (chr3:52440976-5244i547F) of wild-type BAPi mRNA is referred to herein SEQ ID No. 21 as follows:

gtaggcagagacacccaac

[SEQ ID No. 21]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 15 (chr3:5243058i-52437i02F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 22 as follows:

ccttctctggtcatcaatctgt

[SEQ ID No. 22] In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 10 (0^3:52439567-52440143?) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 23 as follows:

ctctgaggtccacaagaggt

[SEQ ID No. 23]

In one embodiment, the nucleic acid sequence of a forward primer used to detect exon 11 (chr3:524389i2-52439525F) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 24 as follows:

tcaagtagagaatcctgcaagg

[SEQ ID No. 24]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 12 (chr3:52438255-524388i7R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 25 as follows:

gagcagcacttgtttgtaactg

[SEQ ID No. 25] In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 8 (chr3:5244063i-5244H38R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 26 as follows:

ctcaactgctcttctctgtctt

[SEQ ID No. 26]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 1 (chr3:52443044-52444094R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 27 as follows:

gagggagggcctggacat

[SEQ ID No. 27]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 3 (chr3:52443356-52443839R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 28 as follows:

ctgtccttccctactgctttc

[SEQ ID No. 28] In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 16 (^3:52436404-5243690511) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 29 as follows:

gaagttcaaggtgggtgatttc

[SEQ ID No. 29]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 17 (chr3:52436i05-52436652R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 30 as follows:

ctcagctcctggcctgag

[SEQ ID No. 30]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 6 (chr3:5244i20i-5244i69iR) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 31 as follows:

ggagaaattattctgatacggcc

[SEQ ID No. 31]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 4 (chr3:52442276-52442837R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 32 as follows:

gaagggaatgctgattgtcttc

[SEQ ID No. 32]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 13a (chr3:524372i8-52437786R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 33 as follows:

ctatccgctcagccaacc

[SEQ ID No. 33]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 13b (chr3:52437388-52437956R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 34 as follows:

ctctcaattcctctgtccatca [SEQ ID No. 34]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 13c (chr3:52437558-52438i25R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 35 as follows:

cgttcccttgcttcacatct

[SEQ ID No. 35]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 14 (chr3:52430940-52437529R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 36 as follows:

tcctgcactctgatgattttct

[SEQ ID No. 36] In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 9 (chr3:52440055-52440607R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 37 as follows:

gatatctgcctcaacctgatgg

[SEQ ID No. 37]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 5 (chr3:5244i76o-524423o8R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 38 as follows:

gtgctgtgtatgggtgacta

[SEQ ID No. 38]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 2 (chr3:524435i6-52443974R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 39 as follows:

gaagatgaataagggctggct

[SEQ ID No. 39]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 7 (chr3:52440976-5244i547R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 40 as follows:

tgatgtggggtgggagtag [SEQ ID No.40]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 15 (chr3:5243058i-52437i02R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 41 as follows:

cccgatcagaggtgcaat

[SEQ ID No. 41]

In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 10 (chr3:52439507-52440i43R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 42 as follows:

agctatttaaggtagaagcccg

[SEQ ID No. 42] In one embodiment, the nucleic acid sequence of a reverse primer used to detect exon 11 (chr3:524389i2-52439525R) of wild-type BAPi mRNA is referred to herein as SEQ ID No. 43 as follows:

actgtgagcttttcttggagat

[SEQ ID No. 43]

The skilled person would appreciate that the binding of an ASXL protein to a wild- type BAPi protein may be achieved using a variety of techniques known in the art, which include protein complex immunoprecipitation, Bimolecular Fluorescence complementation, Affinity electrophoresis, Immunoelectrophoresis, chemical cross linking, Proximity ligation assay and FRET.

The inventors believe that their findings (i.e. that cells containing a mutant BAPi gene or a mutant BAPi protein, or cells expressing reduced levels of a wild-type BAPi gene or with a lower concentration of BAPi protein, are sensitive to DRL-induced cell death) means that they have identified a robust biomarker for sensitivity to DRL- induced cell death.

Therefore, in a third aspect of the invention, there is provided a use of (i) a mutant BAPi gene or a mutant BAPi protein, or (ii) a cancer cell with a reduced level of expression of a wild-type BAPi gene or a lower wild-type BAPi protein concentration compared to the level of expression or protein concentration in a reference cell that is a BAPi wild-type cell, as a biomarker of sensitivity to DRL-induced cell death. The inventors have developed a method of treating subjects suffering from cancer, and especially those suffering from a cancer that is completely or partially insensitive to death receptor ligand-induced cell death.

In a fourth aspect, therefore, there is provided a method of treating an individual suffering from cancer, the method comprising:

(i) detecting for the presence of a mutant BAPi gene or mutant BAPi protein, or for a reduced level of expression of a wild-type BAPi gene or a lower wild-type BAPi protein concentration compared to the level of expression or protein concentration in a reference cell that is a BAPi wild-type cell that is resistant to DRL- induced cell death, or for reduced or non-binding of an ASXL protein to a wild-type BAPi protein compared to the level of binding in a reference cell that is a BAPi wild- type cell, which is resistant to DRL-induced cell death; and

(ii) administering a therapeutically effective amount of a death receptor ligand to the individual.

The death receptor ligand may be administered as a monotherapy or in combination with other agents that are capable of killing cancer cells.

The "subject" or "individual" may be a vertebrate, mammal, or domestic

animal. Hence, medicaments according to the invention may be used to treat any mammal, for example livestock (e.g. a horse), pets, or may be used in other veterinary applications. Most preferably, the subject is a human being.

As mentioned above, mesothelioma cells are resistant to the induction of cell death. This disruption of core-cell death machinery has been implicated in the resistance to conventional cytotoxic agents generally observed clinically. It is believed that disruption of cell death machinery is mediated downstream through elevated expression of anti-cell death proteins such as members of the LAP (inhibitors of apoptosis) family or the BCL-2 family. The LAP family consist of 8 members (BIRC2, BIRC3, BIRC5, BIRC6, BIRC7, BIRC8, NAIP, XIAP). The defining feature of an LAP protein is the presence of a ~70-amino acid baculovirus LAP repeat (BIR) domain that mediates protein-protein interactions (12). Through these domains, LAP members act as endogenous inhibitors of caspases, the main executioners of cell death, and act through either direct caspase inhibition or ubiquitin-mediated regulation of caspase degradation (13). The inventors have demonstrated that BAPi gene expression can be reduced in mesothelioma cell lines using a BAPi shRNA-expressing lentivirus and that this reduction of BAPi gene expression results in increased sensitivity to DLR-induced cell death in these cell lines. Accordingly, the inventors have determined that it is possible to sensitise to DRL-induced cell death, an individual suffering from a cancer that is normally insensitive to DRL-induced cell death, by administering a BAPi inhibitor. Thus, in a fifth aspect of the invention, there is provided a method of:

sensitising, to DRL-induced cell death, an individual that is suffering from a cancer that is insensitive to DRL-induced cell death, or

enhancing the sensitivity to DRL-induced cell death in an individual that is suffering from a cancer that is sensitive to DRL-induced cell death,

the method comprising administering, to the individual, a BAPi inhibitor or an agent that mimics the effect of BAPi inhibition.

Thus, a BAPi inhibitor is any agent that targets the BAPi gene or protein directly, whereas an agent that mimics the effect of BAPi inhibition is a molecule that targets a signalling molecule downstream of the BAPi gene/protein signalling pathway.

A BAPi inhibitor may be any molecule that inactivates BAPi protein function, such as a deubiquitinase inhibitor or antagonist, or which silences or reduces BAPi gene or protein expression or function (such as a small molecule inhibitor of BAPi), or which prevents or reduces binding of a wild-type BAPi protein to an ASXL protein. The

BAPi inhibitor or agent may also be any molecule that mutates a wild-type BAPi gene to create a mutant BAPi gene. Thus, the BAPi inhibitor or agent may be an RNAi molecule, including shRNA, siRNA, miRNA, ribozymes and antisense molecules; a TALEN (Transcriptional Activator Like-Effector Nuclease); or a CRISPR/CAS9 nuclease. The inventors have demonstrated in the Examples below that BAPi gene expression can be reduced in mesothelioma cell lines using shRNA expressing lentivirus and that this reduction of BAPi gene expression results in increased sensitivity to DLR-induced cell death in these cell lines. In addition to a BAPi inhibitor, an agent that mimics the effect of BAPi inhibition is an agent that targets signalling or effector molecules downstream of BAPi, such agents may be used to induce DLR resistance in cancer cell. In one embodiment, the BAPi inhibitor maybe an IAP inhibitor (a SMAC mimetic). An LAP maybe BIRC2, BIRC3, BIRC5, BIRC6, BIRC7, BIRC8, NAIP, XIAP or a fragment thereof. The inventors have found that BAPi expression increases the expression of BIRC3 protein and that inhibition of BIRC3 protein with an LAP inhibitor, such as LCL161, results in sensitization to DRL induced cell death. An LAP inhibitor is an agent that reduces expression or translation of an LAP, or renders an LAP functionally inactive.

