WO2021202780A2 - Methods and compositions for treating cancer - Google Patents

Methods and compositions for treating cancer Download PDF

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Publication number
WO2021202780A2
WO2021202780A2 PCT/US2021/025230 US2021025230W WO2021202780A2 WO 2021202780 A2 WO2021202780 A2 WO 2021202780A2 US 2021025230 W US2021025230 W US 2021025230W WO 2021202780 A2 WO2021202780 A2 WO 2021202780A2
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Prior art keywords
cancer
pkmyt1
protein
subunit
amino
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English (en)
French (fr)
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WO2021202780A3 (en
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Shawn YOST
Stephen Harrison
Christine Taylor Brew
Michael David Winther
Sourabh Banerjee
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Engine Biosciences Pte Ltd
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Engine Biosciences Pte Ltd
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Priority to CN202180039991.2A priority Critical patent/CN115769077A/zh
Priority to MX2022012181A priority patent/MX2022012181A/es
Priority to CA3173799A priority patent/CA3173799A1/en
Priority to JP2022559338A priority patent/JP2023519931A/ja
Priority to KR1020227036696A priority patent/KR20230017167A/ko
Priority to AU2021249111A priority patent/AU2021249111A1/en
Application filed by Engine Biosciences Pte Ltd filed Critical Engine Biosciences Pte Ltd
Priority to EP21780417.8A priority patent/EP4127722A4/en
Publication of WO2021202780A2 publication Critical patent/WO2021202780A2/en
Publication of WO2021202780A3 publication Critical patent/WO2021202780A3/en
Priority to US17/936,089 priority patent/US20230149415A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N9/00—Enzymes; Proenzymes; Compositions thereof; Processes for preparing, activating, inhibiting, separating or purifying enzymes
    • C12N9/14—Hydrolases (3)
    • C12N9/16—Hydrolases (3) acting on ester bonds (3.1)
    • C12N9/22—Ribonucleases [RNase]; Deoxyribonucleases [DNase]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
    • A61K31/5375—1,4-Oxazines, e.g. morpholine
    • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7088—Compounds having three or more nucleosides or nucleotides
    • A61K31/713—Double-stranded nucleic acids or oligonucleotides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

  • cancer e.g., liver or ovarian cancer
  • systemic treatments such as chemotherapies may be toxic and may have negative side effects on patients.
  • the lack of specific biomarkers can complicate development or use of targeted treatments.
  • One approach for treating cancer cells includes identifying target genes and biomarkers which identify which cancer cells may be sensitive to alteration in the activity of those target genes.
  • identifying synthetic lethal gene pairs in which an inhibition of both genes or inhibition or one gene in the presence of a mutation or deletion in a second gene may lead to cell death, may be useful therapeutically in killing cancer cells while maintaining viability of non-cancer cells.
  • a cancer e.g., liver or ovarian cancer
  • the subject having or suspected of having a cancer may have, in one or more cancer cells of the cancer, a mutation in, deletion in, difference in (e.g., a decrease or increase in) expression of, or difference (e.g. decrease, increase or alteration) in activity level of a first gene compared to a healthy or non-cancer control.
  • a mutation in, deletion in, difference in e.g., a decrease or increase in
  • difference e.g. decrease, increase or alteration
  • the first gene and the second gene may form a synthetic lethal pair.
  • the first gene may encode a regulatory protein (e.g. that regulates the cell cycle), and the second gene may encode a therapeutically modifiable protein (e.g. a kinase).
  • a method for treating a subject having or suspected of having a cancer comprising administering to the subject a therapeutically effective amount of one or more therapeutic agents that causes a difference in (e.g., a decrease or increase in) expression or activity of protein kinase, membrane associated tyrosine/threonine 1 (PKMYT1) or WEE1 G2 checkpoint kinase (WEE1) in the subject, thereby treating the subject for the cancer, wherein the cancer is associated with cancerous tissue comprising a cell that has a difference in expression or activity level of Protein Phosphatase 2 (PP2A) or a subunit thereof as compared to a healthy control, or wherein the cancer is associated with cancerous tissue comprising a cell that displays mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control.
