R-Spondin Translocations and Methods Using the Same

Information

  • Patent Application
  • 20210025008
  • Publication Number
    20210025008
  • Date Filed
    June 08, 2020
    4 years ago
  • Date Published
    January 28, 2021
    3 years ago
Abstract
Provided are therapies related to the treatment of pathological conditions, such as cancer.
Description
SEQUENCE LISTING

The Instant application contains a Sequence Listing submitted via EFS-Web and hereby incorporated by reference in its entirety. Said ASCII copy, created on Jun. 5, 2020, is named 2020-06-05_01146-0064-01US_Seq_ListST25.txt and is 56,495 bytes in size.


FIELD

Provided are therapies related to the treatment of pathological conditions, such as cancer.


BACKGROUND

Colorectal cancer (CRC) with over 100,000 new cases reported annually is the fourth most prevalent cancer and accounts for over 50,000 deaths per year in the United States (Siegel, R. et al., CA: A Cancer Journal for Clinicians 61:212-236 (2011)). Approximately 15% of CRCs exhibit microsatellite instability (MSI) arising from defects in DNA mismatch repair (MMR) system (Fearon, E. R., Annu. Rev. Pathol. 6:479-507 (2011)). The other ˜85% of microsatellite stable (MSS) CRCs are the result of chromosomal instability (CIN) (Fearon, E. R., Annu. Rev. Pathol. 6:479-507 (2011)). Genomic studies have identified acquisition of mutations in genes like APC, KRAS, and TP53 during CRC progression (Fearon, E. R., Annu. Rev. Pathol. 6:479-507 (2011)). Sequencing colon cancer protein-coding exons and whole genomes in a small number of samples have identified several additional mutations and chromosomal structural variants that likely contribute to oncogenesis (Wood, L. D. et al., Science 318:1108-1113 (2007); Timmermann, B. et al., PloS One 5:e15661 (2010)). However, recent insertional mutagenesis screens in mouse models of colon cancer suggested involvement of additional genes and pathways in CRC development (Starr, T. K. et al., Science 323:1747-1750 (2009); March, H. N. et al., Nat. Genet. 43:1202-1209 (2011)).


There remains a need to better understand the pathogenesis of cancers, in particular, human colon cancers and also to identify new therapeutic targets.


SUMMARY

The invention provides wnt pathway antagonists including R-spondin-translocation antagonists and methods of using the same.


Provided herein are methods of inhibiting cell proliferation of a cancer cell comprising contacting the cancer cell with an effective amount of an R-spondin-translocation antagonist. Further provided herein are methods of treating cancer in an individual comprising administering to the individual an effective amount of an R-spondin-translocation antagonist. In some embodiments of any of the methods, the cancer or cancer cell comprises an R-spondin translocation.


Provided herein are methods of treating cancer in an individual comprising administering to the individual an effective amount of a wnt pathway antagonist, wherein treatment is based upon the individual having cancer comprising an R-spondin translocation. Provided herein are methods of treating a cancer cell, wherein the cancer cell comprises an R-spondin translocation, and wherein the method comprises providing an effective amount of a wnt pathway antagonist. Also provided herein are methods of treating cancer in an individual provided that the individual has been found to have cancer comprising an R-spondin translocation, the treatment comprising administering to the individual an effective amount of a wnt pathway antagonist.


Further, provided herein are methods for treating cancer in an individual, the method comprising: determining that a sample obtained from the individual comprises an R-spondin translocation, and administering an effective amount of an anti-cancer therapy comprising a wnt pathway antagonist to the individual, whereby the cancer is treated.


Provided herein are methods of treating cancer, comprising: (a) selecting an individual having cancer, wherein the cancer comprising an R-spondin translocation; and (b) administering to the individual thus selected an effective amount of a wnt pathway antagonist, whereby the cancer is treated.


Provided herein are also methods of identifying an individual with cancer who is more likely or less likely to exhibit benefit from treatment with an anti-cancer therapy comprising a wnt pathway antagonist, the method comprising: determining presence or absence of an R-spondin translocation in a sample obtained from the individual, wherein presence of the R-spondin translocation in the sample indicates that the individual is more likely to exhibit benefit from treatment with the anti-cancer therapy comprising the wnt pathway antagonist or absence of the R-spondin translocation indicates that the individual is less likely to exhibit benefit from treatment with the anti-cancer therapy comprising the wnt pathway antagonist. In some embodiments, the method further comprises administering an effective amount of the anti-cancer therapy comprising a wnt pathway antagonist.


Provided herein are methods for predicting whether an individual with cancer is more or less likely to respond effectively to treatment with an anti-cancer therapy comprising a wnt pathway antagonist, the method comprising determining an R-spondin translocation, whereby presence of the R-spondin translocation indicates that the individual is more likely to respond effectively to treatment with the wnt pathway antagonist and absence of the R-spondin translocation indicates that the individual is less likely to respond effectively to treatment with the wnt pathway antagonist. In some embodiments, the method further comprises administering an effective amount of the anti-cancer therapy comprising a wnt pathway antagonist.


Further provided herein are methods of predicting the response or lack of response of an individual with cancer to an anti-cancer therapy comprising a wnt pathway antagonist comprising detecting in a sample obtained from the individual presence or absence of an R-spondin translocation, wherein presence of the R-spondin translocation is predictive of response of the individual to the anti-cancer therapy comprising the wnt pathway antagonist and absence of the R-spondin translocation is predictive of lack of response of the individual to the anti-cancer therapy comprising the wnt pathway antagonist. In some embodiments, the method further comprises administering an effective amount of the anti-cancer therapy comprising a wnt pathway antagonist.


In some embodiments of any of the methods, the R-spondin translocation is a RSPO1 translocation, RSPO2 translocation, RSPO3 translocation and/or RSPO4 translocation. In some embodiments, the R-spondin translocation is a RSPO2 translocation. In some embodiments, the RSPO2 translocation comprises EIF3E and RSPO2. In some embodiments, the RSPO2 translocation comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2 translocation comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2 translocation comprises SEQ ID NO:71 In some embodiments, the R-spondin translocation is a RSPO3 translocation. In some embodiments, the RSPO3 translocation comprises PTPRK and RSPO3. In some embodiments, the RSPO3 translocation comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation comprises SEQ ID NO:72 and/or SEQ ID NO:73. In some embodiments of any of the methods, the R-spondin translocation is detected at the chromosomal level (e.g., FISH), DNA level, RNA level (e.g., RSPO1-translocation fusion transcript), and/or protein level (e.g., RSPO1-translocation fusion polypeptide).


In some embodiments of any of the methods, the cancer is colorectal cancer. In some embodiments, the cancer is a colon cancer or rectal cancer.

  • 1) In some embodiments of any of the methods, the wnt pathway antagonist is an antibody, binding polypeptide, small molecule, or polynucleotide. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist. In some embodiments, the R-spondin antagonist is a RSPO1 antagonist, RSPO2 antagonist, RSPO3 antagonist, and/or RSPO4 antagonist. In some embodiments, the wnt pathway antagonist is an isolated monoclonal antibody which binds R-spondin. In some embodiments, the R-spondin is RSPO2 and/or RSPO3. In some embodiments, the R-spondin antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin-translocation antagonist binds a RSPO1-translocation fusion polypeptide and/or polynucleotide, RSPO2-translocation fusion polypeptide and/or polynucleotide, RSPO3-translocation fusion polypeptide and/or polynucleotide and/or RSPO4-translocation fusion polypeptide and/or polynucleotide. In some embodiments, the R-spondin-translocation antagonist binds a RSPO2-translocation fusion polypeptide and/or polynucleotide. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises EIF3E and RSPO2. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises SEQ ID NO:71. In some embodiments, the R-spondin-translocation fusion polypeptide and/or polynucleotide is a RSPO3-translocation fusion polypeptide and/or polynucleotide. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises PTPRK and RSPO3. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises SEQ ID NO:72 and/or SEQ ID NO:73. In some embodiments, the method further comprises an additional therapeutic agent.


Provided herein are isolated R-spondin-translocation antagonists, wherein the R-spondin-translocation antagonist is an antibody, binding polypeptide, small molecule, or polynucleotide. In some embodiments, the R-spondin-translocation antagonist binds a RSPO1-translocation fusion polypeptide and/or polynucleotide, RSPO2-translocation fusion polypeptide and/or polynucleotide, RSPO3-translocation fusion polypeptide and/or polynucleotide and/or RSPO4-translocation fusion polypeptide and/or polynucleotide. In some embodiments, the R-spondin-translocation antagonist binds a RSPO2-translocation fusion polypeptide and/or polynucleotide. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises EIF3E and RSPO2. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2-translocation fusion polypeptide and/or polynucleotide comprises SEQ ID NO:71. In some embodiments, the R-spondin-translocation fusion polypeptide and/or polynucleotide is a RSPO3-translocation fusion polypeptide and/or polynucleotide. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises PTPRK and RSPO3. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide and/or polynucleotide comprises SEQ ID NO:72 and/or SEQ ID NO:73.





BRIEF DESCRIPTION OF THE FIGURES


FIG. 1|(A) Activation of an alternate novel 5′ exon of MRPL33 in a tumor specific manner alters the N-terminal end of MRPL33 and makes the protein longer. (B) The boxplot shows the read counts for the upstream exon normalized by total number of reads aligning to MRPL33 for each sample. (C) Also shown is evidence of an alternate upstream MRPL33 promoter region showing H3K27Ac marking by USCS genome browser as well as an EST mapping to the upstream exon. MRLP33 Amino Acid Sequence MFLSAVFF AKSKSNETKSPLRGKEKNTLPLNGGLKMTLIYKEKTEGG DTDSEIL (SEQ ID NO:9); MRLP33 alternative promoter amino acid sequence MMAHLDFFLTYKWRAPKSKSLDQLSPNFLLRGRS ETKSPLRGKEKNTLPLNGGLKMTLIYKEKTEGGDTDSEIL (SEQ ID NO:10).



FIG. 2|Recurrent R-spondin translocations. (A) List of the type and frequency of R-spondin gene fusions in colon cancer. (B) Cartoon depicting the location, orientation and exon-intron architecture of EIF3E-RSPO2 fusion on the genome. The read evidence for EIF3E(e1)-RSPO2(e2) fusion identified using RNA-seq data are shown. (C) Independent RT-PCR derived products confirming the EIF3E-RSPO2 somatic fusion resolved on an agarose gel. RT-PCR products were Sanger sequenced to confirm the fusion junction and a relevant representative chromatogram is presented. (D) Schematic of the resulting EIF3E-RSPO2 fusion protein. (E) Tumors harboring R-spondin fusions show elevated expression of the corresponding RSPO gene shows on a heatmap. FIG. 2 discloses SEQ ID NOS 85-92 and 71, respectively, in order of appearance.



FIG. 3|Recurrence of PTPRK-RSPO3 gene fusion. (A) Cartoon depicting the location, orientation and exon-intron architecture of PTPRK-RSPO3 gene fusion on the genome. The read evidence for PTPRK(e1)-RSPO3(e2) fusion identified using RNA-seq data are shown. (B) Independent RT-PCR derived products confirming the PTPRK-RSPO3 somatic fusion resolved on an agarose gel. RT-PCR products were Sanger sequenced to confirm the fusion junction and a relevant representative chromatogram is presented. (C) Schematic of PTPRK, RSPO3 and the resulting PTPRK-RSPO3 fusion proteins. FIG. 3 discloses SEQ ID NOS 93-99 and 72, respectively, in order of appearance.



FIG. 4|(A) PTPRK(e7)-RSPO3(e2) fusion. (B) Gel showing the validation of this fusion by RT-PCR. (C) Schematic diagram of the native and fusion proteins. FIG. 4 discloses SEQ ID NOS 100-104 and 73, respectively, in order of appearance.



FIG. 5|RSPO fusion products activate Wnt signaling. (A) Secreted RSPO fusion proteins detected by Western blot in media from 293T cells transfected with expression constructs encoding the fusion proteins. The expected product is RSPO 1-387. (B and C) RSPO fusion proteins activate and potentiate Wnt signaling as measured using a luciferase reporter assay. Data shown are from condition media derived from cells transfected with the fusion constructs or directly transfected into the cell along with the reporter construct. Representative data from at least three experiments are shown. (D) Cartoon representing R-spondin mediated Wnt signaling pathway activation. (E) Plot depicting RSPO fusions and somatic mutations across a select set of Wnt signaling pathway genes.



FIG. 6|(A) KRAS mutations overlap with RSPO gene fusions. (B) RAS/RTK pathway alterations in colon cancer.



FIG. 7|Whole genome EIF3E-RSPO2 coordinates schematic and sequences. FIG. 7 discloses SEQ ID NOS 105-108, respectively, in order of appearance.



FIG. 8|Whole genome EIF3E-RSPO2 coordinates schematic and sequences. FIG. 8 discloses SEQ ID NOS 109-111, respectively, in order of appearance.



FIG. 9|Whole genome PTPRK-RSPO3 coordinates schematic and sequences. FIG. 9 discloses SEQ ID NOS 112-116, respectively, in order of appearance.



FIG. 10|Whole genome PTPRK-RSPO3 coordinates schematic and sequences. FIG. 10 discloses SEQ ID NOS 112 and 117-120, respectively, in order of appearance.





DETAILED DESCRIPTION
I. Definitions

The terms “R-spondin” and “RSPO” refer herein to a native R-spondin from any vertebrate source, including mammals such as primates (e.g., humans) and rodents (e.g., mice and rats), unless otherwise indicated. The term encompasses “full-length,” unprocessed R-spondin as well as any form of R-spondin that results from processing in the cell. The term also encompasses naturally occurring variants of R-spondin, e.g., splice variants or allelic variants. R-spondin is a family of four proteins, R-spondin 1 (RSPO1), R-spondin 2 (RSPO2), R-spondin 3 (RSPO3), and R-spondin 4 (RSPO4). In some embodiments, the R-spondin is RSPO1. The sequence of an exemplary human RSPO1 nucleic acid sequence is SEQ ID NO:1 or an exemplary human RSPO1 is amino acid sequence of SEQ ID NO:2. In some embodiments, the R-spondin is RSPO2. The sequence of an exemplary human RSPO2 nucleic acid sequence is SEQ ID NO:3 or an exemplary human RSPO2 is amino acid sequence of SEQ ID NO:4. In some embodiments, the R-spondin is RSPO3. The sequence of an exemplary human RSPO3 nucleic acid sequence is SEQ ID NO:5 or an exemplary human RSPO3 is amino acid sequence of SEQ ID NO:6. In some embodiments, the R-spondin is RSPO4. The sequence of an exemplary human RSPO4 nucleic acid sequence is SEQ ID NO:7 or an exemplary human RSPO4 is amino acid sequence of SEQ ID NO:8.


“R-Spondin variant,” “RSPO variant,” or variations thereof, means an R-spondin polypeptide or polynucleotide, generally being or encoding an active R-Spondin polypeptide, as defined herein having at least about 80% amino acid sequence identity with any of the R-Spondin as disclosed herein. Such R-Spondin variants include, for instance, R-Spondin wherein one or more nucleic acid or amino acid residues are added or deleted. Ordinarily, an R-spondin variant will have at least about 80% sequence identity, alternatively at least about 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity, to R-Spondin as disclosed herein. Ordinarily, R-Spondin variant are at least about 10 residues in length, alternatively at least about 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, 500, 510, 520, 530, 540, 550, 560, 570, 580, 590, 600 in length, or more. Optionally, R-Spondin variant will have or encode a sequence having no more than one conservative amino acid substitution as compared to R-Spondin, alternatively no more than 2, 3, 4, 5, 6, 7, 8, 9, or 10 conservative amino acid substitution as compared to R-Spondin.


The terms “R-spondin translocation” and “RSPO translocation” refer herein to an R-spondin wherein a portion of a broken chromosome including, for example, R-spondin, variant, or fragment thereof or a second gene, variant, or fragment thereof, reattaches in a different chromosome location, for example, a chromosome location different from R-spondin native location or a chromosome location in and/or around the R-spondin native location which is different from the second gene's native location. The R-spondin translocation may be a RSPO1 translocation, RSPO2 translocation, RSPO3 translocation, and/or RSPO4 translocation.


The terms “R-spondin-translocation fusion polynucleotide” and “RSPO-translocation fusion polynucleotide” refer herein to the nucleic acid sequence of an R-spondin translocation gene product or fusion polynucleotide. The R-spondin-translocation fusion polynucleotide may be a RSPO1-translocation fusion polynucleotide, RSPO2-translocation fusion polynucleotide, RSPO3-translocation fusion polynucleotide, and/or RSPO4-translocation fusion polynucleotide. The terms “R-spondin-translocation fusion polypeptide” and “RSPO-translocation fusion polypeptide” refer herein to the amino acid sequence of an R-spondin translocation gene product or fusion polynucleotide. The R-spondin-translocation fusion polypeptide may be a RSPO1-translocation fusion polypeptide, RSPO2-translocation fusion polypeptide, RSPO3-translocation fusion polypeptide, and/or RSPO4-translocation fusion polypeptide.


The term “R-spondin-translocation antagonist” as defined herein is any molecule that partially or fully blocks, inhibits, or neutralizes a biological activity mediated by an R-spondin-translocation fusion polypeptide. In some embodiments such antagonist binds to R-spondin-translocation fusion polypeptide. According to one embodiment, the antagonist is a polypeptide. According to another embodiment, the antagonist is an anti-R-spondin-translocation antibody. According to another embodiment, the antagonist is a small molecule antagonist. According to another embodiment, the antagonist is a polynucleotide antagonist. The R-spondin translocation may be a RSPO1-translocation antagonist, RSPO2-translocation antagonist, RSPO3-translocation antagonist, and/or RSPO4-translocation antagonist.


The term “wnt pathway antagonist” as defined herein is any molecule that partially or fully blocks, inhibits, or neutralizes a biological activity mediated by the wnt pathway (e.g., wnt pathway polypeptide). In some embodiments such antagonist binds to a wnt pathway polypeptide. According to one embodiment, the antagonist is a polypeptide. According to another embodiment, the antagonist is an antibody antagonist. According to another embodiment, the antagonist is a small molecule antagonist. According to another embodiment, the antagonist is a polynucleotide antagonist.


“Polynucleotide” or “nucleic acid” as used interchangeably herein, refers to polymers of nucleotides of any length, and include DNA and RNA. The nucleotides can be deoxyribonucleotides, ribonucleotides, modified nucleotides or bases, and/or their analogs, or any substrate that can be incorporated into a polymer by DNA or RNA polymerase or by a synthetic reaction. A polynucleotide may comprise modified nucleotides, such as methylated nucleotides and their analogs. A sequence of nucleotides may be interrupted by non-nucleotide components. A polynucleotide may comprise modification(s) made after synthesis, such as conjugation to a label. Other types of modifications include, for example, “caps,” substitution of one or more of the naturally occurring nucleotides with an analog, internucleotide modifications such as, for example, those with uncharged linkages (e.g., methyl phosphonates, phosphotriesters, phosphoamidates, carbamates, etc.) and with charged linkages (e.g., phosphorothioates, phosphorodithioates, etc.), those containing pendant moieties, such as, for example, proteins (e.g., nucleases, toxins, antibodies, signal peptides, ply-L-lysine, etc.), those with intercalators (e.g., acridine, psoralen, etc.), those containing chelators (e.g., metals, radioactive metals, boron, oxidative metals, etc.), those containing alkylators, those with modified linkages (e.g., alpha anomeric nucleic acids, etc.), as well as unmodified forms of the polynucleotides(s). Further, any of the hydroxyl groups ordinarily present in the sugars may be replaced, for example, by phosphonate groups, phosphate groups, protected by standard protecting groups, or activated to prepare additional linkages to additional nucleotides, or may be conjugated to solid or semi-solid supports. The 5′ and 3′ terminal OH can be phosphorylated or substituted with amines or organic capping group moieties of from 1 to 20 carbon atoms. Other hydroxyls may also be derivatized to standard protecting groups. Polynucleotides can also contain analogous forms of ribose or deoxyribose sugars that are generally known in the art, including, for example, 2′-O-methyl-, 2′-O-allyl-, 2′-fluoro- or 2′-azido-ribose, carbocyclic sugar analogs, α-anomeric sugars, epimeric sugars such as arabinose, xyloses or lyxoses, pyranose sugars, furanose sugars, sedoheptuloses, acyclic analogs, and basic nucleoside analogs such as methyl riboside. One or more phosphodiester linkages may be replaced by alternative linking groups. These alternative linking groups include, but are not limited to, embodiments wherein phosphate is replaced by P(O)S (“thioate”), P(S)S (“dithioate”), (O)NR2 (“amidate”), P(O)R, P(O)OR′, CO, or CH2 (“formacetal”), in which each R or R′ is independently H or substituted or unsubstituted alkyl (1-20 C) optionally containing an ether (—O—) linkage, aryl, alkenyl, cycloalkyl, cycloalkenyl or araldyl. Not all linkages in a polynucleotide need be identical. The preceding description applies to all polynucleotides referred to herein, including RNA and DNA.


“Oligonucleotide,” as used herein, refers to generally single-stranded, synthetic polynucleotides that are generally, but not necessarily, less than about 200 nucleotides in length. The terms “oligonucleotide” and “polynucleotide” are not mutually exclusive. The description above for polynucleotides is equally and fully applicable to oligonucleotides.


The term “primer” refers to a single stranded polynucleotide that is capable of hybridizing to a nucleic acid and following polymerization of a complementary nucleic acid, generally by providing a free 3′-OH group.


The term “small molecule” refers to any molecule with a molecular weight of about 2000 Daltons or less, preferably of about 500 Daltons or less.


The terms “host cell,” “host cell line,” and “host cell culture” are used interchangeably and refer to cells into which exogenous nucleic acid has been introduced, including the progeny of such cells. Host cells include “transformants” and “transformed cells,” which include the primary transformed cell and progeny derived therefrom without regard to the number of passages. Progeny may not be completely identical in nucleic acid content to a parent cell, but may contain mutations. Mutant progeny that have the same function or biological activity as screened or selected for in the originally transformed cell are included herein.


The term “vector,” as used herein, refers to a nucleic acid molecule capable of propagating another nucleic acid to which it is linked. The term includes the vector as a self-replicating nucleic acid structure as well as the vector incorporated into the genome of a host cell into which it has been introduced. Certain vectors are capable of directing the expression of nucleic acids to which they are operatively linked. Such vectors are referred to herein as “expression vectors.”


An “isolated” antibody is one which has been separated from a component of its natural environment. In some embodiments, an antibody is purified to greater than 95% or 99% purity as determined by, for example, electrophoretic (e.g., SDS-PAGE, isoelectric focusing (IEF), capillary electrophoresis) or chromatographic (e.g., ion exchange or reverse phase HPLC). For review of methods for assessment of antibody purity, see, e.g., Flatman et al., J. Chromatogr. B 848:79-87 (2007).


An “isolated” nucleic acid refers to a nucleic acid molecule that has been separated from a component of its natural environment. An isolated nucleic acid includes a nucleic acid molecule contained in cells that ordinarily contain the nucleic acid molecule, but the nucleic acid molecule is present extrachromosomally or at a chromosomal location that is different from its natural chromosomal location.


The term “antibody” herein is used in the broadest sense and encompasses various antibody structures, including but not limited to monoclonal antibodies, polyclonal antibodies, multispecific antibodies (e.g., bispecific antibodies), and antibody fragments so long as they exhibit the desired antigen-binding activity.


An “antibody fragment” refers to a molecule other than an intact antibody that comprises a portion of an intact antibody that binds the antigen to which the intact antibody binds. Examples of antibody fragments include but are not limited to Fv, Fab, Fab′, Fab′-SH, F(ab′)2; diabodies; linear antibodies; single-chain antibody molecules (e.g., scFv); and multispecific antibodies formed from antibody fragments.


An “antibody that binds to the same epitope” as a reference antibody refers to an antibody that blocks binding of the reference antibody to its antigen in a competition assay by 50% or more, and conversely, the reference antibody blocks binding of the antibody to its antigen in a competition assay by 50% or more. An exemplary competition assay is provided herein.


The terms “full length antibody,” “intact antibody,” and “whole antibody” are used herein interchangeably to refer to an antibody having a structure substantially similar to a native antibody structure or having heavy chains that contain an Fc region as defined herein.


The term “monoclonal antibody” as used herein refers to an antibody obtained from a population of substantially homogeneous antibodies, i.e., the individual antibodies comprising the population are identical and/or bind the same epitope, except for possible variant antibodies, e.g., containing naturally occurring mutations or arising during production of a monoclonal antibody preparation, such variants generally being present in minor amounts. In contrast to polyclonal antibody preparations, which typically include different antibodies directed against different determinants (epitopes), each monoclonal antibody of a monoclonal antibody preparation is directed against a single determinant on an antigen. Thus, the modifier “monoclonal” indicates the character of the antibody as being obtained from a substantially homogeneous population of antibodies, and is not to be construed as requiring production of the antibody by any particular method. For example, the monoclonal antibodies to be used in accordance with the present invention may be made by a variety of techniques, including but not limited to the hybridoma method, recombinant DNA methods, phage-display methods, and methods utilizing transgenic animals containing all or part of the human immunoglobulin loci, such methods and other exemplary methods for making monoclonal antibodies being described herein.


“Native antibodies” refer to naturally occurring immunoglobulin molecules with varying structures. For example, native IgG antibodies are heterotetrameric glycoproteins of about 150,000 Daltons, composed of two identical light chains and two identical heavy chains that are disulfide-bonded. From N- to C-terminus, each heavy chain has a variable region (VH), also called a variable heavy domain or a heavy chain variable domain, followed by three constant domains (CH1, CH2, and CH3). Similarly, from N- to C-terminus, each light chain has a variable region (VL), also called a variable light domain or a light chain variable domain, followed by a constant light (CL) domain. The light chain of an antibody may be assigned to one of two types, called kappa (κ) and lambda (λ), based on the amino acid sequence of its constant domain.


The term “chimeric” antibody refers to an antibody in which a portion of the heavy and/or light chain is derived from a particular source or species, while the remainder of the heavy and/or light chain is derived from a different source or species.


A “human antibody” is one which possesses an amino acid sequence which corresponds to that of an antibody produced by a human or a human cell or derived from a non-human source that utilizes human antibody repertoires or other human antibody-encoding sequences. This definition of a human antibody specifically excludes a humanized antibody comprising non-human antigen-binding residues.


A “humanized” antibody refers to a chimeric antibody comprising amino acid residues from non-human HVRs and amino acid residues from human FRs. In certain embodiments, a humanized antibody will comprise substantially all of at least one, and typically two, variable domains, in which all or substantially all of the HVRs (e.g., CDRs) correspond to those of a non-human antibody, and all or substantially all of the FRs correspond to those of a human antibody. A humanized antibody optionally may comprise at least a portion of an antibody constant region derived from a human antibody. A “humanized form” of an antibody, e.g., a non-human antibody, refers to an antibody that has undergone humanization.


The “class” of an antibody refers to the type of constant domain or constant region possessed by its heavy chain. There are five major classes of antibodies: IgA, IgD, IgE, IgG, and IgM, and several of these may be further divided into subclasses (isotypes), e.g., IgG1, IgG2, IgG3, IgG4, IgA1, and IgA2. The heavy chain constant domains that correspond to the different classes of immunoglobulins are called α, δ, ε, γ, and μ, respectively.


“Effector functions” refer to those biological activities attributable to the Fc region of an antibody, which vary with the antibody isotype. Examples of antibody effector functions include: C1q binding and complement dependent cytotoxicity (CDC); Fc receptor binding; antibody-dependent cell-mediated cytotoxicity (ADCC); phagocytosis; down regulation of cell surface receptors (e.g., B cell receptor); and B cell activation.


The term “Fc region” herein is used to define a C-terminal region of an immunoglobulin heavy chain that contains at least a portion of the constant region. The term includes native sequence Fc regions and variant Fc regions. In one embodiment, a human IgG heavy chain Fc region extends from Cys226, or from Pro230, to the carboxyl-terminus of the heavy chain. However, the C-terminal lysine (Lys447) of the Fc region may or may not be present. Unless otherwise specified herein, numbering of amino acid residues in the Fc region or constant region is according to the EU numbering system, also called the EU index, as described in Kabat et al., Sequences of Proteins of Immunological Interest, 5th Ed. Public Health Service, National Institutes of Health, Bethesda, Md., 1991.


“Framework” or “FR” refers to variable domain residues other than hypervariable region (HVR) residues. The FR of a variable domain generally consists of four FR domains: FR1, FR2, FR3, and FR4. Accordingly, the HVR and FR sequences generally appear in the following sequence in VH (or VL): FR1-H1(L1)-FR2-H2(L2)-FR3-H3(L3)-FR4.


A “human consensus framework” is a framework which represents the most commonly occurring amino acid residues in a selection of human immunoglobulin VL or VH framework sequences. Generally, the selection of human immunoglobulin VL or VH sequences is from a subgroup of variable domain sequences. Generally, the subgroup of sequences is a subgroup as in Kabat et al., Sequences of Proteins of Immunological Interest, Fifth Edition, NIH Publication 91-3242, Bethesda Md. (1991), vols. 1-3. In one embodiment, for the VL, the subgroup is subgroup kappa I as in Kabat et al., supra. In one embodiment, for the VH, the subgroup is subgroup III as in Kabat et al., supra.


An “acceptor human framework” for the purposes herein is a framework comprising the amino acid sequence of a light chain variable domain (VL) framework or a heavy chain variable domain (VH) framework derived from a human immunoglobulin framework or a human consensus framework, as defined below. An acceptor human framework “derived from” a human immunoglobulin framework or a human consensus framework may comprise the same amino acid sequence thereof, or it may contain amino acid sequence changes. In some embodiments, the number of amino acid changes are 10 or less, 9 or less, 8 or less, 7 or less, 6 or less, 5 or less, 4 or less, 3 or less, or 2 or less. In some embodiments, the VL acceptor human framework is identical in sequence to the VL human immunoglobulin framework sequence or human consensus framework sequence.


The term “variable region” or “variable domain” refers to the domain of an antibody heavy or light chain that is involved in binding the antibody to antigen. The variable domains of the heavy chain and light chain (VH and VL, respectively) of a native antibody generally have similar structures, with each domain comprising four conserved framework regions (FRs) and three hypervariable regions (HVRs). (See, e.g., Kindt et al., Kuby Immunology, 6th ed., W.H. Freeman and Co., page 91 (2007).) A single VH or VL domain may be sufficient to confer antigen-binding specificity. Furthermore, antibodies that bind a particular antigen may be isolated using a VH or VL domain from an antibody that binds the antigen to screen a library of complementary VL or VH domains, respectively. See, e.g., Portolano et al., J. Immunol. 150:880-887 (1993); Clarkson et al., Nature 352:624-628 (1991).


The term “hypervariable region” or “HVR,” as used herein, refers to each of the regions of an antibody variable domain which are hypervariable in sequence and/or form structurally defined loops (“hypervariable loops”). Generally, native four-chain antibodies comprise six HVRs; three in the VH (H1, H2, H3), and three in the VL (L1, L2, L3). HVRs generally comprise amino acid residues from the hypervariable loops and/or from the “complementarity determining regions” (CDRs), the latter being of highest sequence variability and/or involved in antigen recognition. Exemplary hypervariable loops occur at amino acid residues 26-32 (L1), 50-52 (L2), 91-96 (L3), 26-32 (H1), 53-55 (H2), and 96-101 (H3). (Chothia and Lesk, J. Mol. Biol. 196:901-917 (1987).) Exemplary CDRs (CDR-L1, CDR-L2, CDR-L3, CDR-H1, CDR-H2, and CDR-H3) occur at amino acid residues 24-34 of L1, 50-56 of L2, 89-97 of L3, 31-35B of H1, 50-65 of H2, and 95-102 of H3. (Kabat et al., Sequences of Proteins of Immunological Interest, 5th Ed. Public Health Service, National Institutes of Health, Bethesda, Md. (1991).) With the exception of CDR1 in VH, CDRs generally comprise the amino acid residues that form the hypervariable loops. CDRs also comprise “specificity determining residues,” or “SDRs,” which are residues that contact antigen. SDRs are contained within regions of the CDRs called abbreviated-CDRs, or a-CDRs. Exemplary a-CDRs (a-CDR-L1, a-CDR-L2, a-CDR-L3, a-CDR-H1, a-CDR-H2, and a-CDR-H3) occur at amino acid residues 31-34 of L1, 50-55 of L2, 89-96 of L3, 31-35B of H1, 50-58 of H2, and 95-102 of H3. (See Almagro and Fransson, Front. Biosci. 13:1619-1633 (2008).) Unless otherwise indicated, HVR residues and other residues in the variable domain (e.g., FR residues) are numbered herein according to Kabat et al., supra.


“Affinity” refers to the strength of the sum total of noncovalent interactions between a single binding site of a molecule (e.g., an antibody) and its binding partner (e.g., an antigen). Unless indicated otherwise, as used herein, “binding affinity” refers to intrinsic binding affinity which reflects a 1:1 interaction between members of a binding pair (e.g., antibody and antigen). The affinity of a molecule X for its partner Y can generally be represented by the dissociation constant (Kd) Affinity can be measured by common methods known in the art, including those described herein. Specific illustrative and exemplary embodiments for measuring binding affinity are described in the following.


An “affinity matured” antibody refers to an antibody with one or more alterations in one or more hypervariable regions (HVRs), compared to a parent antibody which does not possess such alterations, such alterations resulting in an improvement in the affinity of the antibody for antigen.


The terms “anti-R-spondin-translocation antibody” and “an antibody that binds to R-spondin-translocation fusion polypeptide” refer to an antibody that is capable of binding R-spondin-translocation fusion polypeptide with sufficient affinity such that the antibody is useful as a diagnostic and/or therapeutic agent in targeting R-spondin translocation. In one embodiment, the extent of binding of an anti-R-spondin translocation antibody to an unrelated, non-R-spondin-translocation fusion polypeptide, and/or nontranslocated-R-spondin polypeptide is less than about 10% of the binding of the antibody to R-spondin-translocation fusion polypeptides measured, e.g., by a radioimmunoassay (RIA). In certain embodiments, an antibody that binds to R-spondin-translocation fusion polypeptide has a dissociation constant (Kd) of ≤1 μM, ≤100 nM, ≤10 nM, ≤1 nM, ≤0.1 nM, ≤0.01 nM, or ≤0.001 nM (e.g.,10−8 M or less, e.g., from 10−8 M to 10−13 M, e.g., from 10−9 M to 10−13 M). In certain embodiments, an anti-R-spondin translocation antibody binds to an epitope of R-spondin translocation that is unique among R-spondin translocations.


A “blocking” antibody or an “antagonist” antibody is one which inhibits or reduces biological activity of the antigen it binds. Preferred blocking antibodies or antagonist antibodies substantially or completely inhibit the biological activity of the antigen.


A “naked antibody” refers to an antibody that is not conjugated to a heterologous moiety (e.g., a cytotoxic moiety) or radiolabel. The naked antibody may be present in a pharmaceutical formulation.


An “immunoconjugate” is an antibody conjugated to one or more heterologous molecule(s), including but not limited to a cytotoxic agent.


“Percent (%) amino acid sequence identity” with respect to a reference polypeptide sequence is defined as the percentage of amino acid residues in a candidate sequence that are identical with the amino acid residues in the reference polypeptide sequence, after aligning the sequences and introducing gaps, if necessary, to achieve the maximum percent sequence identity, and not considering any conservative substitutions as part of the sequence identity. Alignment for purposes of determining percent amino acid sequence identity can be achieved in various ways that are within the skill in the art, for instance, using publicly available computer software such as BLAST, BLAST-2, ALIGN or Megalign (DNASTAR) software. Those skilled in the art can determine appropriate parameters for aligning sequences, including any algorithms needed to achieve maximal alignment over the full length of the sequences being compared. For purposes herein, however, % amino acid sequence identity values are generated using the sequence comparison computer program ALIGN-2. The ALIGN-2 sequence comparison computer program was authored by Genentech, Inc., and the source code has been filed with user documentation in the U.S. Copyright Office, Washington D.C., 20559, where it is registered under U.S. Copyright Registration No. TXU510087. The ALIGN-2 program is publicly available from Genentech, Inc., South San Francisco, Calif., or may be compiled from the source code. The ALIGN-2 program should be compiled for use on a UNIX operating system, including digital UNIX V4.0D. All sequence comparison parameters are set by the ALIGN-2 program and do not vary.


In situations where ALIGN-2 is employed for amino acid sequence comparisons, the % amino acid sequence identity of a given amino acid sequence A to, with, or against a given amino acid sequence B (which can alternatively be phrased as a given amino acid sequence A that has or comprises a certain % amino acid sequence identity to, with, or against a given amino acid sequence B) is calculated as follows:





100 times the fraction X/Y


where X is the number of amino acid residues scored as identical matches by the sequence alignment program ALIGN-2 in that program's alignment of A and B, and where Y is the total number of amino acid residues in B. It will be appreciated that where the length of amino acid sequence A is not equal to the length of amino acid sequence B, the % amino acid sequence identity of A to B will not equal the % amino acid sequence identity of B to A. Unless specifically stated otherwise, all % amino acid sequence identity values used herein are obtained as described in the immediately preceding paragraph using the ALIGN-2 computer program.


The term “detection” includes any means of detecting, including direct and indirect detection.


The term “biomarker” as used herein refers to an indicator, e.g., predictive, diagnostic, and/or prognostic, which can be detected in a sample. The biomarker may serve as an indicator of a particular subtype of a disease or disorder (e.g., cancer) characterized by certain, molecular, pathological, histological, and/or clinical features. In some embodiments, the biomarker is a gene. In some embodiments, the biomarker is a variation (e.g., mutation and/or polymorphism) of a gene. In some embodiments, the biomarkers is a translocation. Biomarkers include, but are not limited to, polynucleotides (e.g., DNA, and/or RNA), polypeptides, polypeptide and polynucleotide modifications (e.g., posttranslational modifications), carbohydrates, and/or glycolipid-based molecular markers.


The “presence,” “amount,” or “level” of a biomarker associated with an increased clinical benefit to an individual is a detectable level in a biological sample. These can be measured by methods known to one skilled in the art and also disclosed herein. The expression level or amount of biomarker assessed can be used to determine the response to the treatment.


The terms “level of expression” or “expression level” in general are used interchangeably and generally refer to the amount of a biomarker in a biological sample. “Expression” generally refers to the process by which information (e.g., gene-encoded and/or epigenetic) is converted into the structures present and operating in the cell. Therefore, as used herein, “expression” may refer to transcription into a polynucleotide, translation into a polypeptide, or even polynucleotide and/or polypeptide modifications (e.g., posttranslational modification of a polypeptide). Fragments of the transcribed polynucleotide, the translated polypeptide, or polynucleotide and/or polypeptide modifications (e.g., posttranslational modification of a polypeptide) shall also be regarded as expressed whether they originate from a transcript generated by alternative splicing or a degraded transcript, or from a post-translational processing of the polypeptide, e.g., by proteolysis. “Expressed genes” include those that are transcribed into a polynucleotide as mRNA and then translated into a polypeptide, and also those that are transcribed into RNA but not translated into a polypeptide (for example, transfer and ribosomal RNAs).


“Elevated expression,” “elevated expression levels,” or “elevated levels” refers to an increased expression or increased levels of a biomarker in an individual relative to a control, such as an individual or individuals who are not suffering from the disease or disorder (e.g., cancer) or an internal control (e.g., housekeeping biomarker).


“Reduced expression,” “reduced expression levels,” or “reduced levels” refers to a decrease expression or decreased levels of a biomarker in an individual relative to a control, such as an individual or individuals who are not suffering from the disease or disorder (e.g., cancer) or an internal control (e.g., housekeeping biomarker).


The term “housekeeping biomarker” refers to a biomarker or group of biomarkers (e.g., polynucleotides and/or polypeptides) which are typically similarly present in all cell types. In some embodiments, the housekeeping biomarker is a “housekeeping gene.” A “housekeeping gene” refers herein to a gene or group of genes which encode proteins whose activities are essential for the maintenance of cell function and which are typically similarly present in all cell types.


“Amplification,” as used herein generally refers to the process of producing multiple copies of a desired sequence. “Multiple copies” mean at least two copies. A “copy” does not necessarily mean perfect sequence complementarity or identity to the template sequence. For example, copies can include nucleotide analogs such as deoxyinosine, intentional sequence alterations (such as sequence alterations introduced through a primer comprising a sequence that is hybridizable, but not complementary, to the template), and/or sequence errors that occur during amplification.


The term “multiplex-PCR” refers to a single PCR reaction carried out on nucleic acid obtained from a single source (e.g., an individual) using more than one primer set for the purpose of amplifying two or more DNA sequences in a single reaction.


“Stringency” of hybridization reactions is readily determinable by one of ordinary skill in the art, and generally is an empirical calculation dependent upon probe length, washing temperature, and salt concentration. In general, longer probes require higher temperatures for proper annealing, while shorter probes need lower temperatures. Hybridization generally depends on the ability of denatured DNA to reanneal when complementary strands are present in an environment below their melting temperature. The higher the degree of desired homology between the probe and hybridizable sequence, the higher the relative temperature which can be used. As a result, it follows that higher relative temperatures would tend to make the reaction conditions more stringent, while lower temperatures less so. For additional details and explanation of stringency of hybridization reactions, see Ausubel et al., Current Protocols in Molecular Biology, Wiley Interscience Publishers, (1995).


“Stringent conditions” or “high stringency conditions”, as defined herein, can be identified by those that: (1) employ low ionic strength and high temperature for washing, for example 0.015 M sodium chloride/0.0015 M sodium citrate/0.1% sodium dodecyl sulfate at 50° C.; (2) employ during hybridization a denaturing agent, such as formamide, for example, 50% (v/v) formamide with 0.1% bovine serum albumin/0.1% Ficoll/0.1% polyvinylpyrrolidone/50 mM sodium phosphate buffer at pH 6.5 with 750 mM sodium chloride, 75 mM sodium citrate at 42° C.; or (3) overnight hybridization in a solution that employs 50% formamide, 5×SSC (0.75 M NaCl, 0.075 M sodium citrate), 50 mM sodium phosphate (pH 6.8), 0.1% sodium pyrophosphate, 5× Denhardt's solution, sonicated salmon sperm DNA (50 μg/ml), 0.1% SDS, and 10% dextran sulfate at 42° C., with a 10 minute wash at 42° C. in 0.2×SSC (sodium chloride/sodium citrate) followed by a 10 minute high-stringency wash consisting of 0.1×SSC containing EDTA at 55° C.


“Moderately stringent conditions” can be identified as described by Sambrook et al., Molecular Cloning: A Laboratory Manual, New York: Cold Spring Harbor Press, 1989, and include the use of washing solution and hybridization conditions (e.g., temperature, ionic strength and % SDS) less stringent that those described above. An example of moderately stringent conditions is overnight incubation at 37° C. in a solution comprising: 20% formamide, 5×SSC (150 mM NaCl, 15 mM trisodium citrate), 50 mM sodium phosphate (pH 7.6), 5× Denhardt's solution, 10% dextran sulfate, and 20 mg/ml denatured sheared salmon sperm DNA, followed by washing the filters in 1×SSC at about 37-50° C. The skilled artisan will recognize how to adjust the temperature, ionic strength, etc. as necessary to accommodate factors such as probe length and the like.


The term “diagnosis” is used herein to refer to the identification or classification of a molecular or pathological state, disease or condition (e.g., cancer). For example, “diagnosis” may refer to identification of a particular type of cancer. “Diagnosis” may also refer to the classification of a particular subtype of cancer, e.g., by histopathological criteria, or by molecular features (e.g., a subtype characterized by expression of one or a combination of biomarkers (e.g., particular genes or proteins encoded by said genes)).


The term “aiding diagnosis” is used herein to refer to methods that assist in making a clinical determination regarding the presence, or nature, of a particular type of symptom or condition of a disease or disorder (e.g., cancer). For example, a method of aiding diagnosis of a disease or condition (e.g., cancer) can comprise detecting certain biomarkers in a biological sample from an individual.


The term “sample,” as used herein, refers to a composition that is obtained or derived from a subject and/or individual of interest that contains a cellular and/or other molecular entity that is to be characterized and/or identified, for example based on physical, biochemical, chemical and/or physiological characteristics. For example, the phrase “disease sample” and variations thereof refers to any sample obtained from a subject of interest that would be expected or is known to contain the cellular and/or molecular entity that is to be characterized. Samples include, but are not limited to, primary or cultured cells or cell lines, cell supernatants, cell lysates, platelets, serum, plasma, vitreous fluid, lymph fluid, synovial fluid, follicular fluid, seminal fluid, amniotic fluid, milk, whole blood, blood-derived cells, urine, cerebro-spinal fluid, saliva, sputum, tears, perspiration, mucus, tumor lysates, and tissue culture medium, tissue extracts such as homogenized tissue, tumor tissue, cellular extracts, and combinations thereof.


By “tissue sample” or “cell sample” is meant a collection of similar cells obtained from a tissue of a subject or individual. The source of the tissue or cell sample may be solid tissue as from a fresh, frozen and/or preserved organ, tissue sample, biopsy, and/or aspirate; blood or any blood constituents such as plasma; bodily fluids such as cerebral spinal fluid, amniotic fluid, peritoneal fluid, or interstitial fluid; cells from any time in gestation or development of the subject. The tissue sample may also be primary or cultured cells or cell lines. Optionally, the tissue or cell sample is obtained from a disease tissue/organ. The tissue sample may contain compounds which are not naturally intermixed with the tissue in nature such as preservatives, anticoagulants, buffers, fixatives, nutrients, antibiotics, or the like.