The LAP inhibitor or agent may also be any molecule that mutates an LAP gene or protein to create a mutant LAP gene or protein. Thus, the LAPi inhibitor or agent may be an RNAi molecule, including shRNA, siRNA, miRNA, ribozymes and antisense molecules; a TALEN (Transcriptional Activator Like-Effector Nuclease); or a

CRISPR/CAS9 nuclease. An agent that mimics the effect of BAPi inhibition maybe an RNA helicase inhibitor, such as, YK-4279 or a tyrosine kinase inhibitor, such as sorafenib. The inventors believe that their surprising observation (i.e. that BAPi plays a role in regulating DRL-induced cell death of cancer cells) can be used to develop a novel targeted approach for treatment of any cancer comprising mutants of BAPi.

Thus, in a sixth aspect of the invention, there is provided a composition comprising (i) a BAPi inhibitor or an agent that mimics the effect of BAPi inhibition and (ii) a death receptor ligand.

In a seventh aspect, there is provided a composition comprising (i) a BAPi inhibitor or an agent that mimics the effect of BAPi inhibition and (ii) a death receptor ligand, for use in therapy or as a medicament.

In an eighth aspect, there is provided a composition comprising (i) a BAPi inhibitor or an agent that mimics the effect of BAPi inhibition and (ii) a death receptor ligand, for use in treating, preventing or ameliorating cancer.

In a ninth aspect, there is provided a method of treating, preventing or ameliorating an individual suffering from a cancer, the method comprising administering, to the individual, a therapeutically effective amount of the composition of the sixth aspect. The BAPi inhibitor or agent that mimics the effect of BAPi inhibition and the death receptor ligand may be administered simultaneously, or the BAPi inhibitor may be administered prior to the death receptor ligand. It will be appreciated that administration of the BAPi inhibitor first sensitizes the subject to DRL-induced cell death. Then, administration of the death receptor ligand can be effectively used to induce cell death in cancerous cells.

Preferably, the BAPi inhibitor is any molecule or approach which inactivates BAPi protein function, such as a deubiquitinase inhibitor or antagonist, or which silences or reduces BAPi gene transcription or BAPi protein expression, or which mutates a wild-type BAPi gene to create a BAPi mutant gene and protein. The BAPi inhibitor may be WP1130, Usp9x, Usp5, Uspi4, Usp24, UCH37, b-APi5, CRISPR/CAS9 or a small molecule inhibitor of BAPi.

Preferred death receptor ligands maybe, but are not limited to TRAIL, TNFalpha, FAS ligand (FASL), recombinant TRAIL (dulanermin), death receptor antibodies (such as mapatumuab, drozitumumab, conatumumab, lexatumumab, tigatuzumab, LBY-135) or death receptor agonists such as Medi 3038 or Medi 3039, or a combination thereof.

Mesothelioma (or Malignant Pleural Mesothelioma) is a rare form of cancer that develops from cells of the mesothelium, the protective lining that covers many of the internal organs of the body. The most common anatomical site for mesothelioma is the pleura (the outer lining of the lungs and internal chest wall), but it can also arise in the peritoneum (the lining of the abdominal cavity), the pericardium (the sac that surrounds the heart) or the tunica vaginalis (a sac that surrounds the testis). Thus, the cancer which may be treated according to any aspect of the invention may be selected from mesothelioma, Malignant Pleural Mesothelioma, uveal melanoma, melanoma, non-melanoma skin cancer, renal cancers, cholangiocarcinomas, lung cancers, cancer of the pleura, abdominal cancer, peritoneal cancer, cancer of the pericardium, head and neck cancers, brain cancers, breast cancers, liver and biliary tract cancers, gastrointestinal cancers including upper and lower tracts, urothelial cancers, prostate cancers, testicular cancer, cancer of the tunica vaginalis, ovarian cancers, cervical cancers, sarcomas, lymphomas and leukaemia.

More preferably, the cancer which is treated is mesothelioma. Most preferably, the cancer which is treated is an asbestos-induced cancer. The compositions according to the invention may have a number of different forms depending, in particular, on the manner in which the composition is to be used. Thus, for example, the composition may be in the form of a powder, tablet, capsule, liquid, ointment, cream, gel, hydrogel, aerosol, spray, micellar solution, transdermal patch, liposome suspension or any other suitable form that may be administered to a person or animal in need of treatment. It will be appreciated that the vehicle of medicaments according to the invention should be one which is well tolerated by the subject to whom it is given. Compositions according to the invention may be used in a number of ways. For instance, oral administration may be required, in which case the agents may be contained within a composition that may, for example, be ingested orally in the form of a tablet, capsule or liquid. Compositions comprising agents of the invention maybe administered by inhalation (e.g. intranasally). Compositions may also be formulated for topical use. For instance, creams or ointments may be applied to the skin.

Agents or compositions according to the invention may also be incorporated within a slow- or delayed-release device. Such devices may, for example, be inserted on or under the skin, and the medicament may be released over weeks or even months. The device may be located at least adjacent to the treatment site. Such devices may be particularly advantageous when long-term treatment with agents used according to the invention is required and which would normally require frequent administration (e.g. at least daily injection).

In a preferred embodiment, compositions and agents according to the invention maybe administered to a subject by injection into the blood stream or directly into a site requiring treatment. For example, the medicament may be injected at least adjacent to a sensitive cell, or within a tumour. Injections maybe intravenous (bolus or infusion) or subcutaneous (bolus or infusion), or intradermal (bolus or infusion), or intrapleural.

It will be appreciated that the amount of the composition and agent that is required is determined by its biological activity and bioavailability, which in turn depends on the mode of administration, the physicochemical properties of the modulator and whether it is being used as a monotherapy or in a combined therapy. The frequency of administration will also be influenced by the half-life of the BAPi inhibitors and DRLs within the subject being treated. Optimal dosages to be administered may be determined by those skilled in the art, and will vary with the particular agent in use, the strength of the pharmaceutical composition, the mode of administration, and the advancement of the cancer. Additional factors depending on the particular subject being treated will result in a need to adjust dosages, including subject age, weight, gender, diet, and time of administration.

Generally, a daily dose of between o.o^g/kg of body weight and 500mg/kg of body weight of the agents (e.g. the inhibitor or the DRL) according to the invention may be used for treating, ameliorating, or preventing cancer, depending upon which agent is used. More preferably, the daily dose is between o.oimg/kg of body weight and 400mg/kg of body weight, more preferably between o.img/kg and 200mg/kg body weight, and most preferably between approximately lmg/kg and loomg/kg body weight.

The composition or agent(s) may be administered before, during or after onset of the cancer. Daily doses may be given as a single administration (e.g. a single daily injection). Alternatively, the agent may require administration twice or more times during a day. As an example, agents may be administered as two (or more depending upon the severity of the disease being treated) daily doses of between 25mg and 7000 mg (i.e. assuming a body weight of 70 kg). A subject receiving treatment may take a first dose upon waking and then a second dose in the evening (if on a two dose regime) or at 3- or 4-hourly intervals thereafter.

Alternatively, a slow release device may be used to provide optimal doses of agents according to the invention to a patient without the need to administer repeated doses.

Known procedures, such as those conventionally employed by the

pharmaceutical industry (e.g. in vivo experimentation, clinical trials, etc.), may be used to form specific formulations comprising the agents according to the invention and precise therapeutic regimes (such as daily doses of the agents and the frequency of administration). The inventors believe that they are the first to describe a pharmaceutical composition for treating cancer, based on the use of a BAPi inhibitor to sensitise the subject to death receptor-induced cell death, and a death receptor ligand, which induces cell death of the cells that express death receptors and previously insensitive to death receptor-induced cell death. According to a tenth aspect, there is provided a pharmaceutical composition comprising the composition according to the sixth aspect, and a pharmaceutically acceptable vehicle.

According to an eleventh aspect, there is provided a method for preparing the pharmaceutical composition according to the tenth aspect, the method comprising contacting a therapeutically effective amount of a BAPi inhibitor or agent that mimics the effect of BAPi inhibition and a death receptor ligand, and a pharmaceutically acceptable vehicle.

A "therapeutically effective amount" of BAPi inhibitor is any amount which, when administered to a subject, is the amount needed to sensitise an individual's cells to death receptor-induced cell death. A "therapeutically effective amount" of death receptor ligand is any amount which, when administered to a subject, is the amount needed to treat the cancer, or produce the desired effect.