  • a cancer e.g., liver or ovarian cancer
  • the cancer is associated with cancerous tissue comprising a cell that has a difference in expression or activity level of Protein Phosphatase 2 (PP2A) or a subunit thereof as compared to a healthy control.
  • P2A Protein Phosphatase 2
  • the cancer is associated with cancerous tissue comprising a cell that displays mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control.
  • P2A Protein Phosphatase 2
  • the presence or absence of the mutations and/or deletions is identified by an assay of cells derived from tissue obtained from the subject.
  • the assay is a next generation sequencing-based assay.
  • the one or more therapeutic agents comprise one or more members selected from the group consisting of a small molecule (e.g., a molecule having a molecular weight of less than 900 Daltons), a protein, an intrabody, a peptide, a ribonucleic acid (RNA) molecule, and, an endonuclease complex and a deoxyribonucleic acid (DNA) construct.
  • a small molecule e.g., a molecule having a molecular weight of less than 900 Daltons
  • RNA ribonucleic acid
  • DNA deoxyribonucleic acid
  • the DNA construct comprises an endonuclease gene.
  • the endonuclease gene encodes a CRISPR associated (Cas) protein.
  • the Cas is Cas9.
  • the DNA construct comprises a guide RNA targeting a PKMYT1 gene.
  • the endonuclease complex comprises an endonuclease.
  • the endonuclease is a CRISPR associated (Cas) protein.
  • the small molecule comprises a PKMYT1 inhibitor.
  • the PKMYT1 inhibitor comprises 5-((5-methoxy-2-((4- morpholinophenyl)amino)pyrimidin-4-yl)amino)-2-methylphenol, N-(2-chloro-6- methylphenyl)-2-((6-(4-(2 -hydroxy ethyl)piperazin-l -yl)-2-methylpyrimidin-4- yl)amino)thiazole-5-carboxamide (dasatinib), 4-((2,4-dichloro-5-methoxyphenyl)amino)-6- methoxy-7-(3-(4-methylpiperazin-l-yl)propoxy)quinoline-3-carbonitrile (bosutinib), N-(5- chlorobenzo[d][l,3]dioxol-4-yl)-7-(2-(4-chloro-6-methylphenyl)
  • the small molecule comprises a WEE1 inhibitor.
  • the WEE1 inhibitor comprises 6-(2,6-dichlorophenyl)-2-((4-(2- (diethylamino)ethoxy)phenyl)amino)-8-methylpyrido[2,3- d]pyrimidin-7(8H )-one (PD- 0166285), 2-allyl- 1 -(6-(2-hydroxypropan-2-yl)pyri din-2 -yl)-6-((4-(4-methylpiperazin- 1 - yl)phenyl)amino)-l,2-dihydro-3H -pyrazolo[3,4- d]pyrimidin-3-one (MK-1775), 9-hydroxy-4- phenylpyrrolo[3, 4-c]carbazole-l, 3(2H , 6H )-di one (PD-407824), 6-butyl-4-(2-chlorophen
  • the PP2A subunit is selected from the group consisting of 65 kDa regulatory subunit A alpha (PPP2R1 A), 65 kDa regulatory subunit A beta (PPP2R1B), 55 kDa regulatory subunit B alpha (PPP2R2A), 55 kDa regulatory subunit B beta (PPP2R2B), 55 kDa regulatory subunit B gamma (PPP2R2C), 55 kDa regulatory subunit B delta (PPP2R2D), 72/130 kDa regulatory subunit B (PPP2R3A), 48 kDa regulatory subunit B (PPP2R3B), regulatory subunit B” subunit gamma (PPP2R3C), regulatory subunit B’ (PPP2R4), 56 kDa regulatory subunit alpha (PPP2R5A), 56 kDa regulatory subunit beta (PPP2R5B), 56 kDa regulatory subunit gamma (PPP2R4), 56 kDa
  • the PP2A subunit is PPP2R2A.