A “reference sample”, “reference cell”, “reference tissue”, “control sample”, “control cell”, or “control tissue”, as used herein, refers to a sample, cell, tissue, standard, or level that is used for comparison purposes. In one embodiment, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is obtained from a healthy and/or non-diseased part of the body (e.g., tissue or cells) of the same subject or individual. For example, healthy and/or non-diseased cells or tissue adjacent to the diseased cells or tissue (e.g., cells or tissue adjacent to a tumor). In another embodiment, a reference sample is obtained from an untreated tissue and/or cell of the body of the same subject or individual. In yet another embodiment, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is obtained from a healthy and/or non-diseased part of the body (e.g., tissues or cells) of an individual who is not the subject or individual. In even another embodiment, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is obtained from an untreated tissue and/or cell of the body of an individual who is not the subject or individual.


For the purposes herein a “section” of a tissue sample is meant a single part or piece of a tissue sample, e.g., a thin slice of tissue or cells cut from a tissue sample. It is understood that multiple sections of tissue samples may be taken and subjected to analysis, provided that it is understood that the same section of tissue sample may be analyzed at both morphological and molecular levels, or analyzed with respect to both polypeptides and polynucleotides.


By “correlate” or “correlating” is meant comparing, in any way, the performance and/or results of a first analysis or protocol with the performance and/or results of a second analysis or protocol. For example, one may use the results of a first analysis or protocol in carrying out a second protocols and/or one may use the results of a first analysis or protocol to determine whether a second analysis or protocol should be performed. With respect to the embodiment of polynucleotide analysis or protocol, one may use the results of the polynucleotide expression analysis or protocol to determine whether a specific therapeutic regimen should be performed.


“Individual response” or “response” can be assessed using any endpoint indicating a benefit to the individual, including, without limitation, (1) inhibition, to some extent, of disease progression (e.g., cancer progression), including slowing down and complete arrest; (2) a reduction in tumor size; (3) inhibition (i.e., reduction, slowing down or complete stopping) of cancer cell infiltration into adjacent peripheral organs and/or tissues; (4) inhibition (i.e. reduction, slowing down or complete stopping) of metasisis; (5) relief, to some extent, of one or more symptoms associated with the disease or disorder (e.g., cancer); (6) increase in the length of progression free survival; and/or (9) decreased mortality at a given point of time following treatment.


The phrase “substantially similar,” as used herein, refers to a sufficiently high degree of similarity between two numeric values (generally one associated with a molecule and the other associated with a reference/comparator molecule) such that one of skill in the art would consider the difference between the two values to not be of statistical significance within the context of the biological characteristic measured by said values (e.g., Kd values). The difference between said two values may be, for example, less than about 20%, less than about 10%, and/or less than about 5% as a function of the reference/comparator value. The phrase “substantially normal” refers to substantially similar to a reference (e.g., normal reference).


The phrase “substantially different,” refers to a sufficiently high degree of difference between two numeric values (generally one associated with a molecule and the other associated with a reference/comparator molecule) such that one of skill in the art would consider the difference between the two values to be of statistical significance within the context of the biological characteristic measured by said values (e.g., Kd values). The difference between said two values may be, for example, greater than about 10%, greater than about 20%, greater than about 30%, greater than about 40%, and/or greater than about 50% as a function of the value for the reference/comparator molecule.


The word “label” when used herein refers to a detectable compound or composition. The label is typically conjugated or fused directly or indirectly to a reagent, such as a polynucleotide probe or an antibody, and facilitates detection of the reagent to which it is conjugated or fused. The label may itself be detectable (e.g., radioisotope labels or fluorescent labels) or, in the case of an enzymatic label, may catalyze chemical alteration of a substrate compound or composition which results in a detectable product.


An “effective amount” of an agent refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired therapeutic or prophylactic result.


A “therapeutically effective amount” of a substance/molecule of the invention, agonist or antagonist may vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the substance/molecule, agonist or antagonist to elicit a desired response in the individual. A therapeutically effective amount is also one in which any toxic or detrimental effects of the substance/molecule, agonist or antagonist are outweighed by the therapeutically beneficial effects. A “prophylactically effective amount” refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired prophylactic result. Typically but not necessarily, since a prophylactic dose is used in subjects prior to or at an earlier stage of disease, the prophylactically effective amount will be less than the therapeutically effective amount.


The term “pharmaceutical formulation” refers to a preparation which is in such form as to permit the biological activity of an active ingredient contained therein to be effective, and which contains no additional components which are unacceptably toxic to a subject to which the formulation would be administered.


A “pharmaceutically acceptable carrier” refers to an ingredient in a pharmaceutical formulation, other than an active ingredient, which is nontoxic to a subject., A pharmaceutically acceptable carrier includes, but is not limited to, a buffer, excipient, stabilizer, or preservative.


As used herein, “treatment” (and grammatical variations thereof such as “treat” or “treating”) refers to clinical intervention in an attempt to alter the natural course of the individual being treated, and can be performed either for prophylaxis or during the course of clinical pathology. Desirable effects of treatment include, but are not limited to, preventing occurrence or recurrence of disease, alleviation of symptoms, diminishment of any direct or indirect pathological consequences of the disease, preventing metastasis, decreasing the rate of disease progression, amelioration or palliation of the disease state, and remission or improved prognosis. In some embodiments, antibodies of the invention are used to delay development of a disease or to slow the progression of a disease.


The terms “cancer” and “cancerous” refer to or describe the physiological condition in mammals that is typically characterized by unregulated cell growth/proliferation. Examples of cancer include, but are not limited to, carcinoma, lymphoma (e.g., Hodgkin's and non-Hodgkin's lymphoma), blastoma, sarcoma, and leukemia. More particular examples of such cancers include squamous cell cancer, small-cell lung cancer, non-small cell lung cancer, adenocarcinoma of the lung, squamous carcinoma of the lung, cancer of the peritoneum, hepatocellular cancer, gastrointestinal cancer, pancreatic cancer, glioma, cervical cancer, ovarian cancer, liver cancer, bladder cancer, hepatoma, breast cancer, colon cancer, colorectal cancer, endometrial or uterine carcinoma, salivary gland carcinoma, kidney cancer, liver cancer, prostate cancer, vulval cancer, thyroid cancer, hepatic carcinoma, leukemia and other lymphoproliferative disorders, and various types of head and neck cancer.


The term “anti-cancer therapy” refers to a therapy useful in treating cancer. Examples of anti-cancer therapeutic agents include, but are limited to, e.g., chemotherapeutic agents, growth inhibitory agents, cytotoxic agents, agents used in radiation therapy, anti-angiogenesis agents, apoptotic agents, anti-tubulin agents, and other agents to treat cancer, anti-CD20 antibodies, platelet derived growth factor inhibitors (e.g., Gleevec™ (Imatinib Mesylate)), a COX-2 inhibitor (e.g., celecoxib), interferons, cytokines, antagonists (e.g., neutralizing antibodies) that bind to one or more of the following targets PDGFR-beta, BlyS, APRIL, BCMA receptor(s), TRAIL/Apo2, and other bioactive and organic chemical agents, etc. Combinations thereof are also included in the invention.


The term “cytotoxic agent” as used herein refers to a substance that inhibits or prevents a cellular function and/or causes cell death or destruction. Cytotoxic agents include, but are not limited to, radioactive isotopes (e.g., At211, I131, I125, Y90, Re186, Re188, Sm153, Bi212, P32, Pb212 and radioactive isotopes of Lu); chemotherapeutic agents or drugs (e.g., methotrexate, adriamicin, vinca alkaloids (vincristine, vinblastine, etoposide), doxorubicin, melphalan, mitomycin C, chlorambucil, daunorubicin or other intercalating agents); growth inhibitory agents; enzymes and fragments thereof such as nucleolytic enzymes; antibiotics; toxins such as small molecule toxins or enzymatically active toxins of bacterial, fungal, plant or animal origin, including fragments and/or variants thereof; and the various antitumor or anticancer agents disclosed below.


A “chemotherapeutic agent” refers to a chemical compound useful in the treatment of cancer. Examples of chemotherapeutic agents include alkylating agents such as thiotepa and cyclosphosphamide (CYTOXAN®); alkyl sulfonates such as busulfan, improsulfan and piposulfan; aziridines such as benzodopa, carboquone, meturedopa, and uredopa; ethylenimines and methylamelamines including altretamine, triethylenemelamine, triethylenephosphoramide, triethylenethiophosphoramide and trimethylomelamine; acetogenins (especially bullatacin and bullatacinone); delta-9-tetrahydrocannabinol (dronabinol, MARINOL®); beta-lapachone; lapachol; colchicines; betulinic acid; a camptothecin (including the synthetic analogue topotecan (HYCAMTIN®), CPT-11 (irinotecan, CAMPTOSAR®), acetylcamptothecin, scopolectin, and 9-aminocamptothecin); bryostatin; callystatin; CC-1065 (including its adozelesin, carzelesin and bizelesin synthetic analogues); podophyllotoxin; podophyllinic acid; teniposide; cryptophycins (particularly cryptophycin 1 and cryptophycin 8); dolastatin; duocarmycin (including the synthetic analogues, KW-2189 and CB1-TM1); eleutherobin; pancratistatin; a sarcodictyin; spongistatin; nitrogen mustards such as chlorambucil, chlornaphazine, chlorophosphamide, estramustine, ifosfamide, mechlorethamine, mechlorethamine oxide hydrochloride, melphalan, novembichin, phenesterine, prednimustine, trofosfamide, uracil mustard; nitrosoureas such as carmustine, chlorozotocin, fotemustine, lomustine, nimustine, and ranimnustine; antibiotics such as the enediyne antibiotics (e. g., calicheamicin, especially calicheamicin gammall and calicheamicin omegaI1 (see, e.g., Nicolaou et al., Angew. Chem Intl. Ed. Engl., 33: 183-186 (1994)); CDP323, an oral alpha-4 integrin inhibitor; dynemicin, including dynemicin A; an esperamicin; as well as neocarzinostatin chromophore and related chromoprotein enediyne antibiotic chromophores), aclacinomysins, actinomycin, authramycin, azaserine, bleomycins, cactinomycin, carabicin, carminomycin, carzinophilin, chromomycins, dactinomycin, daunorubicin, detorubicin, 6-diazo-5-oxo-L-norleucine, doxorubicin (including ADRIAMYCIN®, morpholino-doxorubicin, cyanomorpholino-doxorubicin, 2-pyrrolino-doxorubicin, doxorubicin HCl liposome injection (DOXIL®), liposomal doxorubicin TLC D-99 (MYOCET®), pegylated liposomal doxorubicin (CAELYX®), and deoxydoxorubicin), epirubicin, esorubicin, idarubicin, marcellomycin, mitomycins such as mitomycin C, mycophenolic acid, nogalamycin, olivomycins, peplomycin, porfiromycin, puromycin, quelamycin, rodorubicin, streptonigrin, streptozocin, tubercidin, ubenimex, zinostatin, zorubicin; anti-metabolites such as methotrexate, gemcitabine (GEMZAR®), tegafur (UFTORAL®), capecitabine (XELODA®), an epothilone, and 5-fluorouracil (5-FU); folic acid analogues such as denopterin, methotrexate, pteropterin, trimetrexate; purine analogs such as fludarabine, 6-mercaptopurine, thiamiprine, thioguanine; pyrimidine analogs such as ancitabine, azacitidine, 6-azauridine, carmofur, cytarabine, dideoxyuridine, doxifluridine, enocitabine, floxuridine; androgens such as calusterone, dromostanolone propionate, epitiostanol, mepitiostane, testolactone; anti-adrenals such as aminoglutethimide, mitotane, trilostane; folic acid replenisher such as frolinic acid; aceglatone; aldophosphamide glycoside; aminolevulinic acid; eniluracil; amsacrine; bestrabucil; bisantrene; edatraxate; defofamine; demecolcine; diaziquone; elfornithine; elliptinium acetate; an epothilone; etoglucid; gallium nitrate; hydroxyurea; lentinan; lonidainine; maytansinoids such as maytansine and ansamitocins; mitoguazone; mitoxantrone; mopidanmol; nitraerine; pentostatin; phenamet; pirarubicin; losoxantrone; 2-ethylhydrazide; procarbazine; PSK® polysaccharide complex (JHS Natural Products, Eugene, Oreg.); razoxane; rhizoxin; sizofiran; spirogermanium; tenuazonic acid; triaziquone; 2,2′,2′-trichlorotriethylamine; trichothecenes (especially T-2 toxin, verracurin A, roridin A and anguidine); urethan; vindesine (ELDISINE®, FILDESIN®); dacarbazine; mannomustine; mitobronitol; mitolactol; pipobroman; gacytosine; arabinoside (“Ara-C”); thiotepa; taxoid, e.g., paclitaxel (TAXOL®), albumin-engineered nanoparticle formulation of paclitaxel (ABRAXANE™), and docetaxel (TAXOTERE®); chloranbucil; 6-thioguanine; mercaptopurine; methotrexate; platinum agents such as cisplatin, oxaliplatin (e.g., ELOXATIN®), and carboplatin; vincas, which prevent tubulin polymerization from forming microtubules, including vinblastine (VELBAN®), vincristine (ONCOVIN®), vindesine (ELDISINE®, FILDESIN®), and vinorelbine (NAVELBINE®); etoposide (VP-16); ifosfamide; mitoxantrone; leucovorin; novantrone; edatrexate; daunomycin; aminopterin; ibandronate; topoisomerase inhibitor RFS 2000; difluoromethylornithine (DMFO); retinoids such as retinoic acid, including bexarotene (TARGRETIN®); bisphosphonates such as clodronate (for example, BONEFOS® or OSTAC®), etidronate (DIDROCAL®), NE-58095, zoledronic acid/zoledronate (ZOMETA®), alendronate (FOSAMAX®), pamidronate (AREDIA®), tiludronate (SKELID®), or risedronate (ACTONEL®); troxacitabine (a 1,3-dioxolane nucleoside cytosine analog); antisense oligonucleotides, particularly those that inhibit expression of genes in signaling pathways implicated in aberrant cell proliferation, such as, for example, PKC-alpha, Raf, H-Ras, and epidermal growth factor receptor (EGF-R); vaccines such as THERATOPE® vaccine and gene therapy vaccines, for example, ALLOVECTIN® vaccine, LEUVECTIN® vaccine, and VAXID® vaccine; topoisomerase 1 inhibitor (e.g., LURTOTECAN®); rmRH (e.g., ABARELIX®); BAY439006 (sorafenib; Bayer); SU-11248 (sunitinib, SUTENT®, Pfizer); perifosine, COX-2 inhibitor (e.g., celecoxib or etoricoxib), proteosome inhibitor (e.g., PS341); bortezomib (VELCADE®); CCI-779; tipifarnib (R11577); orafenib, ABT510; Bcl-2 inhibitor such as oblimersen sodium (GENASENSE®); pixantrone; EGFR inhibitors (see definition below); tyrosine kinase inhibitors (see definition below); serine-threonine kinase inhibitors such as rapamycin (sirolimus, RAPAMUNE®); farnesyltransferase inhibitors such as lonafarnib (SCH 6636, SARASAR™); and pharmaceutically acceptable salts, acids or derivatives of any of the above; as well as combinations of two or more of the above such as CHOP, an abbreviation for a combined therapy of cyclophosphamide, doxorubicin, vincristine, and prednisolone; and FOLFOX, an abbreviation for a treatment regimen with oxaliplatin (ELOXATIN™) combined with 5-FU and leucovorin.


Chemotherapeutic agents as defined herein include “anti-hormonal agents” or “endocrine therapeutics” which act to regulate, reduce, block, or inhibit the effects of hormones that can promote the growth of cancer. They may be hormones themselves, including, but not limited to: anti-estrogens with mixed agonist/antagonist profile, including, tamoxifen (NOLVADEX®), 4-hydroxytamoxifen, toremifene (FARESTON®), idoxifene, droloxifene, raloxifene (EVISTA®), trioxifene, keoxifene, and selective estrogen receptor modulators (SERMs) such as SERM3; pure anti-estrogens without agonist properties, such as fulvestrant (FASLODEX®), and EM800 (such agents may block estrogen receptor (ER) dimerization, inhibit DNA binding, increase ER turnover, and/or suppress ER levels); aromatase inhibitors, including steroidal aromatase inhibitors such as formestane and exemestane (AROMASIN®), and nonsteroidal aromatase inhibitors such as anastrazole (ARIMIDEX®), letrozole (FEMARA®) and aminoglutethimide, and other aromatase inhibitors include vorozole (RIVISOR®), megestrol acetate (MEGASE®), fadrozole, and 4(5)-imidazoles; lutenizing hormone-releaseing hormone agonists, including leuprolide (LUPRON® and ELIGARD®), goserelin, buserelin, and tripterelin; sex steroids, including progestines such as megestrol acetate and medroxyprogesterone acetate, estrogens such as diethylstilbestrol and premarin, and androgens/retinoids such as fluoxymesterone, all transretionic acid and fenretinide; onapristone; anti-progesterones; estrogen receptor down-regulators (ERDs); anti-androgens such as flutamide, nilutamide and bicalutamide; and pharmaceutically acceptable salts, acids or derivatives of any of the above; as well as combinations of two or more of the above.


The term “prodrug” as used in this application refers to a precursor or derivative form of a pharmaceutically active substance that is less cytotoxic to tumor cells compared to the parent drug and is capable of being enzymatically activated or converted into the more active parent form. See, e.g., Wilman, “Prodrugs in Cancer Chemotherapy” Biochemical Society Transactions, 14, pp. 375-382, 615th Meeting Belfast (1986) and Stella et al., “Prodrugs: A Chemical Approach to Targeted Drug Delivery,” Directed Drug Delivery, Borchardt et al., (ed.), pp. 247-267, Humana Press (1985). The prodrugs of this invention include, but are not limited to, phosphate-containing prodrugs, thiophosphate-containing prodrugs, sulfate-containing prodrugs, peptide-containing prodrugs, D-amino acid-modified prodrugs, glycosylated prodrugs, β-lactam-containing prodrugs, optionally substituted phenoxyacetamide-containing prodrugs or optionally substituted phenylacetamide-containing prodrugs, 5-fluorocytosine and other 5-fluorouridine prodrugs which can be converted into the more active cytotoxic free drug. Examples of cytotoxic drugs that can be derivatized into a prodrug form for use in this invention include, but are not limited to, those chemotherapeutic agents described above.


A “growth inhibitory agent” when used herein refers to a compound or composition which inhibits growth of a cell (e.g., a cell whose growth is dependent upon a wnt pathway gene and/or R-spondin translocation expression either in vitro or in vivo). Examples of growth inhibitory agents include agents that block cell cycle progression (at a place other than S phase), such as agents that induce G1 arrest and M-phase arrest. Classical M-phase blockers include the vincas (vincristine and vinblastine), taxanes, and topoisomerase II inhibitors such as doxorubicin, epirubicin, daunorubicin, etoposide, and bleomycin. Those agents that arrest G1 also spill over into S-phase arrest, for example, DNA alkylating agents such as tamoxifen, prednisone, dacarbazine, mechlorethamine, cisplatin, methotrexate, 5-fluorouracil, and ara-C. Further information can be found in The Molecular Basis of Cancer, Mendelsohn and Israel, eds., Chapter 1, entitled “Cell cycle regulation, oncogenes, and antineoplastic drugs” by Murakami et al., (W B Saunders: Philadelphia, 1995), especially p. 13. The taxanes (paclitaxel and docetaxel) are anticancer drugs both derived from the yew tree. Docetaxel (TAXOTERE®, Rhone-Poulenc Rorer), derived from the European yew, is a semisynthetic analogue of paclitaxel (TAXOL®, Bristol-Myers Squibb). Paclitaxel and docetaxel promote the assembly of microtubules from tubulin dimers and stabilize microtubules by preventing depolymerization, which results in the inhibition of mitosis in cells.


By “radiation therapy” is meant the use of directed gamma rays or beta rays to induce sufficient damage to a cell so as to limit its ability to function normally or to destroy the cell altogether. It will be appreciated that there will be many ways known in the art to determine the dosage and duration of treatment. Typical treatments are given as a one time administration and typical dosages range from 10 to 200 units (Grays) per day.


An “individual” or “subject” is a mammal. Mammals include, but are not limited to, domesticated animals (e.g., cows, sheep, cats, dogs, and horses), primates (e.g., humans and non-human primates such as monkeys), rabbits, and rodents (e.g., mice and rats). In certain embodiments, the individual or subject is a human.


The term “concurrently” is used herein to refer to administration of two or more therapeutic agents, where at least part of the administration overlaps in time. Accordingly, concurrent administration includes a dosing regimen when the administration of one or more agent(s) continues after discontinuing the administration of one or more other agent(s).


By “reduce” or “inhibit” is meant the ability to cause an overall decrease of 20%, 30%, 40%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, or greater. Reduce or inhibit can refer to the symptoms of the disorder being treated, the presence or size of metastases, or the size of the primary tumor.


The term “package insert” is used to refer to instructions customarily included in commercial packages of therapeutic products, that contain information about the indications, usage, dosage, administration, combination therapy, contraindications and/or warnings concerning the use of such therapeutic products.


An “article of manufacture” is any manufacture (e.g., a package or container) or kit comprising at least one reagent, e.g., a medicament for treatment of a disease or disorder (e.g., cancer), or a probe for specifically detecting a biomarker described herein. In certain embodiments, the manufacture or kit is promoted, distributed, or sold as a unit for performing the methods described herein.


A “target audience” is a group of people or an institution to whom or to which a particular medicament is being promoted or intended to be promoted, as by marketing or advertising, especially for particular uses, treatments, or indications, such as individuals, populations, readers of newspapers, medical literature, and magazines, television or internet viewers, radio or internet listeners, physicians, drug companies, etc.


As is understood by one skilled in the art, reference to “about” a value or parameter herein includes (and describes) embodiments that are directed to that value or parameter per se. For example, description referring to “about X” includes description of “X”.


It is understood that aspect and embodiments of the invention described herein include “consisting” and/or “consisting essentially of” aspects and embodiments. As used herein, the singular form “a”, “an”, and “the” includes plural references unless indicated otherwise.


II. Methods and Uses

Provided herein are methods utilizing a wnt pathway antagonist. In particular, provided herein are methods utilizing an R-spondin-translocation antagonist. For example, provided herein are methods of inhibiting cell proliferation of a cancer cell comprising contacting the cancer cell with an effective amount of an R-spondin-translocation antagonist. Also provided herein are methods of treating cancer in an individual comprising administering to the individual an effective amount of an R-spondin-translocation antagonist. In some embodiments, the cancer or cancer comprises an R-spondin translocation.


Also provided herein are methods of treating cancer in an individual comprising administering to the individual an effective amount of an anti-cancer therapy, wherein treatment is based upon the individual having cancer comprising one or more biomarkers. In some embodiments, the anti-cancer therapy comprises a wnt pathway antagonist. For example, provided are methods of treating cancer in an individual comprising administering to the individual an effective amount of a wnt pathway antagonist, wherein treatment is based upon the individual having cancer comprising an R-spondin translocation. In some embodiments, the win pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


Further provided herein are methods of treating cancer in an individual provided that the individual has been found to have cancer comprising one or more biomarkers, the treatment comprising administering to the individual an effective amount of an anti-cancer therapy. In some embodiments, the anti-cancer therapy comprises a wnt pathway antagonist. For example, provided herein are methods of treating cancer in an individual provided that the individual has been found to have cancer comprising an R-spondin translocation, the treatment comprising administering to the individual an effective amount of a wnt pathway antagonist. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


Provided herein are methods of treating a cancer cell, wherein the cancer cell comprises one or more biomarkers, the method comprising providing an effective amount of a wnt pathway antagonist. For example, provided herein are methods of treating a cancer cell, wherein the cancer cell comprises an R-spondin translocation, the method comprising providing an effective amount of a wnt pathway antagonist. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


Provided herein are methods for treating cancer in an individual, the method comprising: determining that a sample obtained from the individual comprises one or more biomarkers, and administering an effective amount of an anti-cancer therapy comprising a wnt pathway antagonist to the individual, whereby the cancer is treated. For example, provided herein are methods for treating cancer in an individual, the method comprising: determining that a sample obtained from the individual comprises an R-spondin translocation, and administering an effective amount of an anti-cancer therapy comprising a wnt pathway antagonist to the individual, whereby the cancer is treated. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


Provided herein are also methods of treating cancer, comprising: (a) selecting an individual having cancer, wherein the cancer comprises one or more biomarkers; and (b) administering to the individual thus selected an effective amount of a wnt pathway antagonist, whereby the cancer is treated. For example, provided herein are also methods of treating cancer, comprising: (a) selecting an individual having cancer, wherein the cancer comprises an R-spondin translocation; and (b) administering to the individual thus selected an effective amount of a wnt pathway antagonist, whereby the cancer is treated. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


Further provided herein are methods of identifying an individual with cancer who is more or less likely to exhibit benefit from treatment with an anti-cancer therapy, the method comprising: determining presence or absence of one or more biomarkers in a sample obtained from the individual, wherein presence of the one or more biomarkers in the sample indicates that the individual is more likely to exhibit benefit from treatment with the anti-cancer therapy or absence of the one or more biomarkers indicates that the individual is less likely to exhibit benefit from treatment with the anti-cancer therapy. In some embodiments, the anti-cancer therapy comprises a wnt pathway antagonist. For example, provided herein are methods of identifying an individual with cancer who is more or less likely to exhibit benefit from treatment with an anti-cancer therapy comprising a wnt pathway antagonist, the method comprising: determining presence or absence of an R-spondin translocation in a sample obtained from the individual, wherein presence of the R-spondin translocation in the sample indicates that the individual is more likely to exhibit benefit from treatment with the anti-cancer therapy comprising the wnt pathway antagonist or absence of the R-spondin translocation indicates that the individual is less likely to exhibit benefit from treatment with the anti-cancer therapy comprising the wnt pathway antagonist. In some embodiments, the method further comprises administering an effective amount of a wnt pathway antagonist. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


Provided herein are methods for predicting whether an individual with cancer is more or less likely to respond effectively to treatment with an anti-cancer therapy comprising a wnt pathway antagonist, the method comprising determining one or more biomarkers, whereby presence of the one or more biomarkers indicates that the individual is more likely to respond effectively to treatment with the wnt pathway antagonist and absence of the one or more biomarkers indicates that the individual is less likely to respond effectively to treatment with the wnt pathway antagonist. For example, provided herein are methods for predicting whether an individual with cancer is more or less likely to respond effectively to treatment with an anti-cancer therapy comprising a win pathway antagonist, the method comprising determining an R-spondin translocation, whereby presence of the R-spondin translocation indicates that the individual is more likely to respond effectively to treatment with the wnt pathway antagonist and absence of the R-spondin translocation indicates that the individual is less likely to respond effectively to treatment with the wnt pathway antagonist. In some embodiments, the method further comprises administering an effective amount of a wnt pathway antagonist. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


Provided herein are methods of predicting the response or lack of response of an individual with cancer to an anti-cancer therapy comprising a wnt pathway antagonist comprising detecting in a sample obtained from the individual presence or absence of one or more biomarkers, wherein presence of the one or more biomarkers is predictive of response of the individual to the anti-cancer therapy comprising the wnt pathway antagonist and absence of the one or more biomarkers is predictive of lack of response of the individual to the anti-cancer therapy comprising the wnt pathway antagonist. For example, provided herein are methods of predicting the response or lack of response of an individual with cancer to an anti-cancer therapy comprising a wnt pathway antagonist comprising detecting in a sample obtained from the individual presence or absence of an R-spondin translocation, wherein presence of the R-spondin translocation is predictive of response of the individual to the anti-cancer therapy comprising the wnt pathway antagonist and absence of the R-spondin translocation is predictive of lack of response of the individual to the anti-cancer therapy comprising the wnt pathway antagonist. In some embodiments, the method further comprises administering an effective amount of a wnt pathway antagonist. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments, the wnt pathway antagonist is an R-spondin-translocation antagonist. In some embodiments, the R-spondin antagonist and/or R-spondin translocation antagonist is an isolated antibody that binds R-spondin (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4).


In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes listed in Table 2. In some embodiments, the presence of one or more biomarkers comprises the presence of a variation (e.g., polymorphism or mutation) of one or more genes listed in Table 2 (e.g., a variation (e.g., polymorphism or mutation) in Table 2). In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes listed in Table 3. In some embodiments, the presence of one or more biomarkers comprises the presence of a variation (e.g., polymorphism or mutation) of one or more genes listed in Table 3 (e.g., a variation (e.g., polymorphism or mutation) in Table 3). In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes listed in Table 4. In some embodiments, the presence of one or more biomarkers comprises the presence of a variation (e.g., polymorphism or mutation) of one or more genes listed in Table 4 (e.g., a variation (e.g., polymorphism or mutation) in Table 4). In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes listed in Table 5. In some embodiments, the presence of one or more biomarkers comprises the presence of a variation (e.g., polymorphism or mutation) of one or more genes listed in Table 5 (e.g., a variation (e.g., polymorphism or mutation) in Table 5). In some embodiments, the variation (e.g., polymorphism or mutation) is a somatic variation (e.g., polymorphism or mutation).


In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes selected from the group consisting of KRAS, TP53, APC, PIK3CA, SMAD4, FBXW7, CSMD1, NRXN1, DNAH5, MRVI1, TRPS1, DMD, KIF2B, ATM, FAM5C, EVC2, OR2W3, SIN3A, SMARCA5, NCOR1, JARID2, TCF12, TCF7L2, PHF2, SOS2, RASGRF2, ARHGAP10, ARHGEF33, Rab40c, TET2, TET3, EP400, MLL, TMPRSS11A, ERBB3, EPHB4, EFNB3, EPHA1, TYRO3, TIE1, FLT, RIOK3, PRKCB, MUSK, MAP2K7, MAP4K5, PTPRN2, GPR4, GPR98, TOPORS, and SCN10A. In some embodiments, the one or more biomarkers comprise one or more genes selected from the group consisting of CSMD1, NRXN1, DNAH5, MRVI1, TRPS1, DMD, KIF2B, ATM, FAM5C, EVC2, OR2W3, TMPRSS11A, and SCN10A. In some embodiments, the one or more biomarkers comprise RAB40C, TCF12, C20orf132, GRIN3A, and/or SOS2. In some embodiments, the one or more biomarkers comprise ETV4, GRIND2D, FOXQ1, and/or CLDN1. In some embodiments, the one or more biomarkers comprise MRPL33. In some embodiments In some embodiments, the one or more biomarkers comprise one or more transcriptional regulators (e.g., TCF12, TCF7L2 and/or PHF2) In some embodiments, the one or more biomarkers comprise one or more Ras/Rho related regulators (e.g., SOS1 (e.g., R547W, T614M R854*, G1129V), SOS2 (e.g., R225*, R854C, and Q1296H) RASGRF2, ARHGAP10, ARHGEF33 and/or Rab40c (e.g., G251S)). In some embodiments, the one or more biomarkers comprise one or more chromatin modifying enzymes (e.g., TET1, TET2, TET3, EP400 and/or MLL). In some embodiments, the one or more chromatin modifying enzymes are TET1 and/or TET3. In some embodiments, the one or more chromatin modifying enzymes are TET1 (e.g., R81H, E417A, K540T, K792T, S879L, S1012*, Q1322*, C1482Y, A1896V, and A2129V), TET2 (e.g., K108T, T1181, S289L, F373L, K1056N, Y1169*, A1497V, and V1857M), and/or TET3 (e.g., T165M, A874T, M977V, G1398R, and R1576Q/W). In some embodiments, the one or more biomarkers comprise one or more receptor tyrosine kinases (e.g., ERBB3, EPHB4, EFNB3, EPHA1, TYRO3, TIE1 and FLT4). In some embodiments, the one or more biomarkers comprise one or more kinases (e.g., RIOK3, PRKCB, MUSK, MAP2K7 and MAP4K5). In some embodiments, the one or more biomarkers comprise one or more protein phosphatase (e.g., PTPRN2). In some embodiments, the one or more biomarkers comprise one or more GPRCs (e.g., GPR4 and/or GPR98). In some embodiments, the one or more biomarkers comprise one or more E3-ligase (e.g., TOPORS). In some embodiments, the presence of the one or more biomarkers comprise presence of a variation (e.g., polymorphism or mutation) of the one or more biomarkers listed in Table 2, 3, 4, and/or 5 (e.g., a variation (e.g., polymorphism or mutation) in Table 2, 3, 4, and/or 5). In some embodiments, the variation (e.g., polymorphism or mutation) comprise a somatic variation (e.g., polymorphism or mutation).


In some embodiments of any of the methods, the one or more biomarkers comprise one or more RSPO (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4). In some embodiments, presence of the one or more biomarkers is indicated by the presence of elevated expression levels (e.g., compared to reference) of one or more RSPO (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4). In some embodiments, the one or more biomarkers comprises RSPO1. In some embodiments, the one or more biomarkers comprises RSPO2. In some embodiments, the one or more biomarkers comprises RSPO3. In some embodiments, the one or more biomarkers comprises RSPO4.


In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes listed in Table 6. In some embodiments, presence of the one or more biomarkers is indicated by the presence of elevated expression levels (e.g., compared to reference) of one or more genes listed in Table 6. In some embodiments, the one or more biomarkers comprise FOXA1, CLND1, and/or IGF2. In some embodiments, presence of the one or more biomarkers is indicated by presence of elevated expression levels (e.g., compared to reference) of FOXA1, CLND1, and/or IGF2. In some embodiments, the one or more biomarkers comprise a differentially expressed signaling pathway including, but not limited to, Calcium Signaling, cAMP-mediated signaling, Glutamate Receptor Signaling, Amyotrophic Lateral Sclerosis Signaling, Nitrogen Metabolism, Axonal Guidance Signaling, Role of IL-17A in Psoriasis, Serotonin Receptor Signaling, Airway Pathology in Chronic Obstructive Pulmonary Disease, Protein Kinase A Signaling, Bladder Cancer Signaling, HIF1α Signaling, Cardiac β-adrenergic Signaling, Synaptic Long Term Potentiation, Atherosclerosis Signaling, Circadian Rhythm Signaling, CREB Signaling in Neurons, G-Protein Coupled Receptor Signaling, Leukocyte Extravasation Signaling, Complement System, Eicosanoid Signaling, Tyrosine Metabolism, Cysteine Metabolism, Synaptic Long Term Depression, Role of IL-17A in Arthritis, Cellular Effects of Sildenafil (Viagra), Neuropathic Pain Signaling In Dorsal Horn Neurons, D-arginine and D-ornithine Metabolism, Role of IL-17F in Allergic Inflammatory Airway Diseases, Thyroid Cancer Signaling, Hepatic Fibrosis/Hepatic Stellate Cell Activation, Dopamine Receptor Signaling, Role of NANOG in Mammalian Embryonic Stem Cell Pluripotency, Chondroitin Sulfate Biosynthesis, Endothelin-1 Signaling, Keratan Sulfate Biosynthesis, Phototransduction Pathway, Wnt/β-catenin Signaling, Chemokine Signaling, Alanine and Aspartate Metabolism, Glycosphingolipid Biosynthesis—Neolactoseries, Bile Acid Biosynthesis, Role of Macrophages, Fibroblasts and Endothelial Cells in Rheumatoid Arthritis, α-Adrenergic Signaling, Taurine and Hypotaurine Metabolism, LPS/IL-1 Mediated Inhibition of RXR Function, Colorectal Cancer Metastasis Signaling, CCR3 Signaling in Eosinophils, and/or O-Glycan Biosynthesis.


In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes listed in Table 7. In some embodiments, presence of the one or more biomarkers is indicated by the presence of elevated gene copy number (e.g., compared to reference) of one or more genes listed in Table 7. In some embodiments, the one or more biomarkers comprise IGF2, KRAS, and/or MYC. In some embodiments, presence of the one or more biomarkers is indicated by the presence of elevated gene copy number (e.g., compared to reference) of IGF2, KRAS, and/or MYC. In some embodiments, presence of the one or more biomarkers is indicated by the presence of reduced gene copy number (e.g., compared to reference) of one or more genes listed in Table 7. In some embodiments, the one or more biomarkers comprise FHIT, APC, and/or SMAD4. In some embodiments, presence of the one or more biomarkers is indicated by the presence of reduced gene copy number (e.g., compared to reference) of FHIT, APC, and/or SMAD4. In some embodiments, presence of the one or more biomarkers is indicated by the presence of elevated copy number (e.g., compared to reference) of chromosome 20q. In some embodiments, presence of the one or more biomarkers is indicated by the presence of reduced copy number (e.g., compared to reference) of chromosome 18q.


In some embodiments of any of the methods, the one or more biomarkers comprise one or more genes listed in Table 9. In some embodiments, presence of the one or more biomarkers is indicated by the presence of a variation (e.g., polymorphism or mutation) of one or more genes listed in Table 9 (e.g., a variation (e.g., polymorphism or mutation) in Table 9) and/or alternative splicing (e.g., compared to reference) of one or more genes listed in Table 9. In some embodiments, the one or more biomarkers comprise TP53, NOTCH2, MRPL33, and/or EIF5B. In some embodiments, the one or more biomarkers is MRPL33. In some embodiments, presence of the one or more biomarkers is indicated by the presence of a variation (e.g., polymorphism or mutation) of TP53, NOTCH2, MRPL33, and/or EIF5B (e.g., a variation (e.g., polymorphism or mutation) in Table 9) and/or alternative splicing (e.g., compared to reference) of TP53, NOTCH2, MRPL33, and/or EIF5B.


In some embodiments of any of the methods, the one or more biomarkers comprise a translocation (e.g., rearrangement and/or fusion) of one or more genes listed in Table 10. In some embodiments, the presence of one or more biomarkers comprises the presence of a translocation (e.g., rearrangement and/or fusion) of one or more genes listed in Table 10 (e.g., a translocation (e.g., rearrangement and/or fusion) in Table 10). In some embodiments of any of the methods, the translocation (e.g., rearrangement and/or fusion) is a PVT1 translocation (e.g., rearrangement and/or fusion). In some embodiments, the PVT1 translocation (e.g., rearrangement and/or fusion) comprises PVT1 and MYC. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises PVT1 and IncDNA. In some embodiments of any of the methods, the translocation (e.g., rearrangement and/or fusion) is an R-spondin translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO1 translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO2 translocation (e.g., rearrangement and/or fusion). In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E and RSPO2. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises SEQ ID NO:71. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is detectable by primers which include SEQ ID NO:12, 41, and/or 42. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is driven by the EIF3E promoter. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is driven by the RSPO2 promoter. In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO3 translocation (e.g., rearrangement and/or fusion). In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK and RSPO3. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises SEQ ID NO:72 and/or SEQ ID NO:73. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is detectable by primers which include SEQ ID NO:13, 14, 43, and/or 44. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is driven by the PTPRK promoter. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is driven by the RSPO3 promoter. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises the PTPRK secretion signal sequence (and/or does not comprise the RSPO3 secretion signal sequence). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO4 translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) results in elevated expression levels of R-spondin (e.g., compared to a reference without the R-spondin translocation). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) results in elevated activity and/or activation of R-spondin (e.g., compared to a reference without the R-spondin translocation). In some embodiments, the presence of one or more biomarkers comprises an R-spondin translocation (e.g., rearrangement and/or fusion), such as a translocation (e.g., rearrangement and/or fusion) in Table 10, and KRAS and/or BRAF. In some embodiments, the presence of one or more biomarkers is presence of an R-spondin translocation (e.g., rearrangement and/or fusion), such as a translocation (e.g., rearrangement and/or fusion) in Table 10, and a variation (e.g., polymorphism or mutation) KRAS and/or BRAF. In some embodiments, the presence of one or more biomarkers is presence of an R-spondin translocation (e.g., rearrangement and/or fusion), such as a translocation (e.g., rearrangement and/or fusion) in Table 10, and the absence of one or more biomarkers is absence of a variation (e.g., polymorphism or mutation) CTNNB1 and/or APC.


In some embodiments of any of the translocation (e.g., rearrangement and/or fusion), the translocation (e.g., rearrangement and/or fusion) is a somatic translocation (e.g., rearrangement and/or fusion). In some embodiments, the translocation (e.g., rearrangement and/or fusion) is an intra-chromosomal translocation (e.g., rearrangement and/or fusion). In some embodiments, the translocation (e.g., rearrangement and/or fusion) is an inter-chromosomal translocation (e.g., rearrangement and/or fusion). In some embodiments, the translocation (e.g., rearrangement and/or fusion) is an inversion. In some embodiments, the translocation (e.g., rearrangement and/or fusion) is a deletion. In some embodiments, the translocation (e.g., rearrangement and/or fusion) is a functional translocation fusion polynucleotide (e.g., functional R-spondin-translocation fusion polynucleotide) and/or functional translocation fusion polypeptide (e.g., functional R-spondin-translocation fusion polypeptide). In some embodiments, the functional translocation fusion polypeptide (e.g., functional R-spondin-translocation fusion polypeptide) activates a pathway known to be modulated by one of the tranlocated genes (e.g., wnt signaling pathway). In some embodiments, the pathway is canonical wnt signaling pathway. In some embodiments, the pathway is noncanonical wnt signaling pathway. In some embodiments, the Methods of determining pathway activation are known in the art and include luciferase reporter assays as described herein.


Examples of cancers and cancer cells include, but are not limited to, carcinoma, lymphoma, blastoma (including medulloblastoma and retinoblastoma), sarcoma (including liposarcoma and synovial cell sarcoma), neuroendocrine tumors (including carcinoid tumors, gastrinoma, and islet cell cancer), mesothelioma, schwannoma (including acoustic neuroma), meningioma, adenocarcinoma, melanoma, and leukemia or lymphoid malignancies. More particular examples of such cancers include squamous cell cancer (e.g., epithelial squamous cell cancer), lung cancer including small-cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), adenocarcinoma of the lung and squamous carcinoma of the lung, cancer of the peritoneum, hepatocellular cancer, gastric or stomach cancer including gastrointestinal cancer, pancreatic cancer, glioblastoma, cervical cancer, ovarian cancer, liver cancer, bladder cancer, hepatoma, breast cancer (including metastatic breast cancer), colon cancer, rectal cancer, colorectal cancer, endometrial or uterine carcinoma, salivary gland carcinoma, kidney or renal cancer, prostate cancer, vulval cancer, thyroid cancer, hepatic carcinoma, anal carcinoma, penile carcinoma, testicular cancer, esophageal cancer, tumors of the biliary tract, as well as head and neck cancer. In some embodiments, the cancer is colorectal cancer. In some embodiments, the cancer is colon cancer. In some embodiments, the cancer is rectal cancer.


Presence and/or expression levels/amount of a biomarker (e.g., R-spondin translocation) can be determined qualitatively and/or quantitatively based on any suitable criterion known in the art, including but not limited to DNA, mRNA, cDNA, proteins, protein fragments and/or gene copy number. In certain embodiments, presence and/or expression levels/amount of a biomarker in a first sample is increased as compared to presence/absence and/or expression levels/amount in a second sample. In certain embodiments, presence/absence and/or expression levels/amount of a biomarker in a first sample is decreased as compared to presence and/or expression levels/amount in a second sample. In certain embodiments, the second sample is a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue. Additional disclosures for determining presence/absence and/or expression levels/amount of a gene are described herein.


In some embodiments of any of the methods, elevated expression refers to an overall increase of about any of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 96%, 97%, 98%, 99% or greater, in the level of biomarker (e.g., protein or nucleic acid (e.g., gene or mRNA)), detected by standard art known methods such as those described herein, as compared to a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue. In certain embodiments, the elevated expression refers to the increase in expression level/amount of a biomarker in the sample wherein the increase is at least about any of 1.5×, 1.75×, 2×, 3×, 4×, 5×, 6×, 7×, 8×, 9×, 10×, 25×, 50×, 75×, or 100× the expression level/amount of the respective biomarker in a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue. In some embodiments, elevated expression refers to an overall increase of greater than about 1.5 fold, about 1.75 fold, about 2 fold, about 2.25 fold, about 2.5 fold, about 2.75 fold, about 3.0 fold, or about 3.25 fold as compared to a reference sample, reference cell, reference tissue, control sample, control cell, control tissue, or internal control (e.g., housekeeping gene).


In some embodiments of any of the methods, reduced expression refers to an overall reduction of about any of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 96%, 97%, 98%, 99% or greater, in the level of biomarker (e.g., protein or nucleic acid (e.g., gene or mRNA)), detected by standard art known methods such as those described herein, as compared to a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue. In certain embodiments, reduced expression refers to the decrease in expression level/amount of a biomarker in the sample wherein the decrease is at least about any of 0.9×, 0.8×, 0.7×, 0.6×, 0.5×, 0.4×, 0.3×, 0.2×, 0.1×, 0.05×, or 0.01× the expression level/amount of the respective biomarker in a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue.


Presence and/or expression level/amount of various biomarkers in a sample can be analyzed by a number of methodologies, many of which are known in the art and understood by the skilled artisan, including, but not limited to, immunohistochemical (“IHC”), Western blot analysis, immunoprecipitation, molecular binding assays, ELISA, ELIFA, fluorescence activated cell sorting (“FACS”), MassARRAY, proteomics, quantitative blood based assays (as for example Serum ELISA), biochemical enzymatic activity assays, in situ hybridization, Southern analysis, Northern analysis, whole genome sequencing, polymerase chain reaction (“PCR”) including quantitative real time PCR (“qRT-PCR”) and other amplification type detection methods, such as, for example, branched DNA, SISBA, TMA and the like), RNA-Seq, FISH, microarray analysis, gene expression profiling, and/or serial analysis of gene expression (“SAGE”), as well as any one of the wide variety of assays that can be performed by protein, gene, and/or tissue array analysis. Typical protocols for evaluating the status of genes and gene products are found, for example in Ausubel et al., eds., 1995, Current Protocols In Molecular Biology, Units 2 (Northern Blotting), 4 (Southern Blotting), 15 (Immunoblotting) and 18 (PCR Analysis). Multiplexed immunoassays such as those available from Rules Based Medicine or Meso Scale Discovery (“MSD”) may also be used.