For example, the therapeutically effective amount of active agent (i.e. BAPi inhibitor and a death receptor ligand) used maybe from about o.oi mg/kg body weight to about 8oo mg/kg body weight, and preferably from about o.oi mg to about 500 mg. It is preferred that the amount of agent is an amount from about o.i mg to about 250 mg, and most preferably from about 0.1 mg/ kg body weight to about 20 mg/ kg body weight. A "pharmaceutically acceptable vehicle" as referred to herein, is any known compound or combination of known compounds that are known to those skilled in the art to be useful in formulating pharmaceutical compositions.

In one embodiment, the pharmaceutically acceptable vehicle maybe a solid, and the composition may be in the form of a powder or tablet. A solid

pharmaceutically acceptable vehicle may include one or more substances which may also act as flavouring agents, lubricants, solubilisers, suspending agents, dyes, fillers, glidants, compression aids, inert binders, sweeteners, preservatives, dyes, coatings, or tablet-disintegrating agents. The vehicle may also be an encapsulating material. In powders, the vehicle is a finely divided solid that is in admixture with the finely divided active agents according to the invention. In tablets, the active agent (e.g. the peptide, antibody, DRL or BAPi inhibitor) may be mixed with a vehicle having the necessary compression properties in suitable proportions and compacted in the shape and size desired. The powders and tablets preferably contain up to 99% of the active agents. Suitable solid vehicles include, for example calcium phosphate, magnesium stearate, talc, sugars, lactose, dextrin, starch, gelatin, cellulose, polyvinylpyrrolidone, low melting waxes and ion exchange resins. In another embodiment, the pharmaceutical vehicle may be a gel and the composition may be in the form of a cream or the like. However, the pharmaceutical vehicle may be a liquid, and the pharmaceutical composition is in the form of a solution. Liquid vehicles are used in preparing solutions, suspensions, emulsions, syrups, elixirs and pressurized compositions. The active agent according to the invention may be dissolved or suspended in a pharmaceutically acceptable liquid vehicle such as water, an organic solvent, a mixture of both or pharmaceutically acceptable oils or fats. The liquid vehicle can contain other suitable pharmaceutical additives such as solubilisers, emulsifiers, buffers, preservatives, sweeteners, flavouring agents, suspending agents, thickening agents, colours, viscosity regulators, stabilizers or osmo- regulators. Suitable examples of liquid vehicles for oral and parenteral administration include water (partially containing additives as above, e.g.

cellulose derivatives, preferably sodium carboxymethyl cellulose solution), alcohols (including monohydric alcohols and polyhydric alcohols, e.g. glycols) and their derivatives, and oils (e.g. fractionated coconut oil and arachis oil). For parenteral administration, the vehicle can also be an oily ester such as ethyl oleate and isopropyl myristate. Sterile liquid vehicles are useful in sterile liquid form compositions for parenteral administration. The liquid vehicle for pressurized compositions can be a halogenated hydrocarbon or other pharmaceutically acceptable propellant. Liquid pharmaceutical compositions, which are sterile solutions or suspensions, can be utilised by, for example, intramuscular, intrathecal, epidural,

intraperitoneal, intravenous and particularly subcutaneous injection. The composition or antibody may be prepared as a sterile solid composition that may be dissolved or suspended at the time of administration using sterile water, saline, or other appropriate sterile injectable medium. The agents and compositions of the invention may be administered orally in the form of a sterile solution or suspension containing other solutes or suspending agents (for example, enough saline or glucose to make the solution isotonic), bile salts, acacia, gelatin, sorbitan monoleate, polysorbate 80 (oleate esters of sorbitol and its anhydrides copolymerized with ethylene oxide) and the like. The agent or composition according to the invention can also be administered orally either in liquid or solid composition form. Compositions and agents suitable for oral administration include solid forms, such as pills, capsules, granules, tablets, and powders, and liquid forms, such as solutions, syrups, elixirs, and suspensions. Forms useful for parenteral administration include sterile solutions, emulsions, and suspensions.

It will be appreciated that the invention extends to any nucleic acid or peptide or variant, derivative or analogue thereof, which comprises substantially the amino acid or nucleic acid sequences of any of the sequences referred to herein, including variants or fragments thereof. The terms "substantially the amino acid/nucleotide/peptide sequence", " variant" and "fragment", can be a sequence that has at least 40% sequence identity with the amino acid/nucleotide/peptide sequences of any one of the sequences referred to herein, for example 40% identity with the polypeptide identified as SEQ ID Nos. 3 or 4, and so on.

Amino acid/polynucleotide/polypeptide sequences with a sequence identity which is greater than 50%, more preferably greater than 65%, 70%, 75%, and still more preferably greater than 80% sequence identity to any of the sequences referred to are also envisaged. Preferably, the amino

acid/polynucleotide/polypeptide sequence has at least 85% identity with any of the sequences referred to, more preferably at least 90%, 92%, 95%, 97%, 98%, and most preferably at least 99% identity with any of the sequences referred to herein.

The skilled technician will appreciate how to calculate the percentage identity between two amino acid/polynucleotide/polypeptide sequences. In order to calculate the percentage identity between two amino

acid/polynucleotide/polypeptide sequences, an alignment of the two sequences must first be prepared, followed by calculation of the sequence identity value. The percentage identity for two sequences may take different values depending on:- (i) the method used to align the sequences, for example, ClustalW, BLAST, ASTA, Smiih-Waierman (implemented in different programs), or structural alignment from 3D comparison; and (ii) the parameters used by the alignment method, for example, local vs global alignment, the pair-score matrix used (e.g. BLOSUM62, PAM250, Gonnet etc.), and gap-penalty, e.g. functional form and constants.

Having made the alignment, there are many different ways of calculating percentage identity between the two sequences. For example, one may divide the number of identities by: (i) the length of shortest sequence; (ii) the length of alignment; (iii) the mean length of sequence; (iv) the number of non-gap positions; or (iv) the number of equivalenced positions excluding overhangs. Furthermore, it will be appreciated that percentage identity is also strongly length dependent. Therefore, the shorter a pair of sequences is, the higher the sequence identity one may expect to occur by chance. Hence, it will be appreciated that the accurate alignment of protein or DNA sequences is a complex process. The popular multiple alignment program ClustalW (Thompson et al, 1994, Nucleic Acids Research, 22, 4673-4680; Thompson et al, 1997, Nucleic Acids Research, 24, 4876-4882) is a preferred way for generating multiple alignments of proteins or DNA in accordance with the invention.

Suitable parameters for ClustalW may be as follows: For DNA alignments: Gap Open Penalty = 15.0, Gap Extension Penalty = 6.66, and Matrix = Identity. For protein alignments: Gap Open Penalty = 10.0, Gap Extension Penalty = 0.2, and Matrix = Gonnet. For DNA and Protein alignments: ENDGAP = -1, and GAPDIST = 4. Those skilled in the art will be aware that it may be necessary to vary these and other parameters for optimal sequence alignment. Preferably, calculation of percentage identities between two amino acid/polynucleotide/polypeptide sequences may then be calculated from such an alignment as (N/T)*ioo, where N is the number of positions at which the sequences share an identical residue, and T is the total number of positions compared including gaps but excluding overhangs. Hence, a most preferred method for calculating percentage identity between two sequences comprises (i) preparing a sequence alignment using the ClustalW program using a suitable set of parameters, for example, as set out above; and (ii) inserting the values of N and T into the following formula: - Sequence Identity = (N/T)*ioo.

Alternative methods for identifying similar sequences will be known to those skilled in the art. For example, a substantially similar nucleotide sequence will be encoded by a sequence which hybridizes to any sequences referred to herein or their complements under stringent conditions. By stringent conditions, we mean the nucleotide hybridises to filter-bound DNA or RNA in 3x sodium

chloride/sodium citrate (SSC) at approximately 45°C followed by at least one wash in o.2x SSC/o.i% SDS at approximately 20-65°C. Alternatively, a

substantially similar polypeptide may differ by at least l, but less than 5, 10, 20, 50 or 100 amino acids from the sequences shown in SEQ ID Nos. 3 or 4.

Due to the degeneracy of the genetic code, it is clear that any nucleic acid

sequence described herein could be varied or changed without substantially affecting the sequence of the protein encoded thereby, to provide a variant thereof. Suitable nucleotide variants are those having a sequence altered by the substitution of different codons that encode the same amino acid within the sequence, thus producing a silent change. Other suitable variants are those having homologous nucleotide sequences but comprising all, or portions of, sequence, which are altered by the substitution of different codons that encode an amino acid with a side chain of similar biophysical properties to the amino acid it substitutes, to produce a conservative change. For example small non- polar, hydrophobic amino acids include glycine, alanine, leucine, isoleucine, valine, proline, and methionine. Large non-polar, hydrophobic amino acids include phenylalanine, tryptophan and tyrosine. The polar neutral amino acids include serine, threonine, cysteine, asparagine and glutamine. The positively charged (basic) amino acids include lysine, arginine and histidine. The negatively charged (acidic) amino acids include aspartic acid and glutamic acid. It will therefore be appreciated which amino acids may be replaced with an amino acid having similar biophysical properties, and the skilled technician will know the nucleotide sequences encoding these amino acids.