  • the method disclosed herein further comprises administering to the subject a therapeutically effective amount of one or more therapeutic agents that causes a difference in (e.g., a decrease in) expression or activity of PPP2R2A.
  • the healthy control is from one or more subjects that do not exhibit the cancer (e.g., liver or ovarian cancer).
  • the cancerous tissue is breast tissue, pancreatic tissue, uterine tissue, bladder tissue, colorectal tissue, prostate tissue, liver tissue, or ovarian tissue.
  • the cancerous tissue is liver tissue. In some embodiments, the cancerous tissue is ovarian tissue.
  • compositions for treating a subject having or suspected of having a cancer comprising a formulation comprising at least one therapeutic agent, wherein the at least one therapeutic agent is present in an amount that is effective to cause a difference in (e.g., a decrease or increase in) expression or activity of protein kinase, membrane associated tyrosine/threonine 1 (PKMYT1) or WEE1 G2 checkpoint kinase (WEE1) following administration to the subject, and wherein the cancer is associated with cancerous tissue comprising a cell that has a difference in expression or activity level of Protein Phosphatase 2 (PP2A) or a subunit thereof as compared to a healthy control, or wherein the cancer is associated with cancerous tissue comprising a cell that displays mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control.
  • a cancer e.g., liver or ovarian cancer
  • the cancer is associated with cancerous tissue comprising a cell that has a difference in expression or activity level of Protein Phosphatase 2 (PP2A) or a subunit thereof as compared to a healthy control.
  • P2A Protein Phosphatase 2
  • the cancer is associated with cancerous tissue comprising a cell that displays mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control.
  • P2A Protein Phosphatase 2
  • the presence or absence of the mutations and/or deletions is identified by an assay of cells derived from tissue obtained from the subject.
  • the assay is a next generation sequencing-based assay.
  • the at least one therapeutic agent comprises one or more members selected from the group consisting of a small molecule (e.g., a molecule having a molecular weight of less than 900 Daltons), a protein, an intrabody, a peptide, a ribonucleic acid (RNA) molecule, and, an endonuclease complex and a deoxyribonucleic acid (DNA) construct.
  • a small molecule e.g., a molecule having a molecular weight of less than 900 Daltons
  • the DNA construct comprises an endonuclease gene.
  • the endonuclease gene encodes a CRISPR associated (Cas) protein.
  • the Cas is Cas9.
  • the DNA construct comprises a guide RNA directed to a PKMYTlgene.
  • the endonuclease complex comprises an endonuclease.
  • the endonuclease is a CRISPR associated (Cas) protein.
  • the small molecule comprises a PKMYT1 inhibitor.
  • the PKMYT1 inhibitor comprises 5-((5-methoxy-2-((4- morpholinophenyl)amino)pyrimidin-4-yl)amino)-2-methylphenol, N-(2-chloro-6- methylphenyl)-2-((6-(4-(2 -hydroxy ethyl)piperazin-l -yl)-2-methylpyrimidin-4- yl)amino)thiazole-5-carboxamide (dasatinib), 4-((2,4-dichloro-5-methoxyphenyl)amino)-6- methoxy-7-(3-(4-methylpiperazin-l-yl)propoxy)quinoline-3-carbonitrile (bosutinib), N-(5- chlorobenzo[ d][l,3]dioxol-4-yl)-7-(2-(
  • the small molecule comprises a WEE1 inhibitor.