In some embodiments, presence and/or expression level/amount of a biomarker is determined using a method comprising: (a) performing gene expression profiling, PCR (such as rtPCR), RNA-seq, microarray analysis, SAGE, MassARRAY technique, or FISH on a sample (such as a subject cancer sample); and b) determining presence and/or expression level/amount of a biomarker in the sample. In some embodiments, the microarray method comprises the use of a microarray chip having one or more nucleic acid molecules that can hybridize under stringent conditions to a nucleic acid molecule encoding a gene mentioned above or having one or more polypeptides (such as peptides or antibodies) that can bind to one or more of the proteins encoded by the genes mentioned above. In one embodiment, the PCR method is qRT-PCR. In one embodiment, the PCR method is multiplex-PCR. In some embodiments, gene expression is measured by microarray. In some embodiments, gene expression is measured by qRT-PCR. In some embodiments, expression is measured by multiplex-PCR.


Methods for the evaluation of mRNAs in cells are well known and include, for example, hybridization assays using complementary DNA probes (such as in situ hybridization using labeled riboprobes specific for the one or more genes, Northern blot and related techniques) and various nucleic acid amplification assays (such as RT-PCR using complementary primers specific for one or more of the genes, and other amplification type detection methods, such as, for example, branched DNA, SISBA, TMA and the like).


Samples from mammals can be conveniently assayed for mRNAs using Northern, dot blot or PCR analysis. In addition, such methods can include one or more steps that allow one to determine the levels of target mRNA in a biological sample (e.g., by simultaneously examining the levels a comparative control mRNA sequence of a “housekeeping” gene such as an actin family member). Optionally, the sequence of the amplified target cDNA can be determined.


Optional methods of the invention include protocols which examine or detect mRNAs, such as target mRNAs, in a tissue or cell sample by microarray technologies. Using nucleic acid microarrays, test and control mRNA samples from test and control tissue samples are reverse transcribed and labeled to generate cDNA probes. The probes are then hybridized to an array of nucleic acids immobilized on a solid support. The array is configured such that the sequence and position of each member of the array is known. For example, a selection of genes whose expression correlates with increased or reduced clinical benefit of anti-angiogenic therapy may be arrayed on a solid support. Hybridization of a labeled probe with a particular array member indicates that the sample from which the probe was derived expresses that gene.


According to some embodiments, presence and/or expression level/amount is measured by observing protein expression levels of an aforementioned gene. In certain embodiments, the method comprises contacting the biological sample with antibodies to a biomarker (e.g., anti-R-spondin translocation antibodies) described herein under conditions permissive for binding of the biomarker, and detecting whether a complex is formed between the antibodies and biomarker. Such method may be an in vitro or in vivo method. In one embodiment, an antibody is used to select subjects eligible for therapy with wnt pathway antagonist, in particular R-spondin-translocation antagonist, e.g., a biomarker for selection of individuals.


In certain embodiments, the presence and/or expression level/amount of biomarker proteins in a sample is examined using IHC and staining protocols. IHC staining of tissue sections has been shown to be a reliable method of determining or detecting presence of proteins in a sample. In one aspect, expression level of biomarker is determined using a method comprising: (a) performing IHC analysis of a sample (such as a subject cancer sample) with an antibody; and b) determining expression level of a biomarker in the sample. In some embodiments, IHC staining intensity is determined relative to a reference value.


IHC may be performed in combination with additional techniques such as morphological staining and/or fluorescence in-situ hybridization. Two general methods of IHC are available; direct and indirect assays. According to the first assay, binding of antibody to the target antigen is determined directly. This direct assay uses a labeled reagent, such as a fluorescent tag or an enzyme-labeled primary antibody, which can be visualized without further antibody interaction. In a typical indirect assay, unconjugated primary antibody binds to the antigen and then a labeled secondary antibody binds to the primary antibody. Where the secondary antibody is conjugated to an enzymatic label, a chromogenic or fluorogenic substrate is added to provide visualization of the antigen. Signal amplification occurs because several secondary antibodies may react with different epitopes on the primary antibody.


The primary and/or secondary antibody used for IHC typically will be labeled with a detectable moiety. Numerous labels are available which can be generally grouped into the following categories: (a) Radioisotopes, such as 35S, 14C, 125I, 3H, and 131I; (b) colloidal gold particles; (c) fluorescent labels including, but are not limited to, rare earth chelates (europium chelates), Texas Red, rhodamine, fluorescein, dansyl, Lissamine, umbelliferone, phycocrytherin, phycocyanin, or commercially available fluorophores such SPECTRUM ORANGE7 and SPECTRUM GREEN7 and/or derivatives of any one or more of the above; (d) various enzyme-substrate labels are available and U.S. Pat. No. 4,275,149 provides a review of some of these. Examples of enzymatic labels include luciferases (e.g., firefly luciferase and bacterial luciferase; U.S. Pat. No. 4,737,456), luciferin, 2,3-dihydrophthalazinediones, malate dehydrogenase, urease, peroxidase such as horseradish peroxidase (HRPO), alkaline phosphatase, β-galactosidase, glucoamylase, lysozyme, saccharide oxidases (e.g., glucose oxidase, galactose oxidase, and glucose-6-phosphate dehydrogenase), heterocyclic oxidases (such as uricase and xanthine oxidase), lactoperoxidase, microperoxidase, and the like.


Examples of enzyme-substrate combinations include, for example, horseradish peroxidase (HRPO) with hydrogen peroxidase as a substrate; alkaline phosphatase (AP) with para-Nitrophenyl phosphate as chromogenic substrate; and β-D-galactosidase (β-D-Gal) with a chromogenic substrate (e.g., p-nitrophenyl-β-D-galactosidase) or fluorogenic substrate (e.g., 4-methylumbelliferyl-β-D-galactosidase). For a general review of these, see U.S. Pat. Nos. 4,275,149 and 4,318,980.


Specimens thus prepared may be mounted and coverslipped. Slide evaluation is then determined, e.g., using a microscope, and staining intensity criteria, routinely used in the art, may be employed. In some embodiments, a staining pattern score of about 1+ or higher is diagnostic and/or prognostic. In certain embodiments, a staining pattern score of about 2+ or higher in an IHC assay is diagnostic and/or prognostic. In other embodiments, a staining pattern score of about 3 or higher is diagnostic and/or prognostic. In one embodiment, it is understood that when cells and/or tissue from a tumor or colon adenoma are examined using IHC, staining is generally determined or assessed in tumor cell and/or tissue (as opposed to stromal or surrounding tissue that may be present in the sample).


In alternative methods, the sample may be contacted with an antibody specific for said biomarker (e.g., anti-R-spondin translocation antibody) under conditions sufficient for an antibody-biomarker complex to form, and then detecting said complex. The presence of the biomarker may be detected in a number of ways, such as by Western blotting and ELISA procedures for assaying a wide variety of tissues and samples, including plasma or serum. A wide range of immunoassay techniques using such an assay format are available, see, e.g., U.S. Pat. Nos. 4,016,043, 4,424,279 and 4,018,653. These include both single-site and two-site or “sandwich” assays of the non-competitive types, as well as in the traditional competitive binding assays. These assays also include direct binding of a labeled antibody to a target biomarker.


Presence and/or expression level/amount of a selected biomarker in a tissue or cell sample may also be examined by way of functional or activity-based assays. For instance, if the biomarker is an enzyme, one may conduct assays known in the art to determine or detect the presence of the given enzymatic activity in the tissue or cell sample.


In certain embodiments, the samples are normalized for both differences in the amount of the biomarker assayed and variability in the quality of the samples used, and variability between assay runs. Such normalization may be accomplished by detecting and incorporating the expression of certain normalizing biomarkers, including well known housekeeping genes, such as ACTB. Alternatively, normalization can be based on the mean or median signal of all of the assayed genes or a large subset thereof (global normalization approach). On a gene-by-gene basis, measured normalized amount of a subject tumor mRNA or protein is compared to the amount found in a reference set. Normalized expression levels for each mRNA or protein per tested tumor per subject can be expressed as a percentage of the expression level measured in the reference set. The presence and/or expression level/amount measured in a particular subject sample to be analyzed will fall at some percentile within this range, which can be determined by methods well known in the art.


In certain embodiments, relative expression level of a gene is determined as follows:





Relative expression gene1 sample1=2 exp (Ct housekeeping gene−Ct gene1) with Ct determined in a sample.





Relative expression gene1 reference RNA=2 exp (Ct housekeeping gene−Ct gene1) with Ct determined in the reference sample.





Normalized relative expression gene1 sample1=(relative expression gene1 sample1/relative expression gene1 reference RNA)×100


Ct is the threshold cycle. The Ct is the cycle number at which the fluorescence generated within a reaction crosses the threshold line.


All experiments are normalized to a reference RNA, which is a comprehensive mix of RNA from various tissue sources (e.g., reference RNA #636538 from Clontech, Mountain View, Calif.). Identical reference RNA is included in each qRT-PCR run, allowing comparison of results between different experimental runs.


In one embodiment, the sample is a clinical sample. In another embodiment, the sample is used in a diagnostic assay. In some embodiments, the sample is obtained from a primary or metastatic tumor. Tissue biopsy is often used to obtain a representative piece of tumor tissue. Alternatively, tumor cells can be obtained indirectly in the form of tissues or fluids that are known or thought to contain the tumor cells of interest. For instance, samples of lung cancer lesions may be obtained by resection, bronchoscopy, fine needle aspiration, bronchial brushings, or from sputum, pleural fluid or blood. Genes or gene products can be detected from cancer or tumor tissue or from other body samples such as urine, sputum, serum or plasma. The same techniques discussed above for detection of target genes or gene products in cancerous samples can be applied to other body samples. Cancer cells may be sloughed off from cancer lesions and appear in such body samples. By screening such body samples, a simple early diagnosis can be achieved for these cancers. In addition, the progress of therapy can be monitored more easily by testing such body samples for target genes or gene products.


In certain embodiments, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is a single sample or combined multiple samples from the same subject or individual that are obtained at one or more different time points than when the test sample is obtained. For example, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is obtained at an earlier time point from the same subject or individual than when the test sample is obtained. Such reference sample, reference cell, reference tissue, control sample, control cell, or control tissue may be useful if the reference sample is obtained during initial diagnosis of cancer and the test sample is later obtained when the cancer becomes metastatic.


In certain embodiments, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is a combined multiple samples from one or more healthy individuals who are not the subject or individual. In certain embodiments, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is a combined multiple samples from one or more individuals with a disease or disorder (e.g., cancer) who are not the subject or individual. In certain embodiments, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is pooled RNA samples from normal tissues or pooled plasma or serum samples from one or more individuals who are not the subject or individual. In certain embodiments, a reference sample, reference cell, reference tissue, control sample, control cell, or control tissue is pooled RNA samples from tumor tissues or pooled plasma or serum samples from one or more individuals with a disease or disorder (e.g., cancer) who are not the subject or individual.


In some embodiments of any of the methods, the win pathway antagonist is an R-spondin antagonist (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4 antagonist). In some embodiments of any of the methods, the R-spondin antagonist in particular R-spondin-translocation antagonist is an antibody, binding polypeptide, binding small molecule, or polynucleotide. In some embodiments, the R-spondin antagonist in particular R-spondin-translocation antagonist is an antibody. In some embodiments, the antibody is a monoclonal antibody. In some embodiments, the antibody is a human, humanized, or chimeric antibody. In some embodiments, the antibody is an antibody fragment and the antibody fragment binds wnt pathway polypeptide in particular R-spondin antagonist and/or R-spondin-translocation fusion polypeptide.


In some embodiments of any of the methods, the individual according to any of the above embodiments may be a human.


In some embodiments of any of the methods, the method comprises administering to an individual having such cancer an effective amount of a wnt pathway antagonist in particular R-spondin-translocation antagonist. In one such embodiment, the method further comprises administering to the individual an effective amount of at least one additional therapeutic agent, as described below. In some embodiments, the individual may be a human.


The wnt pathway antagonist, in particular R-spondin-translocation antagonist, described herein can be used either alone or in combination with other agents in a therapy. For instance, a wnt pathway antagonist, in particular R-spondin-translocation antagonist, described herein may be co-administered with at least one additional therapeutic agent including another wnt pathway antagonist. In certain embodiments, an additional therapeutic agent is a chemotherapeutic agent.


Such combination therapies noted above encompass combined administration (where two or more therapeutic agents are included in the same or separate formulations), and separate administration, in which case, administration of the wnt pathway antagonist, in particular R-spondin-translocation antagonist, can occur prior to, simultaneously, and/or following, administration of the additional therapeutic agent and/or adjuvant. Wnt pathway antagonist, in particular R-spondin-translocation antagonist, can also be used in combination with radiation therapy.


A wnt pathway antagonist, in particular R-spondin-translocation antagonist (e.g., an antibody, binding polypeptide, and/or small molecule) described herein (and any additional therapeutic agent) can be administered by any suitable means, including parenteral, intrapulmonary, and intranasal, and, if desired for local treatment, intralesional administration. Parenteral infusions include intramuscular, intravenous, intraarterial, intraperitoneal, or subcutaneous administration. Dosing can be by any suitable route, e.g., by injections, such as intravenous or subcutaneous injections, depending in part on whether the administration is brief or chronic. Various dosing schedules including but not limited to single or multiple administrations over various time-points, bolus administration, and pulse infusion are contemplated herein.


Wnt pathway antagonist, in particular R-spondin antagonist (e.g., an antibody, binding polypeptide, and/or small molecule) described herein may be formulated, dosed, and administered in a fashion consistent with good medical practice. Factors for consideration in this context include the particular disorder being treated, the particular mammal being treated, the clinical condition of the individual, the cause of the disorder, the site of delivery of the agent, the method of administration, the scheduling of administration, and other factors known to medical practitioners. The wnt pathway antagonist, in particular R-spondin antagonist, need not be, but is optionally formulated with one or more agents currently used to prevent or treat the disorder in question. The effective amount of such other agents depends on the amount of the wnt pathway antagonist, in particular R-spondin antagonist, present in the formulation, the type of disorder or treatment, and other factors discussed above. These are generally used in the same dosages and with administration routes as described herein, or about from 1 to 99% of the dosages described herein, or in any dosage and by any route that is empirically/clinically determined to be appropriate.


For the prevention or treatment of disease, the appropriate dosage of a wnt pathway antagonist, in particular R-spondin antagonist, described herein (when used alone or in combination with one or more other additional therapeutic agents) will depend on the type of disease to be treated, the severity and course of the disease, whether the wnt pathway antagonist, in particular R-spondin antagonist, is administered for preventive or therapeutic purposes, previous therapy, the subject's clinical history and response to the wnt pathway antagonist, and the discretion of the attending physician. The wnt pathway antagonist, in particular R-spondin antagonist, is suitably administered to the individual at one time or over a series of treatments. One typical daily dosage might range from about 1 μg/kg to 100 mg/kg or more, depending on the factors mentioned above. For repeated administrations over several days or longer, depending on the condition, the treatment would generally be sustained until a desired suppression of disease symptoms occurs. Such doses may be administered intermittently, e.g., every week or every three weeks (e.g., such that the individual receives from about two to about twenty, or e.g., about six doses of the wnt pathway antagonist). An initial higher loading dose, followed by one or more lower doses may be administered. An exemplary dosing regimen comprises administering. However, other dosage regimens may be useful. The progress of this therapy is easily monitored by conventional techniques and assays.


It is understood that any of the above formulations or therapeutic methods may be carried out using an immunoconjugate of the invention in place of or in addition to the wnt pathway antagonist, in particular R-spondin antagonist.


III. Therapeutic Compositions

Provided herein are wnt pathway antagonists useful in the methods described herein. In some embodiments, the wnt pathway antagonists are an antibody, binding polypeptide, binding small molecule, and/or polynucleotide. In some embodiments, the wnt pathway antagonists are canonical wnt pathway antagonists. In some embodiments, the win pathway antagonists are non-canonical wnt pathway antagonists.


In some embodiments, the wnt pathway antagonists are R-spondin antagonists. In some embodiments, the R-spondin antagonists are R-spondin-translocation antagonists. In some embodiments, the R-spondin antagonist inhibits LPR6 mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and LRP6. In some embodiments, the R-spondin antagonist inhibits LGR5 mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and LGR5. In some embodiments, the R-spondin antagonist inhibits KRM mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and KRM. In some embodiments, the R-spondin antagonist inhibits syndecan (e.g., syndecan 4) mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and syndecan (e.g., syndecan 4). Examples of R-spondin antagonists include, but are not limited to, those described in WO 2008/046649, WO 2008/020942, WO 2007/013666, WO 2005/040418, WO 2009/005809, U.S. Pat. Nos. 8,088,374, 7,541,431, WO 2011/076932, and/or US 2009/0074782, which are incorporated by reference in their entirety.


A wnt signaling pathway component or wnt pathway polypeptide is a component that transduces a signal originating from an interaction between a Wnt protein and an Fz receptor. As the wnt signaling pathway is complex, and involves extensive feedback regulation. Example of wnt signaling pathway components include Wnt (e.g., WNT1, WNT2, WNT2B, WNT3, WNT3A, WNT4, WNT5A, WNT5B, WNT6, WNT7A, WNT7B, WNT8A, WNT8B, WNT9A, WNT9B, WNT10A, WNT10B, WNT11, WNT16), Frizzled (e.g., Frz 1-10), RSPO (e.g., RSPO1, RSPO2, RSPO3, and/or RSPO4), LGR (e.g., LGR5), WTX, WISP (e.g., WISP1, WISP2, and/or WISP3), βTrCp, STRA6, the membrane associated proteins LRP (e.g., LRP5 and/or LRP6), Axin, and Dishevelled, the extracellular Wnt interactive proteins sFRP, WIF-1, the LRP inactivating proteins Dkk and Krn, the cytoplasmic protein β-catenin, members of the β-catenin “degradation complex” APC, GSK3β, CKIα and PP2A, the nuclear transport proteins APC, pygopus and bcl9/legless, and the transcription factors TCF/LEF, Groucho and various histone acetylases such as CBP/p300 and Brg-1.


A. Antibodies

In one aspect, provided herein isolated antibodies that bind to a wnt pathway polypeptide. In any of the above embodiments, an antibody is humanized In a further aspect of the invention, an anti-wnt pathway antibody according to any of the above embodiments is a monoclonal antibody, including a chimeric, humanized or human antibody. In one embodiment, an anti-wnt pathway antibody is an antibody fragment, e.g., an Fv, Fab, Fab′, scFv, diabody, or F(ab′)2 fragment. In another embodiment, the antibody is a full length antibody, e.g., an intact IgG1″ antibody or other antibody class or isotype as defined herein.


In some embodiments of any of the antibodies, the anti-win pathway antibody is an anti-LRP6 antibody. Examples of anti-LRP6 antibodies include, but are not limited to, the anti-LRP6 antibodies described in U.S. Patent Application No. 2011/0256127, which is incorporated by reference in its entirety. In some embodiments, the anti-LRP6 antibody inhibits signaling induced by a first Wnt isoform and potentiates signaling induced by a second Wnt isoform. In some embodiments, the first Wnt isoform is selected from the group consisting of Wnt3 and Wnt3a and the second Wnt isoform is selected from the group consisting of Wnt 1, 2, 2b, 4, 6, 7a, 7b, 8a, 9a, 9b, 10a, and 10b. In some embodiments, the first Wnt isoform is selected from the group consisting of Wnt 1, 2, 2b, 6, 8a, 9a, 9b, and 10b and the second Wnt isoform is selected from the group consisting of Wnt3 and Wnt3a.


In some embodiments of any of the antibodies, the anti-wnt pathway antibody is an anti-Frizzled antibody. Examples of anti-Frizzled antibodies include, but are not limited to, the anti-Frizzled antibodies described in U.S. Pat. No. 7,947,277, which is incorporated by reference in its entirety.


In some embodiments of any of the antibodies, the anti-wnt pathway antibody is an anti-STRA6 antibody. Examples of anti-STRA6 antibodies include, but are not limited to, the anti-STRA6 antibodies described in U.S. Pat. Nos. 7,173,115, 7,741,439, and/or 7,855,278, which are incorporated by reference in their entirety.


In some embodiments of any of the antibodies, the anti-wnt pathway antibody is an anti-S100-like cytokine polypeptide antibody. In some embodiments, the anti-S100-like cytokine polypeptide antibody is an anti-S100-A14 antibody. Examples of anti-S100-like cytokine polypeptide antibodies include, but are not limited to, the anti-S100-like cytokine polypeptide antibodies described in U.S. Pat. Nos. 7,566,536 and/or 7,005,499, which are incorporated by reference in their entirety.


In some embodiments of any of the antibodies, the anti-wnt pathway antibody is an anti-R-spondin antibody. In some embodiment, the R-spondin is RSPO1. In some embodiment, the R-spondin is RSPO2. In some embodiment, the R-spondin is RSPO3. In some embodiment, the R-spondin is RSPO4. In some embodiments, the R-spondin antagonist inhibits LPR6 mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and LRP6. In some embodiments, the R-spondin antagonist inhibits LGRS mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and LGR5. In some embodiments, the R-spondin antagonist inhibits LGR4 mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and LGR4. In some embodiments, the R-spondin antagonist inhibits ZNRF3 and/or RNF43 mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and ZNRF3 and/or RNF43. In some embodiments, the R-spondin antagonist inhibits KRM mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and KRM. In some embodiments, the R-spondin antagonist inhibits syndecan (e.g., syndecan 4) mediated wnt signaling. In some embodiments, the R-spondin antagonist inhibits and/or blocks the interaction of R-spondin and syndecan (e.g., syndecan 4). Examples of R-spondin antibodies include, but are not limited to, any antibody disclosed in US 2009/0074782, U.S. Pat. Nos. 8,088,374, 8,158,757, 8,1587,58 and/or US Biological R9417-50C, which are incorporated by reference in their entirety.


In some embodiments, the anti-R-spondin antibody binds to an R-spondin-translocation fusion polypeptide. In some embodiments, the antibodies that bind to an R-spondin-translocation fusion polypeptide specifically bind an R-spondin-translocation fusion polypeptide, but do not substantially bind wild-type R-spondin and/or a second gene of the translocation. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO1-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO2-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO3-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO4-translocation fusion polypeptide. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E and RSPO2. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2-translocation fusion polypeptide comprises SEQ ID NO:71. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK and RSPO3. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide comprises SEQ ID NO:72 and/or SEQ ID NO:73.


In a further aspect, an anti-wnt pathway antibody, in particular, an anti-R-spondin-translocation antibody, according to any of the above embodiments may incorporate any of the features, singly or in combination, as described in Sections below:


1. Antibody Affinity


In certain embodiments, an antibody provided herein has a dissociation constant (Kd) of ≤1 μM. In one embodiment, Kd is measured by a radiolabeled antigen binding assay (RIA) performed with the Fab version of an antibody of interest and its antigen as described by the following assay. Solution binding affinity of Fabs for antigen is measured by equilibrating Fab with a minimal concentration of (125I)-labeled antigen in the presence of a titration series of unlabeled antigen, then capturing bound antigen with an anti-Fab antibody-coated plate (see, e.g., Chen et al., J. Mol. Biol. 293:865-881(1999)). To establish conditions for the assay, MICROTITER® multi-well plates (Thermo Scientific) are coated overnight with 5 μg/ml of a capturing anti-Fab antibody (Cappel Labs) in 50 mM sodium carbonate (pH 9.6), and subsequently blocked with 2% (w/v) bovine serum albumin in PBS for two to five hours at room temperature (approximately 23° C.). In a non-adsorbent plate (Nunc #269620), 100 pM or 26 pM [125I]-antigen are mixed with serial dilutions of a Fab of interest (e.g., consistent with assessment of the anti-VEGF antibody, Fab-12, in Presta et al., Cancer Res. 57:4593-4599 (1997)). The Fab of interest is then incubated overnight; however, the incubation may continue for a longer period (e.g., about 65 hours) to ensure that equilibrium is reached. Thereafter, the mixtures are transferred to the capture plate for incubation at room temperature (e.g., for one hour). The solution is then removed and the plate washed eight times with 0.1% polysorbate 20 (TWEEN-20®) in PBS. When the plates have dried, 150 μl/well of scintillant (MICROSCINT-20™; Packard) is added, and the plates are counted on a TOPCOUNT™ gamma counter (Packard) for ten minutes. Concentrations of each Fab that give less than or equal to 20% of maximal binding are chosen for use in competitive binding assays.


According to another embodiment, Kd is measured using surface plasmon resonance assays using a BIACORE®-2000 or a BIACORE ®-3000 (BIAcore, Inc., Piscataway, N.J.) at 25° C. with immobilized antigen CM5 chips at ˜10 response units (RU). Briefly, carboxymethylated dextran biosensor chips (CM5, BIACORE, Inc.) are activated with N-ethyl-N′-(3-dimethylaminopropyl)-carbodiimide hydrochloride (EDC) and N-hydroxysuccinimide (NHS) according to the supplier's instructions. Antigen is diluted with 10 mM sodium acetate, pH 4.8, to 5 μg/ml (˜0.2 μM) before injection at a flow rate of 5 μl/minute to achieve approximately 10 response units (RU) of coupled protein. Following the injection of antigen, 1 M ethanolamine is injected to block unreacted groups. For kinetics measurements, two-fold serial dilutions of Fab (0.78 nM to 500 nM) are injected in PBS with 0.05% polysorbate 20 (TWEEN-20™) surfactant (PBST) at 25° C. at a flow rate of approximately 25 μl/min. Association rates (kon) and dissociation rates (koff) are calculated using a simple one-to-one Langmuir binding model (BIACORE® Evaluation Software version 3.2) by simultaneously fitting the association and dissociation sensorgrams. The equilibrium dissociation constant (Kd) is calculated as the ratio koff/kon. See, e.g., Chen et al., J. Mol. Biol. 293:865-881 (1999). If the on-rate exceeds 106M−1s−1 by the surface plasmon resonance assay above, then the on-rate can be determined by using a fluorescent quenching technique that measures the increase or decrease in fluorescence emission intensity (excitation=295 nm; emission=340 nm, 16 nm band-pass) at 25° C. of a 20 nM anti-antigen antibody (Fab form) in PBS, pH 7.2, in the presence of increasing concentrations of antigen as measured in a spectrometer, such as a stop-flow equipped spectrophometer (Aviv Instruments) or a 8000-series SLM-AMINCO™ spectrophotometer (ThermoSpectronic) with a stirred cuvette.


2. Antibody Fragments


In certain embodiments, an antibody provided herein is an antibody fragment. Antibody fragments include, but are not limited to, Fab, Fab′, Fab′-SH, F(ab′)2, Fv, and scFv fragments, and other fragments described below. For a review of certain antibody fragments, see Hudson et al., Nat. Med. 9:129-134 (2003). For a review of scFv fragments, see, e.g., Pluckthün, in The Pharmacology of Monoclonal Antibodies, vol. 113, Rosenburg and Moore eds., (Springer-Verlag, New York), pp. 269-315 (1994); see also WO 93/16185; and U.S. Pat. Nos. 5,571,894 and 5,587,458. For discussion of Fab and F(ab′)2 fragments comprising salvage receptor binding epitope residues and having increased in vivo half-life, see U.S. Pat. No. 5,869,046.


Diabodies are antibody fragments with two antigen-binding sites that may be bivalent or bispecific. See, for example, EP 404,097; WO 1993/01161; Hudson et al., Nat. Med. 9:129-134 (2003); and Hollinger et al., Proc. Natl. Acad. Sci. USA 90: 6444-6448 (1993). Triabodies and tetrabodies are also described in Hudson et al., Nat. Med. 9:129-134 (2003).


Single-domain antibodies are antibody fragments comprising all or a portion of the heavy chain variable domain or all or a portion of the light chain variable domain of an antibody. In certain embodiments, a single-domain antibody is a human single-domain antibody (Domantis, Inc., Waltham, Mass.; see, e.g., U.S. Pat. No. 6,248,516 B1).


Antibody fragments can be made by various techniques, including but not limited to proteolytic digestion of an intact antibody as well as production by recombinant host cells (e.g., E. coli or phage), as described herein.


3. Chimeric and Humanized Antibodies


In certain embodiments, an antibody provided herein is a chimeric antibody. Certain chimeric antibodies are described, e.g., in U.S. Pat. No. 4,816,567; and Morrison et al., Proc. Natl. Acad. Sci. USA, 81:6851-6855 (1984)). In one example, a chimeric antibody comprises a non-human variable region (e.g., a variable region derived from a mouse, rat, hamster, rabbit, or non-human primate, such as a monkey) and a human constant region. In a further example, a chimeric antibody is a “class switched” antibody in which the class or subclass has been changed from that of the parent antibody. Chimeric antibodies include antigen-binding fragments thereof.


In certain embodiments, a chimeric antibody is a humanized antibody. Typically, a non-human antibody is humanized to reduce immunogenicity to humans, while retaining the specificity and affinity of the parental non-human antibody. Generally, a humanized antibody comprises one or more variable domains in which HVRs, e.g., CDRs, (or portions thereof) are derived from a non-human antibody, and FRs (or portions thereof) are derived from human antibody sequences. A humanized antibody optionally will also comprise at least a portion of a human constant region. In some embodiments, some FR residues in a humanized antibody are substituted with corresponding residues from a non-human antibody (e.g., the antibody from which the HVR residues are derived), e.g., to restore or improve antibody specificity or affinity.


Humanized antibodies and methods of making them are reviewed, e.g., in Almagro and Fransson, Front. Biosci. 13:1619-1633 (2008), and are further described, e.g., in Riechmann et al., Nature 332:323-329 (1988); Queen et al., Proc. Nat'l Acad. Sci. USA 86:10029-10033 (1989); U.S. Pat. Nos. 5,821,337, 7,527,791, 6,982,321, and 7,087,409; Kashmiri et al., Methods 36:25-34 (2005) (describing SDR (a-CDR) grafting); Padlan, Mol. Immunol. 28:489-498 (1991) (describing “resurfacing”); Dall'Acqua et al., Methods 36:43-60 (2005) (describing “FR shuffling”); and Osbourn et al., Methods 36:61-68 (2005) and Klimka et al., Br. J. Cancer, 83:252-260 (2000) (describing the “guided selection” approach to FR shuffling).


Human framework regions that may be used for humanization include but are not limited to: framework regions selected using the “best-fit” method (see, e.g., Sims et al., J. Immunol. 151:2296 (1993)); framework regions derived from the consensus sequence of human antibodies of a particular subgroup of light or heavy chain variable regions (see, e.g., Carter et al., Proc. Natl. Acad. Sci. USA, 89:4285 (1992); and Presta et al., J. Immunol., 151:2623 (1993)); human mature (somatically mutated) framework regions or human germline framework regions (see, e.g., Almagro and Fransson, Front. Biosci. 13:1619-1633 (2008)); and framework regions derived from screening FR libraries (see, e.g., Baca et al., J. Biol. Chem. 272:10678-10684 (1997) and Rosok et al., J. Biol. Chem. 271:22611-22618 (1996)).


4. Human Antibodies


In certain embodiments, an antibody provided herein is a human antibody. Human antibodies can be produced using various techniques known in the art. Human antibodies are described generally in van Dijk and van de Winkel, Curr. Opin. Pharmacol. 5: 368-74 (2001) and Lonberg, Curr. Opin. Immunol. 20:450-459 (2008).


Human antibodies may be prepared by administering an immunogen to a transgenic animal that has been modified to produce intact human antibodies or intact antibodies with human variable regions in response to antigenic challenge. Such animals typically contain all or a portion of the human immunoglobulin loci, which replace the endogenous immunoglobulin loci, or which are present extrachromosomally or integrated randomly into the animal's chromosomes. In such transgenic mice, the endogenous immunoglobulin loci have generally been inactivated. For review of methods for obtaining human antibodies from transgenic animals, see Lonberg, Nat. Biotech. 23:1117-1125 (2005). See also, e.g., U.S. Pat. Nos. 6,075,181 and 6,150,584 describing XENOMOUSE™ technology; U.S. Pat. No. 5,770,429 describing HuMab® technology; U.S. Pat. No. 7,041,870 describing K-M MOUSE® technology, and U.S. Patent Application Publication No. US 2007/0061900, describing VelociMouse® technology). Human variable regions from intact antibodies generated by such animals may be further modified, e.g., by combining with a different human constant region.


Human antibodies can also be made by hybridoma-based methods. Human myeloma and mouse-human heteromyeloma cell lines for the production of human monoclonal antibodies have been described. (See, e.g., Kozbor J. Immunol., 133: 3001 (1984); and Boerner et al., J. Immunol., 147: 86 (1991).) Human antibodies generated via human B-cell hybridoma technology are also described in Li et al., Proc. Natl. Acad. Sci. USA, 103:3557-3562 (2006). Additional methods include those described, for example, in U.S. Pat. No. 7,189,826 (describing production of monoclonal human IgM antibodies from hybridoma cell lines) and Ni, Xiandai Mianyixne, 26(4):265-268 (2006) (describing human-human hybridomas). Human hybridoma technology (Trioma technology) is also described in Vollmers and Brandlein, Histology and Histopathology, 20(3):927-937 (2005) and Vollmers and Brandlein, Methods and Findings in Experimental and Clin. Pharma., 27(3):185-91 (2005).


Human antibodies may also be generated by isolating Fv clone variable domain sequences selected from human-derived phage display libraries. Such variable domain sequences may then be combined with a desired human constant domain. Techniques for selecting human antibodies from antibody libraries are described below.


5. Library Derived Antibodies


Antibodies of the invention may be isolated by screening combinatorial libraries for antibodies with the desired activity or activities. For example, a variety of methods are known in the art for generating phage display libraries and screening such libraries for antibodies possessing the desired binding characteristics. Such methods are reviewed, e.g., in Hoogenboom et al., in METHODS IN MOL. BIOL. 178:1-37 (O'Brien et al., ed., Human Press, Totowa, N.J., 2001) and further described, e.g., in the McCafferty et al., Nature 348:552-554; Clackson et al., Nature 352: 624-628 (1991); Marks et al., J. Mol. Biol. 222: 581-597 (1992); Marks and Bradbury, in METHODS IN MOL. BIOL. 248:161-175 (Lo, ed., Human Press, Totowa, N.J., 2003); Sidhu et al., J. Mol. Biol. 338(2): 299-310 (2004); Lee et al., J. Mol. Biol. 340(5): 1073-1093 (2004); Fellouse, Proc. Natl. Acad. Sci. USA 101(34): 12467-12472 (2004); and Lee et al., J. Immunol. Methods 284(1-2): 119-132(2004).


In certain phage display methods, repertoires of VH and VL genes are separately cloned by polymerase chain reaction (PCR) and recombined randomly in phage libraries, which can then be screened for antigen-binding phage as described in Winter et al., Ann. Rev. Immunol., 12: 433-455 (1994). Phage typically display antibody fragments, either as single-chain Fv (scFv) fragments or as Fab fragments. Libraries from immunized sources provide high-affinity antibodies to the immunogen without the requirement of constructing hybridomas. Alternatively, the naive repertoire can be cloned (e.g., from human) to provide a single source of antibodies to a wide range of non-self and also self antigens without any immunization as described by Griffiths et al., EMBO J, 12: 725-734 (1993). Finally, naive libraries can also be made synthetically by cloning unrearranged V-gene segments from stem cells, and using PCR primers containing random sequence to encode the highly variable CDR3 regions and to accomplish rearrangement in vitro, as described by Hoogenboom and Winter, J. Mol. Biol., 227: 381-388 (1992). Patent publications describing human antibody phage libraries include, for example: U.S. Pat. No. 5,750,373, and US Patent Publication Nos. 2005/0079574, 2005/0119455, 2005/0266000, 2007/0117126, 2007/0160598, 2007/0237764, 2007/0292936, and 2009/0002360.


Antibodies or antibody fragments isolated from human antibody libraries are considered human antibodies or human antibody fragments herein.


6. Multispecific Antibodies


In certain embodiments, an antibody provided herein is a multispecific antibody, e.g., a bispecific antibody. Multispecific antibodies are monoclonal antibodies that have binding specificities for at least two different sites. In certain embodiments, one of the binding specificities is for wnt pathway polypeptide such as an R-spondin-translocation fusion polypeptide and the other is for any other antigen. In certain embodiments, bispecific antibodies may bind to two different epitopes of wnt pathway polypeptide such as an R-spondin-translocation fusion polypeptide. Bispecific antibodies may also be used to localize cytotoxic agents to cells which express wnt pathway polypeptide such as an R-spondin-translocation fusion polypeptide. Bispecific antibodies can be prepared as full length antibodies or antibody fragments.


Techniques for making multispecific antibodies include, but are not limited to, recombinant co-expression of two immunoglobulin heavy chain-light chain pairs having different specificities (see Milstein and Cuello, Nature 305: 537 (1983)), WO 93/08829, and Traunecker et al., EMBO J. 10: 3655 (1991)), and “knob-in-hole” engineering (see, e.g., U.S. Pat. No. 5,731,168). Multi-specific antibodies may also be made by engineering electrostatic steering effects for making antibody Fc-heterodimeric molecules (WO 2009/089004A1); cross-linking two or more antibodies or fragments (see, e.g., U.S. Pat. No. 4,676,980, and Brennan et al., Science, 229: 81 (1985)); using leucine zippers to produce bi-specific antibodies (see, e.g., Kostelny et al., J. Immunol., 148(5):1547-1553 (1992)); using “diabody” technology for making bispecific antibody fragments (see, e.g., Hollinger et al., Proc. Natl. Acad. Sci. USA, 90:6444-6448 (1993)); and using single-chain Fv (sFv) dimers (see, e.g., Gruber et al., J. Immunol., 152:5368 (1994)); and preparing trispecific antibodies as described, e.g., in Tutt et al., J. Immunol. 147: 60 (1991).


Engineered antibodies with three or more functional antigen binding sites, including “Octopus antibodies,” are also included herein (see, e.g., US 2006/0025576).


The antibody or fragment herein also includes a “Dual Acting FAb” or “DAF” comprising an antigen binding site that binds to a wnt pathway polypeptide such as an R-spondin-translocation fusion polypeptide as well as another, different antigen (see, US 2008/0069820, for example).


7. Antibody Variants


a) Glycosylation Variants


In certain embodiments, an antibody provided herein is altered to increase or decrease the extent to which the antibody is glycosylated. Addition or deletion of glycosylation sites to an antibody may be conveniently accomplished by altering the amino acid sequence such that one or more glycosylation sites is created or removed.


Where the antibody comprises an Fc region, the carbohydrate attached thereto may be altered. Native antibodies produced by mammalian cells typically comprise a branched, biantennary oligosaccharide that is generally attached by an N-linkage to Asn297 of the CH2 domain of the Fc region. See, e.g., Wright et al., TIBTECH 15:26-32 (1997). The oligosaccharide may include various carbohydrates, e g., mannose, N-acetyl glucosamine (GlcNAc), galactose, and sialic acid, as well as a fucose attached to a GlcNAc in the “stem” of the biantennary oligosaccharide structure. In some embodiments, modifications of the oligosaccharide in an antibody of the invention may be made in order to create antibody variants with certain improved properties.


In one embodiment, antibody variants are provided having a carbohydrate structure that lacks fucose attached (directly or indirectly) to an Fc region. For example, the amount of fucose in such antibody may be from 1% to 80%, from 1% to 65%, from 5% to 65% or from 20% to 40%. The amount of fucose is determined by calculating the average amount of fucose within the sugar chain at Asn297, relative to the sum of all glycostructures attached to Asn 297 (e.g., complex, hybrid and high mannose structures) as measured by MALDI-TOF mass spectrometry, as described in WO 2008/077546, for example. Asn297 refers to the asparagine residue located at about position 297 in the Fc region (Eu numbering of Fc region residues); however, Asn297 may also be located about ±3 amino acids upstream or downstream of position 297, i.e., between positions 294 and 300, due to minor sequence variations in antibodies. Such fucosylation variants may have improved ADCC function. See, e.g., US Patent Publication Nos. US 2003/0157108 (Presta, L.); US 2004/0093621 (Kyowa Hakko Kogyo Co., Ltd). Examples of publications related to “defucosylated” or “fucose-deficient” antibody variants include: US 2003/0157108; WO 2000/61739; WO 2001/29246; US 2003/0115614; US 2002/0164328; US 2004/0093621; US 2004/0132140; US 2004/0110704; US 2004/0110282; US 2004/0109865; WO 2003/085119; WO 2003/084570; WO 2005/035586; WO 2005/035778; W02005/053742; WO2002/031140; Okazaki et al., J. Mol. Biol. 336:1239-1249 (2004); Yamane-Ohnuki et al., Biotech. Bioeng. 87: 614 (2004). Examples of cell lines capable of producing defucosylated antibodies include Lec13 CHO cells deficient in protein fucosylation (Ripka et al., Arch. Biochem. Biophys. 249:533-545 (1986); US 2003/0157108, Presta, L; and WO 2004/056312, Adams et al., especially at Example 11), and knockout cell lines, such as alpha-1,6-fucosyltransferase gene, FUT8, knockout CHO cells (see, e.g., Yamane-Ohnuki et al., Biotech. Bioeng. 87: 614 (2004); Kanda, Y. et al., Biotechnol. Bioeng., 94(4):680-688 (2006); and WO2003/085107).


Antibodies variants are further provided with bisected oligosaccharides, e.g., in which a biantennary oligosaccharide attached to the Fc region of the antibody is bisected by GlcNAc. Such antibody variants may have reduced fucosylation and/or improved ADCC function. Examples of such antibody variants are described, e.g., in WO 2003/011878 (Jean-Mairet et al.); U.S. Pat. No. 6,602,684 (Umana et al.); and US 2005/0123546 (Umana et al.). Antibody variants with at least one galactose residue in the oligosaccharide attached to the Fc region are also provided. Such antibody variants may have improved CDC function. Such antibody variants are described, e.g., in WO 1997/30087 (Patel et al.); WO 1998/58964 (Raju, S.); and WO 1999/22764 (Raju, S.).


b) Fc Region Variants


In certain embodiments, one or more amino acid modifications may be introduced into the Fc region of an antibody provided herein, thereby generating an Fc region variant. The Fc region variant may comprise a human Fc region sequence (e.g., a human IgG1, IgG2, IgG3 or IgG4 Fc region) comprising an amino acid modification (e.g., a substitution) at one or more amino acid positions.


In certain embodiments, the invention contemplates an antibody variant that possesses some but not all effector functions, which make it a desirable candidate for applications in which the half life of the antibody in vivo is important yet certain effector functions (such as complement and ADCC) are unnecessary or deleterious. In vitro and/or in vivo cytotoxicity assays can be conducted to confirm the reduction/depletion of CDC and/or ADCC activities. For example, Fc receptor (FcR) binding assays can be conducted to ensure that the antibody lacks FcγR binding (hence likely lacking ADCC activity), but retains FcRn binding ability. The primary cells for mediating ADCC, NK cells, express Fc(RIII only, whereas monocytes express Fc(RI, Fc(RII and Fc(RIII. FcR expression on hematopoietic cells is summarized in Table 3 on page 464 of Ravetch and Kinet, Annu. Rev. Immunol. 9:457-492 (1991). Non-limiting examples of in vitro assays to assess ADCC activity of a molecule of interest is described in U.S. Pat. No. 5,500,362 (see, e.g., Hellstrom, I. et al., Proc. Nat'l Acad. Sci. USA 83:7059-7063 (1986)) and Hellstrom, I et al., Proc. Nat'l Acad. Sci. USA 82:1499-1502 (1985); U.S. Pat. No. 5,821,337 (see Bruggemann, M. et al., J. Exp. Med. 166:1351-1361 (1987)). Alternatively, non-radioactive assays methods may be employed (see, for example, ACTI™ non-radioactive cytotoxicity assay for flow cytometry (CellTechnology, Inc. Mountain View, Calif.; and CytoTox 96® non-radioactive cytotoxicity assay (Promega, Madison, Wis.). Useful effector cells for such assays include peripheral blood mononuclear cells (PBMC) and Natural Killer (NK) cells. Alternatively, or additionally, ADCC activity of the molecule of interest may be assessed in vivo, e.g., in a animal model such as that disclosed in Clynes et al., Proc. Natl. Acad. Sci. USA 95:652-656 (1998). C1q binding assays may also be carried out to confirm that the antibody is unable to bind C1q and hence lacks CDC activity. See, e.g., C1q and C3c binding ELISA in WO 2006/029879 and WO 2005/100402. To assess complement activation, a CDC assay may be performed (see, for example, Gazzano-Santoro et al., J. Immunol. Methods 202:163 (1996); Cragg, M. S. et al., Blood 101:1045-1052 (2003); and Cragg, M. S. and M. J. Glennie, Blood 103:2738-2743 (2004)). FcRn binding and in vivo clearance/half life determinations can also be performed using methods known in the art (see, e.g., Petkova, S. B. et al., Int I. Immunol. 18(12):1759-1769 (2006)).


Antibodies with reduced effector function include those with substitution of one or more of Fc region residues 238, 265, 269, 270, 297, 327 and 329 (U.S. Pat. No. 6,737,056). Such Fc mutants include Fc mutants with substitutions at two or more of amino acid positions 265, 269, 270, 297 and 327, including the so-called “DANA” Fc mutant with substitution of residues 265 and 297 to alanine (U.S. Pat. No. 7,332,581).


Certain antibody variants with improved or diminished binding to FcRs are described. (See, e.g., U.S. Pat. No. 6,737,056; WO 2004/056312, and Shields et al., J. Biol. Chem. 9(2): 6591-6604 (2001).) In certain embodiments, an antibody variant comprises an Fc region with one or more amino acid substitutions which improve ADCC, e.g., substitutions at positions 298, 333, and/or 334 of the Fc region (EU numbering of residues). In some embodiments, alterations are made in the Fc region that result in altered (i.e., either improved or diminished) C1q binding and/or Complement Dependent Cytotoxicity (CDC), e.g., as described in U.S. Pat. No. 6,194,551, WO 99/51642, and Idusogie et al., J. Immunol. 164: 4178-4184 (2000).