All of the features described herein (including any accompanying claims, abstract and drawings), and/ or all of the steps of any method or process so disclosed, may be combined with any of the above aspects in any combination, except combinations where at least some of such features and/ or steps are mutually exclusive.

For a better understanding of the invention, and to show how embodiments of the same may be carried into effect, reference will now be made, by way of example, to the accompanying diagrammatic drawings, in which:- Figure lA shows various types of mutations in different malignant pleural mesothelioma (MPM) cell lines. Figure lB is an analysis of TCGA exomes for enrichment of BAPi loss of function mutations. Figure lc is a schematic of BAPi gene exons with Mutations annotated from 5180 TCGA exomes.

Figure 2A is a volcano plot showing drug-genome interactions in MPM. The volcano plot displays the mean delta AUC by genotype for 92 library compounds. The Y-axis denotes adjusted p-Value, X-axis denotes effect size. Size of circle indicates number of mutant lines in cohort tested. Figure 2B is a histogram which shows the results of a 6-day viability assay for multiple mesothelioma cell lines (n=i9). rTRAIL

(40ng/ml). Met 5a is a mesothelial normal control line. Figure 2C is a scatter plot showing AUC following 6 day viability assay in response to 40ng/ ml rTRAIL

(normalised to DMSO treated control) in cell lines discretized by BAPi mutation status. BAPi mutation status significantly correlates with response to rTRAIL. Two- tailed t-test, p=o.oi5.

Figure 3A shows the results of a viability assay in which various MPM cells lines are treated with rTRAIL. MPM cell lines were treated with a dose range from o.5ng/ml to loong/ ml and cell viability was measured using Syto-60 assay. Based on their cell viability, the cell lines were classified into resistant (red), partially sensitive (orange) and sensitive (green). Cell lines were western blotted to probe the expression of BAPi protein expression. Figure 3B shows the results of a viability assay in which various MPM cells lines are treated with rTRAIL. Three BAPi wild-type cell lines (MPP-89, H2869 & H2818) and four BAPi mutant cell lines (H2722, H2461, H28 and H2731) were treated with TRAIL (0-1000 ng/ml) for 24 hours and cell death quantified using an Annexin V/DAPI cell death assay.

Figure 4 is a graph (and Western blot), which shows that knocking down BAPi in a BAPi wild-type mesothelioma cell line H2818 confers increased cell death response to rTRAIL.

Figure 5A is an immunoblot for BAPi protein in BAPi null mesothelioma lines following transfection with empty vector and BAPi expression vector. Figure 5B is a dose-response curve for an Annexin V/DAPI cell death assay performed with rTRAIL on the BAPi null H226 parental line, a BAPi wt overexpressing stable line, and BAPi C91 hydrolase inactive stable cell line. Figure 5C is a graph showing the effect of rTRAIL on cell viability of an untransduced H226 cell line, a BAPi (transduced) cell line, and a H226 cell line with the NLS deleted.

Figure 6A shows that cell death is significantly dysregulated with the loss of the BAPi catalytic ubiquitin hydrolation domain. Comparing GEX profile of C91 variant (catalytically inactive) BAPi transduced H226 with H226 BAPi wild-type transduced H226 Kegg pathway analysis on significantly dysregulated genes analysis with adj p <0.05 and FDR <20%. Figure 6B is a graph showing RMA normalised gene centered mRNA expression of LAP genes BIRC2 and BIRC3 in C91 mutant BAPi vs wild-type BAPi expressing H226 cell line. The Western blot shows dysregulation of LAP family proteins in H226 cell line expressing catalytically inactivated C91 mutant BAPi.

Figure 7A is a volcano plot showing drug-genome interactions when rTRAIL was used as an anchor drug in combination with the library of 94 single agent

compounds. Synergy was described using delta AUC metric. Figure 7B & 7C are graphs showing the effect of rTRAIL on cell viability of MPM cells in the presence of LCL161. TRAIL resistant MPM cells were treated with either 0-1000 ng/ml of TRAIL alone or a combination of 5 μΜ LCLi6i and 0-1000 ng/ml of TRAIL for 24 hours and cell death was quantified by Annexin V/DAPI assay. Figure 7D is a graph showing the effect of rTRAIL on cell viability of cells in the presence of the LAP inhibitor, LCL161. BAPi-transduced or BAPi C9iA-transduced H226 cells were treated either with 0-1000 ng/ml of TRAIL alone or combination of 5 μΜ LCLi6i and 0-1000 ng/ml of TRAIL for 24 hours and cell death was quantified by Annexin V/DAPI assay.

Figure 8A is a graph showing the effect of rTRAIL on the viability of various cancer cell lines. Bladder (RT4) and Breast (HCC1187) cancer cell lines with nonsense mutations in BAPi show sensitivity to rTRAIL while renal cell cancer cell lines (769P & RCC10RGB) with missense mutation and wild-type renal (BB65RCC) and bladder cancer (SW1710) cell lines are resistant to TRAIL. Figure 8B shows that knockdown of BAPi in Breast cancer cell line MDA MB-231 increases sensitivity to rTRAIL.

Figure 9A is a protocol of an in vivo experiment. Figure 9B is a box plot showing the weight of tumours extracted from mice injected with mutant or wild-type BAPi- expressing cells after treatment with rTRAIL. Tumour weights of mutated BAPi xenografts are significantly smaller than wild-type BAPi xenografts after TRAIL treatment. Figure 9C is a graph showing that TRAIL treatment reduces the tumour burden (measured by bioluminescence) of mutated BAPi xenografts when compared to TRAIL treated wild-type BAPi xenografts or untreated BAPi mutated and BAPi wild-type xenografts. Figure io is a graph, which shows that BAPi the that catalytic domain of BAPi also regulates the sensitivity of H226 cells to the cell death-inducing ligands, TRAIL, FASL and TNFa. Untransduced BAPi-negative H226 cells, BAPi-expressing and catalytically dead BAPi-expressing H226 cells were treated with 100 ng/ml of FASL, TRAIL and TNF-alpha for 24 hours and cell death was quantified by Annexin V/DAPI assay. * p<0.05 indicating significant difference between untransduced H226 cells H226 BAPi expressing cells. NS no significant difference between untransduced H226 cells and BAPi C91A transduced cells. # p<0.05 indicating significant difference between untransduced H226 cells and BAPi C91A transduced cells. Figure 11 is a graph, which shows that BAPi that catalytic domain of BAPi also regulates the sensitivity of H226 cells to the cell death inducing ligands, TRAIL, FASL and TNFa. Untransduced BAPi-negative H226 cells, BAPi-expressing, ASXL binding site deleted BAPi-expressing H226 cells and catalytically dead BAPi-expressing H226 cells were treated with 100 ng/ml of FASL, TRAIL and TNF-alpha for 24 hours and cell death was quantified by Annexin V/DAPI assay.

Examples

The inventors have discovered that mutation of the BAPi tumour suppressor gene confers sensitivity to therapeutic modulation of the apoptotic pathway in human cancers. They have explored and validated this association in malignant pleural mesothelioma, bladder carcinoma and breast carcinoma and have evidence that it can be extended to between 1-36% human cancers, including renal cell carcinoma, and cervical cancer and uveal melanoma. Although the data described herein focuses on rTRAIL, a recombinant protein that activates the TRAIL pathway by binding to TRAIL receptor 1 (TRAIL-Ri, also known as death receptor 4; DR4) and TRAIL-R2 (also known as DR5), BAPi is also found to modulate other pro-apoptotic pathways, such as the FAS ligand pathway or the TNF pathway or intrinsic apoptotic pathway (see Example 6). MATERIALS AND METHODS

Whole exome sequencing DNA was extracted using the column extraction technique as per manufacturer's instructions (QIAGEN). Genomic libraries were prepared using the Illumina paired end sample prep kit following the manufacturer's instructions. Exome enrichment was performed using the Agilent SureSelect Human All Exon 50Mb kit following the manufacturer's recommended protocol. Each exome was sequenced using the 75-bp paired end protocol on an Illumina HiSeq 2000 DNA Analyser to produce

approximately 5-10 Gb of sequence per exome. Sequencing reads were aligned to the human genome (NCBI build GrCh 37) using the Burrows- Wheeler aligner (BWA) algorithm with default settings (17). Unmapped reads and PCR duplicates were excluded from the analysis. Average coverage of the cell line exomes at 20x or higher was 80%.

Copy Number Annotation

DNA was extracted as above. DNA was outsourced to AROS for SNP 6.0 array (httx)://arOsSab/seivices/rakiroarrays/genotyping/). Copy number annotation was derived from the PICNIC algorithm [18].