  • the WEE1 inhibitor comprises 6-(2,6-dichlorophenyl)-2-((4-(2- (diethylamino)ethoxy)phenyl)amino)-8-methylpyrido[2,3-6/]pyrimidin-7(8H )-one (PD- 0166285), 2-allyl- 1 -(6-(2-hydroxypropan-2-yl)pyri din-2 -yl)-6-((4-(4-methylpiperazin- 1 - yl)phenyl)amino)-l,2-dihydro-3H -pyrazolo[3,4-d]pyrimidin-3-one (MK-1775), 9-hydroxy-4- phenylpyrrolo[3, 4-c]carbazole-1,3(2H , 6H )-di one (PD-407824), 6-butyl-4-(2-chlorophenyl)-
  • the PP2A subunit is selected from the group consisting of 65 kDa regulatory subunit A alpha (PPP2R1 A), 65 kDa regulatory subunit A beta (PPP2R1B), 55 kDa regulatory subunit B alpha (PPP2R2A), 55 kDa regulatory subunit B beta (PPP2R2B), 55 kDa regulatory subunit B gamma (PPP2R2C), 55 kDa regulatory subunit B delta (PPP2R2D), 72/130 kDa regulatory subunit B (PPP2R3A), 48 kDa regulatory subunit B (PPP2R3B), regulatory subunit B” subunit gamma (PPP2R3C), regulatory subunit B’ (PPP2R4), 56 kDa regulatory subunit alpha (PPP2R5A), 56 kDa regulatory subunit beta (PPP2R5B), 56 kDa regulatory subunit gamma (PPP2R4), 56 kDa
  • the composition further comprises a formulation comprising at least one therapeutic agent present in an amount that is effective to cause a difference in (e.g., a decrease or increase in) expression or activity of PPP2R2A.
  • the healthy control is from one or more subjects that do not exhibit the cancer (e.g., liver or ovarian cancer).
  • the cancerous tissue is breast tissue. In some embodiments, the cancerous tissue is liver tissue. In some embodiments, the cancerous tissue is ovarian tissue.
  • the formulation further comprises an excipient.
  • the excipient stabilizes the at least one therapeutic agent or provides therapeutic enhancement of the at least one therapeutic agent following administration to the subject as compared to the at least one therapeutic agent being administered to the subject in absence of the excipient.
  • kits for treating a subject having or suspected of having a cancer comprising: a composition comprising a formulation comprising at least one therapeutic agent, wherein the at least one therapeutic agent is present in an amount that is effective to cause a difference in expression or activity of protein kinase, membrane associated tyrosine/threonine 1 (PKMYT1) or WEE1 G2 checkpoint kinase (WEE1) following administration to the subject, and wherein the cancer is associated with cancerous tissue comprising a cell that has a difference in expression or activity level of Protein Phosphatase 2 (PP2A) or a subunit thereof as compared to a healthy control, or wherein the cancer is associated with cancerous tissue comprising a cell that displays mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control; and one or more instructions for administration of the composition to the subject.
  • a composition comprising a formulation comprising at least one therapeutic agent, where
  • the cancer is associated with cancerous tissue comprising a cell that has a difference in expression or activity level of Protein Phosphatase 2 (PP2A) or a subunit thereof as compared to a healthy control.
  • the difference in expression or activity level is a decrease in expression or activity level.
  • the cancer is associated with cancerous tissue comprising a cell that displays mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control.
  • P2A Protein Phosphatase 2
  • the presence or absence of the mutations and/or deletions is identified by an assay of cells derived from tissue obtained from the subject.
  • the assay is a next generation sequencing-based assay.
  • a method for identifying a disease in a subject comprising assaying cells derived from tissue obtained from a subject to identify the presence or absence of mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control, and outputting a report indicative of the presence or absence of mutations and/or deletions in genes encoding subunits of Protein Phosphatase 2 (PP2A) as compared to a healthy control.
  • the method comprises a next generation sequencing-based assay.
  • FIGS. 1A-B schematically show signaling pathways for protein kinase, membrane associated tyrosine/threonine 1 (PKMYT1, MYT1), Weel, and Protein Phosphatase 2 55 kDa regulatory subunit B alpha (PPP2R2A).
  • PPMYT1, MYT1 membrane associated tyrosine/threonine 1
  • PPP2R2A Protein Phosphatase 2 55 kDa regulatory subunit B alpha
  • FIG. 2 shows a plot of frequency of PPP2R2A inactivation or deficiency in different cancer types.