Antibodies with increased half lives and improved binding to the neonatal Fc receptor (FcRn), which is responsible for the transfer of maternal IgGs to the fetus (Guyer et al., J. Immunol. 117:587 (1976) and Kim et al., J. Immunol. 24:249 (1994)), are described in US2005/0014934A1 (Hinton et al.). Those antibodies comprise an Fc region with one or more substitutions therein which improve binding of the Fc region to FcRn. Such Fc variants include those with substitutions at one or more of Fc region residues: 238, 256, 265, 272, 286, 303, 305, 307, 311, 312, 317, 340, 356, 360, 362, 376, 378, 380, 382, 413, 424 or 434, e.g., substitution of Fc region residue 434 (U.S. Pat. No. 7,371,826). See also Duncan & Winter, Nature 322:738-40 (1988); U.S. Pat. Nos. 5,648,260; 5,624,821; and WO 94/29351 concerning other examples of Fc region variants.


c) Cysteine Engineered Antibody Variants


In certain embodiments, it may be desirable to create cysteine engineered antibodies, e.g., “thioMAbs,” in which one or more residues of an antibody are substituted with cysteine residues. In particular embodiments, the substituted residues occur at accessible sites of the antibody. By substituting those residues with cysteine, reactive thiol groups are thereby positioned at accessible sites of the antibody and may be used to conjugate the antibody to other moieties, such as drug moieties or linker-drug moieties, to create an immunoconjugate, as described further herein. In certain embodiments, any one or more of the following residues may be substituted with cysteine: V205 (Kabat numbering) of the light chain; A118 (EU numbering) of the heavy chain; and S400 (EU numbering) of the heavy chain Fc region. Cysteine engineered antibodies may be generated as described, e.g., in U.S. Pat. No. 7,521,541.


B. Immunoconjugates

Further provided herein are immunoconjugates comprising an anti-wnt pathway antibody such as an R-spondin-translocation fusion polypeptide herein conjugated to one or more cytotoxic agents, such as chemotherapeutic agents or drugs, growth inhibitory agents, toxins (e.g., protein toxins, enzymatically active toxins of bacterial, fungal, plant, or animal origin, or fragments thereof), or radioactive isotopes.


In one embodiment, an immunoconjugate is an antibody-drug conjugate (ADC) in which an antibody is conjugated to one or more drugs, including but not limited to a maytansinoid (see U.S. Pat. Nos. 5,208,020, 5,416,064 and European Patent EP 0 425 235 B1); an auristatin such as monomethylauristatin drug moieties DE and DF (MMAE and MMAF) (see U.S. Pat. Nos. 5,635,483 and 5,780,588, and 7,498,298); a dolastatin; a calicheamicin or derivative thereof (see U.S. Pat. Nos. 5,712,374, 5,714,586, 5,739,116, 5,767,285, 5,770,701, 5,770,710, 5,773,001, and 5,877,296; Hinman et al., Cancer Res. 53:3336-3342 (1993); and Lode et al., Cancer Res. 58:2925-2928 (1998)); an anthracycline such as daunomycin or doxorubicin (see Kratz et al., Current Med. Chem. 13:477-523 (2006); Jeffrey et al., Bioorganic & Med. Chem. Letters 16:358-362 (2006); Torgov et al., Bioconj. Chem. 16:717-721 (2005); Nagy et al., Proc. Natl. Acad. Sci. USA 97:829-834 (2000); Dubowchik et al., Bioorg. & Med. Chem. Letters 12:1529-1532 (2002); King et al., J. Med. Chem. 45:4336-4343 (2002); and U.S. Pat. No. 6,630,579); methotrexate; vindesine; a taxane such as docetaxel, paclitaxel, larotaxel, tesetaxel, and ortataxel; a trichothecene; and CC1065.


In another embodiment, an immunoconjugate comprises an antibody as described herein conjugated to an enzymatically active toxin or fragment thereof, including but not limited to diphtheria A chain, nonbinding active fragments of diphtheria toxin, exotoxin A chain (from Pseudomonas aeruginosa), ricin A chain, abrin A chain, modeccin A chain, alpha-sarcin, Aleurites fordii proteins, dianthin proteins, Phytolaca americana proteins (PAPI, PAPII, and PAP-S), Momordica charantia inhibitor, curcin, crotin, Sapaonaria officinalis inhibitor, gelonin, mitogellin, restrictocin, phenomycin, enomycin, and the tricothecenes.


In another embodiment, an immunoconjugate comprises an antibody as described herein conjugated to a radioactive atom to form a radioconjugate. A variety of radioactive isotopes are available for the production of radioconjugates. Examples include At211, I131, I125, Y90, Re186, Re188, Sm153, Bi212, P32, Pb212 and radioactive isotopes of Lu. When the radioconjugate is used for detection, it may comprise a radioactive atom for scintigraphic studies, for example Tc99 or I123, or a spin label for nuclear magnetic resonance (NMR) imaging (also known as magnetic resonance imaging, MRI), such as iodine-123 again, iodine-131, indium-111, fluorine-19, carbon-13, nitrogen-15, oxygen-17, gadolinium, manganese or iron.


Conjugates of an antibody and cytotoxic agent may be made using a variety of bifunctional protein coupling agents such as N-succinimidyl-3-(2-pyridyldithio) propionate (SPDP), succinimidyl-4-(N-maleimidomethyl) cyclohexane-1-carboxylate (SMCC), iminothiolane (IT), bifunctional derivatives of imidoesters (such as dimethyl adipimidate HCl), active esters (such as disuccinimidyl suberate), aldehydes (such as glutaraldehyde), bis-azido compounds (such as bis (p-azidobenzoyl) hexanediamine), bis-diazonium derivatives (such as bis-(p-diazoniumbenzoyl)-ethylenediamine), diisocyanates (such as toluene 2,6-diisocyanate), and bis-active fluorine compounds (such as 1,5-difluoro-2,4-dinitrobenzene). For example, a ricin immunotoxin can be prepared as described in Vitetta et al., Science 238:1098 (1987). Carbon-14-labeled 1-isothiocyanatobenzyl-3-methyldiethylene triaminepentaacetic acid (MX-DTPA) is an exemplary chelating agent for conjugation of radionucleotide to the antibody. See WO94/11026. The linker may be a “cleavable linker” facilitating release of a cytotoxic drug in the cell. For example, an acid-labile linker, peptidase-sensitive linker, photolabile linker, dimethyl linker or disulfide-containing linker (Chari et al., Cancer Res. 52:127-131 (1992); U.S. Pat. No. 5,208,020) may be used.


The immunuoconjugates or ADCs herein expressly contemplate, but are not limited to such conjugates prepared with cross-linker reagents including, but not limited to, BMPS, EMCS, GMBS, HBVS, LC-SMCC, MBS, MPBH, SBAP, SIA, SIAB, SMCC, SMPB, SMPH, sulfo-EMCS, sulfo-GMBS, sulfo-KMUS, sulfo-MBS, sulfo-SIAB, sulfo-SMCC, and sulfo-SMPB, and SVSB (succinimidyl-(4-vinylsulfone)benzoate) which are commercially available (e.g., from Pierce Biotechnology, Inc., Rockford, Ill., U.S.A).


C. Binding Polypeptides

Provided herein are wnt pathway binding polypeptide antagonists for use as a wnt pathway antagonist in any of the methods described herein. Wnt pathway binding polypeptide antagonists are polypeptides that bind, preferably specifically, to a wnt pathway polypeptide.


In some embodiments of any of the wnt pathway binding polypeptide antagonists, the wnt pathway binding polypeptide antagonist is a chimeric polypeptide. In some embodiments, the wnt pathway binding polypeptide antagonist comprises (a) a Frizzled domain component, and (b) a Fc domain. For example, any wnt pathway antagonists described in U.S. Pat. No. 7,947,277, which is incorporated by reference in its entirety.


In some embodiments of any of the wnt pathway binding polypeptide antagonists, the wnt pathway binding polypeptide antagonist is a polypeptide that binds specifically to Dvl PDZ, wherein said polypeptide comprises a C-terminal region comprising a sequence with Gly at position −2, Trp or Tyr at position '1, Phe or Leu at position 0, and a hydrophobic or aromatic residue at position −3, wherein amino acid numbering is based on the C-terminal residue being in position 0. In some embodiments, position −6 is Trp. In some embodiments, position −1 is Trp. In some embodiments of any of the wnt pathway binding polypeptide antagonists, the wnt pathway binding polypeptide antagonist is a polypeptide that binds specifically to Dvl PDZ at a binding affinity of IC50=1.5 uM or better. In some embodiments, the polypeptide inhibits Dvl PDZ interaction with its endogenous binding partner. In some embodiments, the polypeptide inhibits endogenous Dvl-mediated Wnt signaling. In some embodiments, a polypeptide comprising a C-terminus consisting of KWYGWL (SEQ ID NO: 80). In some embodiments, the polypeptide comprises the amino acid sequence X1-X2-W-X3-D-X4-P, and wherein X1 is L or V, X2 is L, X3 is S or T, and X4 is I, F or L. In some embodiments, the polypeptide comprises the amino acid sequence GEIVLWSDIPG (SEQ ID NO:81). In some embodiments, the polypeptide is any polypeptide described in U.S. Pat. Nos. 7,977,064 and/or 7,695,928, which are incorporated by reference in their entirety.


In some embodiments of any of the wnt pathway binding polypeptide antagonists, the binding polypeptide binds WISP. In some embodiments, the WISP is WISP1, WISP2, and/or WISP3. In some embodiments, the polypeptide is any polypeptide described in U.S. Pat. Nos. 6,387,657, 7,455,834, 7,732,567, 7,687,460, and/or 7,101,850 and/or U.S. Patent Application No. 2006/0292150, which are incorporated by reference in their entirety.


In some embodiments of any of the wnt pathway binding polypeptide antagonists, the binding polypeptide binds a S100-like cytokine polypeptide. In some embodiments, the S100-like cytokine polypeptide is a S100-A14 polypeptide. In some embodiments, the polypeptide is any polypeptide described in U.S. Pat. Nos. 7,566,536 and/or 7,005,499, which are incorporated by reference in their entirety.


In some embodiments of any of the wnt pathway binding polypeptide antagonists, the wnt pathway binding polypeptide antagonist is a polypeptide that binds specifically to STRA6. In some embodiments, the polypeptide is any polypeptide described in U.S. Pat. Nos. 7,173,115, 7,741,439, and/or 7,855,278, which are incorporated by reference in their entirety.


In some embodiments of any of the wnt pathway binding polypeptide antagonists, the binding polypeptide binds R-spondin polypeptide. In some embodiment, the R-spondin polypeptide is RSPO1 polypeptide. In some embodiment, the R-spondin polypeptide is RSPO2 polypeptide. In some embodiment, the R-spondin polypeptide is RSPO3 polypeptide. In some embodiment, the R-spondin polypeptide is RSPO4 polypeptide.


In some embodiments of any of the binding polypeptides, the wnt pathway binding polypeptide antagonists bind to an R-spondin-translocation fusion polypeptide. In some embodiments, the binding polypeptide specifically bind an R-spondin-translocation fusion polypeptide, but do not substantially bind wild-type R-spondin and/or a second gene of the translocation. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO1-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO2-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO3-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO4-translocation fusion polypeptide. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E and RSPO2. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2-translocation fusion polypeptide comprises SEQ ID NO:71. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK and RSPO3. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide comprises SEQ ID NO:72 and/or SEQ ID NO:73.


Binding polypeptides may be chemically synthesized using known polypeptide synthesis methodology or may be prepared and purified using recombinant technology. Binding polypeptides are usually at least about 5 amino acids in length, alternatively at least about 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100 amino acids in length or more, wherein such binding polypeptides that are capable of binding, preferably specifically, to a target, wnt pathway polypeptide, as described herein. Binding polypeptides may be identified without undue experimentation using well known techniques. In this regard, it is noted that techniques for screening polypeptide libraries for binding polypeptides that are capable of specifically binding to a polypeptide target are well known in the art (see, e.g., U.S. Pat. Nos. 5,556,762, 5,750,373, 4,708,871, 4,833,092, 5,223,409, 5,403,484, 5,571,689, 5,663,143; PCT Publication Nos. WO 84/03506 and WO84/03564; Geysen et al., Proc. Natl. Acad. Sci. U.S.A., 81:3998-4002 (1984); Geysen et al., Proc. Natl. Acad. Sci. U.S.A., 82:178-182 (1985); Geysen et al., in Synthetic Peptides as Antigens, 130-149 (1986); Geysen et al., J. Immunol. Meth., 102:259-274 (1987); Schoofs et al., J. Immunol., 140:611-616 (1988), Cwirla, S. E. et al., (1990) Proc. Natl. Acad. Sci. USA, 87:6378; Lowman, H. B. et al., (1991) Biochemistry, 30:10832; Clackson, T. et al., (1991) Nature, 352: 624; Marks, J. D. et al., (1991), J. Mol. Biol., 222:581; Kang, A. S. et al., (1991) Proc. Natl. Acad. Sci. USA, 88:8363, and Smith, G. P. (1991) Current Opin. Biotechnol., 2:668).


In this regard, bacteriophage (phage) display is one well known technique which allows one to screen large polypeptide libraries to identify member(s) of those libraries which are capable of specifically binding to a target polypeptide, win pathway polypeptide. Phage display is a technique by which variant polypeptides are displayed as fusion proteins to the coat protein on the surface of bacteriophage particles (Scott, J. K. and Smith, G. P. (1990) Science, 249: 386). The utility of phage display lies in the fact that large libraries of selectively randomized protein variants (or randomly cloned cDNAs) can be rapidly and efficiently sorted for those sequences that bind to a target molecule with high affinity. Display of peptide (Cwirla, S. E. et al., (1990) Proc. Natl. Acad. Sci. USA, 87:6378) or protein (Lowman, H. B. et al., (1991) Biochemistry, 30:10832; Clackson, T. et al., (1991) Nature, 352: 624; Marks, J. D. et al., (1991), J. Mol. Biol., 222:581; Kang, A. S. et al., (1991) Proc. Natl. Acad. Sci. USA, 88:8363) libraries on phage have been used for screening millions of polypeptides or oligopeptides for ones with specific binding properties (Smith, G. P. (1991) Current Opin. Biotechnol., 2:668). Sorting phage libraries of random mutants requires a strategy for constructing and propagating a large number of variants, a procedure for affinity purification using the target receptor, and a means of evaluating the results of binding enrichments. U.S. Pat. Nos. 5,223,409, 5,403,484, 5,571,689, and 5,663,143.


Although most phage display methods have used filamentous phage, lambdoid phage display systems (WO 95/34683; U.S. Pat. No. 5,627,024), T4 phage display systems (Ren et al., Gene, 215: 439 (1998); Zhu et al., Cancer Research, 58(15): 3209-3214 (1998); Jiang et al., Infection & Immunity, 65(11): 4770-4777 (1997); Ren et al., Gene, 195(2):303-311 (1997); Ren, Protein Sci., 5: 1833 (1996); Efimov et al., Virus Genes, 10: 173 (1995)) and T7 phage display systems (Smith and Scott, Methods in Enzymology, 217: 228-257 (1993); U.S. Pat. No. 5,766,905) are also known.


Additional improvements enhance the ability of display systems to screen peptide libraries for binding to selected target molecules and to display functional proteins with the potential of screening these proteins for desired properties. Combinatorial reaction devices for phage display reactions have been developed (WO 98/14277) and phage display libraries have been used to analyze and control bimolecular interactions (WO 98/20169; WO 98/20159) and properties of constrained helical peptides (WO 98/20036). WO 97/35196 describes a method of isolating an affinity ligand in which a phage display library is contacted with one solution in which the ligand will bind to a target molecule and a second solution in which the affinity ligand will not bind to the target molecule, to selectively isolate binding ligands. WO 97/46251 describes a method of biopanning a random phage display library with an affinity purified antibody and then isolating binding phage, followed by a micropanning process using microplate wells to isolate high affinity binding phage. The use of Staphylococcus aureus protein A as an affinity tag has also been reported (Li et al., (1998) Mol Biotech., 9:187). WO 97/47314 describes the use of substrate subtraction libraries to distinguish enzyme specificities using a combinatorial library which may be a phage display library. A method for selecting enzymes suitable for use in detergents using phage display is described in WO 97/09446. Additional methods of selecting specific binding proteins are described in U.S. Pat. Nos. 5,498,538, 5,432,018, and WO 98/15833.


Methods of generating peptide libraries and screening these libraries are also disclosed in U.S. Pat. Nos. 5,723,286, 5,432,018, 5,580,717, 5,427,908, 5,498,530, 5,770,434, 5,734,018, 5,698,426, 5,763,192, and 5,723,323.


D. Binding Small Molecules

Provided herein are wnt pathway small molecule antagonists for use as a wnt pathway antagonist in any of the methods described herein. In some embodiments, the wnt pathway antagonist is a canonical wnt pathway antagonist. In some embodiments, the wnt pathway antagonist is a non-canonical wnt pathway antagonist.


In some embodiments of any of the small molecules, the wnt pathway small molecule antagonist is an R-spondin small molecule antagonist (e.g., RSPO1, 2, 3, and/or 4 small molecule antagonist). In some embodiment, the R-spondin small molecule antagonist is RSPO1-translocation small molecule antagonist. In some embodiment, the R-spondin small molecule antagonist is RSPO2-translocation small molecule antagonist. In some embodiment, the R-spondin small molecule antagonist is RSPO3-translocation antagonist. In some embodiment, the R-spondin small molecule antagonist is RSPO4-translocation small molecule antagonist.


In some embodiments of any of the small molecules, the small molecule binds to an R-spondin-translocation fusion polypeptide. In some embodiments, small molecule specifically binds an R-spondin-translocation fusion polypeptide, but do not substantially bind wild-type R-spondin and/or a second gene of the translocation. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO1-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO2-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO3-translocation fusion polypeptide. In some embodiments, the R-spondin-translocation fusion polypeptide is RSPO4-translocation fusion polypeptide. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E and RSPO2. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2-translocation fusion polypeptide comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2-translocation fusion polypeptide comprises SEQ ID NO:71. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK and RSPO3. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polypeptide comprises SEQ ID NO:72 and/or SEQ ID NO:73.


Small molecules are preferably organic molecules other than binding polypeptides or antibodies as defined herein that bind, preferably specifically, to wnt pathway polypeptide as described herein. Organic small molecules may be identified and chemically synthesized using known methodology (see, e.g., PCT Publication Nos. WO00/00823 and WO00/39585). Organic small molecules are usually less than about 2000 Daltons in size, alternatively less than about 1500, 750, 500, 250 or 200 Daltons in size, wherein such organic small molecules that are capable of binding, preferably specifically, to a polypeptide as described herein may be identified without undue experimentation using well known techniques. In this regard, it is noted that techniques for screening organic small molecule libraries for molecules that are capable of binding to a polypeptide target are well known in the art (see, e.g., PCT Publication Nos. WO00/00823 and WO00/39585). Organic small molecules may be, for example, aldehydes, ketones, oximes, hydrazones, semicarbazones, carbazides, primary amines, secondary amines, tertiary amines, N-substituted hydrazines, hydrazides, alcohols, ethers, thiols, thioethers, disulfides, carboxylic acids, esters, amides, ureas, carbamates, carbonates, ketals, thioketals, acetals, thioacetals, aryl halides, aryl sulfonates, alkyl halides, alkyl sulfonates, aromatic compounds, heterocyclic compounds, anilines, alkenes, alkynes, diols, amino alcohols, oxazolidines, oxazolines, thiazolidines, thiazolines, enamines, sulfonamides, epoxides, aziridines, isocyanates, sulfonyl chlorides, diazo compounds, acid chlorides, or the like.


E. Antagonist Polynucleotides

Provided herein are wnt pathway polynucleotide antagonists for use as a wnt pathway antagonist in any of the methods described herein. The polynucleotide may be an antisense nucleic acid and/or a ribozyme. The antisense nucleic acids comprise a sequence complementary to at least a portion of an RNA transcript of a wnt pathway gene. However, absolute complementarity, although preferred, is not required. In some embodiments, the wnt pathway antagonist is a canonical wnt pathway antagonist. In some embodiments, the wnt pathway antagonist is a non-canonical wnt pathway antagonist. In some embodiments, wnt pathway polynucleotide is R-spondin. In some embodiments, the R-spondin is RSPO1. In some embodiments, the R-spondin is RSPO2. In some embodiments, the R-spondin is RSPO3. In some embodiments, the R-spondin is RSPO4. Examples of polynucleotide antagonists include those described in WO 2005/040418 such as TCCCATTTGCAAGGGTTGT (SEQ ID NO: 82) and/or AGCTGACTGTGATACCTGT(SEQ ID NO: 83).


In some embodiments of any of the polynucleotides, the polynucleotide binds to an R-spondin-translocation fusion polynucleotide. In some embodiments, polynucleotide specifically binds an R-spondin-translocation fusion polynucleotide, but do not substantially bind wild-type R-spondin and/or a second gene of the translocation. In some embodiments, the R-spondin-translocation fusion polynucleotide is RSPO1-translocation fusion polynucleotide. In some embodiments, the R-spondin-translocation fusion polynucleotide is RSPO2-translocation fusion polynucleotide. In some embodiments, the R-spondin-translocation fusion polynucleotide is RSPO3-translocation fusion polynucleotide. In some embodiments, the R-spondin-translocation fusion polynucleotide is RSPO4-translocation fusion polynucleotide. In some embodiments, the RSPO2-translocation fusion polynucleotide comprises EIF3E and RSPO2. In some embodiments, the RSPO2-translocation fusion polynucleotide comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2-translocation fusion polynucleotide comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2-translocation fusion polynucleotide comprises SEQ ID NO:71. In some embodiments, the RSPO3-translocation fusion polynucleotide comprises PTPRK and RSPO3. In some embodiments, the RSPO3-translocation fusion polynucleotide comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polynucleotide comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3-translocation fusion polynucleotide comprises SEQ ID NO:72 and/or SEQ ID NO:73.


A sequence “complementary to at least a portion of an RNA,” referred to herein, means a sequence having sufficient complementarity to be able to hybridize with the RNA, forming a stable duplex; in the case of double stranded win pathway antisense nucleic acids, a single strand of the duplex DNA may thus be tested, or triplex formation may be assayed. The ability to hybridize will depend on both the degree of complementarity and the length of the antisense nucleic acid. Generally, the larger the hybridizing nucleic acid, the more base mismatches with an wnt pathway RNA it may contain and still form a stable duplex (or triplex as the case may be). One skilled in the art can ascertain a tolerable degree of mismatch by use of standard procedures to determine the melting point of the hybridized complex.


Polynucleotides that are complementary to the 5′ end of the message, e.g., the 5′ untranslated sequence up to and including the AUG initiation codon, should work most efficiently at inhibiting translation. However, sequences complementary to the 3′ untranslated sequences of mRNAs have been shown to be effective at inhibiting translation of mRNAs as well. See generally, Wagner, R., 1994, Nature 372:333-335. Thus, oligonucleotides complementary to either the 5′- or 3′-non-translated, non-coding regions of the wnt pathway gene, could be used in an antisense approach to inhibit translation of endogenous wnt pathway mRNA. Polynucleotides complementary to the 5′ untranslated region of the mRNA should include the complement of the AUG start codon. Antisense polynucleotides complementary to mRNA coding regions are less efficient inhibitors of translation but could be used in accordance with the invention. Whether designed to hybridize to the 5′-, 3′- or coding region of wnt pathway mRNA, antisense nucleic acids should be at least six nucleotides in length, and are preferably oligonucleotides ranging from 6 to about 50 nucleotides in length. In specific aspects the oligonucleotide is at least 10 nucleotides, at least 17 nucleotides, at least 25 nucleotides or at least 50 nucleotides.


In one embodiment, the wnt pathway antisense nucleic acid of the invention is produced intracellularly by transcription from an exogenous sequence. For example, a vector or a portion thereof, is transcribed, producing an antisense nucleic acid (RNA) of the wnt pathway gene. Such a vector would contain a sequence encoding the wnt pathway antisense nucleic acid. Such a vector can remain episomal or become chromosomally integrated, as long as it can be transcribed to produce the desired antisense RNA. Such vectors can be constructed by recombinant DNA technology methods standard in the art. Vectors can be plasmid, viral, or others know in the art, used for replication and expression in vertebrate cells. Expression of the sequence encoding wnt pathway, or fragments thereof, can be by any promoter known in the art to act in vertebrate, preferably human cells. Such promoters can be inducible or constitutive. Such promoters include, but are not limited to, the SV40 early promoter region (Bernoist and Chambon, Nature 29:304-310 (1981), the promoter contained in the 3′ long terminal repeat of Rous sarcoma virus (Yamamoto et al., Cell 22:787-797 (1980), the herpes thymidine promoter (Wagner et al., Proc. Natl. Acad. Sci. U.S.A. 78:1441-1445 (1981), the regulatory sequences of the metallothionein gene (Brinster et al., Nature 296:39-42 (1982)), etc.


F. Antibody and Binding Polypeptide Variants

In certain embodiments, amino acid sequence variants of the antibodies and/or the binding polypeptides provided herein are contemplated. For example, it may be desirable to improve the binding affinity and/or other biological properties of the antibody and/or binding polypeptide. Amino acid sequence variants of an antibody and/or binding polypeptides may be prepared by introducing appropriate modifications into the nucleotide sequence encoding the antibody and/or binding polypeptide, or by peptide synthesis. Such modifications include, for example, deletions from, and/or insertions into and/or substitutions of residues within the amino acid sequences of the antibody and/or binding polypeptide. Any combination of deletion, insertion, and substitution can be made to arrive at the final construct, provided that the final construct possesses the desired characteristics, e.g., target-binding.


In certain embodiments, antibody variants and/or binding polypeptide variants having one or more amino acid substitutions are provided. Sites of interest for substitutional mutagenesis include the HVRs and FRs. Conservative substitutions are shown in Table 1 under the heading of “conservative substitutions.” More substantial changes are provided in Table 1 under the heading of “exemplary substitutions,” and as further described below in reference to amino acid side chain classes. Amino acid substitutions may be introduced into an antibody and/or binding polypeptide of interest and the products screened for a desired activity, e.g., retained/improved antigen binding, decreased immunogenicity, or improved ADCC or CDC.











TABLE 1





Original

Preferred


Residue
Exemplary Substitutions
Substitutions







Ala (A)
Val; Leu; Ile
Val


Arg (R)
Lys; Gln; Asn
Lys


Asn (N)
Gln; His; Asp, Lys; Arg
Gln


Asp (D)
Glu; Asn
Glu


Cys (C)
Ser; Ala
Ser


Gln (Q)
Asn; Glu
Asn


Glu (E)
Asp; Gln
Asp


Gly (G)
Ala
Ala


His (H)
Asn; Gln; Lys; Arg
Arg


Ile (I)
Leu; Val; Met; Ala; Phe; Norleucine
Leu


Leu (L)
Norleucine; Ile; Val; Met; Ala; Phe
Ile


Lys (K)
Arg; Gln; Asn
Arg


Met (M)
Leu; Phe; Ile
Leu


Phe (F)
Trp; Leu; Val; Ile; Ala; Tyr
Tyr


Pro (P)
Ala
Ala


Ser (S)
Thr
Thr


Thr (T)
Val; Ser
Ser


Trp (W)
Tyr; Phe
Tyr


Tyr (Y)
Trp; Phe; Thr; Ser
Phe


Val (V)
Ile; Leu; Met; Phe; Ala; Norleucine
Leu









Amino acids may be grouped according to common side-chain properties:


(1) hydrophobic: Norleucine, Met, Ala, Val, Leu, Ile;


(2) neutral hydrophilic: Cys, Ser, Thr, Asn, Gln;


(3) acidic: Asp, Glu;


(4) basic: His, Lys, Arg;


(5) residues that influence chain orientation: Gly, Pro;


(6) aromatic: Trp, Tyr, Phe.


Non-conservative substitutions will entail exchanging a member of one of these classes for another class.


One type of substitutional variant involves substituting one or more hypervariable region residues of a parent antibody (e.g., a humanized or human antibody). Generally, the resulting variant(s) selected for further study will have modifications (e.g., improvements) in certain biological properties (e.g., increased affinity, reduced immunogenicity) relative to the parent antibody and/or will have substantially retained certain biological properties of the parent antibody. An exemplary substitutional variant is an affinity matured antibody, which may be conveniently generated, e.g., using phage display-based affinity maturation techniques such as those described herein. Briefly, one or more HVR residues are mutated and the variant antibodies displayed on phage and screened for a particular biological activity (e.g., binding affinity).


Alterations (e.g., substitutions) may be made in HVRs, e.g., to improve antibody affinity. Such alterations may be made in HVR “hotspots,” i.e., residues encoded by codons that undergo mutation at high frequency during the somatic maturation process (see, e.g., Chowdhury, Methods Mol. Biol. 207:179-196 (2008)), and/or SDRs (a-CDRs), with the resulting variant VH or VL being tested for binding affinity. Affinity maturation by constructing and reselecting from secondary libraries has been described, e.g., in Hoogenboom et al., in METHODS IN MOL. BIOL. 178:1-37 (O'Brien et al., ed., Human Press, Totowa, N.J., (2001).) In some embodiments of affinity maturation, diversity is introduced into the variable genes chosen for maturation by any of a variety of methods (e.g., error-prone PCR, chain shuffling, or oligonucleotide-directed mutagenesis). A secondary library is then created. The library is then screened to identify any antibody variants with the desired affinity. Another method to introduce diversity involves HVR-directed approaches, in which several HVR residues (e.g., 4-6 residues at a time) are randomized. HVR residues involved in antigen binding may be specifically identified, e.g., using alanine scanning mutagenesis or modeling. CDR-H3 and CDR-L3 in particular are often targeted.


In certain embodiments, substitutions, insertions, or deletions may occur within one or more HVRs so long as such alterations do not substantially reduce the ability of the antibody to bind antigen. For example, conservative alterations (e.g., conservative substitutions as provided herein) that do not substantially reduce binding affinity may be made in HVRs. Such alterations may be outside of HVR “hotspots” or SDRs. In certain embodiments of the variant VH and VL sequences provided above, each HVR either is unaltered, or contains no more than one, two or three amino acid substitutions.


A useful method for identification of residues or regions of the antibody and/or the binding polypeptide that may be targeted for mutagenesis is called “alanine scanning mutagenesis” as described by Cunningham and Wells (1989) Science, 244:1081-1085. In this method, a residue or group of target residues (e.g., charged residues such as arg, asp, his, lys, and glu) are identified and replaced by a neutral or negatively charged amino acid (e.g., alanine or polyalanine) to determine whether the interaction of the antibody with antigen is affected. Further substitutions may be introduced at the amino acid locations demonstrating functional sensitivity to the initial substitutions. Alternatively, or additionally, a crystal structure of an antigen-antibody complex to identify contact points between the antibody and antigen. Such contact residues and neighboring residues may be targeted or eliminated as candidates for substitution. Variants may be screened to determine whether they contain the desired properties.


Amino acid sequence insertions include amino- and/or carboxyl-terminal fusions ranging in length from one residue to polypeptides containing a hundred or more residues, as well as intrasequence insertions of single or multiple amino acid residues. Examples of terminal insertions include an antibody with an N-terminal methionyl residue. Other insertional variants of the antibody molecule include the fusion to the N- or C-terminus of the antibody to an enzyme (e.g., for ADEPT) or a polypeptide which increases the serum half-life of the antibody.


G. Antibody and Binding Polypeptide Derivatives

In certain embodiments, an antibody and/or binding polypeptide provided herein may be further modified to contain additional nonproteinaceous moieties that are known in the art and readily available. The moieties suitable for derivatization of the antibody and/or binding polypeptide include but are not limited to water soluble polymers. Non-limiting examples of water soluble polymers include, but are not limited to, polyethylene glycol (PEG), copolymers of ethylene glycol/propylene glycol, carboxymethylcellulose, dextran, polyvinyl alcohol, polyvinyl pyrrolidone, poly-1,3-dioxolane, poly-1,3,6-trioxane, ethylene/maleic anhydride copolymer, polyaminoacids (either homopolymers or random copolymers), and dextran or poly(n-vinyl pyrrolidone)polyethylene glycol, propropylene glycol homopolymers, prolypropylene oxide/ethylene oxide co-polymers, polyoxyethylated polyols (e.g., glycerol), polyvinyl alcohol, and mixtures thereof. Polyethylene glycol propionaldehyde may have advantages in manufacturing due to its stability in water. The polymer may be of any molecular weight, and may be branched or unbranched. The number of polymers attached to the antibody and/or binding polypeptide may vary, and if more than one polymer is attached, they can be the same or different molecules. In general, the number and/or type of polymers used for derivatization can be determined based on considerations including, but not limited to, the particular properties or functions of the antibody and/or binding polypeptide to be improved, whether the antibody derivative and/or binding polypeptide derivative will be used in a therapy under defined conditions, etc.


In another embodiment, conjugates of an antibody and/or binding polypeptide to nonproteinaceous moiety that may be selectively heated by exposure to radiation are provided. In one embodiment, the nonproteinaceous moiety is a carbon nanotube (Kam et al., Proc. Natl. Acad. Sci. USA 102: 11600-11605 (2005)). The radiation may be of any wavelength, and includes, but is not limited to, wavelengths that do not harm ordinary cells, but which heat the nonproteinaceous moiety to a temperature at which cells proximal to the antibody and/or binding polypeptide-nonproteinaceous moiety are killed.


H. Recombinant Methods and Compositions

Antibodies and/or binding polypeptides may be produced using recombinant methods and compositions, e.g., as described in U.S. Pat. No. 4,816,567. In one embodiment, isolated nucleic acid encoding an anti-wnt pathway antibody. Such nucleic acid may encode an amino acid sequence comprising the VL and/or an amino acid sequence comprising the VH of the antibody (e.g., the light and/or heavy chains of the antibody). In a further embodiment, one or more vectors (e.g., expression vectors) comprising such nucleic acid encoding the antibody and/or binding polypeptide are provided. In a further embodiment, a host cell comprising such nucleic acid is provided. In one such embodiment, a host cell comprises (e.g., has been transformed with): (1) a vector comprising a nucleic acid that encodes an amino acid sequence comprising the VL of the antibody and an amino acid sequence comprising the VH of the antibody, or (2) a first vector comprising a nucleic acid that encodes an amino acid sequence comprising the VL of the antibody and a second vector comprising a nucleic acid that encodes an amino acid sequence comprising the VH of the antibody. In one embodiment, the host cell is eukaryotic, e.g., a Chinese Hamster Ovary (CHO) cell or lymphoid cell (e.g., Y0, NS0, Sp20 cell). In one embodiment, a method of making an antibody such as an anti-wnt pathway antibody and/or binding polypeptide is provided, wherein the method comprises culturing a host cell comprising a nucleic acid encoding the antibody and/or binding polypeptide, as provided above, under conditions suitable for expression of the antibody and/or binding polypeptide, and optionally recovering the antibody and/or polypeptide from the host cell (or host cell culture medium).


For recombinant production of an antibody such as an anti-wnt pathway antibody and/or a binding polypeptide, nucleic acid encoding the antibody and/or the binding polypeptide, e.g., as described above, is isolated and inserted into one or more vectors for further cloning and/or expression in a host cell. Such nucleic acid may be readily isolated and sequenced using conventional procedures (e.g., by using oligonucleotide probes that are capable of binding specifically to genes encoding the heavy and light chains of the antibody).


Suitable host cells for cloning or expression of vectors include prokaryotic or eukaryotic cells described herein. For example, antibodies may be produced in bacteria, in particular when glycosylation and Fc effector function are not needed. For expression of antibody fragments and polypeptides in bacteria, see, e.g., U.S. Pat. Nos. 5,648,237, 5,789,199, and 5,840,523. (See also Charlton, METHODS IN MOL. BIOL., Vol. 248 (B. K. C. Lo, ed., Humana Press, Totowa, N.J., 2003), pp. 245-254, describing expression of antibody fragments in E. coli.) After expression, the antibody may be isolated from the bacterial cell paste in a soluble fraction and can be further purified.


In addition to prokaryotes, eukaryotic microbes such as filamentous fungi or yeast are suitable cloning or expression hosts for vectors, including fungi and yeast strains whose glycosylation pathways have been “humanized,” resulting in the production of an antibody with a partially or fully human glycosylation pattern. See Gerngross, Nat. Biotech. 22:1409-1414 (2004), and Li et al., Nat. Biotech. 24:210-215 (2006).


Suitable host cells for the expression of glycosylated antibody and/or glycosylated binding polypeptides are also derived from multicellular organisms (invertebrates and vertebrates). Examples of invertebrate cells include plant and insect cells. Numerous baculoviral strains have been identified which may be used in conjunction with insect cells, particularly for transfection of Spodoptera frugiperda cells.


Plant cell cultures can also be utilized as hosts. See, e.g., U.S. Pat. Nos. 5,959,177, 6,040,498, 6,420,548, 7,125,978, and 6,417,429 (describing PLANTIBODIES™ technology for producing antibodies in transgenic plants).


Vertebrate cells may also be used as hosts. For example, mammalian cell lines that are adapted to grow in suspension may be useful. Other examples of useful mammalian host cell lines are monkey kidney CV1 line transformed by SV40 (COS-7); human embryonic kidney line (293 or 293 cells as described, e.g., in Graham et al., J. Gen Virol. 36:59 (1977)); baby hamster kidney cells (BHK); mouse sertoli cells (TM4 cells as described, e.g., in Mather, Biol. Reprod. 23:243-251 (1980)); monkey kidney cells (CV1); African green monkey kidney cells (VERO-76); human cervical carcinoma cells (HELA); canine kidney cells (MDCK; buffalo rat liver cells (BRL 3A); human lung cells (W138); human liver cells (Hep G2); mouse mammary tumor (MMT 060562); TRI cells, as described, e.g., in Mather et al., Annals N.Y. Acad. Sci. 383:44-68 (1982); MRC 5 cells; and FS4 cells. Other useful mammalian host cell lines include Chinese hamster ovary (CHO) cells, including DHFR CHO cells (Urlaub et al., Proc. Natl. Acad. Sci. USA 77:4216 (1980)); and myeloma cell lines such as Y0, NS0 and Sp2/0. For a review of certain mammalian host cell lines suitable for antibody production and/or binding polypeptide production, see, e.g., Yazaki and Wu, METHODS IN MOL. BIOL., Vol. 248 (B. K. C. Lo, ed., Humana Press, Totowa, N.J.), pp. 255-268 (2003).


While the description relates primarily to production of antibodies and/or binding polypeptides by culturing cells transformed or transfected with a vector containing antibody- and binding polypeptide-encoding nucleic acid. It is, of course, contemplated that alternative methods, which are well known in the art, may be employed to prepare antibodies and/or binding polypeptides. For instance, the appropriate amino acid sequence, or portions thereof, may be produced by direct peptide synthesis using solid-phase techniques [see, e.g., Stewart et al., Solid-Phase Peptide Synthesis, W.H. Freeman Co., San Francisco, Calif. (1969); Merrifield, J. Am. Chem. Soc., 85:2149-2154 (1963)]. In vitro protein synthesis may be performed using manual techniques or by automation. Automated synthesis may be accomplished, for instance, using an Applied Biosystems Peptide Synthesizer (Foster City, Calif.) using manufacturer's instructions. Various portions of the antibody and/or binding polypeptide may be chemically synthesized separately and combined using chemical or enzymatic methods to produce the desired antibody and/or binding polypeptide.


IV. Methods of Screening and/or Identifying Wnt Pathway Antagonists with Desired Function


Techniques for generating wnt pathway antagonists such as antibodies, binding polypeptides, and/or small molecules have been described above. Additional wnt pathway antagonists such as anti-wnt pathway antibodies, binding polypeptides, small molecules, and/or polynucleotides provided herein may be identified, screened for, or characterized for their physical/chemical properties and/or biological activities by various assays known in the art.


Provided herein are methods of screening for and/or identifying a wnt pathway antagonist which inhibits wnt pathway signaling, induces cancer cell cycle arrest, inhibits cancer cell proliferation, and/or promotes cancer cell death said method comprising: (a) contacting (i) a cancer cell, cancer tissue, and/or cancer sample, wherein the cancer cell, cancer tissue, and/or cancer comprises one or more biomarkers, and (ii) a reference cancer cell, reference cancer tissue, and/or reference cancer sample with a wnt pathway candidate antagonist, (b) determining the level of wnt pathway signaling, distribution of cell cycle stage, level of cell proliferation, and/or level of cancer cell death, whereby decreased level of wnt pathway signaling, a difference in distribution of cell cycle stage, decreased level of cell proliferation, and/or increased level of cancer cell death between the cancer cell, cancer tissue, and/or cancer sample, wherein the cancer cell, cancer tissue, and/or cancer comprises one or more biomarkers, and reference cancer cell, reference cancer tissue, and/or reference cancer sample identifies the wnt pathway candidate antagonist as an wnt pathway antagonist which inhibits wnt pathway signaling, induces cancer cell cycle arrest, inhibits cancer cell proliferation, and/or promotes cancer cell cancer death. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist.


Further provided herein are methods of screening for and/or identifying a wnt pathway antagonist which inhibits wnt pathway signaling, induces cancer cell cycle arrest, inhibits cancer cell proliferation, and/or promotes cancer cell death said method comprising: (a) contacting a cancer cell, cancer tissue, and/or cancer sample, wherein the cancer cell, cancer tissue, and/or cancer comprises one or more biomarkers with a wnt pathway candidate antagonist, (b) determining the level of wnt pathway signaling, distribution of cell cycle stage, level of cell proliferation, and/or level of cancer cell death to the cancer cell, cancer tissue, and/or cancer sample in the absence of the wnt pathway candidate antagonist, whereby decreased level of win pathway signaling, a difference in distribution of cell cycle stage, decreased level of cell proliferation, and/or increased level of cancer cell death between the cancer cell, cancer tissue, and/or cancer sample in the presence of the wnt pathway candidate antagonist and the cancer cell, cancer tissue, and/or cancer sample in the absence of the wnt pathway candidate antagonist identifies the wnt pathway candidate antagonist as an wnt pathway antagonist which inhibits wnt pathway signaling, induces cancer cell cycle arrest, inhibits cancer cell proliferation, and/or promotes cancer cell cancer death. In some embodiments, the wnt pathway antagonist is an R-spondin antagonist.


In some embodiments of any of the methods, the one or more biomarkers is a translocation (e.g., rearrangement and/or fusion) of one or more genes listed in Table 9. In some embodiments of any of the methods, the translocation (e.g., rearrangement and/or fusion) is an R-spondin translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO1 translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO2 translocation (e.g., rearrangement and/or fusion). In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E and RSPO2. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises SEQ ID NO:71 In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is detectable by primers which include SEQ ID NO:12, 41, and/or 42. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is driven by the EIF3E promoter. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is driven by the RSPO2 promoter. In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO3 translocation (e.g., rearrangement and/or fusion). In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK and RSPO3. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises SEQ ID NO:72 and/or SEQ ID NO:73. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is detectable by primers which include SEQ ID NO:13, 14, 43, and/or 44. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is driven by the PTPRK promoter. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is driven by the RSPO3 promoter. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises the PTPRK secretion signal sequence (and/or does not comprise the RSPO3 secretion signal sequence). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO4 translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) results in elevated expression levels of R-spondin (e.g., compared to a reference without the R-spondin translocation. In some embodiments, the one or more biomarkers is an R-spondin translocation (e.g., rearrangement and/or fusion) and KRAS and/or BRAF. In some embodiments, the presence of one or more biomarkers is presence of an R-spondin translocation (e.g., rearrangement and/or fusion) and a variation (e.g., polymorphism or mutation) KRAS and/or BRAF. In some embodiments, the presence of one or more biomarkers is presence of an R-spondin translocation (e.g., rearrangement and/or fusion) and the absence of one or more biomarkers is absence of a variation (e.g., polymorphism or mutation) CTNNB1 and/or APC.


Methods of determining the level of win pathway signaling are known in the art and are described in the Examples herein. In some embodiments, the levels of wnt pathway signaling are determined using a luciferase reporter assay as described in the Examples. In some embodiments, the wnt pathway antagonist inhibits wnt pathway signaling by reducing the level of wnt pathway signaling by about any of 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100%.


The growth inhibitory effects of a wnt pathway antagonist described herein may be assessed by methods known in the art, e.g., using cells which express wnt pathway either endogenously or following transfection with the respective gene(s). For example, appropriate tumor cell lines, and wnt pathway polypeptide-transfected cells may be treated with a wnt pathway antagonist described herein at various concentrations for a few days (e.g., 2-7) days and stained with crystal violet or MTT or analyzed by some other colorimetric assay. Another method of measuring proliferation would be by comparing 3H-thymidine uptake by the cells treated in the presence or absence an antibody, binding polypeptide, small molecule, and/or polynucleotides of the invention. After treatment, the cells are harvested and the amount of radioactivity incorporated into the DNA quantitated in a scintillation counter. Appropriate positive controls include treatment of a selected cell line with a growth inhibitory antibody known to inhibit growth of that cell line. Growth inhibition of tumor cells in vivo can be determined in various ways known in the art.


Methods of determining the distribution of cell cycle stage, level of cell proliferation, and/or level of cell death are known in the art. In some embodiments, cancer cell cycle arrest is arrest in G1.


In some embodiments, the wnt pathway antagonist will inhibit cancer cell proliferation of the cancer cell, cancer tissue, or cancer sample in vitro or in vivo by about 25-100% compared to the untreated cancer cell, cancer tissue, or cancer sample, more preferably, by about 30-100%, and even more preferably by about 50-100% or about 70-100%. For example, growth inhibition can be measured at a wnt pathway antagonist concentration of about 0.5 to about 30 μg/ml or about 0.5 nM to about 200 nM in cell culture, where the growth inhibition is determined 1-10 days after exposure of the tumor cells to the wnt pathway candidate antagonist. The wnt pathway antagonist is growth inhibitory in vivo if administration of the wnt pathway candidate antagonist at about 1 μg/kg to about 100 mg/kg body weight results in reduction in tumor size or reduction of tumor cell proliferation within about 5 days to 3 months from the first administration of the wnt pathway candidate antagonist, preferably within about 5 to 30 days.