Variant detection

The CaVEMan algorithm was used to call single nucleotide substitutions [19]. The algorithm uses a na ^' ive Bayesian classifier to estimate the posterior probability of each possible genotype (wild-type, germline or somatic mutation) at each base. To call insertions and deletions, split read mapping was implemented as a modification of the Pindel Algorithm [19]. Pindel searches for one read anchored on the genome with the other read mapped in two portions, spanning a putative insertion/ deletion. For both algorithms, an identical putative normal from the CGP panel of tumours was nominated that has been used in all cell lines studied without available matched normal tissue. Significant post processing filtering against various panels of normal was subsequently undertaken to eliminate as many germline single nucleotide polymorphisms as possible. These include the 1000 genomes database, DB SNP, and an internal panel of CGP normal. Following these steps missense variants were annotated using the FATHM algorithm (Cancer Genome Project) as to potential functional consequence of the variant.

Combination (genome-drug) therapeutic screen approaches

Manual "single dose" combination screening was undertaken using 96 well formats. Cells were plated on day 1 in previously optimized seeding densities in ιδθμΐ if media. On day 2 20 μΐ of a 10X concentration of media from a stock of drugs was added. Cells were then allowed to grow for 72hrs or 6 days and fixed at the end of the assay. Drug wells were compared to DMSO treated control wells.

Single agent high throughput 5 point viability screening was undertaken in 384 well formats [18] using robotic liquid handling with fixing with 4% paraformaldehyde and staining for viability with Syto6o nucleic acid dye (Invitrogen) (see below). Single agent dose response curves were derived for each library of 85-95 drugs according to the experiment used, and log IC50 or area under the curve (AUC) metrics were derived for each library compound in each cell line according to a previously derived formula [18]. Using this data various 2-drug synergy was measured with a Delta AUC metric.

A binary event matrix was compiled for the cell lines in the mesothelioma screen by aggregating copy number and exome data and this was used as input classifiers for genomic correlation. Data from this therapeutic screen was then analysed using a Multivariate Analysis of Variance (MANOVA) [18] to annotate the sensitizing effect of genotype on dose response. The results are presented as a volcano plot

demonstrating significance of the interaction (above a Benjamin Hochberg false discovery threshold) and magnitude of effect size.

Analyses ofTCGA data

Frequency of BAPi truncating mutations in various cancer types is based upon data generated by The Cancer Genome Atlas (TCGA) Research Network:

http:/ / cancergenome.nih.gov/.

Cell culture

293T cells were cultured in Dulbecco's modified Eagle's medium (DMEM) supplemented with 10% fetal bovine serum (FBS), nonessential amino acids, 50 U/mL penicillin, 50 g/mL streptomycin, and 1% sodium pyruvate. Human mesothelioma cell lines were cultured in RPMI-1640 medium supplemented with 10% FBS, 1% penicillin-streptomycin and 1% sodium pyruvate (H2369, H2373, H2461, H2591, H2595, H2722, H2731, H2795, H2803, H2804, H2869, H290, H513, IST-MESi, MPP-89, MSTO-211H, NCI-H2052, NCI-H2452, NCI-H226, NCI-H28) or Dulbecco's Modified Eagle Medium/Nutrient Mixture F-12 (DMEM/F-12) supplemented with 10% FBS, nonessential amino acids, 50 U/mL penicillin, 50 g/mL streptomycin, and 1% sodium pyruvate (H2818, H2810). Cells were maintained at 37°C at 5% C0 ₂ . Western blotting

Cell monolayers were washed in phosphate buffered saline (PBS) and lysed in radioimmunoprecipitation assay (RIPA) buffer (Sigma-Aldrich) and protease inhibitors (Complete-mini; Roche) on ice. Lysates were centrifuged at 14000 rpm for ten minutes and the supernatant aspirated. Protein concentration was calculated from a standard curve of bovine serum albumin using the BCA assay (Calbiotech) according to the manufacturer's instructions. Lysates were prepared to the appropriate concentration and 4x Laemelli buffer and ιοχ reducing agent added prior to the sample being heated at 70°C for ten minutes. Lysates were subjected to SDS- PAGE on pre- cast 4-12% Bis-Tris gels (Invitrogen) at 200V for 1 hr. Protein was transferred onto a nitrocellulose membrane using an iBlot gel transfer device (Invitrogen) as per manufacturer's instructions. Membranes were blocked in 5% milk in tris-buffered saline with Tween 20 (TBS-T) before the addition of primary antibody (at 1:1000 in TBS-T unless otherwise stated) overnight at 4°C. The following day the membrane was washed three times in TBS-T and secondary antibody added (at 1:2500 in TBS-T) Antibodies used include BAPi (C-4; Santa Cruz sc-28383), alpha tubulin (Cell Signalling #2125), c-IAPi (Cell signaling #7065), cIAP2 (Cell signaling, #3130), Livin (Cell Signalling #5471), Survivin (Cell signaling, #2803), Alexa Fluor® 488 (Invitrogen A-21202). Immunoblots were imaged using an ImageQuant™ LAS 4000 biomolecular imager.

Cell viability assays

Adherent cell lines were seeded 24 hours before drugging. Cells were trypsinised and counted before seeding at the optimal density for the size of well (96 or 384) and duration of assay. 72hr after drug treatment cells were fixed with 4%

paraformaldehyde for 30 minutes. Following two washes of dH20 Ιθθμΐ Syto6o nucleic acid stain (Invitrogen) was added at a final concentration of ΐμΜ and plates fixed for lhr at room temperature. Quantification of fluorescent signal was achieved using excitation/ emission wavelength of 630/695 nM.

Cell death assays

Adherent mesothelioma cell lines were plated in a 96 well plate at

approximately 10000 cells per well. Cells were plated and given 1 day to adhere at which time drug was added. After 48 hrs media, including floating cells, was collected from each well. The remaining adherent cells were washed with PBS and mobilised with 0.05% trypsin in EDTA. All cells were collected into tubes containing the previously removed media and pelleted by centrifugation (300g, 5 minutes). Cells were then re-suspended in lX Annexin V binding buffer with ιομΐ/iml

concentration of Annexin V-647 antibody (Invitrogen) and incubated for 15 minutes at room temperature. DAPI was then added to each sample before flow cytometry analysis as below. Annexin V-/DAPI- cells were judged to be viable, AnnexinV+/DAPI- cells were considered to be undergoing apoptosis (early apoptotic phase), and Annexin V+/DAPI+ cells were considered late apoptotic or necrotic, and recorded as dead.

Flow cytometry analyses

Cells were washed with phosphate buffered saline and fixed by incubation in 4% paraformaldehyde for 20 minutes at room temperature. For intracellular BAPi staining, fixed cells were permeabilised in 0.1% triton X-100 in PBS for 20 minutes on ice, washed twice with PBS, incubated with primary antibody (C-4; Santa Cruz sc- 28383, 1:100) for 20 minutes on ice, washed twice again and incubated with a fluorescent secondary antibody (Alexa Fluor® 488, 1:200 (Invitrogen A-21202)). Cells were washed twice with PBS and suspended in PBS for flow cytometry analysis. Cells analysed as part of the cell death assays were prepared as above. Flow cytometry analysis was conducted on an LSRFortessa cell analyser (BD

Biosciences) and data analysed with FlowJo software. mRNA microarray

The mRNA from catalytically inactive BAPi expressing H226 cells (H226 C91A) and WT BAPi expressing H226 cells (H226 BAPi) was extracted and run on an Illumina HT12 array.

Pathway analysis

The significantly differentially expressed genes identified from the mRNA microarray were analysed using KEGG pathway analysis.

Plasmids

The cDNA full-length clone of human BAPi was obtained in a pCMV6-AC backbone (Origene, SC117256), which was cloned into a PCCL.CMVlentiviral backbone for all further experiments. BAPi mutant constructs were generated using site directed mutagenesis kits (NEB) and confirmed by full length DNA sequencing. Short hairpin RNAs were obtained through UCL RNAi library in a GIPZ shRNAmir lentiviral vector (Dharmacon V2LHS41473). The sequence (SEQ ID NO. 44) for the short hairpin is as follows:

TAAAGGTGCAGATGAACTC

[SEQ ID NO. 44]

Lentivirus production and concentration

Lentiviruses were generated by transfection of 293T cells with the lentivirus vector plasmids together with the packaging plasmid pCMVdR8.2 and envelope plasmid pMDG.2 using jetPEI (Polyplus Transfection) as the transfection reagent. The 293T cells were incubated at 37°C and the medium containing the lentiviruses harvested at 24 and 48 hrs. The lentivirus was concentrated by ultracentrifugation at i8ooorpm for 2hours at 4°C (SW28 rotor, Optima LE80K Ultracentrifuge, Beckman) and stored at -8o°C before use.