To select for a writ pathway antagonists which induces cancer cell death, loss of membrane integrity as indicated by, e.g., propidium iodide (PI), trypan blue or 7AAD uptake may be assessed relative to a reference. API uptake assay can be performed in the absence of complement and immune effector cells. wnt pathway-expressing tumor cells are incubated with medium alone or medium containing the appropriate a wnt pathway antagonist. The cells are incubated for a 3-day time period. Following each treatment, cells are washed and aliquoted into 35 mm strainer-capped 12×75 tubes (1 ml per tube, 3 tubes per treatment group) for removal of cell clumps. Tubes then receive PI (10 μg/ml). Samples may be analyzed using a FACSCAN® flow cytometer and FACSCONVERT® CellQuest software (Becton Dickinson). Those wnt pathway antagonists that induce statistically significant levels of cell death as determined by PI uptake may be selected as cell death-inducing antibodies, binding polypeptides, small molecules, and/or polynucleotides.


To screen for wnt pathway antagonists which bind to an epitope on or interact with a polypeptide bound by an antibody of interest, a routine cross-blocking assay such as that described in Antibodies, A Laboratory Manual, Cold Spring Harbor Laboratory, Ed Harlow and David Lane (1988), can be performed. This assay can be used to determine if a candidate wnt pathway antagonist binds the same site or epitope as a known antibody. Alternatively, or additionally, epitope mapping can be performed by methods known in the art. For example, the antibody and/or binding polypeptide sequence can be mutagenized such as by alanine scanning, to identify contact residues. The mutant antibody is initially tested for binding with polyclonal antibody and/or binding polypeptide to ensure proper folding. In a different method, peptides corresponding to different regions of a polypeptide can be used in competition assays with the candidate antibodies and/or polypeptides or with a candidate antibody and/or binding polypeptide and an antibody with a characterized or known epitope.


In some embodiments of any of the methods of screening and/or identifying, the wnt pathway candidate antagonist is an antibody, binding polypeptide, small molecule, or polynucleotide. In some embodiments, the wnt pathway candidate antagonist is an antibody. In some embodiments, the wnt pathway antagonist (e.g., R-spondin-translocation antagonist) antagonist is a small molecule.


In one aspect, a wnt pathway antagonist is tested for its antigen binding activity, e.g., by known methods such as ELISA, Western blot, etc.


V. Pharmaceutical Formulations

Pharmaceutical formulations of a wnt pathway antagonist as described herein are prepared by mixing such antibody having the desired degree of purity with one or more optional pharmaceutically acceptable carriers (REMINGTON'S PHARMA. SCI. 16th edition, Osol, A. Ed. (1980)), in the form of lyophilized formulations or aqueous solutions. In some embodiments, the wnt pathway antagonist is a small molecule, an antibody, binding polypeptide, and/or polynucleotide. Pharmaceutically acceptable carriers are generally nontoxic to recipients at the dosages and concentrations employed, and include, but are not limited to: buffers such as phosphate, citrate, and other organic acids; antioxidants including ascorbic acid and methionine; preservatives (such as octadecyldimethylbenzyl ammonium chloride; hexamethonium chloride; benzalkonium chloride; benzethonium chloride; phenol, butyl or benzyl alcohol; alkyl parabens such as methyl or propyl paraben; catechol; resorcinol; cyclohexanol; 3-pentanol; and m-cresol); low molecular weight (less than about 10 residues) polypeptides; proteins, such as serum albumin, gelatin, or immunoglobulins; hydrophilic polymers such as polyvinylpyrrolidone; amino acids such as glycine, glutamine, asparagine, histidine, arginine, or lysine; monosaccharides, disaccharides, and other carbohydrates including glucose, mannose, or dextrins; chelating agents such as EDTA; sugars such as sucrose, mannitol, trehalose or sorbitol; salt-forming counter-ions such as sodium; metal complexes (e.g., Zn-protein complexes); and/or non-ionic surfactants such as polyethylene glycol (PEG). Exemplary pharmaceutically acceptable carriers herein further include interstitial drug dispersion agents such as soluble neutral-active hyaluronidase glycoproteins (sHASEGP), for example, human soluble PH-20 hyaluronidase glycoproteins, such as rHuPH20 (HYLENEX®, Baxter International, Inc.). Certain exemplary sHASEGPs and methods of use, including rHuPH20, are described in US Patent Publication Nos. 2005/0260186 and 2006/0104968. In one aspect, a sHASEGP is combined with one or more additional glycosaminoglycanases such as chondroitinases.


Exemplary lyophilized formulations are described in U.S. Pat. No. 6,267,958. Aqueous antibody formulations include those described in U.S. Pat. No. 6,171,586 and WO 2006/044908, the latter formulations including a histidine-acetate buffer.


The formulation herein may also contain more than one active ingredients as necessary for the particular indication being treated, preferably those with complementary activities that do not adversely affect each other. Such active ingredients are suitably present in combination in amounts that are effective for the purpose intended.


Active ingredients may be entrapped in microcapsules prepared, for example, by coacervation techniques or by interfacial polymerization, for example, hydroxymethylcellulose or gelatin-microcapsules and poly-(methylmethacylate) microcapsules, respectively, in colloidal drug delivery systems (for example, liposomes, albumin microspheres, microemulsions, nano-particles and nanocapsules) or in macroemulsions. Such techniques are disclosed in REMINGTON'S PHARMA. SCI. 16th edition, Osol, A. Ed. (1980).


Sustained-release preparations may be prepared. Suitable examples of sustained-release preparations include semipermeable matrices of solid hydrophobic polymers containing the wnt pathway antagonist, which matrices are in the form of shaped articles, e.g., films, or microcapsules.


The formulations to be used for in vivo administration are generally sterile. Sterility may be readily accomplished, e.g., by filtration through sterile filtration membranes.


VI. Articles of Manufacture

In another aspect of the invention, an article of manufacture containing materials useful for the treatment, prevention and/or diagnosis of the disorders described above is provided. The article of manufacture comprises a container and a label or package insert on or associated with the container. Suitable containers include, for example, bottles, vials, syringes, IV solution bags, etc. The containers may be formed from a variety of materials such as glass or plastic. The container holds a composition which is by itself or combined with another composition effective for treating, preventing and/or diagnosing the condition and may have a sterile access port (for example the container may be an intravenous solution bag or a vial having a stopper pierceable by a hypodermic injection needle). At least one active agent in the composition is a wnt pathway antagonist (e.g., R-spondin antagonist, e.g., R-spondin-translocation antagonist) described herein. The label or package insert indicates that the composition is used for treating the condition of choice. Moreover, the article of manufacture may comprise (a) a first container with a composition contained therein, wherein the composition comprises a wnt pathway antagonist (e.g., R-spondin antagonist, e.g., R-spondin-translocation antagonist); and (b) a second container with a composition contained therein, wherein the composition comprises a further cytotoxic or otherwise therapeutic agent.


In some embodiments, the article of manufacture comprises a container, a label on said container, and a composition contained within said container; wherein the composition includes one or more reagents (e.g., primary antibodies that bind to one or more biomarkers or probes and/or primers to one or more of the biomarkers described herein), the label on the container indicating that the composition can be used to evaluate the presence of one or more biomarkers in a sample, and instructions for using the reagents for evaluating the presence of one or more biomarkers in a sample. The article of manufacture can further comprise a set of instructions and materials for preparing the sample and utilizing the reagents. In some embodiments, the article of manufacture may include reagents such as both a primary and secondary antibody, wherein the secondary antibody is conjugated to a label, e.g., an enzymatic label. In some embodiments, the article of manufacture one or more probes and/or primers to one or more of the biomarkers described herein.


In some embodiments of any of the articles of manufacture, the one or more biomarkers comprises a translocation (e.g., rearrangement and/or fusion) of one or more genes listed in Table 9. In some embodiments of any of the articles of manufacture, the translocation (e.g., rearrangement and/or fusion) is an R-spondin translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO1 translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO2 translocation (e.g., rearrangement and/or fusion). In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E and RSPO2. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E exon 1 and RSPO2 exon 2. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises EIF3E exon 1 and RSPO2 exon 3. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) comprises SEQ ID NO:71. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is detectable by primers which include SEQ ID NO:12, 41, and/or 42. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is driven by the EIF3E promoter. In some embodiments, the RSPO2 translocation (e.g., rearrangement and/or fusion) is driven by the RSPO2 promoter. In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO3 translocation (e.g., rearrangement and/or fusion). In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK and RSPO3. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK exon 1 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises PTPRK exon 7 and RSPO3 exon 2. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises SEQ ID NO:72 and/or SEQ ID NO:73. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is detectable by primers which include SEQ ID NO:13, 14, 43, and/or 44. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is driven by the PTPRK promoter. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) is driven by the RSPO3 promoter. In some embodiments, the RSPO3 translocation (e.g., rearrangement and/or fusion) comprises the PTPRK secretion signal sequence (and/or does not comprise the RSPO3 secretion signal sequence). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) is a RSPO4 translocation (e.g., rearrangement and/or fusion). In some embodiments, the R-spondin translocation (e.g., rearrangement and/or fusion) results in elevated expression levels of R-spondin (e.g., compared to a reference without the R-spondin translocation. In some embodiments, the one or more biomarkers is an R-spondin translocation (e.g., rearrangement and/or fusion) and KRAS and/or BRAF. In some embodiments, the presence of one or more biomarkers is presence of an R-spondin translocation (e.g., rearrangement and/or fusion) and a variation (e.g., polymorphism or mutation) KRAS and/or BRAF. In some embodiments, the presence of one or more biomarkers is presence of an R-spondin translocation (e.g., rearrangement and/or fusion) and the absence of one or more biomarkers is absence of a variation (e.g., polymorphism or mutation) CTNNB1 and/or APC.


In some embodiments of any of the articles of manufacture, the articles of manufacture comprise primers. In some embodiments, the primers are any of SEQ ID NO:12, 13, 14, 41, 42, 43, and/or 44.


In some embodiments of any of the article of manufacture, the wnt pathway antagonist (e.g., R-spondin-translocation antagonist) is an antibody, binding polypeptide, small molecule, or polynucleotide. In some embodiments, the wnt pathway antagonist (e.g., R-spondin-translocation antagonist) is a small molecule. In some embodiments, the wnt pathway antagonist (e.g., R-spondin-translocation antagonist) is an antibody. In some embodiments, the antibody is a monoclonal antibody. In some embodiments, the antibody is a human, humanized, or chimeric antibody. In some embodiments, the antibody is an antibody fragment and the antibody fragment binds wnt pathway polypeptide (e.g., R-spondin-translocation fusion polypeptide).


The article of manufacture in this embodiment of the invention may further comprise a package insert indicating that the compositions can be used to treat a particular condition. Alternatively, or additionally, the article of manufacture may further comprise a second (or third) container comprising a pharmaceutically-acceptable buffer, such as bacteriostatic water for injection (BWFI), phosphate-buffered saline, Ringer's solution and dextrose solution. It may further include other materials desirable from a commercial and user standpoint, including other buffers, diluents, filters, needles, and syringes.


Other optional components in the article of manufacture include one or more buffers (e.g., block buffer, wash buffer, substrate buffer, etc), other reagents such as substrate (e.g., chromogen) which is chemically altered by an enzymatic label, epitope retrieval solution, control samples (positive and/or negative controls), control slide(s) etc.


It is understood that any of the above articles of manufacture may include an immunoconjugate described herein in place of or in addition to a wnt pathway antagonist.


EXAMPLES

The following are examples of methods and compositions of the invention. It is understood that various other embodiments may be practiced, given the general description provided above.


Materials and Methods for Examples

Samples, DNA and RNA Preps and MSI Testing


Patient-matched fresh frozen primary colon tumors and normal tissue samples were obtained from commercial sources subjected to genomic analysis described below. All tumor and normal tissue were subject to pathology review. From a set of 90 samples 74 tumor pairs were identified for further analysis. Tumor DNA and RNA were extracted using Qiagen AllPrep DNA/RNA kit (Qiagen, CA). Tumor samples were assessed for microsatellite instability using an MSI detection kit (Promega, WI).


Exome Capture and Sequencing


Seventy two tumor samples and matched normal tissues were analyzed by exome sequencing. Exome capture was performed using SeqCap EZ human exome library v2.0 (Nimblegen, WI) consisting of 2.1 million empirically optimized long oligonucleotides that target 30,000 coding genes (300,000 exons, total size 36.5 Mb). The library was capable of capturing a total of 44.1 Mb of the genome, including genes and exons represented in RefSeq (January 2010), CCDS (September 2009) and miRBase (v.14, September 2009). Exome capture libraries generated were sequenced on HiSeq 2000 (Illumina, CA). One lane of 2×75 bp paired-end data was collected for each sample.


RNA-seq


RNA from 68 colon tumor and matched normal sample pairs was used to generate RNA-seq libraries using TruSeq RNA Sample Preparation kit (Illumina, CA). RNA-seq libraries were multiplex (two per lane) and sequenced on HiSeq 2000 as per manufacturer's recommendation (Illumina, CA). ˜30 million 2×75 bp paired-end sequencing reads per sample were generated.


Sequence Data Processing


All short read data was evaluated for quality control using the Bioconductor ShortRead package. Morgan, M. et al., Bioinformafics 25, 2607-2608 (2009). To confirm that all samples were identified correctly, all exome and RNA-seq data variants that overlapped with the Illuman 2.5 M array data were compared and checked for consistency. An all by all germline variant comparison was also done between all samples to check that all pairs were correctly matched between the tumor and normal and correspondingly did not match with any other patient pair above a cutoff of 90%.


Variant Calling


Sequencing reads were mapped to UCSC human genome (GRCh37/hg19) using BWA software set to default parameters. Li, H. & Durbin, R. Bioinformatics 25, 1754-1760 (2009). Local realignment, duplicate marking and raw variant calling were performed as described previously. DePristo, M. A. et al., Nat. Genet. 43, 491-498 (2011). Known germline variations represented in dbSNP Build 131 ENREF 4 (Sherry, S. T. et al., Nucleic Acids Res 29, 308-311 (2001)), but not represented in COSMIC ENREF 5 (Forbes, S. A. et al., Nucleic Acids Res. 38, D652-657 (2010)), were additionally filtered out. In addition variants that were present in both the tumor and normal samples were removed as germline variations. Remaining variations present in the tumor sample, but absent in the matched normal were predicted to be somatic. Predicted somatic variations were additionally filtered to include only positions with a minimum of 10× coverage in both the tumor and matched normal as well as an observed variant allele frequency of <3% in the matched normal and a significant difference in variant allele counts using Fisher's exact test. To evaluate the performance of this algorithm, 807 protein-altering variants were randomly selected and validated them using Sequenom (San Diego, Calif.) nucleic acid technology as described previously. Kan, Z. et al., Nature 466, 869-873 (2010). Of these, 93% (753) validated as cancer specific with the invalidated variants being equally split between not being seen in the tumor and also being seen in the adjacent normal (germline). Indels were called using the GATK Indel Genotyper Version 2 which reads both the tumor and normal BAM file for a given pair. DePristo, M. A. et al., Nat. Genet. 43, 491-498 (2011).


In order to identify variants grossly violating a binomial assumption, or variant calls affected by a specific mapper, Sequenom validated variants were additionally included using the following algorithm. Reads were mapped to UCSC human genome (GRCh37/hg19) using GSNAP. Wu, T. D. & Nacu, S. Bioinformatics 26, 873-881 (2010). Variants seen at least twice at a given position and greater than 10% allele frequency were selected. These variants were additionally filtered for significant biases in strand and position using Fisher's exact test. In addition variants that did not have adequate coverage in the adjacent normal as determined as at least a 1% chance of being missed using a beta-binomial distribution at a normal allele frequency of 12.5% were excluded. All novel protein-altering variants included in the second algorithm were validated by Sequenom, which resulted in a total of 515 additional variants. The effect of all non-synonymous somatic mutations on gene function was predicted using SIFT (Ng, P. C. & Henikoff, S. Genome Res 12, 436-446 (2002)) and PolyPhen ENREF 9 (Ramensky, V., Bork, P. & Sunyaev, S. Nucleic Acids Res 30, 3894-3900 (2002)). All variants were annotated using Ensembl (release 59, www.ensembl.org).


Validation of Somatic Mutations and Indels


Single base pair extension followed by nucleic acid mass spectrometry (Sequenom, CA) was used as described previously to validate the predicted somatic mutations. Tumor and matched normal DNA was whole genome amplified and using the REPLI-g Whole Genome Amplification Midi Kit (Qiagen, CA) and cleaned up as per manufacturer's recommendations and used. Variants found as expected in the tumor but absent in the normal were designated somatic. Those that were present in both tumor and normal were classified as germline. Variants that could not be validated in tumor or normal were designated as failed. For indel validation, primers for PCR were designed that will generate an amplicon of ˜300 bp that contained the indel region. The region was PCR amplified in both tumor and matched normal sample using Phusion (NEB, MA) as per manufacturer's instructions. The PCR fragments were then purified on a gel an isolated the relevant bands and Sanger sequenced them. The sequencing trace files were analyzed using Mutation Surveyor (SoftGenetics, PA). Indels that were present in the tumor and absent in the normal were designated somatic and are reported in Table 3.


Mutational Significance


Mutational significance of genes was evaluated using a previously described method ENREF 10. Briefly this method can identify genes that have statistically significant more protein-altering mutations than what would be expected based on a calculated background mutation rate. The background mutation rate was calculated for six different nucleotide mutation categories (A,C,G,T,CG1,CG2) in which there was sufficient coverage (≥10×) in both the tumor and matched normal sample. A nonsynonymous to synonymous ratio, ri, was calculated using a simulation of mutating all protein coding nucleotides and seeing if the resulting change would result in a synonymous or nonsynonymous change. The background mutation rate, fi, was determined by multiplying the number of synonymous somatic variants by ri and normalizing by the total number of protein-coding nucleotides. The number of expected mutations for a given gene was determined as the number of protein-coding bases multiplied by fi and integrated across all mutation categories. A p-value was calculated using a Poisson probability function given the expected and observed number of mutations for each gene. P values were corrected for multiple testing using the Benjamini Hochberg method and the resulting q-values were converted to q-scores by taking the negative log 10 of the q-values. Given that different mutation rates existed for the MSI and MSS samples, qscores were calculated separately for each with the two hypermutated samples being removed completely. In order to not underestimate the background mutation rates, the seven samples with less than 50% tumor content were excluded from the analysis. Pathway mutational significance was also calculated as previously described, with the exception that the BioCara Pathway database used used which was downloaded as part of MSigDB (Subramanian A. et al., Proc. of the Natl Acad. Of Sci. USA 102, 15545-15550 (2005)).


Whole Genome Sequencing and Analysis


Paired-end DNA-Seq reads were aligned to GRCh37 using BWA. Further processing of the alignments to obtain mutation calls was similar to the exome sequencing analysis using the GATK pipeline. Copy-number was calculated by computing the number of reads in 10 kb non-overlapping bins and taking the ratio tumor/normal of these counts. Chromosomal breakpoints were predicted using breakdancer. Chen, K. et al., Nat. Methods 6, 677-681 (2009). Genome plots were created using Circos (Krzywinski, M. et al., Genome Res. 19, 1639-1459 (2009)).


RNA-Seq Data Analysis


RNA-Seq reads were aligned to the human genome version GRCh37 using GSNAP (Wu, T. D. & Nacu, S. Bioinformatics 26, 873-881 (2010). Expression counts per gene were obtained by counting the number of reads aligning concordant and uniquely to each gene locus as defined by CCDS. The gene counts were then normalized for library size and subsequently variance stabilized using the DESeq Bioconductor software package. Anders, S. & Huber, W. Genome Biology 11, R106 (2010). Differential gene expression was computed by pairwise t-tests on the variance stabilized counts followed by correction for multiple testing using the Benjamini & Hochberg method.


SNP Array Data Generation and Analysis


Illumina HumanOmni2.5_4v1 arrays were used to assay 74 colon tumors and matched normals for genotype, DNA copy and LOH at ˜2.5 million SNP positions. These samples all passed our quality control metrics for sample identity and data quality (see below). A subset of 2295239 high-quality SNPs was selected for all analyses.


After making modifications to permit use with Illumina array data, the PICNIC (Greenman, C. D. et al., Biostatistics 11, 164-175 (2010)) algorithm was applied to estimate total copy number and allele-specific copy number/LOH. Modification included replacement of the segment initialization component with the CBS algorithm (Venkatraman, E. S. & Olshen, A. B. Bioinformatics 23, 657-663 (2007)), and adjustment of the prior distribution for background raw copy number signal (abjusted mean of 0.7393 and a standard deviation of 0.05). For the preprocessing required by PICNIC's hidden Markov model (HMM), a Bayesiaan model to estimate cluster centroids for each SNP. For SNP k and genotype g, observed data in normal sample were modeled as following a bivariate Gaussian distribution. Cluster centers for the three diploid genotypes were modeled jointly by a 6-dimensional Gaussian distribution with mean treated as a hyperparameter and set empirically based on a training set of 156 normal samples. Cluster center and within-genotype covariance matrices were modeled as inverse Wishart with scale matrix hyperparameters also set empirically and with degrees of freedom manually tuned to provide satisfactory results for a wide range of probe behavior and minor allele frequencies. Finally, signal for SNP k (for the A and B alleles separately) was transformed with a non-linear function: y=αkxγlk with parameters selected based on the posterior distributions computed above.


Sample identity was verified using genotype concordance between all samples. Pairs of tumors from the same patient were expected to have >90% concordance and all other pairs were expected to have <80% concordance. Samples failing those criteria were excluded from all analyses. Following modified PICNIC, the quality of the overall HMM fit was assessed by measuring the root mean squared error (RMSE) between the raw and HMM-fitted value for each SNP. Samples with and RMSE>1.5 were excluded from all analyses. Finally to account for two commonly observed artifacts, fitted copy number values were set to “NA” for singletons with fitted copy number 0 or when the observed and fitted means differed by more tha 2 for regions of inferred copy gain.


Recurrent DNA Copy Number Gain and Loss


Genomic regions with recurrent DNA copy gain and loss were identified using GISTIC, version 2.0. Mermel, C. H. et al., Genome Biology 12, R41 (2011). Segmented integer total copy number values obtained from PICNIC, c, were converted to loge ratio values, y, as y=log2(c+0.1)−1. Cutoffs of +/−0.2 were used to categorize loge ratio values as gain or loss, respectively. A minimum segment length of 20 SNPs and a loge ratio “cap” value of 3 were used.


Fusion Detection and Validation


Putative fusions were identified using a computational pipeline developed called GSTRUCT-fusions. The pipeline was based on a generate-and-test strategy that is fundamentally similar to methodology reported previously for finding readthrough fusions. Nacu, S. et al., BMC Med Genomics 4, 11 (2011). Paired-end reads were aligned using our alignment program GSNAP. Nacu, S. et al., BMC Med Genomics 4, 11 (2011). GSNAP has the ability to detect splices representing translocations, inversions, and other distant fusions within a single read end.


These distant splices provided one set of candidate fusions for the subsequent testing stage. The other set of candidate fusions derived from unpaired unique alignments, where each end of the paired-end read aligned uniquely to a different chromosome, and also from paired, but discordant unique alignments, where each end aligned uniquely to the same chromosome, but with an apparent genomic distance that exceeded 200,000 bp or with genomic orientations that suggested an inversion or scrambling event.


Candidate fusions were then filtered against known transcripts from RefSeq, aligned to the genome using GMAP. Wu, T. D. & Watanabe, C. K. Bioinformatics 21, 1859-1875 (2005). Both fragments flanking a distant splice, or both ends of an unpaired or discordant paired-end alignment, were required to map to known exon regions. This filtering step eliminated approximately 90% of the candidates. Candidate inversions and deletions were further eliminated that suggested rearrangements of the same gene, as well as apparent readthrough fusion events involving adjacent genes in the genome, which our previous research indicated were likely to have a transcriptional rather than genomic origin.


For the remaining candidate fusion events, artificial exon-exon junctions consisting of the exons distal to the supported donor exon and the exons proximal to the supported acceptor exon were constructed. The exons included in the proximal and distal computations were limited so that the cumulative length along each gene was within an estimated maximum insert length of 200 bp. As a control, all exon-exon junctions consisting of combinations of exons within the same gene were constructed for all genes contributing to a candidate fusion event.


In the testing stage of our pipeline, we constructed a genomic index from the artificial exon-exon junctions and controls using the GMAP_BUILD program included as part of the GMAP and GSNAP package. This genomic index and the GSNAP program with splice detection turned off were used to re-align the original read ends that were not concordant to the genome. Reads were extracted that aligned to an intergenic junction corresponding to a candidate fusion, but not to a control intragenic junction.


The results of the re-alignment were filtered to require that each candidate fusion have at least one read with an overhang of 20 bp. Each candidate fusion was also required to have at least 10 supporting reads. For each remaining candidate fusion, the two component genes were aligned against each other using GMAP and eliminated the fusion if the alignment had any region containing 60 matches in a window of 75 bp. The exon-exon junction were also aligned against each of the component genes using GMAP and eliminated the fusion if the alignment had coverage greater than 90% of the junction and identity greater than 95%.


Validation of gene fusions was done using reverse transcription (RT)-PCR approach using both colon tumor and matched normal samples. 500 ng of total RNA was reverse transcribed to cDNA with a High Capacity cDNA Reverse Transcription kit (Life Technologies, CA) following manufacturer's instructions. 50 ng of cDNA was amplified in a 25 μl reaction containing 400 pM of each primer, 300 μM of each deoxynucleoside triphosphates and 2.5 units of LongAmp Taq DNA polymerase (New England Biolabs, MA). PCR was performed with an initial denaturation at 95° C. for 3 minutes followed by 35 cycles of 95° C. for 10 seconds, 56° C. for 1 minute and 68° C. for 30 seconds and a final extension step at 68° C. for 10 minutes. 3 μl of PCR product was run on 1.2% agarose gel to identify samples containing gene fusion. Specific PCR products were purified with either a QIAquick PCR Purification kit or Gel Extraction kit (Qiagen, CA). The purified DNA was either sequenced directly with PCR primers specific to each fusion or cloned into TOPO cloning vector pCR2.1 (Life Technologies, CA) prior to Sanger sequencing. The clones were sequenced using Sanger sequencing on a ABI3730xl (Life Technologies, CA) as per manufacturer instructions. The Sanger sequencing trace files were analyzed using Sequencher (Gene Cordes Corp., MI).


RSPO Fusion Activity Testing


Eukaryotic expression plasmid pRK5E driving the expression of c-terminal FLAG tag EIF3E, PTPKR (amino acids 1-387), RSPO2, RSPO3, EIF3E(e1)-RSPO2(e2), PTPRK(e1)-RSPO3(e2), PTPRK(e7)-RSPO3(e2) was generated using standard PCR and cloning strategies.


Cells, Conditioned Media, Immunoprecipitation and Western Blot


HEK 293T, human embryonic kidney cells, were maintained in DMEM supplemented with 10% FBS. For expression analysis and condition media generation 3×105 HEK29T cells were plated in 6-well plates in 1.5 ml DMEM containing 10% FBS. Cells were transfected with 1 μg of DNA using FIG. 6 (Roche) according to the manufacturer's instructions. Media was conditioned for 48 hours, collected, centrifuged, and used to stimulate the luciferase reporter assay (final concentration 0.1-0.4×). For expression analysis, media was collected, centrifuged to remove debris and used for immunoprecipitation.


Luciferase Reporter Assays


HEK 293T cells were plated at a density of 50,000 cells/ml in 90 μl of media containing 2.5% FBS per well of a 96-well plate. After 24 hours, cells were transfected using FIG. 6 according to manufacturer's instructions (Roche, CA) with the following DNA per well: 0.04 μg TOPbrite Firefly reporter (Nature Chem. Biol. 5, 217-219 (2009)), 0.02 μg pRL SV40-Renilla (Promega, WI) and 0.01 μg of the appropriate R-spondin or control constructs. Cells were stimulated with 25 μl of either fresh or conditioned media containing 10% FBS with or without rmWnt3a (20-100 ng/ml (final), R&D Systems, MN). Following 24 hours stimulation, 50 μl of media was removed and replaced with Dual-Glo luciferase detection reagents (Promega, WI) according to manufacturer's instructions. An Envision Luminometer (Perkin-Elmer, MA) was used to detect luminescence. To control for transfection efficiency, Firefly luciferase levels were normalized to Renilla luciferase levels to generate the measure of relative luciferase units (RLU). Experimental data was presented as mean±SD from three independent wells.


Immunoprecipitation and Western Blot


To confirm that the RSPO wild type and RSPO fusion proteins were secreted, FLAG tagged proteins were immunoprecipitated from the media using anti-FLAG-M2 antibody coupled beads (Sigma, MO), boiled in SDS-PAGE loading buffer, resolved on a 4-20% SDS-PAGE (Invitrogen, Carlsbad, Calif.) and transferred onto a nitrocellulose membrane. RSPO and other FLAG tagged proteins expressed in cells were detected from cell lysates using western blot as described before (Bijay p85 paper). Briefly, immunoprecipitated proteins and proteins from cell lysates were detected by Western blot using FLAG-HRP-conjugated antibody and chemiluminescences Super signal West Dura chemiluminescence detection substrate (Thermo Fisher Scientific, IL).


Example 1
CRC Mutation Profile

Identifying and understanding changes in cancer genomes is essential for the development of targeted therapeutics. In these examples, a systematically analysis of over 70 pairs of primary human colon cancers was undertaken by applying next generation sequencing to characterize their exomes, transcirptomes and copy number alterations. 36,303 protein altering somatic changes were identified that include several new recurrent mutations in Wnt pathway genes like TCF12 and TCF7L2, chromatin remodeling proteins such as TET2 and TET3 and receptor tyrosine kinases including ERBB3. The analysis for significant cancer genes identified 18 candidates, including cell cycle checkpoint kinase ATM. The copy number and RNA-seq data analysis identified amplifications and corresponding overexpression of IGF2 in a subset of colon tumors. Further, using RNA-seq data multiple fusion transcripts were identified including recurrent gene fusions of the R-spondin genes RSPO2 and RSPO3, occurring in 10% of the samples. The RSPO fusion proteins were demonstrated to be biologically active and potentiate Wnt signaling. The RSPO fusions aremutually exclusive with APC mutations indicating that they likely play a role in activating Wnt signaling and tumorigenesis. The R-spondin gene fusions and several other gene mutations identified in these examples provide new opportunities for therapeutic intervention in colon cancer.


74 primary colon tumors and their matched adjacent normal samples were characterized. Whole-exome sequencing for 72 (15 MSI and 57 MSS) of the 74 colon tumor and adjacent normal sample pairs to assess the mutational spectra was performed. These 74 tumor/normal pairs were also analyzed on Illumina 2.5M array to assess chromosomal copy number changes. RNA-seq data for 68 tumor/normal pairs was also obtained. Finally, the genome of an MSI and MSS tumor/normal pair at 30× coverage from this set of samples was sequenced and analyzed.










Lengthy table referenced here




US20210025008A1-20210128-T00001


Please refer to the end of the specification for access instructions.






Exons were captured using Nimblegen SeqCap EZ human exome library v2.0 and sequenced on HiSeq 2000 (Illumina, CA) to generate 75 bp paired-end sequencing reads. The targeted regions had a mean coverage of 179× with 97.4% bases covered at ≥10 times. 95,075 somatic mutations in the 72 colon tumor samples analyzed were identified of which 36,303 were protein-altering. Two MSS samples showed an unusually large number of mutations (24,830 and 5,780 mutations of which 9,479 and 2,332 were protein-altering mutations respectively). These were designated as hypermutated samples and were not considered for calculating the background mutation rate. 52,312 somatic mutations in the 15 MSI samples (18,436 missense, 929 nonsense, 22 stop lost, 436 essential splice site, 363 protein-altering indels, 8,065 synonymous, 16,675 intronic and 7,386 others) and 12,153 somatic mutations in the 55 MSS samples (3,922 missense, 289 nonsense, 6 stop lost, 69 essential splice site, 20 protein-altering indels 1,584 synonymous, 4,375 intronic and 1,888 others) studied (Table 2 and 3) were found. About 98% (35,524/36,303) of the protein altering single nucleotide variants reported in these examples are novel and have not been reported in COSMIC ENREF 7 v54 (Forbes, S. A. et al., Nucleic Acids Res. 38:D652-657 (2010)). Thirty seven percent of the somatic mutations reported were validated using RNA-seq data or mass spectrometry genotyping with a validation rate of 93% (Table 2). All the indels reported were confirmed somatic using Sanger sequencing (Table 3-Somatic Indels). A mean non-synonymous mutation rate of 2.8/Mb (31-149 coding region mutations in the 55 samples) in the MSS samples and 40/Mb (764-3113 coding region mutations in the 15 samples) in the MSI samples was observed, consistent with the MMR defect in the later.









TABLE 3







Somatic Indels















Pos.
Pos.
AA




Gene
Location
cDNA
protein
chg
Ref
Var
















PRMT6
1:107599370
70
11

CG
C





KCNA10
1:111060763
1035
216

AC
A





CSDE1
1:115262367
0
0

GA
G





SIKE1
1:115316998
0
0

GA
G





SYCP1
1:115537601
3132
964

GA
G





VANGL1
1:116206586
780
170

CT
C





PRDM2
1:14108749
5315
1487

CA
C





PIAS3
1:145585533
1888
600

TG
T





BCL9
1:147091501
2280
514

AC
A





BCL9
1:147092681-147092680
3459
907


C





ZNF687
1:151261079
2337
731

AC
A





RFX5
1:151318741
235
19

TG
T





RFX5
1:151318741
235
19

TG
T





PYGO2
1:154932028
620
150

TG
T





UBQLN4
1:156020953
519
142

GC
G





NES
1:156640235
3878
1249

AC
A





KIRREL
1:158057655
0
0

AG
A





BRP44
1:167893779
0
0

GA
G





CACYBP
1:174976327
874
142

CA
C





RASAL2
1:178426849-178426857
2774
808
DNT/-
GGACAACACA
G







(SEQ ID NO: 84)