Lentivirus titration was performed by transducing 293T cells with serial dilutions of virus in the presence of 4μg/ ml polybrene. After 4 days cells were analyzed for the percentage of BAPi positive cells using flow cytometry. Viral was calculated as follows:

Titre (transduction units (TU)/ml) = Proportion of BAPi positive cells x number of seeded cells / volume of virus (ml) MPM cells were then transduced with a range of multiplicity of infections (MOIs) in the presence of 4μg/ ml polybrene and transduction efficacy assessed by flow cytometry analysis. The optimal population (lowest MOI at which >go% transduction achieved) was selected for further experiments. shRNA experiments

Lentivirus encoding shRNA targeting BAPi was generated as per the lentivirus production protocol above. MPM cells (H2818) were transduced and treated with puromycin until a pure population was achieved. Immunoblotting was performed to assess efficacy of the shRNA knockdown. Animals All animal studies were approved by the University College London Biological Services Ethical Review Committee and licensed under the UK Home Office regulations and the Evidence for the Operation of Animals (Scientific Procedures) Act 1986 (Home Office, London, UK). Mice were purchased from Charles River, kept in individually ventilated cages under specific pathogen-free conditions and had access to sterile-irradiated food and autoclaved water ad libitum.

Xenograft mouse models

Groups of 8 week old NOD.CBi7-Prkdcscid/NcrCrl (NOD SCID) mice (Charles River) were injected on each flank with 1 million cells of luciferase transduced mesothelioma cell lines (H226 BAP and H226 C91A) in a 1:1 mixture of matrigel and media. When tumours were established, as assessed by bioluminescent imaging (rVTS), at 14 days following injection of tumour cells, treatment was began with either vehicle or isoleucine zipper TRAIL (izTRAIL) [20]. Either vehicle or izTRAIL were given intraperitoneally once daily at a dose of 6oomcg for the duration of the experiment. Tumour size was assessed at days o, 13, 19, 26 and 41 using bioluminescent imaging (rVTS). Mice were culled at 42 days and tumours removed and weighed. Six mice per group were treated. Researchers were not blinded in these experiments. Statistical analyses

Statistical analysis was performed using GraphPad Prism V.4 (GraphPad Software). In vivo experiments with multiple groups were analysed using repeated measures ANOVA, and single-group data were assessed using Student t test. All in vitro experiments were performed in triplicate unless specified otherwise.

Example 1 - TRAIL targets BAPi mutant mesothelioma cells

The inventors carried out a combinatorial chemical screen in 15 mesothelioma cell lines (together with the Met5a mesothelial normal control line) using 94 small molecule inhibitors and chemotherapy agents (see Table 1) either alone or in combination with the ligand tumour necrosis factor (TNF)-related cell death inducing ligand (TRAIL). To detect examples of extreme drug sensitivity, the inventors analysed for statistical associations between response and the mutational status of these cell lines based on a set of 8 genes recently identified as being candidate cancer genes in mesothelioma (see Figure lA). Of note BAPi mutations are well recognised across cancer types (see Figure lB and C). The largest effect of a mutation on drug response was that of mesothelioma cells harbouring a mutation in the deubiquitinase BAPi and treated with TRAIL (see Figure 2A). There was no significant effect on cell viability observed in the control normal mesothelial cell line MET-5A included in the screen (see Figure 2B). BAPi mutant cells were significantly more sensitive to TRAIL than their wild-type counterparts (see Figures 2B & 2C). Furthermore, the BAPi

mutations detected in these cell lines would be predicted to be truncating (see Table

2). The inventors confirmed by immunoblot that BAPi mutations were usually

associated with loss of protein expression and the mutant cell lines are generally

sensitive to TRAIL (see Figure 3A).

Table 1 - Compounds used in combinatorial chemical screen with 15 mesothelioma

cell lines together with the Metsa mesothelial normal control line.

max

Targeted min cone

\ compound target cone process/pathway (uM)

(uM)

! AICAR AMPK agonist metabolism 7.81 2000

: Camptothecin DNA topoisomerase I DNA replication 0.0004 0.1

: Vinblastine Microtubules cytoskeleton 0.0004 0.1

; Cisplatin DNA crosslinking DNA replication 0.0234 6 ! Docetaxel Microtubules cytoskeleton 0.0000 0.0125 ! Gefitinib EGFR EGFR signalling 0.0020 0.5

! ABT-263 Bcl-2, Bcl-xL, and Bcl-w apoptosis regulation 0.0078 2 !

HDAC inhibitor Class I, Ila, chromain histone

Vorinostat lib, IV acetylation 0.0391 10 Nilotinib Bcr-Abl ABL signalling 0.0078 2 ! AZD-2281 PARP1/2 Genome integrity 0.0195 5 Bosutinib SRC, ABL, TEC ABL signalling 0.0078 2 !

: Lenalidomide TNF alpha other 0.0195 5

: Axitinib PDGFR, KIT, VEGFR RTK signalling 0.0078 2 !

! AZD7762 Chk 1/2 Genome integrity 0.0078 2 ! GW 441756 Trk A RTK signalling 0.0078 2 !

! CEP-701 FLT3, JAK2, NTRK1, RET RTK signalling 0.0078 2 !

! SB 216763 GSKa/b WNT signalling 0.0391 10

! 17-AAG Hsp90 other 0.0039 1 ! AMG-706 VEGFR, RET, c-KIT, PDGFR RTK signalling 0.0078 2 ! -55933 ATM Genome integrity 0.0391 10

1 BIBW2992 EGFR, HER2 EGFR signalling 0.0020 0.5 GDC-0449 SMO other 0.0391 10

ERK MAPK PLX4720 RAF signalling 0.0391 10

! Bx-795 TBK1, PDK1, IKK, AURKB/C other 0.0195 5

! NU-7441 DNAPK Genome integrity 0.0078 2 !

ERK MAPK

! SL OlOl-1 RSK, AURKB, PIM3 signalling 0.0391 10

! BI-D1870 RSKl/2/3/5, PLK1, AURKB cell cycle 0.0195 5 BIRB 0796 p38, JNK2 JNK and p38 0.0391 10 I signalling

JNK and p38

1 JNK Inhibitor VIII JNK signalling 0.0391 10

! 681640 Weel, Chkl cell cycle 0.0078 2 ! j Nutlin-3a p53-MDM2 interaction p53 pathway 0.0313 8 !

: mirin MRE11-Rad50-Nbsl complex cell cycle 0.3906 100

! PD- 173074 FGFR1, FGFR3 RTK signalling 0.0078 2 !

I ZM-447439 Aurora B mitosis 0.0156 4

! RO-3306 Cdkl cell cycle 0.0195 5

! MK-2206 AKT1/2 PI3K signalling 0.0156 4

! PD-0332991 Cdk 4/6 cell cycle 0.0156 4

! PF477736 Chk 1 (Chk2) cell cycle 0.0039 l ! i GW843682X (AN-

! 13) Plkl mitosis 0.0195 5

1 NVP-BEZ235 PI3K Class 1 and mTORCl/2 PI3K signalling 0.0010 0.25 j GDC0941 PI3K (class 1) PI3K signalling 0.0156 4

! AZD8055 mTORCl/2 TOR signalling 0.0078 2 !

ERK MAPK

! PD-0325901 MEK 1/2 signalling 0.0010 0.25

! AZD6482 PI3K beta PI3K signalling 0.0195 5

; Obatoclax Mesylate Bcl-2, Bxl-xl, Mcl-1 apoptosis regulation 0.0391 10

! EHT 1864 Rac GTPases cytoskeleton 0.0391 10

! BMS-708163 gamma-secretase complex other 0.0195 5

1 5-Fluorouracil antimetabolite mitosis 0.0781 20

1 Paclitaxel Beta subunit of tubulin cytoskeleton 0.0000 0.01 j PF-02341066 MET, ALK RTK signalling 0.0039 1 j Sorafenib PDGFR, KIT, VEGFR RTK signalling 0.0156 4 j BI-2536 Plkl,2,3 mitosis 0.0020 0.5

! BMS-536924 IGF-1R IGFR signalling 0.0156 4

! GSK1904529A IGF-IR and IR IGFR signalling 0.0195 5

! AKT inhibitor VIII AKT1/2/3 PI3K signalling 0.0195 5

! PF-4708671 p70 S6KA TOR signalling 0.0391 10

! JNJ-26854165 MDM2 p53 pathway 0.0391 10

! LY317615 PKC beta other 0.0391 10

! BMS-754807 IGF-1R/IR IGFR signalling 0.0391 10

! TW 37 BCL-2, BCL-XL apoptosis regulation 0.0195 5 i Embelin XIAP apoptosis regulation 0.0391 10

1 Erlotinib EGFR EGFR signalling 0.0078 2 !

ERK MAPK

j AZ628 BRAF signalling 0.0078 2 ! j AG-014699 PARP1/2 Genome integrity 0.0195 5 j Gemcitibine nucleoside analog DNA replication 0.0391 10

! GSK269962A ROCKl/2 cytoskeleton 0.0195 5

! SB-505124 TGFbetaR-I (ALK5) other 0.0391 10

: Tamoxifen ER other 0.0195 5

: Fulvestrant ER other 0.0039 l ! 1 Anastrozole ER other 0.0391 10

! JQ1 BRD2, BRD3, BRD4 chromatin other 0.0039 1

1 YK 4-279 RNA helicase A other 0.0391 10 j CHIR-99021 GSK3B WNT signalling 0.0391 10 j (5Z)-7-Oxozeaenol TAK1 other 0.0391 10 j FK866 NAMPT inhibitor metabolism 0.0039 l j

! BMS-345541 IKK-beta other 0.0391 10

! AZ960 JAK2 other 0.0391 10

! BMN-673 PARP Genome integrity 0.0391 10

! XAV 939 Tankyrase (PARP5a) WNT signalling 0.0195 5

ERK MAPK

! GSK1 120212 MEK1, MEK2 signalling 0.0039 l !