ASPM
1:197059222
0
0

GA
G





UBE2T
1:202304824
209
20

TG
T





PLEKHA6
1:204228411
1359
348

AC
A





PLEKHA6
1:204228411
1359
348

AC
A





PLEKHA6
1:204228411
1359
348

AC
A





PLEKHA6
1:204228411
1359
348

AC
A





DYRK3
1:206821441
1066
300

TA
T





RPS6KC1
1:213414598
1929
593

CA
C





CENPF
1:214815702
4189
1341

GA
G





TGFB2
1:218609371
1365
300

GA
G





ITPKB
1:226924541
619
207

TC
T





OBSCN
1:228481047
0
0

TC
T





CHRM3
1:240071597
1625
282

AC
A





TCEB3
1:24078404
1658
463

TA
T





AHCTF1
1:247014550
4872
1624

CA
C





RHD
1:25599125
145
29

AT
A





FAM54B
1:26156056
741
203

TC
T





EPHA10
1:38185238
2690
868

TG
T





PTCH2
1:45293652-45293653
2051
640

GAC
G





FAM151A
1:55078268-55078270
850
230
KM/M
ATCT
A





L1TD1
1:62675692-62675694
1541
416
E/-
GGAA
G





RPE65
1:68904737
940
296

CT
C





ZNF644
1:91406040
1089
291

CT
C





ADD3
10:111893350
2462
699

CA
C





DHTKD1
10:12139966-12139967
1704
548

GCA
G





TACC2
10:123842278
603
88

AG
A





KIAA1217
10:24783491
1772
581

CT
C





PTCHD3
10:27702951
347
77

CG
C





SVIL
10:29760116
6036
1862

TC
T





ZEB1
10:31815887-31815886
3107
1023


GA





ANK3
10:61831290-61831289
9541
3117


T





SIRT1
10:69648852
813
254

CA
C





DDX50
10:70666693-70666692
420
105


A





USP54
10:75290284
0
0

TA
T





BTAF1
10:93756247
3443
1144

AT
A





MYOF
10:95079629
5598
1866

CT
C





HELLS
10:96352051-96352050
1937
611


A





GOLGA7B
10:99619319-99619318
181
39


C





AP2A2
11:1000475
2184
668

GC
G





ZBED5
11:10875781
1211
238

AT
A





C11orf57
11:111953460
769
216

CA
C





SIDT2
11:117052572
876
119

GC
G





MFRP
11:119213688
1297
384

TG
T





PKNOX2
11:125237794
454
47

GC
G





ZBTB44
11:130131353
710
139

CT
C





COPB1
11:14504704
0
0

TA
T





MYOD1
11:17742463-17742462
864
215


C





KCNC1
11:17794004
1418
455

GA
G





PTPN5
11:18751286-18751285
1840
470


G





PAX6
11:31812317
1635
389

TG
T





CCDC73
11:32635625
2283
747

GT
G





UBQLN3
11:5529015
1922
592

GA
G





TNKS1BP1
11:57080526
1801
546

TC
T





FAM111B
11:58892377
998
269

CA
C





PATL1
11:59434440
0
0

TA
T





PRPF19
11:60666410
0
0

GA
G





STX5
11:62598585
285
44

TG
T





RIN1
11:66102953-66102955
597
157
LP/P
GGGA
G





SPTBN2
11:66457417
0
0

TG
T





PC
11:66617803
2655
869

GC
G





SWAP70
11:9735070
397
100

CA
C





NCOR2
12:124846685
3240
1028

CG
C





SFRS8
12:132210169
966
276

GA
G





GOLGA3
12:133375067
0
0

TA
T





ATF7IP
12:14578133-14578134
1437
428

ACT
A





KDM5A
12:416953
3960
1199

CT
C





FAM113B
12:47628998
883
51

AG
A





MLL2
12:49434492
7061
2354

AG
A





ACVR1B
12:52374795
665
208

GT
G





ESPL1
12:53677181
3027
979

CA
C





DGKA
12:56347514
2434
724

AC
A





BAZ2A
12:57004252
1920
576

TC
T





GLI1
12:57860075
893
272

TG
T





LRIG3
12:59279691
0
0

GA
G





ATN1
12:7045535
1342
369

GC
G





PTPRB
12:70981054
0
0

GA
G





ZFC3H1
12:72021721
0
0

TA
T





ZFC3H1
12:72021721
0
0

TA
T





PTPRQ
12:80904230-80904229
0
0


T





PTPRQ
12:81063246
0
0

TA
T





MGAT4C
12:86373479
1112
371

AG
A





ELK3
12:96641029
798
173

GC
G





TMPO
12:98921672
492
96

CA
C





UPF3A
13:115057211
846
264

CA
C





KL
13:33628153-33628152
1076
356


A





SPG20
13:36909782-36909783
246
62

CTT
C





MRPS31
13:41323308-41323307
961
308


C





NAA16
13:41892982
504
60

GA
G





ZC3H13
13:46543661-46543660
3367
1006


T





DIAPH3
13:60348388
0
0

TA
T





DYNC1H1
14:102483256
7932
2590

GC
G





TPPP2
14:21498757-21498756
140
6


A





CHD8
14:21862450
5180
1727

TG
T





ACIN1
14:23549379
1667
447

GC
G





CBLN3
14:24898079
653
61

TC
T





CTAGE5
14:39788502
0
0

CT
C





C14orf106
14:45693722
2527
690

CT
C





MAP4K5
14:50952368
0
0

CA
C





SPTB
14:65259995
2440
800

CG
C





ISM2
14:77948984-77948983
711
218


A





PTPN21
14:88940113
2750
849

AT
A





DICER1
14:95583036
0
0

GA
G





NIPA2
15:23021236
714
34

GC
G





DUOXA2
15:45406932
414
43

CG
C





ADAM10
15:59009931
0
0

TA
T





TLN2
15:63054019
4811
1593

GA
G





HERC1
15:64015557
0
0

TA
T





ISL2
15:76633583-76633582
1063
301


A





KIAA1024
15:79750586
2172
699

TA
T





BNC1
15:83933100
989
301

CT
C





ANPEP
15:90334189
2978
888

TA
T





SV2B
15:91832792-91832791
2219
583


T





UBE2I
16:1370650
662
182

CG
C





ARHGAP17
16:24942180
2533
814

TG
T





GTF3C1
16:27509009
2339
767

CT
C





ZNF785
16:30594709-30594710
433
130

CTT
C





ZNF434
16:3433715
0
0

GA
G





CREBBP
16:3817721
4055
1084

CT
C





CTCF
16:67645339-67645338
1047
201


A





CDH1
16:68863582
2512
774

AG
A





FTSJD1
16:71318173-71318172
1988
551


A





ZFHX3
16:72992483
2235
521

CT
C





USP7
16:9017275
0
0

CA
C





NUFIP2
17:27614342
759
224

CT
C





EVI2B
17:29632035
741
198

GT
G





MED1
17:37564512
4168
1321

AC
A





WIPF2
17:38420993
805
189

AC
A





FKBP10
17:39975559
929
275

TC
T





COL1A1
17:48271492
1786
556

AG
A





SFRS1
17:56083739
553
115

TG
T





RNF43
17:56435161
2464
659

AC
A





RNF43
17:56438159-56438161
1320
278
E/-
ACTC
A





USP32
17:58300952
0
0

TA
T





SMURF2
17:62602763
0
0

TA
T





TP53
17:7578222-7578223
816
209

TTC
T





TP53
17:7578262-7578263
776
196

TCG
T





TP53
17:7578475
645
152

CG
C





TP53
17:7579420
457
89

AG
A





DNAH2
17:7697598-7697597
7609
2532


C





CBX8
17:77768662
1060
314

TG
T





TEX19
17:80320302-80320301
585
92


G





RNF138
18:29709075-29709074
0
0


T





KLHL14
18:30350229-30350231
712
108
SS/S
GGAA
G





RTTN
18:67697249
5812
1915

CT
C





SMARCA4
19:11141498
3759
1159

TG
T





DAZAP1
19:1430254
953
255

GC
G





CLEC17A
19:14698433-14698435
167
43
ME/M
TGGA
T





NOTCH3
19:15302611
823
249

TC
T





TMEM59L
19:18727842-18727841
680
198


G





C19orf12
19:30193879
326
67

GC
G





TLE2
19:3028804
0
0

TG
T





CLIP3
19:36509879
1332
368

AG
A





ZNF585A
19:37644213-37644212
819
196


A





RYR1
19:38979989
5850
1907

GA
G





SUPT5H
19:39961164-39961163
1856
559


GT





C19orf69
19:41949132
70
20

AC
A





ZNF284
19:44590645
1172
338

CA
C





ZNF230
19:44635227
703
154

TA
T





ZNF541
19:48025197
3682
1228

AT
A





GRIN2D
19:48908418
981
298

GC
G





TEAD2
19:49850473
974
295

TG
T





SLC17A7
19:49933867
1764
531

CG
C





PPP1R12C
19:55607456
1132
372

TG
T





IL11
19:55877466
645
170

GC
G





MAP2K7
19:7968894-7968893
64
22








MAP2K7
19:7975006
325
109

CG
C





GCC2
2:109087914
2176
710

GT
G





LYPD1
2:133426062-133426061
170
57


T





RIF1
2:152319747
3874
1238

TC
T





NEB
2:152471104
0
0

TA
T





PXDN
2:1670168
1160
370

CG
C





NOSTRIN
2:169721406
2367
538

GA
G





GAD1
2:171702015
0
0

AG
A





RAD51AP2
2:17698737
970
316

GT
G





CERKL
2:182430854
0
0

TA
T





AOX1
2:201469483
975
245

TC
T





BMPR2
2:203420130
2281
581

GA
G





BMPR2
2:203420130
2281
581

GA
G





AAMP
2:219132279
427
112

AC
A





ZNF142
2:219507691-219507692
3969
1183

GCT
G





RNF25
2:219528925
1576
379

AG
A





NGEF
2:233785196
905
209

CG
C





HJURP
2:234746304
0
0

GA
G





AGAP1
2:236649677
1672
392

GC
G





HDAC4
2:240002823
3495
901

TG
T





EMILIN1
2:27305819
1879
460

TG
T





FAM82A1
2:38178783
541
142

AT
A





SLC8A1
2:40656343
1239
360

CT
C





OXER1
2:42991089
313
77

AC
A





STON1-
2:48808425
764
218

CA
C


GTF2A1L











PCYOX1
2:70502282
714
229

AC
A





DNAH6
2:84752697
371
78

TA
T





TXNDC9
2:99936266-99936270
0
0

TAAAAA
T





ESF1
20:13740507
0
0

GA
G





POFUT1
20:30804473
553
164

CT
C





ASXL1
20:31022442
2353
643

AG
A





ROMO1
20:34287672
298
40

CT
C





RBL1
20:35663914
0
0

TA
T





ZNF831
20:57766220
146
49

GC
G





SYCP2
20:58467047
2501
788

AT
A





NRIP1
21:16338330
2788
728

CT
C





CXADR
21:18933045
1345
199

TA
T





KRTAP25-1
21:31661780
53
10

GA
G





DOPEY2
21:37619932
0
0

AT
A





BRWD1
21:40558989
7254
2309

TA
T





ZNF295
21:43412316-43412315
2073
630


TO





TRPM2
21:45837907
3257
1082

GC
G





SMARCB1
22:24175857-24175859
1319
371
EK/E
GAGA
G





ZNRF3
22:29445999-29445998
1694
510


G





TIMP3
22:33255324
897
199

GC
G





LARGE
22:33733727-33733726
1764
398


G





TRIOBP
22:38130773
4685
1477

TG
T





ATF4
22:39917951
1172
134

GC
G





CERK
22:47086002
1541
476

TC
T





CERK
22:47103788
780
223

CG
C





PLXNB2
22:50714395
0
0

TG
T





MORC1
3:108813922
0
0

TA
T





KIAA2018
3:113375178
5762
1784

TG
T





POLQ
3:121248570-121248569
1429
477


A





NPHP3
3:132420382-132420381
0
0


A





TMEM108
3:133099024-133099023
678
156


C





HDAC11
3:13538268
468
95

TC
T





ATR
3:142274740
2442
774

AT
A





SLC9A9
3:143567076-143567075
298
30


A





C3orf16
3:149485161-149485160
1745
430


T





NR2C2
3:15084406
1956
580

CT
C





DHX36
3:154007619
0
0

TA
T





METTL6
3:15466599
0
0

TG
T





SMC4
3:160134209-160134210
0
0

GTT
G





SMC4
3:160143940
3008
853

CA
C





FAM131A
3:184062513-184062512
1034
285


C





TGFBR2
3:30691872
732
150

GA
G





TRAK1
3:42242450
1731
444

AC
A





PTH1R
3:46930537
0
0

TG
T





SETD2
3:47165283
886
281

CT
C





PLXNB1
3:48465485
639
179

AC
A





COL7A1
3:48612871
6189
2027

CG
C





APEH
3:49713809-49713808
0
0


A





HESX1
3:57232526
0
0

GA
G





ATXN7
3:63981832
2887
778

GC
G





UBA3
3:69111085
0
0

TA
T





EMCN
4:101337124
0
0

GA
G





GSTCD
4:106640295
725
169

GC
G





TBCK
4:106967842
0
0

GA
G





ANK2
4:114280135
10414
3454

AG
A





KIAA1109
4:123192271-123192270
7964
2531


C





SLC7A11
4:139153539
0
0

TA
T





UCP1
4:141484372-141484373
0
0

GAA
G





FGFBP1
4:15938178
373
26

CT
C





FGFBP1
4:15938178
373
26

CT
C





SNX25
4:186272695
2200
636

GA
G





FAT1
4:187549521
0
0

TA
T





LGI2
4:25005321
1576
464

GC
G





SH3BP2
4:2831451-2831450
901
301


C





RGS12
4:3432431
4767
1288

AC
A





KLF3
4:38690460
617
104

TA
T





ZBTB49
4:4304019-4304018
576
152


C





TEC
4:48169933-48169935
689
177
ED/D
ATCT
A





KIAA1211
4:57179443
826
145

TC
T





UGT2A2
4:70512968-70512967
451
132


T





APC
5:112116587-112116586
1011
211








APC
5:112164566
2020
547

GT
G





APC
5:112173784-112173783
2872
831








APC
5:112173987
3076
899

AC
A





APC
5:112174659-112174658
3747
1123








APC
5:112175162
4251
1291

TC
T





APC
5:112175212-112175216
4301
1307

TAAAAG
T





APC
5:112175530-112175529
4618
1413








APC
5:112175548-112175549
4637
1419

GCC
G





APC
5:112175746
4835
1485

CT
C





APC
5:112175752
4841
1487

CT
C





APC
5:112175752-112175755
4841
1487

CTTTA
C





ZNF608
5:123983544
2656
845

GC
G





FSTL4
5:132534947-132534946
2619
790


C





PCDHB1
5:140431111
151
19

AT
A





PCDHGC3
5:140857742
2173
687

GA
G





PCDH1
5:141244531-141244533
1511
455
K/-
ACTT
A





PDE6A
5:149301270
981
287

AT
A





C5orf52
5:157106903
438
126

GA
G





GABRA6
5:161115971-161115970
516
81


T





DOCK2
5:169081434
123
24

GC
G





LCP2
5:169677853
1567
454

GT
G





FAM193B
5:176958525
0
0

TG
T





CANX
5:179149920
1403
468

AT
A





TBC1D9B
5:179306627
0
0

AC
A





CDH10
5:24488219-24488218
2428
640


T





NIPBL
5:37064899
8819
2774

CA
C





KIAA0947
5:5464626
5401
1727

TG
T





DEPDC1B
5:59893744-59893743
0
0


A





COL4A3BP
5:74807153
558
88

TG
T





CHD1
5:98236745
779
210

CT
C





GRIK2
6:102503432
3029
847

CA
C





C6orf203
6:107361137
863
58

CT
C





KIAA1919
6:111587361
949
199

AT
A





LAMA4
6:112440366-112440365
5105
1605


T





PHACTR1
6:13206135
504
168

TG
T





IYD
6:150690252
225
29

GA
G





IGF2R
6:160485488
4090
1314

CG
C





ATXN1
6:16327163
2317
460

AG
A





THBS2
6:169641977
1021
257

TG
T





LRRC16A
6:25600800
3746
1126

TA
T





TEAD3
6:35446237
753
189

TG
T





DLK2
6:43418413
1267
339

AG
A





DSP
6:7581583-7581585
5501
1720
LE/L
TAGA
T





SENP6
6:76331349
0
0

AT
A





CYB5R4
6:84634231
874
245

CA
C





MANEA
6:96053922
1164
344

AT
A





SFRS18
6:99849343
1696
497

CT
C





DNAJC2
7:102964992
841
197

AT
A





RELN
7:103301977
0
0

TA
T





DOCK4
7:111368605
5724
1909

AG
A





IFRD1
7:112112339
1577
369

TA
T





WNT16
7:120971879
784
165

TG
T





TRIM24
7:138264224-138264223
2746
844


C





ETV1
7:13978876
0
0

GA
G





DENND2A
7:140218541
0
0

TA
T





PRKAG2
7:151372597-151372596
1098
198


G





BAGE3
7:151845524
13878
4553

TA
T





NEUROD6
7:31378635
571
83

CT
C





AEBP1
7:44146447
861
186

AC
A





AUTS2
7:70236570
2091
590

TC
T





CLIP2
7:73731913
364
13

TG
T





STYXL1
7:75651314
0
0

TA
T





PION
7:76950143
0
0

TA
T





MAGI2
7:77762294
3369
1039

AG
A





LMTK2
7:97784092
766
158

AC
A





CSMD3
8:113516210
0
0

GA
G





EIF2C2
8:141561430
1415
459

TG
T





MAPK15
8:144803436-144803437
1178
353

CGA
C





BIN3
8:22487477
435
113

CT
C





C8orf80
8:27888776
2035
631

AT
A





MYBL1
8:67488453-67488452
1259
420


T





NR4A3
9:102607096
1497
485

CT
C





INVS
9:103054983
2629
815

CG
C





ZNF618
9:116770795
814
239

GA
G





NR6A1
9:127287159-127287160
0
0

GAA
G





BRD3
9:136918529
257
24

CG
C





MTAP
9:21815490
143
48

GA
G





LINGO2
9:27949751
1373
307

GC
G





IL33
9:6254556
0
0

TA
T





ZCCHC6
9:88937823
3015
948

TA
T





HNRNPH2
X:100668112
1294
379

CT
C





CLDN2
X:106171948-106171952
816
164

TCTTTA
T





APLN
X:128782615
529
37

TG
T





BCORL1
X:129190011
5372
1753

TC
T





BCORL1
X:129190011
5372
1753

TC
T





BCORL1
X:129190011
5372
1753

TC
T





ARHGEF6
X:135790933
0
0

GA
G





ATP11C
X:138840030
0
0

GA
G





AFF2
X:148037457
2361
628

GA
G





PNMA3
X:152225667
591
85

AG
A





F8
X:154159223
3043
948

AG
A





PHKA2
X:18942259-18942258
0
0


A





DMD
X:32366648
0
0

TA
T





PRRG1
X:37312611-37312610
555
131


C





RP2
X:46713008
361
67

TG
T





WNK3
X:54328300-54328299
0
0


A





VSIG4
X:65242709
0
0

GA
G





EFNB1
X:68060323-68060322
1646
289


G





IL2RG
X:70327614
1174
361

TG
T





RGAG4
X:71350840
912
184

GC
G





ZDHHC15
X:74649036
0
0

TA
T





FAM9A
X:8759221
0
0

CA
C









The analysis of the base level transitions and transversions at mutated sites revealed that in CRCs C to T transitions to be predominant, regardless of the MMR status, both in the whole exome and whole genome analysis. This was consistent with previous mutation reports (Wood, L. D. et al., Science 318:1108-1113 (2007); Sjoblom, T. et al., Science 314:268-274 (2006); Bass, A. J. et al., Nat. Genet. 43:964-968 (2011)). The two hyper mutated tumors samples examined also showed higher proportion of C to A and T to G transversions, consistent with the much higher mutation rate observed for these samples.


Consistent with the exome mutation data, the MSS whole genome analyzed showed 17,651 mutations compared to the 97,968 mutations observed in the MSI whole genome. The average whole genome mutation rate was 6.2/Mb and 34.5/Mb for the MSS and MSI genome respectively. A mutation rate of 4.0-9.8/Mb was previously reported for MSS CRC genomes (Bass, A. J. et al., Nat. Genet. 43:964-968 (2011)).


Example 2
Analysis of Mutated Genes

The mutation analysis identified protein altering somatic single nucleotide variants in 12,956 genes including 3,257 in the MSS samples, 9,851 in the MSI samples and 6,891 in the two hyper mutated samples. Among the frequently mutated class of proteins are human kinases including RTKs, G-protein coupled receptors, and nuclear hormone receptors. In an effort to understand the impact of the mutations on gene function SIFT ENREF 10 (Ng, P. C. & Henikoff, S., Genome Res 12:436-446 (2002)), Polyphen ENREF 11 (Ramensky, V. et al., Nucleic Acids Res 30:3894-3900 (2002)) and mCluster (Yue, P. et al., Hum. Mutat. 31:264-271 (2010)) was applied and 36.7% of the mutations were found likely to have a functional consequence, in contrast to 12% for germline variants from the normal samples, based on at least two of the three methods (Table 2).


To further understand the relevance of the mutated genes, a previously described q-score metric was applied to rank significantly mutated cancer genes ENREF 13 (Kan, Z. et al., Nature 466:869-873 (2010)). In MSS samples, 18 significant cancer genes (q-score>=1; ≤10% false discovery rate) were identified (KRAS, TP53, APC, PIK3CA, SMAD4, FBXW7, CSMD1, NRXN1, DNAH5, MRVI1, TRPS1, DMD, KIF2B, ATM, FAM5C, EVC2, OR2W3, TMPRSS11A, and SCN10A). The significantly mutated MSS colon cancer genes included previously reported genes including KRAS, APC, TP53, SMAD4, FBXW7, and PIK3CA and several new genes including the cell cycle checkpoint gene ATM. Genes like KRAS and TP53 were among the top mutated MSI colon cancer genes, however, none of the genes achieved statistical significance due to the limited number of MSI samples analyzed.


In an effort to establish the relevance of the mutated genes, the mutated genes were compared against 399 candidate colon cancer genes identified in screens involving mouse models of cancer (Starr, T. K. et al., Science 323, 1747-1750 (2009); March, H. N. et al., Nat. Genet. 43, 1202-1209 (2011)). Of the 399 genes mutations were found in 327. When the data sets were analyzed via an alternative method, of the 432 genes, mutations were found in 356. The frequently mutated genes in the data set that overlapped with mouse colon cancer model hits included KRAS, APC, SMAD4, FBXW7 and EP400. Additionally, genes involved in chromatin remodeling like SIN3A, SMARCA5 and NCOR1 and histone modifying enzyme JARID2 found in the mouse CRC screen (Starr, T. K. et al., Science 323, 1747-1750 (2009); March, H. N. et al., Nat. Genet. 43, 1202-1209 (2011)) were also mutated in our exome screen. Further, TCF12, identified in the mouse colon cancer model screen, was mutated in 5 (Q179*, G444*, and R603W/Q) of our samples (7%) and contained a hotspot mutation at R603 (3 of 5 mutations; R603W/Q). This hotspot mutation within the TCF12 helix-loop-helix domain will likely abolish its ability to bind DNA, suggesting a loss-function mutation. Interestingly, all of the TCF12 mutations were identified in MSI samples. The TCF12 transcription factor has been previously implicated in colon cancer metastasis ENREF 14 (Lee, C. C. et al., J. of Biol. Chem. 287:2798-2809 (2011)). The presence of hotspots in this gene and its identification in mouse CRC model screen indicates that it likely functions as a CRC driver gene.


Mutational hotspots, where the same position in a gene was mutated across independent samples, are indicative of functionally relevant driver cancer gene. In this study, 270 genes were identified with hotspot mutation (Table 4). Seventy of these genes were not previously reported in COSMIC ENREF 7. Comparison of our mutations with those reported in COSMIC identified an additional 245 hotspot mutations in 166 genes (Table 5). Utilizing an alternative data analysis method, 274 genes were identified with hotspot mutations with forty of these genes not previously in COSMI and an additional 435 hotspot mutations in 361 genes. Genes with novel hotspot mutations include transcriptional regulators (TCF12, TCF7L2 and PHF2), Ras/Rho related regulators (SOS1 (e.g., R547W, T614M R854*, G1129V), SOS2 (e.g., R225*, R854C, and Q1296H), RASGRF2, ARHGAP10, ARHGEF33 and Rab40c (e.g., G251S)), chromatin modifying enzymes (TET2, TET3, EP400 and MLL), glutamate receptors (GRIN3A and GRM8), receptor tyrosine kinases (ERBB3, EPHB4, EFNB3, EPHA1, TYRO3, TIE1 and FLT4), other kinases (RIOK3, PRKCB , MUSK, MAP2K7 and MAP4K5), protein phosphatase (PTPRN2), GPRCs (GPR4 and GPR98) and E3-ligase (TOPORS). Of further interest in this gene set are TET2 and TET3, both of which encode methylcytosine dioxygenase involved in DNA methylation ENREF 15 (Mohr, F. et al., Exp. Hematol. 39:272-281 (2011)). While mutations in TET2 have been reported in myeloid cancers, thus far mutations in TET3 or TET1 have not been reported in solid tumors, especially, in CRC ENREF 15 (Mohr, F. et al., Exp. Hematol. 39:272-281 (2011)). All the three family members TET1 (e.g., R81H, E417A, K540T, K792T, S879L, S1012*, Q1322*, C1482Y, A1896V, and A2129V), TET2 (e.g., K108T, T1181, S289L, F373L, K1056N, Y1169*, A1497V, and V1857M), and TET3 (e.g., T165M, A874T, M977V, G1398R, and R1576Q/W) are mutated in these examples.









TABLE 4







Hotspot mutations










Gene
Pos. Prot.
Mutation
Locations













SEPT14
157
R157H
7:55910723, 7:55910723


ACMSD
162
A162V
2:135621200, 2:135621200


ACRV1
257
R257Q
11:125542516, 11:125542516


ADAMTS12
604
R604W
5:33637760, 5:33637760


ADAMTS14
297
D297N
10:72489068, 10:72489068


ALDH16A1
581
A581V
19:49969344, 19:49969344


ALK
551
R551Q
2:29519919, 2:29519920


ANGPTL4
136
R136Q
19:8430926, 19:8430926


ANKRD28
401
R401H
3:15753727, 3:15753728


ANKRD28
208
R208C
3:15776944, 3:15776944


APC
1450
R1450*
5:112175639, 5:112175639


APC
232
R232*
5:112128191, 5:112128191


APC
564
R564*
5:112164616, 5:112164616


APC
876
R876*
5:112173917, 5:112173917,





5:112173918, 5:112173917


APC
1378
Q1378*
5:112175423, 5:112175423


APC
653
R653M
5:112170862, 5:112170862


APOB
3036
S3036Y
2:21230633, 2:21230633


APOB
1513
R1513Q
2:21235202, 2:21235202


ARHGAP10
348
V348I
4:148827796, 4:148827796


ARHGEF33
48
Q48K
2:39156114, 2:39156114


ASB10
242
A242V
7:150878540, 7:150878540


ASPG
270
R270C
14:104569983, 14:104569983


ATF7IP
159
P159A
12:14577324, 12:14577324


BCL6
594
R594Q
3:187443345, 3:187443345


BDKRB2
128
T128M
14:96707048, 14:96707048


BEST3
388
R388Q
12:70049531, 12:70049532


BNC2
575
S575R
9:16436469, 9:16436469


BRAF
600
V600E
7:140453136, 7:140453136,





7:140453136, 7:140453136


BRIP1
745
A745T
17:59821817, 17:59821817


BTBD7
667
T667M
14:93714943, 14:93714943


C10orf90
84
A84T
10:128193519, 10:128193519


C12orf35
235
N235K
12:32134594, 12:32134592


C12orf4
335
R335Q
12:4627253, 12:4627253


C13orf1
58
A58T
13:50505205, 13:50505205


C20orf132
57
Q57E
20:35807795, 20:35807795


C2orf86
227
R227Q
2:63661024, 2:63661024


C5orf49
66
Y66H
5:7835563, 5:7835563


C6orf118
212
A212T
6:165715177, 6:165715176


C6orf174
368
G368C
6:127768362, 6:127768362


C7orf63
125
K125N
7:89894633, 7:89894633


C8A
484
R484C
1:57378145, 1:57378146


C9orf167
145
A145V
9:140173575, 9:140173575


CACNA1A
110
A110V
19:13565991, 19:13565991


CACNA1D
1278
A1278T
3:53787695, 3:53787695


CACNA1E
398
E398*
1:181684494, 1:181684494


CACNA1I
601
R601Q
22:40045722, 22:40045721


CBX6
199
R199C
22:39262858, 22:39262857


CCDC117
277
M277I
22:29182305, 22:29182305


CCDC157
469
R469Q
22:30769656, 22:30769655


CCDC6
139
E139*
10:61612349, 10:61612349


CCRL1
26
Q26*
3:132319317, 3:132319317


CDH8
291
L291H
16:61854981, 16:61854981


CLEC2L
145
E145A
7:139226768, 7:139226767


CLEC3A
156
R156C
16:78064610, 16:78064610


COL14A1
1048
F1048S
8:121282343, 8:121282343


CRISP2
88
R88C
6:49667526, 6:49667525


CSNK1G2
263
R263W
19:1979336, 19:1979336


CYP11A1
86
G86D
15:74659670, 15:74659670


CYP2E1
328
E328*
10:135350581, 10:135350581


DAB2IP
333
R333H
9:124522546, 9:124522545


DDX21
440
R440C
10:70730038, 10:70730039


DENND2A
572
S572Y
7:140266950, 7:140266950


DICER1
1813
E1813Q
14:95557630, 14:95557630


DLGAP2
912
R912Q
8:1645425, 8:1645424


DNAH11
1281
A1281V
7:21646341, 7:21646341


DNAJC10
180
R180Q
2:183593627, 2:183593626


DPYD
561
R561Q
1:97981340, 1:97981340


DSEL
56
K56R
18:65181709, 18:65181709


DSP
2586
R2586*
6:7585251, 6:7585252


DVL1L1
227
R227C
1:1275810, 1:1275809


EFNB3
106
R106H
17:7611470, 17:7611469


EGFR
671
R671C
7:55240767, 7:55240767


EMR1
887
A887T
19:6937648, 19:6937648


ENOX1
298
R298H
13:43918817, 13:43918818


EP400
1786
R1786C
12:132512700, 12:132512700


EP400
2523
A2523T
12:132537755, 12:132537755


EPHA1
844
R844W
7:143090930, 7:143090929


EPHB4
866
R866H
7:100403204, 7:100403204


EPHB4
535
R535W
7:100411629, 7:100411629


EPS8
571
R571Q
12:15793746, 12:15793747


ERC2
619
R619Q
3:56044541, 3:56044541


EXOC6B
785
R785Q
2:72406546, 2:72406547


F8
2166
R2166*
X:154091436, X:154091436


FAM110B
160
A160V
8:59059268, 8:59059267


FAM43B
273
D273E
1:20880285, 1:20880285


FAM90A1
71
P71L
12:8376723, 12:8376724


FAT4
132
A132T
4:126237960, 4:126237960


FBXL17
216
R216*
5:107216863, 5:107216863


FBXW7
465
R465C
4:153249385, 4:153249385,





4:153249384, 4:153249384


FBXW7
582
S582L
4:153245446, 4:153245446


FBXW7
505
R505C
4:153247289, 4:153247289


FBXW7
369
E369*
4:153251901, 4:153251901


FCAR
110
R110W
19:55396904, 19:55396904


FHOD3
1353
R1353C
18:34340727, 18:34340727


FKBP1C
19
R19C
6:63921516, 6:63921516


FLT4
1031
R1031*
5:180043905, 5:180043905


FRMD4A
851
R851C
10:13699038, 10:13699037


FRY
2194
T2194M
13:32813912, 13:32813912


FSTL5
404
R404C
4:162459420, 4:162459420


FSTL5
252
D252Y
4:162577620, 4:162577620


FUBP1
451
R451C
1:78428511, 1:78428511


GAL3ST2
326
G326S
2:242743360, 2:242743360


GALNTL2
395
E395K
3:16252734, 3:16252734


GBF1
1243
A1243V
10:104135186, 10:104135186


GCG
65
Y65*
2:163003931, 2:163003931


GCM2
265
R265I
6:10874955, 6:10874955


GDF3
84
R84C
12:7848075, 12:7848075


GNAS
844
R844C
20:57484420, 20:57484421,





20:57484420


GPR4
14
R14H
19:46095084, 19:46095085


GPR98
2200
S2200Y
5:89985786, 5:89985786


GRHL1
434
R434*
2:10130854, 2:10130855


GRIN3A
225
R225C
9:104499589, 9:104499589


GRLF1
1187
R1187Q
19:47425492, 19:47425492


GRM8
30
R30I
7:126883170, 7:126883170


GSR
233
R233C
8:30553995, 8:30553994


GYLTL1B
267
R267W
11:45947619, 11:45947619


HAO1
84
R84H
20:7915169, 20:7915169


HCFC2
191
E191*
12:104473320, 12:104473320


HERC2
4634
A4634V
15:28359770, 15:28359770


HGF
234
R234C
7:81374362, 7:81374361


HHIPL2
303
K303N
1:222716944, 1:222716944


HIST1H1T
167
G167W
6:26107823, 6:26107823


HIVEP2
1028
R1028*
6:143092794, 6:143092794,





6:143092794


HMCN1
1647
T1647M
1:185985120, 1:185985120


HRASLS5
118
K118T
11:63256365, 11:63256365


HSD17B3
184
S184Y
9:99007682, 9:99007682


HTR1A
50
A50T
5:63257399, 5:63257398


HYI
118
R118Q
1:43917949, 1:43917949


IGDCC3
132
R132C
15:65667450, 15:65667450


IGLL5
176
A176V
22:23237753, 22:23237753


IKZF4
255
R255Q
12:56426393, 12:56426392


ITGAD
669
V669I
16:31424528, 16:31424528


KBTBD3
356
R356Q
11:105924349, 11:105924350


KBTBD6
670
R670H
13:41704639, 13:41704640


KCNA3
105
R105H
1:111217118, 1:111217118


KCND2
247
R247H
7:119915426, 7:119915425


KIAA0895
282
A282T
7:36396534, 7:36396534


KIAA1024
73
V73A
15:79748707, 15:79748707


KIF21A
911
G911C
12:39726518, 12:39726518


KIF27
623
R623Q
9:86504110, 9:86504110


KIF7
841
R841W
15:90176988, 15:90176988


LAMB3
367
R367H
1:209803114, 1:209803115


LASS3
95
E95D
15:101031058, 15:101031058


LCT
694
A694S
2:136570154, 2:136570154


LDLRAD2
148
L148M
1:22141247, 1:22141247


LRP2
3726
R3726C
2:170028612, 2:170028611


LRP2
2095
R2095*
2:170066149, 2:170066149


KRAS
12
G12V
12:25398284, 12:25398284,





12:25398284, 12:25398284,





12:25398285, 12:25398284,





12:25398284, 12:25398285,





12:25398284, 12:25398284,





12:25398285, 12:25398284,





12:25398284, 12:25398284,





12:25398284, 12:25398284,





12:25398284, 12:25398284,





12:25398284, 12:25398284,





12:25398284, 12:25398284,





12:25398285, 12:25398284,





12:25398284, 12:25398284,





12:25398284, 12:25398284,





12:25398284


MAP7D2
546
E546*
X:20031734, X:20031734


MDN1
3240
R3240C
6:90405377, 6:90405377


MGST3
13
R13H
1:165619080, 1:165619080


MID1
178
H178Q
X:10535054, X:10535054


MLL
933
R933W
11:118344671, 11:118344672


MPP3
257
R257H
17:41898416, 17:41898416


MRPL18
108
R108H
6:160218402, 6:160218402


MRVI1
517
P517H
11:10628314, 11:10628314


MUSK
842
R842H
9:113563165, 9:113563165


MYH2
445
R445H
17:10442604, 17:10442605


NBEA
203
R203*
13:35619164, 13:35619164


NKAIN4
110
R110C
20:61879073, 20:61879073


NLRP12
656
R656C
19:54312947, 19:54312946


NLRP2
467
R467Q
19:55494466, 19:55494465


NMUR2
108
R108H
5:151784352, 5:151784352


NUDCD1
521
R521H
8:110255428, 8:110255428


NUP93
77
R77*
16:56792499, 16:56792499


OIT3
506
R506H
10:74692161, 10:74692161


OLFML2B
679
V679I
1:161953686, 1:161953686


OR10A7
261
R261Q
12:55615590, 12:55615589


OR2D2
122
R122H
11:6913367, 11:6913368


OR4N4
290
R290H
15:22383341, 15:22383341,





15:22383341


OR5D18
237
R237C
11:55587808, 11:55587808


OR6P1
201
L201R
1:158532793, 1:158532793


PCBP1
100
L100Q
2:70315174, 2:70315174


PCDHA13
301
E301*
5:140262754, 5:140262756


PCDHA4
266
A266T
5:140187568, 5:140187568


PCDHA7
681
R681W
5:140216009, 5:140216010


PCMTD1
200
R200Q
8:52744111, 8:52744111


PDE8B
436
R436H
5:76703224, 5:76703223


PDZRN3
971
R971H
3:73432805, 3:73432806


PER2
1049
A1049T
2:239160369, 2:239160369


PHF2
700
P700L
9:96428129, 9:96428129


PHLDB2
438
R438M
3:111604237, 3:111604236


PIK3CA
545
E545A
3:178936092, 3:178936091,





3:178936091, 3:178936092,





3:178936091, 3:178936091


PIK3CA
1025
T1025A
3:178952018, 3:178952018


PIK3CA
1047
H1047R
3:178952085, 3:178952085,





3:178952085, 3:178952085,





3:178952085


PIK3CA
111
K111E
3:178916944, 3:178916946,





3:178916944


PKD2L2
448
R448Q
5:137257339, 5:137257339


PLEKHA4
204
R204H
19:49362807, 19:49362808


PLEKHH3
155
G155S
17:40825688, 17:40825688


PNKD
222
R222Q
2:219206751, 2:219206751


POLE
286
P286R
12:133253184, 12:133253184


PRDM2
282
E282D
1:14105136, 1:14105136


PRKCB
161
R161C
16:24046820, 16:24046821


PRKCH
465
S465L
14:61952335, 14:61952335


PROM1
472
R472Q
4:16008200, 4:16008200


PSKH2
32
A32T
8:87081758, 8:87081758


PTGS2
600
R600H
1:186643501, 1:186643501


PTHLH
94
R94Q
12:28116524, 12:28116524


PTPRN2
545
R545H
7:157903599, 7:157903599


PXDN
1198
R1198W
2:1651960, 2:1651960


RAB40C
251
G251S
16:677527, 16:677527,





16:677527


RASGRF2
244
R244I
5:80369115, 5:80369115


RBM22
216
R216W
5:150075168, 5:150075168


RBMXL2
287
G287R
11:7111210, 11:7111210


RBP3
967
G967S
10:48387979, 10:48387979


RECQL5
872
R872H
17:73624488, 17:73624488


RETSAT
125
R125G
2:85578127, 2:85578126


RIOK3
306
I306S
18:21053494, 18:21053494


RNF43
132
R132*
17:56440943, 17:56440943


SAMSN1
235
R235C
21:15882693, 21:15882692


SCRN2
250
R250W
17:45916181, 17:45916181


SEMA3F
477
R477C
3:50222220, 3:50222220


SEMA7A
261
R261H
15:74708935, 15:74708935


SETD2
1322
R1322Q
3:47162161, 3:47162161


SFMBT2
617
R617W
10:7218087, 10:7218086


SLC13A3
169
R169Q
20:45239120, 20:45239121


SLC13A4
111
R111H
7:135392895, 7:135392896


SLC15A1
677
E677D
13:99337074, 13:99337074


SLC1A6
365
V365F
19:15067364, 19:15067364


SLC28A3
154
R154*
9:86917179, 9:86917179


SLC35B2
333
R333*
6:44222745, 6:44222745


SLC45A3
81
R81H
1:205632677, 1:205632678


SLC6A1
342
V342M
3:11067991, 3:11067991


SMAD4
361
R361H
18:48591919, 18:48591918,





18:48591918, 18:48591918,





18:48591919, 18:48591918


SMARCAL1
541
T541N
2:217300197, 2:217300196,





2:217300197


SMC4
1056
S1056L
3:160149483, 3:160149483


SNW1
198
R198L
14:78203359, 14:78203359


SOS2
824
R824C
14:50612229, 14:50612229


SPTA1
268
R268*
1:158648201, 1:158648201


SULT4A1
32
R32C
22:44258169, 22:44258169


SUV39H1
230
I230M
X:48558973, X:48558973


TCF12
603
R603W
15:57565289, 15:57565290,





15:57565290


TCF7L2
465
R465C
10:114925333, 10:114925334


TECR
66
R66H
19:14674503, 19:14674503


TEKT2
268
R268W
1:36552859, 1:36552860


TET3
1578
R1576Q
2:74328921, 2:74328920


TFIP11
386
R386Q
22:26895242, 22:26895242


TIE1
583
R583C
1:43778092, 1:43778093


TMC7
375
A375P
16:19049313, 16:19049313


TMEM175
335
R335C
4:951772, 4:951772


TMEM201
474
R474H
1:9669925, 1:9669924


TMEM71
83
D83N
8:133764098, 8:133764098


TNRC18
811
A811T
7:5417032, 7:5417032


TOPORS
188
R188Q
9:32543960, 9:32543961


TP53
176
C176Y
17:7578403, 17:7578403


TP53
175
R175H
17:7578406, 17:7578406,





17:7578406, 17:7578406


TP53
213
R213*
17:7578212, 17:7578212


TP53
248
R248L
17:7577538, 17:7577539,





17:7577538, 17:7577539


TP53
273
R273H
17:7577120, 17:7577121,





17:7577120, 17:7577120,





17:7577121


TP53
282
R282W
17:7577094, 17:7577094


TP53
196
R196*
17:7578263, 17:7578263


TP53
257
L257Q
17:7577511, 17:7577511


TP53
245
G245S
17:7577548, 17:7577547


TP53BP1
1405
R1405*
15:43713260, 15:43713260


TRBC2
68
A68T
7:142498925, 7:142498925


TRIM22
262
W262C
11:5729415, 11:5729414


TRIM23
525
E525*
5:64887748, 5:64887748


TRIM66
895
R895Q
11:8643322, 11:8643322


TSHZ2
222
A222V
20:51870662, 20:51870662


TSPAN17
266
A266T
5:176083806, 5:176083806


TYRO3
0

15:41870082


UBQLN3
624
R624W
11:5528919, 11:5528919


UNC13A
285
R285H
19:17769048, 19:17769049


UROC1
656
G656S
3:126207045, 3:126207044


USP6NL
492
A492T
10:11505504, 10:11505504


WDFY4
1091
R1091C
10:49986751, 10:49986751


WDR16
549
E549*
17:9545080, 17:9545080


WHSC1
104
E104K
4:1902691, 4:1902691


WIPF1
458
P458S
2:175431882, 2:175431881


WSCD2
583
Y583*
12:108642111, 12:108642111


XCR1
166
I166V
3:46062944, 3:46062944


ZBTB32
170
P170S
19:36206036, 19:36206036


ZBTB40
1174
A1174V
1:22850933, 1:22850933


ZHX3
249
N249K
20:39832810, 20:39832810


ZNF14
547
R547*
19:19822451, 19:19822451


ZNF142
834
R834*
2:219508739, 2:219508738


ZNF19
45
E45D
16:71512807, 16:71512807


ZNF211
486
R486I
19:58153272, 19:58153272


ZNF235
254
R254C
19:44792828, 19:44792827


ZNF236
154
A154D
18:74580744, 18:74580744,





18:74580744,


ZNF442
309
R309*
19:12461474, 19:12461473


ZNF470
445
R445I
19:57089131, 19:57089131


ZNF480
97
N97H
19:52819176, 19:52819176


ZNF507
56
E56*
19:32843902, 19:32843902


ZNF577
402
E402*
19:52376039, 19:52376039


ZNF662
172
R172H
3:42956002, 3:42956001


ZNF668
206
A206V
16:31075164, 16:31075164


ZNF789
219
H219Q
7:99084490, 7:99084490


ZNF831
1412
S1412I
20:57828999, 20:57828999


ZNRF3
102
R102*
22:29439389, 22:29439389


LSM14A
272
R272C
19:34710328, 19:34710328


MAP2
905
R905*
2:210559607, 2:210559607


MAP2K7
195
R195L
19:7975348, 19:7975348


MAP4K5
172
R172*
14:50941823, 14:50941823


LRRC8D
588
R588W
1:90400389, 1:90400390


KRAS
13
G13D
12:25398281, 12:25398281,





12:25398281, 12:25398281,





12:25398281
















TABLE 5







Hotspot mutations identified through metanalysis


using COSMIC mutation data












Gene
Prot.
Mut.
Locations
















SEPT9
346
T346M
17:75483629



ABP1
660
N660S
7:150557654



ACSL4
133
R133H
X:108926079



ADAMTS14
682
V682I
10:72503414



AGRN
0

1:985612



ALDH18A1
64
R64H
10:97402861



ALDH8A1
69
R69C
6:135265038



ALK
401
R401*
2:29606679



ALOX15
500
R500*
17:4536198



ANO2
704
R704*
12:5708776



ANO2
657
D657N
12:5722087



ANTXR1
192
A192V
2:69304553



APC
1705
T1705A
5:112176404



APC
1400
S1400L
5:112175490



APC
1355
S1355Y
5:112175355



APC
117
S117*
5:112103015



APC
499
R499*
5:112162891



APC
302
R302*
5:112151261



APC
283
R283*
5:112151204



APC
1386
R1386*
5:112175447



APC
1114
R1114*
5:112174631



APC
1367
Q1367*
5:112175390



APC
1338
Q1338*
5:112175303



APC
1009
H1009R
5:112174317



APC
1312
G1312*
5:112175225



APC
1408
E1408*
5:112175513



APC
1379
E1379*
5:112175426



APC
1306
E1306*
5:112175207



ARHGAP20
987
D987Y
11:110450711



ARID1A
1276
R1276Q
1:27099948



ASPM
1610
V1610D
1:197073552



ATM
352
I352N
11:108117844



ATP10A
793
R793W
15:25953415



ATP10A
1211
A1211T
15:25926004



ATP6V1E2
135
R135C
2:46739448



AZGP1
46
A46T
7:99569570



B3GAT1
11
V11I
11:134257523



BAP1
128
G128*
3:52441470



BCL11B
358
S358A
14:99642101



BTBD3
218
L218H
20:11900472



CARD11
353
T353A
7:2977627



CC2D1B
534
R534Q
1:52823367



CD40LG
11
R11Q
X:135730439



CDC73
54
Y54H
1:193094270



CDK5RAP1
169
R169Q
20:31979986



CDKN2A
80
R80*
9:21971120



CDKN2A
124
R124H
9:21970987



CDKN2A
107
R107H
9:21971038



CDKN2A
76
A76T
9:21971132



CDKN2B
60
R60H
9:22006224



COL11A1
1770
A1770V
1:103345240



COL3A1
420
G420S
2:189859023



CORO2B
113
R113Q
15:69003075



CREB3L1
235
A235V
11:46332691



CTNNB1
41
T41A
3:41266124



CTNNB1
45
S45P
3:41266136



CYTH1
386
A386T
17:76672214



DAPK3
454
R454C
19:3959104



DAXX
306
R306Q
6:33288635



DGKB
466
R466H
7:14647098



DLEC1
844
S844L
3:38139094



DMTF1
315
T315A
7:86813835



DNAH3
3772
Y3772C
16:20959833



DNAH5
4200
K4200R
5:13717530



DOCK1
1665
A1665T
10:129224219



DPF3
79
R79H
14:73220034



DSCAML1
1762
V1762I
11:117303143



ECE2
438
R438C
3:184001714



EPHB6
106
R106*
7:142561874



ERBB2
755
L755M
17:37880219



ERBB3
104
V104M
12:56478854



ERBB3
284
G284R
12:56481922



FAM184A
723
T723M
6:119301436



FAM71B
318
I318N
5:156590323



FBLN7
407
T407M
2:112944983



FBXL7
160
T160M
5:15928350



FBXW7
367
R367*
4:153251907



FBXW7
224
R224Q
4:153268137



FBXW7
470
H470R
4:153249369



FER1L6
810
G810D
8:125047660



FREM2
484
V484A
13:39262932



FTSJ2
53
R53W
7:2279194



FZD7
390
A390T
2:202900538



GJD4
340
A340T
10:35897459



GKN1
118
K118N
2:69206110



GPR113
771
A771V
2:26534284



GPR149
542
R542C
3:154056060



GRIK2
723
E723*
6:102483297



GRM3
271
V271I
7:86415919



GRM8
219
S219L
7:126746621



GTF3C1
733
G733W
16:27509111



HCFC2
239
G239V
12:104474557



HCK
389
V389F
20:30681738



HCN3
293
S293L
1:155254337



HEPHL1
687
F687L
11:93819336



HERC2
3384
L3384I
15:28414709



HSD17B7
245
P245L
1:162773312



IQUB
735
R735H
7:123092969



ITGA8
895
R895*
10:15600156



ITGB2
439
V439M
21:46311821



ITPR3
1849
R1849H
6:33653483



JAG1
959
A959V
20:10622148



JUNB
250
R250L
19:12903334



KIAA0100
804
N804T
17:26962194



KIAA1109
0

4:123201138



KIAA1377
68
R68*
11:101793445



KIF26B
2024
R2024H
1:245862232



KIT
52
D52G
4:55561765



KL
920
R920H
13:33638043



KRAS
19
L19F
12:25398262



KRAS
146
A146T
12:25378562



KRTAP21-1
15
G15S
21:32127654



LAMC1
327
P327S
1:183079747



LRFN5
445
R445H
14:42357162



MAEA
357
R357H
4:1332266



MAGI1
971
V971M
3:65365020



MAK
272
R272*
6:10802142



MARK4
418
R418H
19:45783969



MKNK2
149
F149L
19:2043171



MKRN3
76
P76Q
15:23811156



MSH2
580
E580*
2:47698180



MUC16
2683
E2683*
19:9083768



MYST4
1373
E1373G
10:76788700



MYT1
503
T503M
20:62843482



NBEA
2219
R2219H
13:36124684



NCAN
871
T871M
19:19339041



NEB
3538
R3538W
2:152471050



NEURL4
366
R366H
17:7229863



NF1
416
R416*
17:29528489



NF1
1858
A1858T
17:29654820



NF2
459
Q459H
22:30070861



NGEF
259
R259W
2:233785047



NHS
373
R373*
X:17742490



NLRP4
442
G442R
19:56370083



NOS3
474
R474C
7:150698505



NPSR1
85
F85L
7:34724271



NRAS
61
Q61L
1:115256529



NRAS
12
G12A
1:115258747



NTN3
440
D440N
16:2523319



NUP98
493
Y493H
11:3756486



OR5T1
322
F322L
11:56044078



OR6Y1
214
I214S
1:158517255



OXGR1
252
V252I
13:97639260



PALB2
1008
P1008T
16:23632774



PBRM1
0

3:52678719



PGR
740
R740Q
11:100922293



PIK3CA
1052
T1052K
3:178952100



PIK3CA
88
R88Q
3:178916876



PIK3CA
546
Q546K
3:178936094



PIK3CA
986
K986N
3:178951903



PIK3CA
594
K594E
3:178937392



PIK3CA
542
E542K
3:178936082



PIK3CA
420
C420R
3:178927980



PIK3R1
574
R574I
5:67591128



PIK3R1
543
R543I
5:67591035



PIK3R1
348
R348*
5:67588951



PIK3R1
162
R162*
5:67569823



PIK3R1
564
N564D
5:67591097



PIK3R1
527
N527K
5:67590988



PIK3R1
285
N285H
5:67576771



PKHD1
1081
R1081H
6:51897950



PNLIPRP1
129
S129F
10:118354297



PPP1R3A
948
T948M
7:113518304



PPP1R3A
554
G554V
7:113519486



PPP5C
242
D242E
19:46887063



PRPS1L1
58
S58G
7:18067234



PTCH1
563
A563T
9:98238357



PTEN
233
R233*
10:89717672



PTEN
130
R130Q
10:89692905



PTEN
125
K125T
10:89692890



PTEN
28
I28M
10:89653786



PTEN
93
H93Y
10:89692793



PTEN
3
A3D
10:89624234



PTPN11
76
E76G
12:112888211



PTPRC
582
F582Y
1:198697493



RAD50
1109
I1100T
5:131953923



RAP1GAP
609
V609M
1:21926031



RASGEF1C
293
G293S
5:179546376



RBM14
505
G505R
11:66392860



RNF175
221
S221R
4:154636784



RPN1
263
R263C
3:128350847



RPS6KA5
263
S263Y
14:91386568



SAMD7
67
R67W
3:169639114



SEC23IP
770
G770R
10:121685734



SETD4
90
R90Q
21:37420633



SF3B1
568
R568C
2:198268326



SIK1
68
L68V
21:44845358



SLC24A3
82
R82W
20:19261704



SLC27A3
462
G462S
1:153749660



SLC2A5
238
R238C
1:9100032



SLC45A3
272
R272C
1:205632105



SMAD4
509
W509*
18:48604705



SMAD4
356
P356S
18:48591903



SMAD4
386
G386V
18:48593406



SMAD4
493
D493A
18:48604656



SMAD4
351
D351G
18:48591889



SMARCA4
966
R966W
19:11134230



SMARCB1
383
R383W
22:24176329



SMO
324
A324T
7:128846040



SNTB1
401
R401Q
8:121561133



SOX6
93
R93*
11:16340160



SPCS2
4
A4S
11:74660340



SPEN
907
T907I
1:16255455



STK11
314
P314H
19:1223004



SYNE1
3671
V3671M
6:152674795



TAF1B
519
F519C
2:10059940



TAS1R2
707
R707H
1:19166493



TDRD9
564
R564H
14:104471720



TET2
1857
V1857M
4:106197173



TET2
108
K108T
4:106155359



TET2
373
F373L
4:106156155



TEX11
639
R639*
X:69828950



TFDP1
115
G115D
13:114287470



THSD7A
1526
S1526L
7:11419270



TLR9
901
R901C
3:52255631



TMEM132C
563
G563S
12:129180490



TMEM38A
53
A53T
19:16790827



TP53
234
Y234H
17:7577581



TP53
125
T125M
17:7579313



TP53
241
S241Y
17:7577559



TP53
337
R337L
17:7574017



TP53
158
R158H
17:7578457



TP53
152
P152L
17:7578475



TP53
151
P151H
17:7578478



TP53
254
I254S
17:7577520



TP53
232
I232T
17:7577586



TP53
193
H193Y
17:7578272



TP53
244
G244C
17:7577551



TP53
238
C238F
17:7577568



TP53
0

17:7577018



TP53
0

17:7577156



TP53
0

17:7577157



TP53
0

17:7578555



TPO
585
D585N
2:1491748



TREX2
7
P7H
X:152713281



TRIM37
895
A895V
17:57089700



UBR5
1978
R1978*
8:103292691



VHL
127
G127V
3:10188237



WT1
346
T346M
11:32421555



YIPF1
159
R159Q
1:54337050



YSK4
512
I5121
2:135744908



ZDBF2
888
E888K
2:207171914



ZFHX4
2394
A2394T
8:77766385



ZNF429
67
R67Q
19:21713460



ZNF564
157
R157Q
19:12638452










Example 3
Expression and Copy Number Alteration

The RNA-seq data was used to compute differentially expressed genes between tumor and normal samples (Table 6). The top differentially overexpressed genes include FOXQ1 and CLND1 which have both been implicated in tumorigenesis (Kaneda, H. et al., Cancer Res. 70:2053-2063 (2010)). Importantly, in analyzing the RNA-seq data, IGF2 upregulation was identified in 12% (8/68) of the colon tumors examined A majority (7/8) of the tumors with IGF2 overexpression also showed focal amplification of the IGF2 locus as measured by Illumina 2.5M array. Overall the differentially expressed genes affect multiple signaling pathways including Calcium Signaling, cAMP-mediated signaling, Glutamate Receptor Signaling, Amyotrophic Lateral Sclerosis Signaling, Nitrogen Metabolism, Axonal Guidance Signaling, Role of IL-17A in Psoriasis, Serotonin Receptor Signaling, Airway Pathology in Chronic Obstructive Pulmonary Disease, Protein Kinase A Signaling, Bladder Cancer Signaling, HIF1α Signaling, Cardiac β-adrenergic Signaling, Synaptic Long Term Potentiation, Atherosclerosis Signaling, Circadian Rhythm Signaling, CREB Signaling in Neurons, G-Protein Coupled Receptor Signaling, Leukocyte Extravasation Signaling, Complement System, Eicosanoid Signaling, Tyrosine Metabolism, Cysteine Metabolism, Synaptic Long Term Depression, Role of IL-17A in Arthritis, Cellular Effects of Sildenafil (Viagra), Neuropathic Pain Signaling In Dorsal Horn Neurons, D-arginine and D-ornithine Metabolism, Role of IL-17F in Allergic Inflammatory Airway Diseases, Thyroid Cancer Signaling, Hepatic Fibrosis/Hepatic Stellate Cell Activation, Dopamine Receptor Signaling, Role of NANOG in Mammalian Embryonic Stem Cell Pluripotency, Chondroitin Sulfate Biosynthesis, Endothelin-1 Signaling, Keratan Sulfate Biosynthesis, Phototransduction Pathway, Wnt/β-catenin Signaling, Chemokine Signaling, Alanine and Aspartate Metabolism, Glycosphingolipid Biosynthesis—Neolactoseries, Bile Acid Biosynthesis, Role of Macrophages, Fibroblasts and Endothelial Cells in Rheumatoid Arthritis, α-Adrenergic Signaling, Taurine and Hypotaurine Metabolism, LPS/IL-1 Mediated Inhibition of RXR Function, Colorectal Cancer Metastasis Signaling, CCR3 Signaling in Eosinophils, and O-Glycan Biosynthesis.









TABLE 6







Differentially Expressed Genes










Gene
Med. Ratio














GRIN2D
5.527911151



ESM1
5.8492323



SCARA5
−5.385767469



CLEC3B
−4.299952709



CDH3
5.215804799



FAM107A
−3.972772143



ETV4
5.202149185



LIFR
−3.797126397



CFD
−3.553187855



ABCA8
−5.344364012



ADH1B
−6.387892211



CLDN1
5.012197386



PCSK2
−6.510043576



CADM3
−5.656232948



GCNT2
−3.893699055



NFE2L3
3.030392992



PLP1
−6.925097821



GREM2
−4.936580737



KRT80
5.779751934



GNG7
−3.111266907



FIGF
−5.893082321



ABI3BP
−3.927046547



BMP3
−6.026497259



FAM135B
−5.249518149



TMEM100
−4.113484387



FOXQ1
5.961706421



PRIMA1
−6.536400714



RXRG
−5.17454591



NPY2R
−5.14798919



STMN2
−4.313406115



FGL2
−3.470259436



XKR4
−5.330615225



PMP2
−5.699849035



LGI1
−5.654013059



OGN
−5.532547559



STMN4
−5.165270827



CNTN2
−5.725939567



MAL
−4.946126006



CMA1
−4.728693462



TRIB3
3.512044792



C16orf89
−4.647446159



NKX2-3
−3.772558945



NRXN1
−6.423571094



SGCG
−4.315399416



ASPA
−4.85466365



PRPH
−5.709414092



SCGN
−5.617899565



FXYD1
−4.366726331



PDK4
−3.783018003



SCN9A
−4.210073456



LYVE1
−4.003213022



ADCY5
−4.897621234



SCN11A
−4.89796532



LGI4
−3.654270687



TNXB
−4.618096417



TUBB4
−5.392668311



AFF3
−4.544564729



PDX1
4.962327216



FHL1
−5.16962219



TMEFF2
−4.698800032



SLCO4A1
3.054897403



MGAT4C
−3.527256991



MMRN1
−4.358473391



KIAA1199
4.989222927



PLAC9
−3.544659302



PI16
−6.329320626



MAMDC2
−6.16899378



SFRP1
−5.719553754



ANK2
−4.698529299



SPHKAP
−3.648224781



SCN7A
−7.144549308



ENSG00000170091
−5.71036492



CDH19
−6.322889292



SCG2
−3.422093337



CXCL12
−3.487164375



CDH10
−3.421342024



RERGL
−5.731261829



MPZ
−3.920611558



SYT10
−4.190609336



RELN
−3.986177885



CMTM5
−4.756084449



CTNND2
−4.740498304



NOVA1
−5.061410431



CADM2
−5.485961881



ZNF536
−4.571820763



RBM24
−3.569579564



S100B
−3.827538343



ADHFE1
−3.662707626



GLP2R
−4.345544907



PHOX2B
−5.937887122



VAT1L
−3.228136479



PIRT
−6.031181735



SDPR
−4.38545828



GRIK3
−5.197048843



GSTM5
−3.615514934



SST
−5.824093007



PKHD1L1
−4.242036298



SLC7A14
−5.520042397



CHRDL1
−5.107430525



DPT
−5.051072538



NAP1L2
−4.961540922



SOX10
−5.724445462



CTSG
−4.258813557



KIAA1257
3.264630691



CNR1
−5.472912411



C2orf88
−3.489231209



VIP
−4.860630378



TMEM151B
−5.008283549



ANO5
−4.232602678



PTN
−3.44306466



ST8SIA3
−4.79377543



MUSTN1
−3.245149184



GFRA2
−3.811511174



ATP1A2
−7.307217248



PRKCB
−3.797860637



FAM123A
−3.035990832



ANGPTL7
−5.947492322



WNT2
4.717355945



ARPP21
−3.941970851



DNER
−4.314790344



VSTM2A
−5.109872721



GPM6B
−4.031255119



MYOM1
−4.650824187



ASTN1
−5.126882925



RASGRP2
−3.503626906



C6orf223
4.226814021



ANGPTL1
−5.424044031



ENPP6
−3.963010538



LRRN2
−3.5025362



BAALC
−3.426625507



C2orf40
−5.929905648



ATCAY
−5.088408777



ADAM33
−3.969644735



IGSF10
−4.187581248



INHBA
3.61816183



ADCYAP1R1
−5.525027043



GRIN2A
−4.44436921



CHL1
−3.413871889



NTN1
−3.354856128



MYLK
−4.40930035



FOXF2
−3.273857064



USP2
−3.134670717



CNGB1
−3.796951333



PTGS1
−3.928784334



JAM2
−3.225588456



SETBP1
−3.299570168



C2CD4A
4.171923278



MAB21L1
−4.648224781



HBB
−3.10879867



VSNL1
3.375999204



NGB
−5.687368193



MYOC
−6.743818793



KIF1A
−5.583478047



LEMD1
5.429399854



KRT24
−5.939566634



CHODL
−4.306804825



MYH11
−6.614033693



SCN2B
−5.019950619



BAI3
−5.029545504



SORCS1
−5.345853041



SYNPO2
−5.938491333



C9orf4
−3.946781299



C7
−4.817175938



HSPB6
−5.759563929



OLFM3
−5.152622362



SNAP91
−5.039150058



ASB2
−4.463866848



HPSE2
−3.786836392



C12orf53
−3.50784602



CHGA
−5.718288794



KIF5A
−4.179157002



CCDC69
−3.785092508



PPP1R12B
−3.964688977



GPER
−3.374629722



RIC3
−5.121450191



CAMK2A
−3.315318636



UNC5D
−3.456610995



NLGN1
−5.36205776



CBLN2
−4.410205906



CLU
−3.575663389



C1orf95
−5.541950034



ENTPD3
−3.440071356



ZBTB16
−5.143639363



MAPK4
−6.268370446



ENSG00000234602
3.542010519



PDE2A
−3.622736206



CPNE7
4.696574774



RALYL
−3.54986467



CHST9
−3.858149202



SLIT3
−3.701786983



SRPX
−3.676380924



ALK
−4.400128747



FMN2
−5.931523283



MED12L
−3.505446576



GNAO1
−5.424519258



GABRG2
−4.48694237



PLEKHN1
3.36299512



PGM5
−5.403079028



IGSF11
−5.005562617



RYR3
−4.359671118



FAM189A2
−3.291843764



SCN3A
−3.249263581



ZIM2
−3.923857044



MUSK
−4.806618761



PDZD4
−4.652064044



LCN6
−3.528251776



IL8
3.733680463



OTX1
5.606699636



NTRK3
−4.190549367



SPOCK3
−5.313979085



FAM129A
−4.00370568



NEFM
−4.972634341



TMEM59L
−4.351475682



TCEAL5
−4.044195288



SNCG
−3.194688135



SLC27A6
−3.944375846



GAD1
4.607492087



CAMK2B
−3.748134652



ARHGAP20
−3.301303729



GUCA2B
−7.224954766



MYOT
−4.653308928



VIT
−3.54751268



LONRF2
−6.377805944



LMOD1
−5.04599233



CALY
−5.271272834



GAP43
−4.71341546



MYT1L
−3.629480911



ELAVL4
−4.406765367



JPH4
−3.596788653



RGMA
−3.985267039



KCNMA1
−4.992859998



KIAA2022
−5.25714319



ULBP2
3.251373



PDZRN4
−5.95489



KLK6
6.329258



TNS1
−4.19155



TLX2
−3.09629



PGR
−4.27086



FXYD6
−3.75281



ENSG00000186198
−3.577



CA10
−3.80922



P2RX2
−3.60054



SNTG2
−3.04582



ADD2
−3.37298



C7orf58
−3.71657



NTNG1
−4.33834



MT1M
−3.55477



PPP1R1A
−6.04336



SPEG
−4.57945



RBFOX3
−6.45602



MYL9
−4.27584



GRIK1
−3.25517



LRP1B
−3.73288



SLC4A11
3.038906



FRMPD4
−5.18841



SALL4
3.82405



SORBS1
−3.59918



LRFN5
−3.93986



GDNF
−3.38792



LRRC55
−3.23821



PALM
−3.04045



POU5F1B
3.400104



MSRB3
−3.5926



NACAD
−3.3653



SLC30A10
−5.73614



PRICKLE2
−3.00229



CORO2B
−3.16284



JPH2
−4.49583



RNF150
−4.85505



SCARA3
−3.1352



SALL2
−3.43114



SLC17A8
−4.17524



MAOB
−3.46607



ADAMTS8
−4.17885



OTOP3
−4.14905



PACSIN1
−3.12832



UCHL1
−3.37593



TNNI3
3.475204



MFAP5
−3.73929



ITGA7
−3.5897



DNAJB5
−3.77773



C14orf180
−3.28894



CA1
−6.9112



ATP2B4
−3.48549



MRVI1
−3.02877



SIGLEC6
−3.16606



CCBE1
−5.06789



BVES
−4.20565



TMIGD1
−6.41231



KCNQ5
−4.00333



L1CAM
−4.14288



PTH1R
−3.19452



MYEOV
3.166568



SLC2A4
−4.46266



ZCCHC12
−3.49788



VIPR2
−3.68461



PSD
−5.87501



CHRNA3
−3.10067



NRXN2
−3.13659



C8orf46
−4.37921



GPR17
−3.52967



CACNA1H
−3.64108



DKK4
3.476871



PDLIM3
−3.71073



SCN3B
−3.3718



GYLTL1B
4.082537



AGTR1
−4.79524



ULBP1
3.320975



AQP8
−7.23747



ARL4D
−3.38549



FAM46B
−4.53516



RND2
−3.61077



ARHGEF25
−3.24015



PRKAA2
−4.51677



TACR1
−3.80639



NBEA
−3.79003



FABP4
−5.42586



ODZ1
−3.89586



C5orf4
−3.0289



PPP1R14A
−4.03457



HTR1D
3.884431



MMP13
3.671083



RPH3A
−3.35741



SGCA
−4.55537



MAPK15
3.320975



FEV
−4.02478



GDF15
3.02245



RIMS4
−4.24287



SULT1A2
−3.79483



C6orf186
−4.60198



TTYH1
−3.33098



HSPB7
−4.74217



SLITRK3
−6.10753



CD1C
−3.12922



GPR133
−3.04867



EDN3
−3.70756



KCNA1
−4.65058



RERG
−3.17221



CA14
−3.58713



SORCS3
−4.02347



ZG16
−5.39174



CNTNAP3B
−3.6873



DOCK3
−3.39657



DACT3
−3.71844



SIM2
3.536988



CHRM2
−7.34891



PTPRT
−3.37251



ADH1C
−3.51198



FAM189A1
−3.40677



ASCL2
3.879815



SERTM1
−3.06772



POPDC2
−4.95848



WBSCR17
−3.51278



SULT4A1
−5.00147



HLF
−3.91785



DDN
3.337204



MAP1B
−3.10167



CLDN11
−3.45731



PLCXD3
−4.84211



MAP6
−3.67268



MADCAM1
−3.50743



CTNNA2
−4.70269



RET
−3.70964



AZGP1
3.513263



VWC2
−3.11767



GCG
−5.94559



STK31
3.869912



OSR1
−3.8245



TAGLN
−3.54734



RAB9B
−3.67691



FBXL22
−3.44664



NPAS3
−3.21742



FGF10
−3.65639



ADCY2
−3.40603



GRHL3
3.473116



DDR2
−3.12621



EPHA6
−5.87065



WNT7B
3.107819



TNS4
3.872147



ENSG00000172901
−3.34783



CACNA2D1
−3.1969



AQP4
−3.03599



TWIST2
−3.06429



SCRG1
−5.53503



FNDC9
−3.67385



C11orf86
−4.68391



SULT2B1
3.1843



PNCK
−5.38004



ZDHHC15
−3.06835



CLDN2
5.310113



FILIP1
−3.78534



ABCC8
−3.0022



CAP2
−3.2824



LIX1
−4.29903



PRRT4
−3.06141



B3GALT1
−3.69549



CPNE4
−3.60054



STAC2
−3.70576



PPP1R3C
−3.27984



NECAB2
−3.2714



ASB5
−6.21444



PTPRN
−3.45244



NNAT
−4.58578



MGP
−3.10442



WDR72
4.380471



CLMP
−3.01603



KRT6A
3.797132



MPP2
−3.37321



PCK1
−3.24127



KCNK2
−3.80447



IL11
3.803898



LGR5
3.195895



CRABP1
−4.05718



UNC80
−3.71831



CASQ1
−4.56195



UST
−3.03978



NOS1
−6.01896



JPH3
−3.656



CPB1
−3.22272



ATRNL1
−4.89143



LRRC4C
−3.78069



KCNK3
−4.66311



KY
−4.27669



SNAP25
−4.69627



AKAP12
−3.03021



ADRB3
−3.86996



NPTXR
−3.0905



C10orf140
−3.44724



EXTL1
−3.23226



TCN1
5.883899



SOHLH2
−3.7527



SLC26A2
−3.4259



ANO3
−3.40677



SERPINB5
3.010596



TACSTD2
3.803266



COL21A1
−3.21866



CLCA4
−5.73343



WNT9A
−3.10701



SCG3
−4.84991



DSCAML1
−4.05228



WDR17
−4.00891



ADIPOQ
−6.95511



TESC
3.379012



HAND1
−7.23383



ART4
−3.18603



GLDN
−3.09313



KCNIP3
−3.54139



SLIT2
−3.26504



RNF183
3.39193



LRCH2
−3.28776



SH3GL2
−3.57011



KCTD8
−3.83424



CHRNB4
−3.62563



CERS1
−3.17135



CHD5
−3.20136



DTNA
−3.82362



CCDC80
−3.0985



ENSG00000166869
−3.90266



CPXM2
−4.17959



DAND5
−3.98467



DGKB
−4.15446



HIF3A
−3.6805



HPCAL4
−3.24851



CCDC169
−3.48135



TMEM35
−5.87287



NEGR1
−4.18072



LDB3
−6.44118



ELANE
−3.01674



ABCA6
−3.1197



ZNF471
−3.10221



GFRA1
−4.85831



DCLK1
−4.28576



PAPPA2
−4.80217



SFTA2
3.697678



MYOCD
−5.20677



HMGCLL1
−3.57011



SYT9
−3.72752



MMP11
3.476176



PKNOX2
−3.41966



ATP2B2
−3.50563



PLIN4
−6.50771



RGS9
−3.41372



GALNTL1
−3.71028



VWA2
4.684454



EPHA7
−5.68169



KHDRBS2
−3.32022



SLC9A9
−3.02137



CEND1
−3.89797



ADH1A
−3.53935



FAM70A
−3.22263



ATP2B3
−4.40254



SLC5A7
−5.54508



BCHE
−5.9095



NRG2
−4.68132



EPHA5
−4.17595



SEMA6D
−3.01017



HAND2
−5.22194



CNN1
−5.8107



GPC5
−3.57394



TUB
−3.23422



PRKG2
−3.49777



ACTG2
−6.10699



SLC25A34
−3.9354



ZNF229
−3.21126



SLC35F1
−3.74017



RASGEF1C
−4.3263



ZNF727
−3.30848



ABCB5
−3.98259



LRRK2
−3.12594



FAM176A
3.177313



RBM20
−4.1105



MEIS1
−3.19375



DES
−6.69236



C1QTNF9
−3.92526



SLC17A7
−3.3932



EFHC2
−3.27123



TMEM130
−4.36447



DIRAS1
−3.16403



ZMAT4
−3.40709



PTPRZ1
−5.77615



CPEB1
−4.46103



PHOX2A
−4.23422



NLGN4X
−3.04296



ATP6V1G2
−3.55979



BEST4
−5.95684



THRB
−3.20412



WISP2
−5.3983



GRIK5
−4.77377



DARC
−3.24148



C6orf174
−3.92882



GUCA2A
−5.3278



SLC6A15
−4.37144



AOC3
−3.97636



NGFR
−3.93572



LGI3
−4.24132



NFASC
−3.11179



GRIA1
−3.57011



SYP
−3.15922



EPHX4
3.512462



DUSP26
−4.13989



CTHRC1
3.080178



PCDH9
−4.11247



CA7
−6.19335



EGFL6
3.166084



FBXO32
−3.02151



PYY
−6.36724



KIAA1644
−5.0075



NRSN1
−4.23319



SEMA3E
−5.7604



C1orf173
−3.89609



CCL23
−4.10995



ATP1B2
−3.35903



DIRAS2
−4.285



CXCL3
3.414119



PCP4L1
−5.84118



C2orf70
3.623413



NPTX1
−6.3263



PCOLCE2
−3.83253



HEPACAM
−4.285



CNTNAP3
−4.46258



CAV1
−3.2595



KIAA1045
−4.0874



LRRTM1
−4.44609



SEZ6L
−4.32666



CRYAB
−3.85914



ADAMTSL3
−4.67756



ELAVL3
−4.63805



CCL21
−3.44647



SYT5
−4.12123



GFRA3
−5.01204



FIGN
−3.00533



PCDH10
−4.341



MMP7
6.216617



SPARCL1
−3.36702



OTOP2
−8.12168



CNTD2
4.300648



SFRP5
−5.11522



ABCA9
−3.81151



BEND5
−3.66782



FAM163A
−3.67521



TMEM132B
−3.32426



COL11A1
4.703239



IGFBP6
−3.05252



PYGM
−5.86766



LYNX1
−3.79672



ST8SIA1
−3.0922



TLL1
−3.01592



EML1
−3.36098



SLC4A4
−4.54921



MAP2
−3.16049



CCNO
3.479898



COL19A1
−3.66553



HTR3A
−4.72177



CNTN1
−4.35232



ADRA1A
−3.46392



DMD
−3.60911



TMEM179
−3.23581



TACR2
−5.57163



DPYSL5
−4.68945



CSRP1
−3.16604



SCNN1B
−4.78493



CNTFR
−5.48107



GPM6A
−7.05382



CASQ2
−6.97291



CHGB
−4.37302



EEF1A2
−4.32423



RBPMS2
−5.2819



MMP1
4.611965



TAGLN3
−5.51147



ASXL3
−3.25378



CNKSR2
−3.76265



FGFBP2
−3.4953



GHR
−3.12319



CELF4
−4.19572



CUX2
−3.78755



DLG2
−3.41983



GRIA2
−3.13335



SPIB
−4.95933



AR
−3.46973



LMX1A
−3.07579



NAP1L3
−3.15647



HEPN1
−3.48966



SLITRK2
−3.62411



FAM181B
−4.05256



KRT222
−3.88727



RASD2
−3.08403



ENSG00000156475
−3.70456



ABCG2
−4.10507



AKAP6
−3.99525



KCNMB1
−5.21732



FOXD3
−4.61265



MRGPRF
−3.788



ANKRD35
−3.15042



HSPB8
−5.19288



IBSP
3.429821



CFL2
−3.60155



CNGA3
−4.70795



KCNB1
−5.91463



PRELP
−4.32292



KIRREL3
−3.7696



CST1
6.01139



CNTN3
−3.89004



LIMS2
−3.73614



BEX1
−5.05729



FOXP2
−4.26963



BHMT2
−4.36555



TCEAL2
−5.6985



FLNC
−5.09657



SYNGR1
−3.54338



CXCL1
3.08057



SEMA3D
−3.33337



CAND2
−3.47155



GRIA4
−3.67598



KIAA0408
−4.1775



KLK8
4.906754



REEP2
−3.92231



CILP
−4.88337



COL10A1
6.229643



PTCHD1
−5.72018



FGF13
−3.1075



TCEAL6
−3.90028



PRSS22
3.796724



CD300LG
−4.20088



ZDHHC22
−4.05715



GPRASP1
−3.07048



SV2B
−3.47286



NDE1
−4.07805



CTNNA3
−4.63484



DMRTA1
−3.4379



HTR4
−4.20483



CA4
−5.90306



NPAS4
−3.90303



NECAB1
−4.4301



MAPT
−4.07028



TNNT3
−3.6104



INA
−4.86742



LMO3
−6.04405



CLIP4
−3.26924



MASP1
−5.93003



SEZ6
−3.81918



SYT4
−5.08841



CLVS2
−3.44001



TCEAL7
−3.00191



PLN
−4.77387



KCTD4
−3.30001



SLC10A4
−3.7343



C1QTNF7
−4.12134



RSPO2
−5.33522



P2RY12
−3.56585



CHST8
−3.13524



STOX2
−3.05401



MAB21L2
−5.0333



SLC18A3
−3.99774



IL17B
−3.26935



SHISA3
−3.12044



RAB3C
−3.7531



UBE2QL1
−3.20056



GPT
−3.45351



CORO6
−3.60142



PKIB
−3.53135



TRIM9
−3.56341



MORN5
−6.87885



TRPM6
−4.2107



AP3B2
−3.96509



DYNC1I1
−3.84378



TLX1
3.90657



SMYD1
−6.92391



TPO
−3.03245



FEZF1
4.145292



STXBP5L
−4.38119



C15orf59
−3.11512



CSPG4
−3.24734



HOXB8
3.758374



DNASE1L3
−3.78422



STK32A
−3.58912



NIPAL4
−3.75232



SYPL2
−3.51243



BTNL8
−3.56206



GDF1
−3.06235



KRT16
3.228284



LRRTM4
−3.28156



CA9
4.115683



BEND4
−3.23908



PENK
−5.56339



TRPV3
−3.25367



ST6GAL2
−3.08256



C9orf71
−4.08237



FLNA
−3.69003



SLC26A3
−5.74678



TPM2
−3.48339



C8orf85
−3.63174



MMP3
4.001157



MS4A12
−5.72245



NPY
−4.33465



MPPED2
−3.44536



ALPI
−4.27169



KCNC1
−3.18694



TMEM72
−4.72328



FAM163B
−3.57859



DPP10
−4.59947



CLEC5A
3.260118



CPNE6
−3.37143



ITGB1BP2
−3.00778



SLITRK5
−3.90369



PLA2G5
−3.71785



UCN3
−3.72869



CALD1
−3.05258



STON1-GTF2A1L
−3.0375



PDE6A
−3.60006



KRT6B
4.798528



GPIHBP1
−3.50724



KLK10
3.487382



C4orf39
−3.02818



STAC
−3.35799



CRLF1
−3.20379



SLC4A10
−3.13074



AKR1B10
−3.46237



CST2
3.483231



NKX3-2
−3.21332



REEP1
−3.46272



HRASLS5
−4.03008



TUSC5
−4.62354



KRT23
4.884049



TUBB2B
−3.24294



CPLX2
−3.94707



DSCR6
3.028702



FCER2
−4.78069



MYADML2
3.209455



KCNA2
−3.13365



SV2C
−3.78632



DCHS2
−4.2511



PCYT1B
−3.17282



ZNF385B
−3.25358



PTGIS
−3.7594



C6orf168
−3.30589



SNCA
−3.01935



LRAT
−3.89481



TMEM74
−3.406



SCN4A
−3.72869



CA2
−5.11198



SLC8A2
−4.48591



KCNA5
−3.45695



TPH1
−3.20483



WSCD2
−4.87618



KCNMB2
−3.10173



ENSG00000241186
3.118557



CIDEA
−3.26865



GABRB3
−4.50283



KCNIP1
−3.16613



C6orf105
−3.61541



NOTUM
4.401768



KLHL34
−3.1504



C1orf70
−3.00556



CLDN8
−4.97278



DPEP1
6.134526



SCNN1G
−4.65465



STRA6
3.757395



OMD
−3.85155



CARTPT
−5.03476



CCL24
3.328538



SLCO1B3
4.350979



PLIN1
−4.0474



TMEM82
−3.60685



CALB2
−3.70005



CES1
−3.1966



DAO
−4.48241



INSL5
−5.05983



AK5
−3.0314



KRTAP13-2
−4.63517



NXPH3
−3.40456



GTF2A1L
−3.15117



CWH43
−4.40603



CDO1
−3.38273



DSG3
3.778247



TMEM211
3.460662



PRUNE2
−3.08848



PKP1
3.65574



NPPC
−3.53724



RAET1L
3.027935



DHRS9
−3.13217



CCDC136
−3.33404



CDON
−3.00288



PRDM6
−3.28755



PCSK1N
−4.0894



CCL19
−3.40271



DLX1
−3.38643



NKAIN2
−3.32274



KLK7
3.937762



GPR15
−3.81204



FAM19A4
−3.27095



TMEM236
−3.94135



RGS13
−3.26189



ADAMTS19
−3.28724



AFF2
−3.37251



HS6ST2
3.561665



MMP10
3.376316



ADRA1D
−3.54704



COMP
3.932262



SMPX
−5.10753



CYP4B1
−3.06758



LGALS9C
−3.00879



FAM150A
3.651605



TG
3.001709



ANPEP
−3.23022



TNFRSF13B
−3.86004



HSPB3
−3.48254



CD22
−3.53242



HSD17B2
−3.25123



CLEC17A
−3.32539



FAM5C
−3.97373



RPRM
−4.18572



PCP4
−4.67099



PIWIL1
3.12939



BLK
−3.69271



SLC17A4
−3.31472



PEG10
−3.43391



ZIC2
3.206285



UGT2A3
−3.67931



TF
−4.10524



THBS4
−4.81204



ENSG00000181495
−3.35886



FCRLA
−3.79316



TLR10
−3.13859



CXCL5
4.082364



PRSS33
3.145979



PHYHIP
−3.00667



ASPG
−3.38654



C6
−3.27127



MYPN
−3.1019



B4GALNT2
−3.65998



B3GALT5
−3.27156



MT1H
−3.33951



SLC6A19
−5.20458



WFIKKN2
−3.02818



HRASLS2
−3.11679



FCRL1
−3.96835



PNPLA3
3.007076



TEX11
−3.50005



CNR2
−3.60619



UNC93A
3.098461



MS4A1
−4.05133



FAM129C
−3.4555



PTGDR
−3.38298



SOX2
−3.87896



TCL1A
−4.87298



NEUROD1
−3.91126



FCRL4
−3.59163



ABCB11
−3.61699



OR51E2
−3.21721



MSLN
3.156575



NTSR1
−4.19058



SFRP2
−3.06381



CR2
−4.33926



CNTNAP5
−3.28156



HS3ST5
−3.32274



GDF5
−3.6779



IGJ
−3.37943



SLC6A17
−3.03858



CEACAM7
−3.71794



NPR3
−3.0056



HSD3B2
−3.65443



SLC6A20
3.640564



PITX2
3.733959



VPREB3
−3.55929



CLCA1
−4.54287



SI
−3.14912



PLA2G2D
−3.10473



FSTL5
−3.95247



FCRL3
−3.28603



C4orf7
−4.10287



SERPINA9
−3.05435



LEP
−3.10313



PAX5
−3.45097



CNNM1
−3.01846



MEP1B
−3.1861



OTC
−3.16879



ITLN1
−3.06475



GALNT13
−3.23173



FCGBP
−3.06625



REG1A
3.21229



GP2
−3.17456



APOB
−4.0069



FABP6
4.971592



REG3A
4.052759



GDF10
−3.18603



TTR
−3.00706



MTTP
−3.07406










Copy number alterations in 74 tumor/normal pairs were assessed by applying GISTIC to the PICNIC segmented copy number data. In addition to the IGF2 amplifications, known amplifications were found involving KRAS (13%; 10/74) and MYC (31%; 23/74) located in a broad amplicon on chromosome 8q (Table 7). Focal deletion involving FHIT, a tumor suppressor was observed in 21% (16/74) of the samples (Table 8). FHIT, which encodes a diadenosine 5′,5′″-P1,P3-triphosphate hydrolase involved in purine metabolism, has previously been reported to be lost in other cancers ENREF 18 (Pichiorri, F. et al., Future Oncol. 4:815-824 (2008)). Deletion of APC (18%; 14/74) and SMAD4 (29%; 22/74) was also observed. Finally, chromosome 20q was found to be frequently gained and in contrast, 18q to be lost.


When copy number alterations were analyzed using PICNIC probe-level copy number calling, CBS segmentation of the copy number tumor/normal ratios and GISTIC on these tumor/normal ratios, the top set of genes with copy number alterations were similar though the percentages varied slightly. Known amplifications involving KRAS (13%; 10/74) and MYC (23%; 17/74) located in a broad amplicon on chromosome 8q. Deletion involving FHIT, a tumor suppressor was observed in 30% (22/74) of the samples. Deletion of APC (8%; 6/74), PTEN (4%, 3/74) and SMAD3 (9%, 10/74). SMAD4 and SMAD2 are both altered in 27% (20/74) of the samples and are located within 3 Mb from each other on 18q which is frequently lost.









TABLE 7







Genes with significant copy number gain










GeneName
Freq.














LYZL1
0.040541



TH
0.108108



IGF2
0.108108



INS-IGF2
0.108108



INS
0.108108



ERC1
0.121622



RAD52
0.121622



CASC1
0.135135



LRMP
0.121622



C12orf77
0.108108



IFLTD1
0.162162



C12orf5
0.094595



SLCO1A2
0.121622



IAPP
0.121622



PYROXD1
0.121622



RECQL
0.121622



GOLT1B
0.108108



C12orf39
0.108108



GYS2
0.108108



LDHB
0.108108



NECAP1
0.135135



SLC2A14
0.135135



NANOGP1
0.135135



SLC2A3
0.135135



LYRM5
0.135135



KRAS
0.135135



POTEM
0.067568



OR4N2
0.067568



OR4Q3
0.067568



OR4M1
0.067568



OR4K2
0.067568



OR4K5
0.067568



OR4K1
0.067568



C14orf17
0.067568



OR11K2P
0.067568



OR4H12P
0.067568



OR4K6P
0.067568



MIR193B
0.108108



MIR365-1
0.108108



SHISA9
0.081081



ERCC4
0.108108



MKL2
0.094595



MIR144
0.081081



MIR451
0.081081



C17orf63
0.081081



ERAL1
0.081081



NUFIP2
0.081081



TAOK1
0.081081



ABHD15
0.081081



TP53I13
0.081081



GIT1
0.081081



ANKRD13B
0.081081



CORO6
0.081081



SSH2
0.081081



TRAF4
0.081081



ZNF761
0.135135



TPM3P6
0.135135



ZNF813
0.148649



ZNF331
0.135135



GHRH
0.337838



CTNNBL1
0.351351



KIAA1755
0.337838



BPI
0.337838



LBP
0.337838



PTPRT
0.297297



TOX2
0.378378



JPH2
0.364865



MATN4
0.351351



RBPJL
0.351351



SDC4
0.351351



SYS1
0.351351



TP53TG5
0.351351



DBNDD2
0.351351



PIGT
0.351351



WFDC2
0.351351



C20orf123
0.351351



SLC13A3
0.351351



ZFP64
0.405405



TSHZ2
0.364865



BCAS1
0.364865



MIR499
0.378378



MIR644
0.391892



EDEM2
0.378378



PROCR
0.378378



MMP24
0.378378



EIF6
0.378378



FAM83C
0.378378



DYNLRB1
0.391892



MAP1LC3A
0.391892



PIGU
0.391892



TP53INP2
0.378378



NCOA6
0.378378



GGT7
0.378378



ACSS2
0.378378



GSS
0.378378



MYH7B
0.378378



TRPC4AP
0.378378



EBAG9
0.22973



KCNS2
0.243243



ZNF572
0.310811



CPSF1
0.22973



PSCA
0.256757



LY6K
0.256757



C8orf55
0.256757



SLURP1
0.256757



LYPD2
0.256757



LYNX1
0.27027



LY6D
0.27027



GML
0.27027



CYP11B1
0.256757



TIGD5
0.243243



PYCRL
0.243243



CYP11B2
0.256757



HNRNPA1P4
0.27027



TAGLN2P1
0.256757



HMGB1P46
0.256757



PGAM1P13
0.27027



SMOX
0.216216



MRPS33P4
0.364865



SUMO1P1
0.364865



C20orf112
0.351351



COMMD7
0.351351



DNMT3B
0.337838



CDK5RAP1
0.337838



RALY
0.351351



EIF2S2
0.351351



ASIP
0.364865



AHCY
0.364865



ITCH
0.405405



KIF16B
0.256757



CHRNA4
0.378378



KCNQ2
0.378378



EEF1A2
0.378378



C20orf203
0.351351



BAK1P1
0.351351



BPIFB5P
0.337838



BPIFB9P
0.337838



TPM3P2
0.351351



RPS2P1
0.351351



XPOTP1
0.364865



CDC42P1
0.391892



ITCH-AS1
0.391892



ITCH-IT1
0.391892



FDX1P1
0.391892



HMGB3P1
0.378378



MT1P3
0.378378



NCRNA00154
0.378378



SYS1-DBNDD2
0.351351



SRMP1
0.351351



TOP3B
0.081081



IGLVI-70
0.081081



IGLV4-69
0.081081



IGLVI-68
0.081081



IGLV10-67
0.081081



IGLVIV-66-1
0.081081



IGLVV-66
0.081081



IGLVIV-65
0.081081



IGLVIV-64
0.081081



IGLVI-63
0.081081



IGLV1-62
0.081081



IGLV8-61
0.081081



IGLV4-60
0.081081



IGLVIV-59
0.081081



IGILVV-58
0.081081



IGLV6-57
0.081081



IGLVI-56
0.081081



IGLV11-55
0.081081



IGLV10-54
0.081081



IGLVIV-53
0.081081



PRAMEL
0.081081



FAM108A6P
0.081081



SOCS2P2
0.081081



BMP6P1
0.081081



SPINK5
0.027027



SPINK14
0.027027



SNORA9
0.202703



SNORA5A
0.202703



SNORA5C
0.202703



SNORA5B
0.202703



RNU7-35P
0.216216



DNAH11
0.216216



RAMP3
0.202703



NACAD
0.202703



TBRG4
0.202703



C7orf40
0.202703



CCM2
0.202703



GLCCI1
0.22973



ICA1
0.216216



MYO1G
0.202703



CDCA7L
0.216216



AQP1
0.202703



STEAP1B
0.216216



POU6F2
0.22973



HECW1
0.216216



KIAA0087
0.216216



CREB5
0.216216



CHN2
0.216216



HECW1-IT1
0.216216



RNU7-67P
0.256757



RNU7-84P
0.256757



RNY4P5
0.22973



MIR1208
0.283784



MIR548D1
0.256757



MIR1204
0.310811



MIR1205
0.283784



MIR1207
0.283784



MIR30B
0.243243



MIR30D
0.243243



MIR937
0.243243



MIR939
0.22973



MIR1234
0.22973



MIR2053
0.27027



MIR548A3
0.22973



MIR1273
0.256757



MIR875
0.283784



MIR599
0.283784



SLC45A4
0.243243



LY6H
0.256757



ZNF707
0.243243



GPIHBP1
0.22973



ZFP41
0.256757



GLI4
0.256757



ZNF696
0.256757



TOP1MT
0.283784



CCDC166
0.243243



MAPK15
0.243243



FTH1P11
0.283784



IMPA1P
0.283784



NIPA2P4
0.283784



RPS26P34
0.283784



PVT1
0.310811



NACAP1
0.256757



RPS12P15
0.310811



POU5F1P2
0.310811



OSR2
0.27027



SYBU
0.243243



GPR20
0.243243



SQLE
0.324324



VPS13B
0.324324



KIAA0196
0.324324



MMP16
0.243243



STAU2
0.256757



NSMCE2
0.324324



CSMD3
0.283784



TRIB1
0.256757



FAM84B
0.283784



POU5F1B
0.351351



MYC
0.310811



TOX
0.27027



TMEM75
0.283784



GSDMC
0.256757



FAM49B
0.27027



COX6C
0.27027



RGS22
0.283784



ASAP1
0.256757



TRPS1
0.22973



FBXO43
0.27027



POLR2K
0.27027



ADCY8
0.27027



GDAP1
0.256757



EIF3H
0.22973



SPAG1
0.297297



RNF19A
0.310811



EFR3A
0.256757



CRISPLD1
0.256757



UTP23
0.22973



ANKRD46
0.297297



HNF4G
0.27027



OC90
0.256757



NKAIN3
0.256757



HHLA1
0.256757



ZFHX4
0.243243



SNX31
0.297297



KCNQ3
0.256757



PABPC1
0.310811



MED30
0.22973



PEX2
0.243243



EXT1
0.27027



PKIA
0.283784



LRRC6
0.216216



FAM164A
0.283784



IL7
0.283784



SAMD12
0.256757



TNFRSF11B
0.27027



STMN2
0.256757



YWHAZ
0.297297



TMEM71
0.216216



COLEC10
0.27027



NOV
0.243243



ENPP2
0.283784



PHF20L1
0.216216



ZNF706
0.27027



GRHL2
0.297297



TG
0.22973



TAF2
0.283784



TPD52
0.22973



NCALD
0.297297



DSCC1
0.27027



DEPTOR
0.27027



RRM2B
0.283784



SLA
0.22973



UBR5
0.310811



ENY2
0.27027



EYA1
0.27027



NDUFB9
0.297297



DENND3
0.256757



POP1
0.243243



MTSS1
0.283784



PKHD1L1
0.27027



NIPAL2
0.256757



STK3
0.310811



NUDCD1
0.27027



RSPO2
0.310811



TSPYL5
0.22973



MTDH
0.216216



LAPTM4B
0.256757



EIF3E
0.310811



FER1L6
0.310811



TMEM65
0.324324



TRMT12
0.310811



RNF139
0.310811



TATDN1
0.310811



TTC35
0.256757



TMEM74
0.27027



TRHR
0.310811



WDYHV1
0.256757



C8orf17
0.202703



CHRAC1
0.189189



EIF2C2
0.22973



FBXO32
0.297297



KLHL38
0.310811



ANXA13
0.310811



ABRA
0.256757



PTK2
0.22973



MAL2
0.27027



RPL35AP19
0.256757



MRPS36P3
0.256757



HMGB1P19
0.22973



UBA52P5
0.256757



DUTP2
0.256757



IMPDH1P6
0.256757



FER1L6-AS1
0.310811



ARF1P3
0.310811



RPL19P14
0.283784



MRP63P7
0.27027



GAPDHP62
0.297297



RPS26P6
0.297297



RPS10P16
0.22973



RPS26P35
0.243243



RPS17P14
0.27027



TPM3P3
0.243243



ANGPT1
0.256757



FAM91A1
0.297297



PLEKHF2
0.202703



C8orf37
0.202703



RALYL
0.243243



ATAD2
0.256757



C8orf34
0.216216



ZFPM2
0.27027



KCNK9
0.27027



TRAPPC9
0.27027



OXR1
0.310811



CHMP4C
0.243243



SCRIB
0.243243



TMED10P1
0.243243



RHPN1
0.283784



MAFA
0.27027



ZC3H3
0.27027



GSDMD
0.256757



C8orf73
0.256757



PUF60
0.243243



NAPRT1
0.256757



NRBP2
0.243243



EEF1D
0.243243



EPPK1
0.243243



PLEC
0.22973



SLC39A4
0.22973



VPS28
0.22973



TONSL
0.22973



CYHR1
0.22973



WISP1
0.22973



NDRG1
0.22973



ODF1
0.310811



KLF10
0.310811



COL14A1
0.27027



AZIN1
0.310811



ESRP1
0.283784



ST3GAL1
0.256757



ZBTB10
0.283784



ZFAT
0.256757



ATP6V1C1
0.310811



ZNF704
0.243243



ZNF7
0.202703



MRPL13
0.243243



C8orf56
0.310811



MTBP
0.243243



BAALC
0.310811



PMP2
0.283784



SNTB1
0.310811



FABP9
0.283784



HAS2
0.324324



FABP4
0.283784



FZD6
0.310811



FABP12
0.283784



COMMD5
0.202703



IMPA1
0.283784



ZNF250
0.202703



ZHX2
0.27027



CTHRC1
0.283784



DERL1
0.22973



SLC25A32
0.283784



DCAF13
0.283784



WDR67
0.22973



ZNF16
0.243243



SLC10A5
0.283784



RIMS2
0.243243



ZNF252
0.243243



KHDRBS3
0.202703



C8orf77
0.243243



C8orf33
0.243243



CPA6
0.22973



C8orf38
0.202703



ZFAND1
0.283784



FAM135B
0.243243



PREX2
0.256757



FAM83A
0.243243



TM7SF4
0.22973



C8orf76
0.256757



DPYS
0.22973



COL22A1
0.256757



LRP12
0.22973



ZHX1
0.256757



FAM83H
0.243243



TRAPPC2P2
0.27027



PRKRIRP7
0.283784



RPL3P9
0.256757



RPSAP47
0.283784



MCART5P
0.243243



CKS1BP7
0.243243



HMGB1P41
0.243243



BOP1
0.22973



HSF1
0.22973



DGAT1
0.22973



PTP4A3
0.283784



SCRT1
0.22973



GPR172A
0.22973



TSNARE1
0.216216



FBXL6
0.22973



BAI1
0.243243



ARC
0.243243



ADCK5
0.22973



TSTA3
0.22973



LY6E
0.256757



ZNF623
0.243243



AK3P2
0.256757



C8orf31
0.256757



C8orf51
0.283784



MTND2P7
0.256757



MAPRE1P1
0.22973



TMCC1P1
0.27027



NCRNA00051
0.22973



JRK
0.243243



HPYR1
0.216216



ST13P6
0.256757



RPL5P24
0.310811



MTND1P5
0.310811

















TABLE 8







Genes with significant copy number loss










GeneName
Freq.














ZNF29P
0.216216



CDRT15L1
0.216216



IL6STP1
0.216216



MEIS3P1
0.216216



NCRNA00188
0.243243



HS3ST3A1
0.243243



COX10
0.22973



CDRT15
0.22973



PMP22
0.216216



TEKT3
0.22973



MACROD2-AS1
0.189189



GAS7
0.243243



MYH13
0.216216



TRIM16
0.216216



ZNF286A
0.216216



TBC1D26
0.216216



TTC19
0.22973



DSEL
0.418919



TMX3
0.364865



CCDC102B
0.405405



DOK6
0.391892



CD226
0.364865



RTTN
0.337838



SOCS6
0.324324



CBLN2
0.364865



NETO1
0.391892



ZNF407
0.351351



GALR1
0.351351



ATP9B
0.27027



LSM12P1
0.189189



KIAA1328
0.310811



ADAM5P
0.283784



ADNP2
0.27027



PARD6G
0.27027



PIK3C3
0.337838



CHST9-AS1
0.310811



RIT2
0.310811



CTSB
0.189189



CCDC110
0.22973



APC
0.189189



MRO
0.297297



ME2
0.310811



ELAC1
0.297297



TRAPPC8
0.297297



SMAD4
0.297297



MEX3C
0.283784



DCC
0.364865



MBD2
0.351351



POLI
0.351351



STARD6
0.364865



C18orf54
0.364865



C18orf26
0.324324



RAB27B
0.310811



KIAA1456
0.216216



MTND4P7
0.22973



RNF138
0.297297



ADAM3A
0.283784



SYT4
0.337838



SLC14A2
0.256757



SLC14A1
0.27027



PSTPIP2
0.283784



ATP5A1
0.283784



HAUS1
0.283784



DYM
0.310811



C18orf32
0.243243



RPL17
0.243243



BHLHA9
0.216216



TUSC5
0.216216



SLC25A37
0.202703



OR4F21
0.202703



ZNF596
0.202703



FBXO25
0.202703



C8orf42
0.202703



ADAM28
0.216216



ERICH1
0.202703



DLGAP2
0.202703



NAT2
0.22973



UNC5D
0.189189



CDH20
0.297297



NEFL
0.162162



RNF152
0.297297



PIGN
0.297297



KIAA1468
0.310811



PHLPP1
0.297297



ZNF521
0.297297



VPS4B
0.283784



SERPINB7
0.27027



SERPINB2
0.310811



SERPINB10
0.310811



HMSD
0.310811



SERPINB8
0.297297



CHST9
0.297297



CDH7
0.405405



CDH2
0.297297



CDH19
0.391892



ARHGEF10
0.175676



ADAMDEC1
0.216216



FHIT
0.216216



ADAM7
0.216216



CSMD1
0.256757



NEFM
0.162162



RPL23AP53
0.202703



FAM87A
0.202703



MCPH1
0.189189



ARHGAP28
0.216216



ANGPT2
0.189189



HLA-H
0.094595



HLA-T
0.148649



DDX39BP1
0.148649



MCCD1P1
0.148649



HLA-K
0.135135



DEFA6
0.202703



PAICSP4
0.256757



MSRA
0.22973



RAP1GAP2
0.216216



ROBO1
0.162162



PBK
0.175676



INTS10
0.243243



FBXO16
0.189189



FZD3
0.202703



EXTL3
0.189189



RBFOX1
0.121622



IRF2
0.202703



PPP2CB
0.216216



CASP3
0.202703



TEX15
0.22973



PURG
0.22973



WRN
0.22973



NRG1
0.202703



CCDC111
0.202703



MLF1IP
0.202703



SORBS2
0.22973



MIR1539
0.243243



MIR744
0.243243



MIR1288
0.22973



MIR1305
0.22973



MIR596
0.175676



MIR383
0.256757



MIR1261
0.22973



SNORD58C
0.243243



SNORA37
0.324324



SNORD49B
0.243243



SNORD49A
0.243243



SNORD65
0.243243



LONRF1
0.202703



DLC1
0.256757



C8orf48
0.256757



SGCZ
0.283784



PSD3
0.216216



CSGALNACT1
0.202703



ESCO2
0.175676



ODZ3
0.22973



FUT10
0.189189



CADM2
0.162162










Besides assessing expression, the RNA-seq data can be exploited to examine splicing patterns. Among the mutated genes there are several that carry somatic mutations in canonical splice sites that will likely affect their splicing. 112 genes were found with canonical splice site mutations that show evidence for splicing defects based on RNA-seq data. The affected genes include TP53, NOTCH2 and EIF5B (Table 9). RNA-seq data was also used to analyze tumor specific expression of certain exons in gene coding regions. Two novel tumor specific exons upstream of the first 5′annotated exon of a mitochondrial large subunit MRPL33 gene were identified (FIG. 1). Analysis of this genomic region identified transcription factor binding sites 5′ of these novel exons, further supporting our observation.