ERK MAPK

! GSK21 18436 BRAF signalling 0.0391 10 j Temozolomide DNA akylating agent DNA replication 0.1 172 30

: Olaparib +

: Temozolomide DNA damage response Genome integrity 0.0391 10

! AZD2281 PARP Genome integrity 0.0391 10

: Bicalutamide Androgen receptor other 0.0391 10

! PF-562271 FAK cytoskeleton 0.0391 10

! PAC-1 Caspase 3 activator apoptosis regulation 0.0391 10

! INCB- 18424 JAK1, JAK2, TYK2 other 0.0391 10

! OSI-906 IGFR-1 IGFR signalling 0.0098 2.5 j Epirubicin DNA damage DNA replication 0.0391 10 j Cyclophosphamide DNA akylating agent DNA replication 0.0391 10 j Carboplatin DNA damage DNA replication 0.0391 10 j Everolimus mTOR TOR signalling 0.0195 5 j LCL161 SMAC mimetic apoptosis regulation 0.0391 10 j rTRAIL Death receptor ligand apoptosis regulation 0.39ng/ml lOOng/ml j j D M SO CONTR OL NA

Table 2 - BAPi mutation status in selected cell lines.

BAPI

rTRAIL mRNA

SAMPLE_NAME COSMICJD DESCRIPTION ZYGOSITY response expression

H226 Deletion Homozygous Sensitive

Deletion -

H2461 1290810 Frameshift heterozygous Sensitive 0.32

H2722 1290812 HomDel homozygous Resistant -2.52

H2731 1240134 Essential Splice heterozygous Sensitive -0.41

H2795 1290813 Essential Splice heterozygous Sensitive* -0.45

H2804 1240136 Essential Splice heterozygous Sensitive 0.51

IST-MES 1 907173 Essential Splice homozygous Unknown -0.33

Substitution -

NCI-H2452 908462 Missense homozygous Resistant -0.04

NCI-H28 908470 Essential Splice heterozygous Sensitive 1.27

NCI-H226 905941 HomDel homozygous Sensitive** ND

Example 2 - Modulation of BAPi expression determines TRAIL sensitivity through activation of cell death

TRAIL binds via two active transmembrane death receptors, DR4 and DR5, triggering a caspase cascade and subsequently cell death. The viability effect of TRAIL observed in BAPi mutant cells was indeed associated with an increased fraction of cells stained with the apoptotic marker Annexin V (see Figure 3B). The inventors therefore next examined whether modulation of BAPi expression in mesothelioma cells resulted in changes in TRAIL sensitivity. The ablation of BAPi protein with the use of a lentiviral shRNA in the BAPi wild-type cell line H2818 promoted a shift towards increased sensitivity in the BAPi null compared to the BAPi competent parental line (see Figure 4). The BAPi null cell line NCI-H226, which possesses a homozygous deletion of BAPi, was transduced with a BAPi expression vector to restore expression of wild-type full length BAPi (see Figure 5A) or the catalytically dead C91A mutant. Treatment of the null NCI-H226 cell line with a dose range of TRAIL resulted in increased cell death which was significantly reduced in the BAPi expressing H226 cell line (see Figure 5b). The C91A variant however phenocopied the response of the BAPi null parental cell line indicating a functional Ubiquitin hydrolase catalytic domain is critical for sensitivity to TRAIL. The nuclear localization signal (NLS) also plays a key role in imparting TRAIL resistance as deletion of NLS results in significant reduction in BAPi induced TRAIL resistance (see Figure 5c). Example - Loss of BAPi expression and function modulates components of the apoptotic machinery

The H226 mesothelioma cell line harbours a homozygous deletion of BAPi, resulting in complete loss of BAPi expression. The inventors further examined the effect of this catalytically inactive BAPi on differential mRNA gene expression as well as carrying out a signalling pathway impact analysis (SPIA), as previously described (PMID 18990722). Among those pathways significantly altered when comparing wild-type versus C9ia mt BAPi, was that of cell death pathways (see Figure 6A)

(htt iZ/wm^ In particular, there was decreased expression of members of the LAP family in H226 cells stably transduced with the catalytically dead C91A mutant (see Figure 6B). The largest effects were seen in CIAP2, and this was confirmed by western blot (see Figure 6C).

Example 4 - Combination drug screen demonstrates synergy between SMAC mimetic LCL161 and rTRAIL in BAPi competent cell lines. rTRAIL was used as an anchor drug in combination with the library of 94 single agent compounds described above. Synergy was described using delta AUC metric (ref Wessles et αΐ) and this was correlated with the previously described genomic subgroups. The inventors have shown that drugs such as SMAC mimetic LCL161, DNA helicase inhibitor YK-4279 and the tyrosine kinase inhibitor sorafenib to increase the efficacy of DRL - induced apoptosis in otherwise resistant cells. One of the most synergistic findings of this screen was the association of sensitivity to the SMAC mimetic LCL161 and rTRAIL in BAPi wild-type MPM (see Figure 7 A). This was validated by treating TRAIL resistant wild-type BAPi expressing cells with combination of LCL161 and TRAIL. Further validation was also performed in the H226 cell lines stably expressing wild-type BAPi that was previously demonstrated to be resistant to TRAIL alone (see Figure 5 and 7B-D). The combination of the LAP inhibitor, LCL161, and TRAIL showed a synergistic increase in cell death in the both mutant and wild-type line indicating that DRL induced cell death in BAPi mutant and wild-type cells can be enhanced by combining with other agents (see Figure 7B- D). Figure 7D in particular shows that both BAPi mutant and wild-type cells undergo cell death in response to treatment with the combination of TRAIL and LCL161. Endogenous SMAC/Diablo is a specific natural inhibitor of LAP's (14). This data suggests that in the BAPi competent state, BAPi loss can be phenocopied by specifically mimicking this inhibitory effect on LAPs resulting in a net inactivation of LAP's and sensitivity to rTRAIL. This would lend further support to the idea that the BAPi/ extrinsic apoptotic pathway perturbation seen is related to a specific dysregulation of net activity of IAP's.

Example - Extension of BAPi/TRAIL effect to other tissues harboring BAPi loss of function mutations The deubiquitinase BAPi is frequently mutated in pleural mesothelioma (36%), uveal melanoma (47%) and intrahepatic cholangiocarcinomas (25%) as previously noted. To determine whether additional BAPi mutant tumours occur that may also be amenable to this therapeutic approach, the inventors extended this analysis to a cohort of 5180 tumour samples in 20 cancer types using variant data from The Cancer Genome Atlas (TCGA) (h¾p_//cancergej^ Truncating BAPi mutations were also observed in a diverse range of cancer types, with frequencies of up to 6% (see Figure lb and c) Carbone, M. et al, Nature Reviews Cancer 13, 153- 159 (March 2013). When the inventors extended their analysis to a panel of 1001 cancer cell lines that had previously been submitted for whole exome and copy number analysis, they identified 17 cell lines harbouring truncating mutations in BAPi These included clear cell kidney cancer, bladder cancer and breast cancer cell lines.

Treatment of these cell lines with TRAIL resulted in a marked viability effect compared to BAPi wild-type cell lines from the same cancer type (see Figure 8A). The inventors also inactivated BAPi using a lentiviral shRNA in the breast cancer cell line, MDA-MB231, and observed an exaggerated apoptotic response to rTRAIL (see Figure 8B). This suggests that TRAIL therapy may be efficacious in other forms of cancer (in addition to mesothelioma), and that inhibition of BAPi or by targeting the pathway which BAPi induces TRAIL resistance it is possible to sensitise cancer cells to TRAIL. The inventors demonstrated the efficacy of targeting BAPi mutant cells with TRAIL in vivo by mice xenograft models. Mutant and wild-type BAPi cells were injected subcutaneously into left and right flanks of mice. The mice were treated with either rTRAIL or vehicle (see figure 9A). The tumours were weighed at the end of the experiment and the weights of mutated BAPi tumours in mice that received TRAIL was significantly less than wild-type BAPi tumours with TRAIL treatment or mutant and wild-type tumours of mice with vehicle treatment (see figure 9B). The tumour burden was tracked in real time over a period of 4 weeks. The tumour burden of mutated BAPi xenografts in mice that received TRAIL was significantly less than wild-type BAPi xenografts with TRAIL treatment or mutant and wild-type xenografts of mice with vehicle treatment (see figure 9C).