TABLE 9







Splice Site Mutation Effects












GeneName
Position
Ref.
Var.
















TP53
7577157
T
A



EYA3
28369163
T
C



RAD54L
46739138
G
A



RAD54L
46743654
T
C



TBCD
80895237
G
A



MYO5B
47380018
C
A



ZNF780A
40590706
C
A



NAV1
201757595
G
A



EIF5B
100010862
G
A



KNTC1
123042146
G
T



ANKS1A
35054827
G
A



IP6K2
48728917
T
G



ATP13A1
19757157
C
T



YWHAQ
9728458
C
A



SETD2
47127805
C
A



REEP5
112238216
C
A



PHF19
123631609
C
T



TAF10
6632535
C
A



YES1
756836
C
T



LAMP2
119575751
T
G



SETD7
140439198
T
C



FAM102A
130707645
C
T



BRAP
112093368
A
G



SEL1L3
25785913
C
A



TEC
48140840
C
A



PTPRB
70932795
C
A



TP53
7577156
C
A



NOTCH2
120529707
T
C



MRPS2
138393821
T
C



CORO1B
67206140
A
G



C2CD3
73768590
C
T



ALG8
77820487
C
A



POLG
89865248
T
G



LIMD2
61776073
T
G



VAPA
9931961
T
C



TFCP2
51497987
C
A



ABI3BP
100469455
C
A



ABCD4
74753521
T
G



CNOT1
58573864
C
T



IVNS1ABP
185274666
A
G



EPRS
220191851
C
A



KIF13B
29024889
C
A



PKD1
2156679
C
T



ASPHD1
29916287
G
T



INPP5K
1417274
C
A



DUS3L
5788189
T
C



SFRS15
33078671
C
T



PRKCZ
2106661
A
G



SLC2A5
9098566
C
A



LEPRE1
43213085
T
C



ARNT
150790507
C
A



ARHGEF11
156915955
C
A



YWHAQ
9731646
T
C



USP40
234451010
C
A



METTL6
15455670
C
A



GLB1
33055803
C
A



USP19
49149716
C
T



LPCAT1
1474801
C
A



LHFPL2
77784977
C
A



SNX2
122153070
T
G



AARS2
44278899
C
A



PHIP
79727301
C
T



TECPR1
97863225
T
C



TRAPPC9
141321346
C
T



NAPRT1
144659348
C
A



ANXA1
75778390
A
G



PTCH1
98239040
C
T



PKN3
131475777
G
A



ZER1
131493674
C
T



DNMBP
101667853
T
C



SUV420H1
67953396
C
A



USP28
113683227
C
A



KIRREL3
126299185
T
C



CHD4
6688084
C
A



CAPRIN2
30869611
C
A



CSAD
53566434
T
C



PDS5B
33347464
T
C



SIN3A
75682164
T
C



PDXDC2
70072890
T
C



PRPF8
1554252
T
G



TP53
7578555
C
T



PER1
8050991
C
T



HDAC5
42155785
T
C



MED16
871254
C
A



SAE1
47712415
G
T



TTC3L
38572531
A
G



USP11
47099703
G
T



FANCC
97887468
C
A



OTUD7B
149949513
T
C



C1orf9
172554157
G
T



SLC4A3
220500394
G
T



CLASP2
33614847
C
A



LRRFIP2
37100402
C
A



SLC2A9
9909970
C
A



ACSL1
185678862
T
C



FAT1
187527368
C
A



C5orf42
37125512
C
A



SFRS18
99858841
C
A



FAM184A
119332597
C
A



PPP3CC
22380264
T
C



RAB11FIP1
37720632
C
A



CDH17
95143103
C
T



EXT1
119122323
C
A



ALDH1A1
75527039
C
A



DNLZ
139256633
C
A



MTPAP
30604966
C
A



TFAM
60147949
G
A



RSL1D1
11933550
A
C



GPCPD1
5545725
C
A



CXADR
18933019
G
A



KIF13A
17799672
T
C



CELSR2
109815787
G
A



MTO1
74189850
G
C



SOS2
50655420
T
C



RPS10
34389506
C
T



XPNPEP1
111640599
C
T










Example 4
Recurrent R-Spondin Fusions Activate Wnt Pathway Signaling

RNA-seq data was next used to identify intra- and inter-chromosomal rearrangements such as gene fusions that occur in cancer genomes ENREF 9 (Ozsolak, F. & Milos, P. M. Nature Rev Genet. 12:87-98 (2011)). In mapping the paired-end RNA-seq data, 36 somatic gene fusions, including two recurrent ones, were indentified in the analyzed CRC transcriptomes. The somatic nature of the fusions was established by confirming it presence in the tumors and absence in corresponding matched normal using RT-PCR. Further, all fusions reported in these examples were Sanger sequenced and validated (Table 10). The majority of predicted somatic fusions identified were intra-chromosomal (89%; 32/36).









TABLE 10







Gene Fusions













5′ GeneName
3′ GeneName
Type
Genomic position
5′ PCR primer
3′ PCR primer
bp





PVT1
ENST00000502082
intrachrom.
8:128806980-8:128433074
CTTGCGGAAAGGATG
TGGTGATCCAGAGAA
150






TTGG
GAAGC 







(SEQ ID NO: 11)
(SEQ ID NO: 40)






EIF3E(e1)
RSPO2(e2)
deletion
8:109260842-8:109095035
ACTACTCGCATCGCG
GGGAGGACTCAGAGG
155






CACT
GAGAC







(SEQ ID NO: 12)
(SEQ ID NO: 41)






EIF3E(e1)
RSPO2(e2)
deletion
8:109260842-8:109095035
ACTACTCGCATCGCG
GGGAGGACTCAGAGG
155






CACT
GAGAC







(SEQ ID NO: 12)
(SEQ ID NO: 41)






EIF3E(e1)
RSPO2(e3)
deletion
8:109260842-8:109001472
ACTACTCGCATCGCG
TGCAGGCACTCTCCA
205






CACT
TACTG







(SEQ ID NO: 12)
(SEQ ID NO: 42)






EIF3E(e1)
RSPO2(e3)
deletion
8:109260842-8:109001472
ACTACTCGCATCGCG
TGCAGGCACTCTCCA
205






CACT
TACTG







(SEQ ID NO: 12)
(SEQ ID NO: 42)






PTPRK(e1)
RSPO3(e2)
inversion
6:128841404-6:127469793
AAACTCGGCATGGAT
GCTTCATGCCAATTC
226






ACGAC
TTTCC







(SEQ ID NO: 13)
(SEQ ID NO: 43)






PTPRK(e1)
RSPO3(e2)
inversion
6:128841404-6:127469793
AAACTCGGCATGGAT
GCTTCATGCCAATTC
226






ACGAC
TTTCC







(SEQ ID NO: 13)
(SEQ ID NO: 43)






PTPRK(e1)
RSPO3(e2)
inversion
6:128841404-6:127469793
AAACTCGGCATGGAT
GCTTCATGCCAATTC
226






ACGAC
TTTCC







(SEQ ID NO: 13)
(SEQ ID NO: 43)






PTPRK(e1)
RSPO3(e2)
inversion
6:128841404-6:127469793
AAACTCGGCATGGAT
GCTTCATGCCAATTC
226






ACGAC
TTTCC







(SEQ ID NO: 13)
(SEQ ID NO: 43)






PTPRK(e7)
RSPO3(e2)
inversion
6:128505577-6:127469793
TGCAGTCAATGCTCC
GCCAATTCTTTCCAG
250






AACTT
AGCAA







(SEQ ID NO: 14)
(SEQ ID NO: 44)






ETV6
NTRK3
translocation
12:12022903-15:88483984
AAGCCCATCAACCTC
GGGCTGAGGTTGTAG
206






TCTCA
CACTC







(SEQ ID NO: 15)
(SEQ ID NO: 45)






ANXA2
RORA
intrachrom.
15:60674541-15:60824050
CTCTACACCCCCAAG
TGACACCATAATGGA
164






TGCAT
TTCCTG







(SEQ ID NO: 16)
(SEQ ID NO: 46)






TUBGCP3
PDS5B
inversion
13:113200013-13:33327470 
AACAGGAGACCCGTA
AAAGGGCACAGATTG
221






CATGC
CCATA







(SEQ ID NO: 17)
(SEQ ID NO: 47)






ARHGEF18
NCRNA00157
translocation
 19:7460133-21:19212970
CCAGCTGCTAGCTAC
ACTAGGTGGTCCAGG
186






TGTGGA
GTGTG







(SEQ ID NO: 18)
(SEQ ID NO: 48)






NT5C2
ASAH2
deletion
10:104899163-10:51978390 
TGAACCGAAGTTTAG
TGCTCAAGCAGGTAA
156






CAATGG
GATGC







(SEQ ID NO: 19)
(SEQ ID NO: 49)






NRBP2
VPS28
intrachrom.
8:144919211-8:145649651
TGATGAACTTTGCAG
ATGGTCTCCATCAGC
208






CCACT
TCTCG







(SEQ ID NO: 20)
(SEQ ID NO: 50)






CDC42SE2
KIAA0146
translocation
5:130651837-8:48612965 
AGGGCCAGATTTGAG
AAACTGAAAATCCCC
188






TGTGT
GCTGT







(SEQ ID NO: 21)
(SEQ ID NO: 51)






MED13L
LAG3
inversion
12:116675273-12:6886957  
GTGTATGGCGTCGTG
GCTCCAGTCACCAAA
205






ATGTC
AGGAG







(SEQ ID NO: 22)
(SEQ ID NO: 52)






PEX5
LOC389634
inversion
12:7362838-12:8509737
CATGTCGGAGAACAT
TGTGGAGTCTCTTGC
230






CTGGA
GTGTC







(SEQ ID NO: 23)
(SEQ ID NO: 53)






PLCE1
CYP2C19
deletion
10:95792009-10:96602594
CCTTACTGCCTTGTG
TGGGGATGAGGTCGA
224






GGAGA
TGTAT







(SEQ ID NO: 24)
(SEQ ID NO: 54)






TPM3
NTRK1
inversion
1:154142876-1:156844363
CAGAGACCCGTGCTG
CCAAAAGGTGTTTCG
124






AGTTT
TCCTT







(SEQ ID NO: 25)
(SEQ ID NO: 55)






PAN3
RFC3
deletion
13:28752072-13:34395269
GACTTTGGTGCCCTC
CAATTTTTCCACTCC
150






AACAT
AACACC







(SEQ ID NO: 26)
(SEQ ID NO: 56)






CWC27
RNF180
intrachrom.
5:64181373-5:63665442
AACGGGAACTCTTAG
CATGTCAAACCACCA
182






CAGCA
TCCAC







(SEQ ID NO: 27)
(SEQ ID NO: 57)






CAPN1
SPDYC
intrachrom.
11:64956217-11:64939414
GAGACTTCATGCGGG
ATCTGGAAGCAGGGG
199






AGTTC
TCTTT







(SEQ ID NO: 28)
(SEQ ID NO: 58)






COG8
TERF2
intrachrom.
16:69373079-16:69391464
TGGCCTTCGCTAACT
TCCCCATATTTCTGC
233






ACAAGA
ACTCC







(SEQ ID NO: 29)
(SEQ ID NO: 59)






TADA2A
MEF2B
translocation
17:35767040-19:19293492
GCTCTTTGGCGCGGA
GGAGCTACCTGTGGC
152






TTA
CCT







(SEQ ID NO: 30)
(SEQ ID NO: 60)






STRBP
DENND1A
intrachrom.
9:125935956-9:126220176
GTTGCAAAAGGCTTG
ACGAAGGCTTCCTCA
155






CTGAT
CAGAA







(SEQ ID NO: 31)
(SEQ ID NO: 61)






CXorf56
UBE2A
inversion
X:118694231-X:118717090
TGATTGATGCTGCCA
CACGCTTTTCATATT
161






AACAT
CCCGT







(SEQ ID NO: 32)
(SEQ ID NO: 62)






MED13L
CD4
inversion
12:116675273-12:6923308  
GTGTATGGCGTCGTG
TCCCAAAGGCTTCTT
151






ATGTC
CTTGA







(SEQ ID NO: 22)
(SEQ ID NO: 63)






PRR12
PRRG2
intrachrom.
19:50097872-19:50093157
ATGAACCTTATCTCG
GTCGTGTACCCCAGA
227






GCCCT
GGCT







(SEQ ID NO: 33)
(SEQ ID NO: 64)






ATP9A
ARFGEF2
inversion
20:50307278-20:47601266
ATGTGTACGCAGAAG
GTGCAGGAATTGGGC
150






AGCCA
TATGT







(SEQ ID NO: 34)
(SEQ ID NO: 65)






ANKRD17
HS3ST1
deletion
4:73956384-4:11401737
GGAAAATCCTCATAT
AGCAGGGAAGCCTCC
158






TTGCCA
TAGTC







(SEQ ID NO: 35)
(SEQ ID NO: 66)






RBM47
ATP8A1
intrachrom.
4:40517884-4:42629126
AGACCCAGGAGGAGT
GGTCAGCCAGTGAGG
151






GAGGT
TCTTC







(SEQ ID NO: 36)
(SEQ ID NO: 67)






FRS2
RAP1B
intrachrom.
12:69924740-12:69042479
AGATGCCCAGATGCA
CAAAGCAGACTTTCC
161






AAAGT
AACGC







(SEQ ID NO: 37)
(SEQ ID NO: 68)






CHEK2
PARVB
inversion
22:29137757-22:44553862
GGCTGAGGGTGGAGT
CTTCTGATCGAAGCT
191






TTGTA
TTCCG







(SEQ ID NO: 38)
(SEQ ID NO: 69)






SFI1
TPST2
inversion
22:31904362-22:26940641
CCCCAGTTAGAAGGG
CACTCTCATCTCTGG
190






GAAGA
GCTCC







(SEQ ID NO: 39)
(SEQ ID NO: 70)









The recurrent fusions identified in these examples involve the R-spondin family members, RSPO2 (3%; 2/68) and RSPO3 (8%; 5/68; FIG. 2A) found in MSS CRC samples. R-spondins are secreted proteins known to potentiate canonical Wnt signaling ENREF 20 (Yoon, J. K. & Lee, J. S. Cell Signal. 24(2):369-77 (2012)), potentially by binding to the LGR family of GPCRs ENREF 21 (Carmon, K. S. et al., Proceedings of the National Academy of Sciences of the United States of America 108:11452-11457 (2011); de Lau, W. et al., Nature 476:293-297 (2011); Glinka, A. et al., EMBO Reports 12:1055-1061 (2011)). The recurrent RSPO2 fusion identified in two tumor samples involves EIF3E (eukaryotic translation initiation factor 3) exon 1 and RSPO2 exon 2 (FIG. 2B). This fusion transcript was expected to produce a functional RSPO2 protein driven by EIF3E promoter (FIG. 2D). A second RSPO2 fusion detected in the same samples involves EIF3E exon 1 and RSPO2 exon 3 (Table 10). However, this EIF3E(e1)-RSPO2(e3) was not expected to produce a functional protein. To confirm the nature of the alteration at the genome level, whole genome sequencing (WGS) of the tumors was performed containing RSPO2 fusions. Analysis of junction spanning reads, mate-pair reads and copy number data derived from the WGS data, identified a 158 kb deletion in one sample and a 113 kb deletion in the second sample, both of which places exon 1 of EIF3E in close proximity to the 5′ end of RSPO2.


RSPO3 translocations were observed in 5 of 68 tumors and they involve PTPRK (protein tyrosine kinase receptor kappa) as its 5′ partner. WGS reads from the 5 tumors expressing the RSPO3fusions showed rearrangements involving a simple (3 samples) or a complex (2 samples) inversion that places RSPO3 in proximity to PTPRK on the same strand as PTPRK on chromosome 6q. Two different RSPO3 fusion variants were identified consisting either of exon 1 (e 1) or exon 7 (e7) of PTPRK and exon 2 (e2) of RSPO3 (FIG. 3 and FIG. 4). The RSPO3 fusions likely arise from a deletion-inversion event at the chromosomal level as normally PTPRK and RSPO3 are 850 Kb apart on opposing strands on chromosome 6q. The PTPRK(e1)-RSPO3(e2), found in four samples, was an in-frame fusion that preserves the entire coding sequence of RSPO3 and replaces its secretion signal sequence with that of PTPRK (FIG. 3C). The PTPRK(e7)-RSPO3(e2), detected in one sample, was also an in-frame fusion that encodes a ˜70 KDa protein consisting of the first 387 amino acids of PTPRK, including its secretion signal sequence, and the RSPO3 amino acids 34-272 lacking its native signal peptide (FIG. 4C). Interestingly, PTPRK contains a much stronger secretion signal sequence compared to RSPO3 and potentially leads to more efficient secretion of the fusion variants identified. Additionally, RNA-seq data showed that the mRNA expression of RSPO2 and RSPO3 in colon tumor samples containing the fusions was elevated compared to their matched normal samples and tumor samples lacking R-spondin fusions (FIG. 2E). Further, all the RSPO positive fusion tumors expressed the potential R-spondin receptors LGR4/5/623-25, though LGR6 expression was lower compared to LGR4/5.


To determine if the predicted R-spondin fusion proteins were functional, expression constructs containing a C-terminal flag tag were generated and tested their expression following transfecting into mammalian 293T cells. Western blot analysis of the conditioned media showed that the fusion proteins were expressed and secreted (FIG. 5A). The R-spondin fusion products were biologically active as determined by their ability to potentiate Wnt signaling using a Wnt luciferase reporter. As observed with the wildtype RSPO2/3, stimulation with conditioned media of cells transfected with RSPO fusion expression constructs led to activation of the Wnt luciferase reporter (FIG. 5B) compared to that of control transfected cells. The observed activation, while apparent in the absence of exogenous WNT, was further potentiated in the presence of recombinant WNT, consistent with the known role of R-spondins in Wnt signaling ENREF 20 (Carmon, K. S. et al., Proceedings of the National Academy of Sciences of the United States of America 108:11452-11457 (2011); de Lau, W. et al., Nature 476:293-297 (2011); Glinka, A. et al., EMBO Reports 12:1055-1061 (2011)).


To further characterize the RSPO gene fusions, RSPO gene fusions were analyzed in the context of mutations and other alterations that occur in components of cellular signaling pathways including the Wnt signaling cascade (FIG. 6B). The RSPO2 and RSPO3 fusions were mutually exclusive between themselves, besides being mutually exclusive with APC mutations (FIG. 5E), except for one sample that had a single copy deletion in the APC coding region (FIG. 5E). Also, the RSPO gene fusions were mutually exclusive with CTNNB1, another Wnt pathway gene that was mutated in CRC. Further, all of the samples with RSPO gene fusions also carried mutation in KRAS or BRAF (FIG. 6A). The majority of APC mutant samples had RAS pathway gene mutations, indicating that the RSPO gene fusions are likely to play the same role as APC mutations by promoting Wnt signaling during colon tumor development. In data not shown, tumors with RSPO gene fusions were shown to exhibit a WNT expression signature similar to that of APC mutant tumors indicating that R-Spondins can activate the WNT pathway in colon tumors in the absence of downstream WNT mutations. These findings indicate that the R-spondins likely function as drivers in human CRCs.


In these examples, an in-depth extensive genomic analysis of human primary colon tumors was reported. In sequencing and analyzing human CRC exomes and transcriptomes, multiple new recurrent somatic mutations were found. Many of the significantly mutated genes in these examples (APC, KRAS, PIK3CA, SMAD4, FBXW7, TP53, TCF7L2) agree with the previous findings. In addition, multiple mutations in 111 out of the 140 genes they highlighted in their study were reported. Further, 11 additional significant colon cancer genes including ATM and TMPRSS11A have been identified that have not been previously reported. The examples identified multiple hotspot containing genes including TCF12 and ERBB3. The ERBB3 oncogenic mutants identified here potentially provide new opportunities for therapeutic intervention in CRC. Combined analysis of expression and copy number data identified IGF2 overexpression in a subset of our human CRC samples.


Finally, using RNA-seq data, new recurrent fusions involving R-spondins have been identified that occur at a frequency of approximately 10%. The fusions results in functional R-spondin proteins that potentiate Wnt signaling. R-spondins provide attractive targets for antibody based therapy in colon cancer patients that harbor them. Besides directly targeting R-spondins, other therapeutic strategies that block Wnt signaling will likely be effective against tumors positive for R-spondin fusions.










RSPO1 Nuclic Acid Sequence



(SEQ ID NO: 1)



ATGCGGCTTGGGCTGTGTGTGGTGGCCCTGGTTCTGAGCTGGACGCACCTCACCATCAGCAGCCGGG






GGATCAAGGGGAAAAGGCAGAGGCGGATCAGTGCCGAGGGGAGCCAGGCCTGTGCCAAAGGCTGTGA





GCTCTGCTCTGAAGTCAACGGCTGCCTCAAGTGCTCACCCAAGCTGTTCATCCTGCTGGAGAGGAAC





GACATCCGCCAGGTGGGCGTCTGCTTGCCGTCCTGCCCACCTGGATACTTCGACGCCCGCAACCCCG





ACATGAACAAGTGCATCAAATGCAAGATCGAGCACTGTGAGGCCTGCTTCAGCCATAACTTCTGCAC





CAAGTGTAAGGAGGGCTTGTACCTGCACAAGGGCCGCTGCTATCCAGCTTGTCCCGAGGGCTCCTCA





GCTGCCAATGGCACCATGGAGTGCAGTAGTCCTGCGCAATGTGAAATGAGCGAGTGGTCTCCGTGGG





GGCCCTGCTCCAAGAAGCAGCAGCTCTGTGGTTTCCGGAGGGGCTCCGAGGAGCGGACACGCAGGGT





GCTACATGCCCCTGTGGGGGACCATGCTGCCTGCTCTGACACCAAGGAGACCCGGAGGTGCACAGTG





AGGAGAGTGCCGTGTCCTGAGGGGCAGAAGAGGAGGAAGGGAGGCCAGGGCCGGCGGGAGAATGCCA





ACAGGAACCTGGCCAGGAAGGAGAGCAAGGAGGCGGGTGCTGGCTCTCGAAGACGCAAGGGGCAGCA





ACAGCAGCAGCAGCAAGGGACAGTGGGGCCACTCACATCTGCAGGGCCTGCCTAG





RSPO1 Amino Acid Sequence


(SEQ ID NO: 2)



MRLGLCVVALVLSWTHLTISSRGIKGKRQRRISAEGSQACAKGCELCSEVNGCLKCSPKLFILLERN






DIRQVGVCLPSCPPGYFDARNPDMNKCIKCKIEHCEACFSHNFCTKCKEGLYLHKGRCYPACPEGSS





AANGTMECSSPAQCEMSEWSPWGPCSKKQQLCGFRRGSEERTRRVLHAPVGDHAACSDTKETRRCTV





RRVPCPEGQKRRKGGQGRRENANRNLARKESKEAGAGSRRRKGQQQQQQQGTVGPLTSAGPA





RSPO2 Nucleic Acid Sequence


(SEQ ID NO: 3)



ATGCAGTTTCGCCTTTTCTCCTTTGCCCTCATCATTCTGAACTGCATGGATTACAGCCACTGCCAAG






GCAACCGATGGAGACGCAGTAAGCGAGCTAGTTATGTATCAAATCCCATTTGCAAGGGTTGTTTGTC





TTGTTCAAAGGACAATGGGTGTAGCCGATGTCAACAGAAGTTGTTCTTCTTCCTTCGAAGAGAAGGG





ATGCGCCAGTATGGAGAGTGCCTGCATTCCTGCCCATCCGGGTACTATGGACACCGAGCCCCAGATA





TGAACAGATGTGCAAGATGCAGAATAGAAAACTGTGATTCTTGCTTTAGCAAAGACTTTTGTACCAA





GTGCAAAGTAGGCTTTTATTTGCATAGAGGCCGTTGCTTTGATGAATGTCCAGATGGTTTTGCACCA





TTAGAAGAAACCATGGAATGTGTGGAAGGATGTGAAGTTGGTCATTGGAGCGAATGGGGAACTTGTA





GCAGAAATAATCGCACATGTGGATTTAAATGGGGTCTGGAAACCAGAACACGGCAAATTGTTAAAAA





GCCAGTGAAAGACACAATACTGTGTCCAACCATTGCTGAATCCAGGAGATGCAAGATGACAATGAGG





CATTGTCCAGGAGGGAAGAGAACACCAAAGGCGAAGGAGAAGAGGAACAAGAAAAAGAAAAGGAAGC





TGATAGAAAGGGCCCAGGAGCAACACAGCGTCTTCCTAGCTACAGACAGAGCTAACCAATAA





RSPO2 Amino Acid Sequence


(SEQ ID NO: 4)



MQFRLFSFALIILNCMDYSHCQGNRWRRSKRASYVSNPICKGCLSCSKDNGCSRCQQKLEFFLRREG






MRQYGECLHSCPSGYYGHRAPDMNRCARCRIENCDSCFSKDFCTKCKVGFYLHRGRCFDECPDGFAP





LEETMECVEGCEVGHWSEWGTCSRNNRTCGFKWGLETRTRQIVKKPVKDTILCPTIAESRRCKMTMR





HCPGGKRTPKAKEKRNKKKKRKLIERAQEQHSVFLATDRANQ





RSPO3 Nucleic Acid Sequence


(SEQ ID NO: 5)



ATGCACTTGCGACTGATTTCTTGGCTTTTTATCATTTTGAACTTTATGGAATACATCGGCAGCCAAA






ACGCCTCCCGGGGAAGGCGCCAGCGAAGAATGCATCCTAACGTTAGTCAAGGCTGCCAAGGAGGCTG





TGCAACATGCTCAGATTACAATGGATGTTTGTCATGTAAGCCCAGACTATTTTTTGCTCTGGAAAGA





ATTGGCATGAAGCAGATTGGAGTATGTCTCTCTTCATGTCCAAGTGGATATTATGGAACTCGATATC





CAGATATAAATAAGTGTACAAAATGCAAAGCTGACTGTGATACCTGTTTCAACAAAAATTTCTGCAC





AAAATGTAAAAGTGGATTTTACTTACACCTTGGAAAGTGCCTTGACAATTGCCCAGAAGGGTTGGAA





GCCAACAACCATACTATGGAGTGTGTCAGTATTGTGCACTGTGAGGTCAGTGAATGGAATCCTTGGA





GTCCATGCACGAAGAAGGGAAAAACATGTGGCTTCAAAAGAGGGACTGAAACACGGGTCCGAGAAAT





AATACAGCATCCTTCAGCAAAGGGTAACCTGTGTCCCCCAACAAATGAGACAAGAAAGTGTACAGTG





CAAAGGAAGAAGTGTCAGAAGGGAGAACGAGGAAAAAAAGGAAGGGAGAGGAAAAGAAAAAAACCTA





ATAAAGGAGAAAGTAAAGAAGCAATACCTGACAGCAAAAGTCTGGAATCCAGCAAAGAAATCCCAGA





GCAACGAGAAAACAAACAGCAGCAGAAGAAGCGAAAAGTCCAAGATAAACAGAAATCGGTATCAGTC





AGCACTGTACACTAG





RSPO3 Amino Acid Sequence


(SEQ ID NO: 6)



MHLRLISWLFIILNEMEYIGSQNASRGRRQRRMHPNVSQGCQGGCATCSDYNGCLSCKPRLFFALER






IGMKQIGVCLSSCPSGYYGTRYPDINKCTKCKADCDTCFNKNECTKCKSGFYLHLGKCLDNCPEGLE





ANNHTMECVSIVHCEVSEWNPWSPCTKKGKTCGFKRGTETRVREIIQHPSAKGNLCPPTNETRKCTV





QRKKCQKGERGKKGRERK





RSPO4 Nucleic Acid Sequence


(SEQ ID NO: 7)



ATGCGGGCGCCACTCTGCCTGCTCCTGCTCGTCGCCCACGCCGTGGACATGCTCGCCCTGAACCGAA






GGAAGAAGCAAGTGGGCACTGGCCTGGGGGGCAACTGCACAGGCTGTATCATCTGCTCAGAGGAGAA





CGGCTGTTCCACCTGCCAGCAGAGGCTCTTCCTGTTCATCCGCCGGGAAGGCATCCGCCAGTACGGC





AAGTGCCTGCACGACTGTCCCCCTGGGTACTTCGGCATCCGCGGCCAGGAGGTCAACAGGTGCAAAA





AATGTGGGGCCACTTGTGAGAGCTGCTTCAGCCAGGACTTCTGCATCCGGTGCAAGAGGCAGTTTTA





CTTGTACAAGGGGAAGTGTCTGCCCACCTGCCCGCCGGGCACTTTGGCCCACCAGAACACACGGGAG





TGCCAGGGGGAGTGTGAACTGGGTCCCTGGGGCGGCTGGAGCCCCTGCACACACAATGGAAAGACCT





GCGGCTCGGCTTGGGGCCTGGAGAGCCGGGTACGAGAGGCTGGCCGGGCTGGGCATGAGGAGGCAGC





CACCTGCCAGGTGCTTTCTGAGTCAAGGAAATGTCCCATCCAGAGGCCCTGCCCAGGAGAGAGGAGC





CCCGGCCAGAAGAAGGGCAGGAAGGACCGGCGCCCACGCAAGGACAGGAAGCTGGACCGCAGGCTGG





ACGTGAGGCCGCGCCAGCCCGGCCTGCAGCCCTGA





RSPO4 Amino Acid Sequence


(SEQ ID NO: 8)



MRAPLCLLLLVAHAVDMLALNRRKKQVGTGLGGNCTGCTICSEENGCSTCQQRLFLFIRREGIRQYG






KCLHDCPPGYFGIRGQEVNRCKKCGATCESCFSQDFCIRCKRQFYLYKGKCLPTCPPGTLAHQNTRE





CQGECELGPWGGWSPCTHNGKTCGSAWGLESRVREAGRAGHEEAATCQVLSESRKCPIQRPCPGERS





PGQKKGRKDRRPRKDRKLDRRLDVRPRQPGLQP





EIF3E(e1)-RSP02(e2) translocation fusion polynucleotide


(SEQ ID NO: 74)



GAGCACAGACTCCCTTTTCTTTGGCAAGATGGCGGAGTACGACTTGACTACTCGCATCGCGCACTTT






TTGGATCGGCATCTAGTCTTTCCGCTTCTTGAATTTCTCTCTGTAAAGGAGGTTCGTGGCGGAGAGA





TGCTGATCGCGCTGAACTGACCGGTGCGGCCCGGGGGTGAGTGGCGAGTCTCCCTCTGAGTCCTCCC





CAGCAGCGCGGCCGGCGCCGGCTCTTTGGGCGAACCCTCCAGTTCCTAGACTTTGAGAGGCGTCTCT





CCCCCGCCCGACCGCCCAGATGCAGTTTCGCCTTTTCTCCTTTGCCCTCATCATTCTGAACTGCATG





GATTACAGCCACTGCCAAGGCAACCGATGGAGACGCAGTAAGCGAGCTAGTTATGTATCAAATCCCA





TTTGCAAGGGTTGTTTGTCTTGTTCAAAGGACAATGGGTGTAGCCGATGTCAACAGAAGTTGTTCTT





CTTCCTTCGAAGAGAAGGGATGCGCCAGTATGGAGAGTGCCTGCATTCCTGCCCATCCGGGTACTAT





GGACACCGAGCCCCAGATATGAACAGATGTGCAAGATGCAGAATAGAAAACTGTGATTCTTGCTTTA





GCAAAGACTTTTGTACCAAGTGCAAAGTAGGCTTTTATTTGCATAGAGGCCGTTGCTTTGATGAATG





TCCAGATGGTTTTGCACCATTAGAAGAAACCATGGAATGTGTGGAAGGATGTGAAGTTGGTCATTGG





AGCGAATGGGGAACTTGTAGCAGAAATAATCGCACATGTGGATTTAAATGGGGTCTGGAAACCAGAA





CACGGCAAATTGTTAAAAAGCCAGTGAAAGACACAATACTGTGTCCAACCATTGCTGAATCCAGGAG





ATGCAAGATGACAATGAGGCATTGTCCAGGAGGGAAGAGAACACCAAAGGCGAAGGAGAAGAGGAAC





AAGAAAAAGAAAAGGAAGCTGATAGAAAGGGCCCAGGAGCAACACAGCGTCTTCCTAGCTACAGACA





GAGCTAACCAATAA





EIF3E(e1)-RSP02(e2) translocation fusion polypeptide sequence


(SEQ ID NO: 75)



MAEYDLTTRIAHFLDRHLVFPLLEFLSVKEVRGGEMLIALNMQFRLFSFALIILNCMDYSHCQGNRW






RRSKRASYVSNPICKGCLSCSKDNGCSRCQQKLFFFLRREGMRQYGECLHSCPSGYYGHRAPDMNRC





ARCRIENCDSCFSKDFCTKCKVGFYLHRGRCFDECPDGFAPLEETMECVEGCEVGHWSEWGTCSRNN





RTCGFKWGLETRTRQIVKKPVKDTILCPTIAESRRCKMTMRHCPGGKRTPKAKEKRNKKKKRKLIER





AQEQHSVFLATDRANQ





PTPRK(e1)-RSP03(e2) translocation fusion polynucleotide sequence


(SEQ ID NO: 76)



ATGGATACGACTGCGGCGGCGGCGCTGCCTGCTTTTGTGGCGCTCTTGCTCCTCTCTCCTTGGCCTC






TCCTGGGATCGGCCCAAGGCCAGTTCTCCGCAGTGCATCCTAACGTTAGTCAAGGCTGCCAAGGAGG





CTGTGCAACATGCTCAGATTACAATGGATGTTTGTCATGTAAGCCCAGACTATTTTTTGCTCTGGAA





AGAATTGGCATGAAGCAGATTGGAGTATGTCTCTCTTCATGTCCAAGTGGATATTATGGAACTCGAT





ATCCAGATATAAATAAGTGTACAAAATGCAAAGCTGACTGTGATACCTGTTTCAACAAAAATTTCTG





CACAAAATGTAAAAGTGGATTTTACTTACACCTTGGAAAGTGCCTTGACAATTGCCCAGAAGGGTTG





GAAGCCAACAACCATACTATGGAGTGTGTCAGTATTGTGCACTGTGAGGTCAGTGAATGGAATCCTT





GGAGTCCATGCACGAAGAAGGGAAAAACATGTGGCTTCAAAAGAGGGACTGAAACACGGGTCCGAGA





AATAATACAGCATCCTTCAGCAAAGGGTAACCTGTGTCCCCCAACAAATGAGACAAGAAAGTGTACA





GTGCAAAGGAAGAAGTGTCAGAAGGGAGAACGAGGAAAAAAAGGAAGGGAGAGGAAAAGAAAAAAAC





CTAATAAAGGAGAAAGTAAAGAAGCAATACCTGACAGCAAAAGTCTGGAATCCAGCAAAGAAATCCC





AGAGCAACGAGAAAACAAACAGCAGCAGAAGAAGCGAAAAGTCCAAGATAAACAGAAATCGGTATCA





GTCAGCACTGTACACTAG





PTPRK(e1)-RSP03(e2) translocation fusion polypeptide sequence


(SEQ ID NO: 77)



MDTTAAAALPAFVALLLLSPWPLLGSAQGQFSAVHPNVSQGCQGGCATCSDYNGCLSCKPRLFFALE






RIGMKQIGVCLSSCPSGYYGTRYPDINKCTKCKADCDTCFNKNFCTKCKSGFYLHLGKCLDNCPEGL





EANNHTMECVSIVHCEVSEWNPWSPCTKKGKTCGFKRGTETRVREIIQHPSAKGNLCPPTNETRKCT





VQRKKCQKGERGKKGR





PTPRK(e7)-RSP03(e2) translocation fusion polynucleotide sequence


(SEQ ID NO: 78)



ATGGATACGACTGCGGCGGCGGCGCTGCCTGCTTTTGTGGCGCTCTTGCTCCTCTCTCCTTGGCCTC






TCCTGGGATCGGCCCAAGGCCAGTTCTCCGCAGGTGGCTGTACTTTTGATGATGGTCCAGGGGCCTG





TGATTACCACCAGGATCTGTATGATGACTTTGAATGGGTGCATGTTAGTGCTCAAGAGCCTCATTAT





CTACCACCCGAGATGCCCCAAGGTTCCTATATGATAGTGGACTCTTCAGATCACGACCCTGGAGAAA





AAGCCAGACTTCAGCTGCCTACAATGAAGGAGAACGACACTCACTGCATTGATTTCAGTTACCTATT





ATATAGCCAGAAAGGACTGAATCCTGGCACTTTGAACATATTAGTTAGGGTGAATAAAGGACCTCTT





GCCAATCCAATTTGGAATGTGACTGGATTCACGGGTAGAGATTGGCTTCGGGCTGAGCTAGCAGTGA





GCACCTTTTGGCCCAATGAATATCAGGTAATATTTGAAGCTGAAGTCTCAGGAGGGAGAAGTGGTTA





TATTGCCATTGATGACATCCAAGTACTGAGTTATCCTTGTGATAAATCTCCTCATTTCCTCCGTCTA





GGGGATGTAGAGGTGAATGCAGGGCAAAACGCTACATTTCAGTGCATTGCCACAGGGAGAGATGCTG





TGCATAACAAGTTATGGCTCCAGAGACGAAATGGAGAAGATATACCAGTAGCCCAGACTAAGAACAT





CAATCATAGAAGGTTTGCCGCTTCCTTCAGATTGCAAGAAGTGACAAAAACTGACCAGGATTTGTAT





CGCTGTGTAACTCAGTCAGAACGAGGTTCCGGTGTGTCCAATTTTGCTCAACTTATTGTGAGAGAAC





CGCCAAGACCCATTGCTCCTCCTCAGCTTCTTGGTGTTGGGCCTACATATTTGCTGATCCAACTAAA





TGCCAACTCGATCATTGGCGATGGTCCTATCATCCTGAAAGAAGTAGAGTACCGAATGACATCAGGA





TCCTGGACAGAAACCCATGCAGTCAATGCTCCAACTTACAAATTATGGCATTTAGATCCAGATACCG





AATATGAGATCCGAGTTCTACTTACAAGACCTGGTGAAGGTGGAACGGGGCTCCCAGGACCTCCACT





AATCACCAGAACAAAATGTGCAGTGCATCCTAACGTTAGTCAAGGCTGCCAAGGAGGCTGTGCAACA





TGCTCAGATTACAATGGATGTTTGTCATGTAAGCCCAGACTATTTTTTGCTCTGGAAAGAATTGGCA





TGAAGCAGATTGGAGTATGTCTCTCTTCATGTCCAAGTGGATATTATGGAACTCGATATCCAGATAT





AAATAAGTGTACAAAATGCAAAGCTGACTGTGATACCTGTTTCAACAAAAATTTCTGCACAAAATGT





AAAAGTGGATTTTACTTACACCTTGGAAAGTGCCTTGACAATTGCCCAGAAGGGTTGGAAGCCAACA





ACCATACTATGGAGTGTGTCAGTATTGTGCACTGTGAGGTCAGTGAATGGAATCCTTGGAGTCCATG





CACGAAGAAGGGAAAAACATGTGGCTTCAAAAGAGGGACTGAAACACGGGTCCGAGAAATAATACAG





CATCCTTCAGCAAAGGGTAACCTGTGTCCCCCAACAAATGAGACAAGAAAGTGTACAGTGCAAAGGA





AGAAGTGTCAGAAGGGAGAACGAGGAAAAAAAGGAAGGGAGAGGAAAAGAAAAAAACCTAATAAAGG





AGAAAGTAAAGAAGCAATACCTGACAGCAAAAGTCTGGAATCCAGCAAAGAAATCCCAGAGCAACGA





GAAAACAAACAGCAGCAGAAGAAGCGAAAAGTCCAAGATAAACAGAAATCGGTATCAGTCAGCACTG





TACACTAG





PTPRK(e7)-RSP03(e2) translocation fusion polypeptide sequence


(SEQ ID NO: 79)



MDTTAAAALPAFVALLLLSPWPLLGSAQGQFSAGGCTFDDGPGACDYHQDLYDDFEWVHVSAQEPHY






LPPEMPQGSYMIVDSSDHDPGEKARLQLPTMKENDTHCIDFSYLLYSQKGLNPGTLNILVRVNKGPL





ANPIWNVTGFTGRDWLRAELAVSTFWPNEYQVIFEAEVSGGRSGYIAIDDIQVLSYPCDKSPHFLRL





GDVEVNAGQNATFQCIATGRDAVHNKLWLQRRNGEDIPVAQTKNINHRRFAASFRLQEVTKTDQDLY





RCVTQSERGSGVSNFAQLIVREPPRPIAPPQLLGVGPTYLLIQLNANSIIGDGPIILKEVEYRMTSG





SWTETHAVNAPTYKLWHLDPDTEYEIRVLLTRPGEGGTGLPGPPLITRTKCAVHPNVSQGCQGGCAT





CSDYNGCLSCKPRLFFALERIGMKQIGVCLSSCPSGYYGTRYPDINKCTKCKADCDTCFNKNFCTKC





KSGFYLHLGKCLDNCPEGLEANNHTMECVSIVHCEVSEWNPWSPCTKKGKTCGFKRGTETRVREIIQ





HPSAKGNLCPPTNETRKCTVQRKKCQKGERGKKGRERKRKKPNKGESKEAIPDSKSLESSKEIPEQR





ENKQQQKKRKVQDKQKSVSVSTVH






Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, the descriptions and examples should not be construed as limiting the scope of the invention. The disclosures of all patent and scientific literature cited herein are expressly incorporated in their entirety by reference.










LENGTHY TABLES




The patent application contains a lengthy table section. A copy of the table is available in electronic form from the USPTO web site (). An electronic copy of the table will also be available from the USPTO upon request and payment of the fee set forth in 37 CFR 1.19(b)(3).





Claims
  • 1.-44. (canceled)
  • 45. A method of identifying a wnt pathway antagonist, comprising: (a) contacting cancer cells comprising an RSPO2 translocation with a candidate wnt pathway antagonist, (b) contacting reference cancer cells with the candidate antagonist, (c) determining the level of wnt pathway signaling, distribution of cell cycle stage, level of cell proliferation, and/or level of cancer cell death of the cancer cells of (a) compared to the reference cancer cells of (b) in the presence of the antibodies, and (d) identifying the candidate as a wnt pathway antagonist by a decrease the level of wnt pathway signaling, change the distribution of cell cycle stage, decrease the level of cell proliferation, and/or increase the level of cancer cell death in the cancer cells of (a) compared to the reference cancer cells of (b).
  • 46. The method of claim 45, wherein level of wnt pathway signaling is determined for the cancer cells of (a) and the reference cancer cells of (b), using a luciferase reporter assay.
  • 47. The method of claim 45, wherein the distribution of cell cycle stage is determined for the cancer cells of (a) and the reference cancer cells of (b).
  • 48. The method of claim 45, wherein level of cell proliferation is determined for the cancer cells of (a) and the reference cancer cells of (b).
  • 49. The method of claim 45, wherein the level of cancer cell death in the cancer cells of (a) compared to the reference cancer cells of (b) is determined.
  • 50. The method of claim 45, wherein the RSPO2 translocation comprises EIF3E and RSPO2.
  • 51. The method of claim 50, wherein the RSPO2 translocation comprises EIF3E exon 1 and RSPO2 exon 2.
  • 52. The method of claim 50, wherein the RSPO2 translocation comprises EIF3E exon 1 and RSPO2 exon 3.
  • 53. The method of claim 50, wherein the RSPO2 translocation comprises SEQ ID NO:71.
  • 54. The method of claim 45, wherein the wnt pathway antagonist is an antibody.
  • 55. A method of identifying a wnt pathway antagonist, comprising: (a) contacting cancer cells comprising an RSPO3 translocation with a candidate wnt pathway antagonist, (b) contacting reference cancer cells with the candidate antagonist, (c) determining the level of wnt pathway signaling, distribution of cell cycle stage, level of cell proliferation, and/or level of cancer cell death of the cancer cells of (a) compared to the reference cancer cells of (b) in the presence of the antibodies, and (d) identifying the candidate as a wnt pathway antagonist by a decrease the level of wnt pathway signaling, change the distribution of cell cycle stage, decrease the level of cell proliferation, and/or increase the level of cancer cell death in the cancer cells of (a) compared to the reference cancer cells of (b).
  • 56. The method of claim 55, wherein level of wnt pathway signaling is determined for the cancer cells of (a) and the reference cancer cells of (b), using a luciferase reporter assay.
  • 57. The method of claim 55, wherein the distribution of cell cycle stage is determined for the cancer cells of (a) and the reference cancer cells of (b).
  • 58. The method of claim 55, wherein level of cell proliferation is determined for the cancer cells of (a) and the reference cancer cells of (b).
  • 59. The method of claim 55, wherein the level of cancer cell death in the cancer cells of (a) compared to the reference cancer cells of (b) is determined.
  • 60. The method of claim 55, wherein the RSPO3 translocation comprises PTPRK and RSPO3.
  • 61. The method of claim 50, wherein the RSPO3 translocation comprises PTPRK exon 1 and RSPO3 exon 2.
  • 62. The method of claim 50, wherein the RSPO3 translocation comprises PTPRK exon 7 and RSPO3 exon 2.
  • 63. The method of claim 50, wherein the RSPO3 translocation comprises SEQ ID NO:72 and/or SEQ ID NO: 73.
  • 64. The method of claim 45, wherein the wnt pathway antagonist is an antibody.
CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patent application Ser. No. 13/764,631, filed on Feb. 11, 2013, which claims benefit under 35 U.S.C. § 119 to U.S. Patent Application No. 61/597,746, filed on Feb. 11, 2012 and 61/674,763 filed on Jul. 23, 2012, the entire contents of which are incorporated herein by reference.

Provisional Applications (2)
Number Date Country
61674763 Jul 2012 US
61597746 Feb 2012 US
Continuations (1)
Number Date Country
Parent 13764631 Feb 2013 US
Child 16895395 US