Example 6 - Role of ASXL binding site on of BAPi function

The inventors have also demonstrated that a mutation in the ASXL protein binding site of the BAPi gene impairs BAPi-induced TRAIL resistance (see Figure 11). BAPi has been shown to form a complex with proteins ASXLi, ASXL2 or ASXL3. Mutation of the binding site for ASXL protein inhibits formation of BAPi-ASXL complexes. The BAPi-ASXL complex has been shown to deubiquitinate Histone 2A, and other substrates, and both BAPi and ASXLi, ASXL2, or ASXL3 are required for this deubiquitination function. This complex is an important regulator of the Polycomb Respressor Complex and gene transcription. The inventors have shown that the BAPi wild-type and ASXL3 mutant (truncating mutation) cell line H513 is TRAIL sensitive. Hence loss of function of ASXLi, ASXL2 or ASXL3 increases the sensitivity of cells to DRL induced cell death. Mutations of ASXLi, ASXL2 or ASXL3 also predict sensitivity to DLR and hence can be used as a biomarker for cell death independent of BAPi mutational status.

Example 7 - Extension of BAPi/TRAIL effect to other extrinsic death pathways

Although the data in this application focus on rTRAIL, a recombinant protein that activates the TRAIL pathway by binding to DR4 and DR5 receptors, the observed BAPi mutation-sensitisation extends to other extrinsic apoptotic pathways including the FAS ligand pathway and the TNFalpha pathway (see figure 10).

Summary

The inventors have found that BAPi is an important regulator of whether a cell will undergo cell death in response to the activation of a death receptor by a death receptor ligand, such as TRAIL, TNF alpha (TNFa) and FAS ligand (FASL).

Specifically, non-functional or low expression of wild-type BAPi causes cells to become sensitive to death receptor ligand-induced cell death. Consequently, it has been discovered that a mutant BAPi gene or a mutant BAPi protein, or a cancer cell with low expression of a wild-type BAPi protein may be used as a biomarker of sensitivity to DRL-induced cell death.

Thus, the invention also encompasses an advantageous: method of determining if an individual's cancer cell is sensitive to death receptor ligand (DRL)-induced cell death;

kit for determining if an individual's cancer cell is sensitive to DRL-induced cell death;

method of selectively inducing death receptor ligand induced cell death in an individual suffering from a cancer that is insensitive to death receptor ligand induced cell death;

a method of sensitising to DRL-induced cell death, an individual suffering from a cancer that is insensitive to DRL-induced cell death;

a composition comprising a BAPi inhibitor and a death receptor ligand; and a method of treating, preventing or ameliorating an individual suffering from a cancer, which is insensitive to DRL-induced cell death.

References

1. Lanphear BP, Buncher CR. Latent period for malignant mesothelioma of occupational origin. Journal of occupational medicine : official publication of the Industrial Medical Association. I992;34(7):7i8-2i. Epub 1992/07/01.

2. Lemen RA, Dement JM, Wagoner JK. Epidemiology of asbestos-related diseases. Environmental health perspectives. 1980;34:1-11. Epub 1980/02/01.

3. Algranti E, Saito CA, Carneiro AP, Moreira B, Mendonca EM, Bussacos MA. The next mesothelioma wave: Mortality trends and forecast to 2030 in Brazil. Cancer epidemiology. 2015. Epub 2015/09/01.

4. Treasure T, Waller D, Tan C, Entwisle J, O'Brien M, O'Byrne K, et al. The Mesothelioma and Radical surgery randomized controlled trial: the Mars feasibility study. Journal of thoracic oncology : official publication of the International

Association for the Study of Lung Cancer. 2009;4(io):i254-8. Epub 2009/08/08.

:

Epub 2003/07/16.

6. Guo G, Chmielecki J, Goparaju C, Heguy A, Dolgalev I, Carbone M, et al. Whole-exome sequencing reveals frequent genetic alterations in BAPi, NF2,

CDKN2A, and CULi in malignant pleural mesothelioma. Cancer research.

20i5;75(2):204-9. Epub 2014/12/10.

7. Bott M, Brevet M, Taylor BS, Shimizu S, Ito T, Wang L, et al. The nuclear deubiquitinase BAPi is commonly inactivated by somatic mutations and 3p2i.i losses in malignant pleural mesothelioma. Nature genetics. 20ii;43(7):668-72. Epub

8. Martin M, Masshofer L, Temming P, Rahmann S, Metz C, Bornfeld N, et al. Exome sequencing identifies recurrent somatic mutations in EIFiAX and SF3B1 in uveal melanoma with disomy 3. Nature genetics. 20i3;45(8):933-6. Epub

9. Geriinger M, Horswell S, Larkin J, Rowan AJ, Salm MP, Varela I, et al.

Genomic architecture and evolution of clear cell renal cell carcinomas defined by multiregion sequencing. Nature genetics. 20i4;46(3):225-33. Epub 2014/02/04.

10. Chan-On W, Nairismagi ML, Ong CK, Lim WK, Dima S, Pairojkul C, et al. Exome sequencing identifies distinct mutational patterns in liver fluke-related and non-infection-related bile duct cancers. Nature genetics. 2013545(12): 1474-8. Epub

11. Narasimhan SR, Yang L, Gerwin BI, Broaddus VC. Resistance of pleural mesothelioma cell lines to apoptosis: relation to expression of Bcl-2 and Bax. The

American journal of physiology. 19985275(1 Pt i):Li65-7i. Epub 1998/08/05.

12. Hinds MG, Norton RS, Vaux DL, Day CL. Solution structure of a baculoviral inhibitor of aappooppttoossiiss ((IIAAPP)) rreeppeeaatt.. NNaattuurree ssttrruuccttuurraall bbiioollooggyy.. 11999999;;66((77))::664488--5511.. EEppuubb

11999999//0077//1155..

1133.. ddee AAllmmaaggrroo MMCC,, VVuucciicc DD.. TThhee iinnhhiibbiittoorr ooff aappooppttoossiiss ((IIAAPP)) pprrootteeiinnss aarree ccrriittiiccaall rreegguullaattoorrss ooff ssiiggnnaalliinngg ppaatthhwwaayyss aanndd ttaarrggeettss ffoorr aannttii--ccaanncceerr tthheerraappyy.. EExxppeerriimmeennttaall oonnccoollooggyy.. 2200ii22;;3344((33))::220000--nn.. EEppuubb 22001122//1100//1177..

1144.. YYuu JJ,, WWaanngg PP,, MMiinngg LL,, WWoooodd MMAA,, ZZhhaanngg LL.. SSMMAACC//DDiiaabblloo mmeeddiiaatteess tthhee pprrooaappooppttoottiicc ffuunnccttiioonn ooff PPUUMMAA bbyy rreegguullaattiinngg PPUUMMAA--iinndduucceedd mmiittoocchhoonnddrriiaall eevveennttss.. OOnnccooggeennee.. 22000077;;2266((2299))::44ii8899--9988.. EEppuubb 22000077//0011//2244..

1155.. BBeehhjjaattii SS eett aall.. RReeccuurrrreenntt PPTTPPRRBB aanndd PPLLCCGGii mmuuttaattiioonnss iinn aannggiioossaarrccoommaa.. NNaatt GGeenneett.. 22001144 AApprr;;4466((44)) 1:337766--99.. ddooii:: iioo..ii003388//nngg..229922ii.. 1166.. TTaarrppeeyy PPSS eett aall FFrreeqquueenntt mmuuttaattiioonn ooff tthhee mmaajjoorr ccaarrttiillaaggee ccoollllaaggeenn ggeennee CCOOLL22AA11 iinn

17. Li, H and Durbin, R Fast and accurate short read alignment with Burrows- Wheeler transform. Bioinformatics, 2009. 25(14): PI754-60.

18. Garnett, M.J., et al., Systemic identification of genomic markers of drug sensitivity in cancer cells. Nature, 2012. 483 (7391): p.473-81.

19. Behjati, S. et al., Mobile DNA in cancer. Extensive transduction of

nonrepetitive DNA mediated by Li retrotransposition in cancer genome. Science, 2014. 345(6196): p.1251343.

20. Ganten T, Koschny R, Sykora J, Schulze-Bergkamen H, Buchler P, Haas T, et al. Preclinical differentiation between apparently safe and potentially hepatotoxic applications of TRAIL either alone or in combination with chemotherapeutic drugs. Clin Cancer Res. 2006;12:2640-6