  • FIG. 3 schematically shows an example workflow for determining the effect of treatment of a population of cultured cancer cells with a nucleic acid molecule.
  • FIG. 4 schematically shows another example workflow for determining the effect of treatment of cultured cancer cells that are deficient in a gene using a single guide RNA that can induce a mutation in a specific gene.
  • FIG. 5 shows a plot of the expression level of PKMYT1 in cancer versus normal cells in various cancer types.
  • FIG. 6 shows a scatterplot of expression level of PKMYT1 in cancer (tumor) cells compared to normal cells.
  • FIGS. 7A-B show scatterplots of essentiality of PKMYT1 in two different databases (Achilles, Demeter) of cells, having inactive PPP2R2A or having wild-type PPP2R2A.
  • FIGS. 8A-B show example data of a CRISPR-based approach to knock out PKMYT1 and PPP2R2A in cells from two cancer types.
  • FIG. 9 shows HEP3B colony formation data for dual knock-out of PKMYT1 and PPP2R2A.
  • FIG. 10 shows the results of PKMYT1 knockout in Huhl cells which have an endogenous deletion of the PPP2R2A gene locus.
  • FIG. 11 shows the results of a screen of 21 different genes to determine synthetic lethality with PKMYT1.
  • FIG. 12 shows the results of PKMYT1 inhibition with small molecule inhibitors in isogenic cell lines with PPP2R2A knockout.
  • the term “subject,” as used herein, generally refers to an animal, such as a mammal (e.g., human), reptile, or avian (e.g., bird), or other organism, such as a plant.
  • the subject can be a vertebrate, a mammal, a rodent (e.g., a mouse), a primate, a simian or a human.
  • the subject can be a healthy individual, an individual that is asymptomatic with respect to a disease (e.g., liver or ovarian cancer), an individual that has or is suspected of having the disease (e.g., liver or ovarian cancer) or a pre-disposition to the disease, or an individual that is symptomatic with respect to the disease.
  • the subject may be in need of therapy.
  • the subject can be a patient undergoing monitoring or treatment by a healthcare provider, such as a treating physician.
  • genomic information generally refers to genomic information from a subject, which may be, for example, at least a portion or an entirety of a subject’s hereditary information.
  • a genome can be encoded in a deoxyribonucleic acid (DNA) molecule (s) and may be expressed in a ribonucleic acid (RNA) molecule(s).
  • a genome can comprise coding regions (e.g., that code for proteins) as well as non-coding regions.
  • a genome can include the sequence of all chromosomes together in an organism. For example, the human genome ordinarily has a total of 46 chromosomes. The sequence of all of these together may constitute a human genome.
  • protein phosphatase 2 regulatory subunit B alpha and “serine/threonine-protein phosphatase 2A 55 kDa regulatory subunit B alpha isoform” both refer to the same gene, PPP2R2A.
  • a method for treating a subject having or suspected of having a cancer can comprise administering to the subject a therapeutically effective amount of one or more therapeutic agents that cause a difference in (e.g., a decrease or increase in) expression or activity of one or more genes, thereby treating the subject for the cancer.
  • the cancer may comprise a cell that has a difference in (e.g., a decrease or increase in) expression or a difference (e.g.
  • the first gene and the second gene form a synthetic lethal gene pair.
  • the first gene is Protein Phosphatase 2 55 kDa regulatory subunit B alpha (PPP2R2A)
  • PPP2R2A Protein Phosphatase 2 55 kDa regulatory subunit B alpha
  • the second gene encodes a kinase, e.g., protein kinase, membrane associated tyrosine/threonine 1 (PKMYT1) or WEE1 G2 checkpoint kinase (WEE1).
  • the first gene encodes for a biomarker that is deficient (e.g., under-expressed, mutated, over-expressed) in the cancer cell
  • the second gene comprises a gene target to be knocked down or knocked out, thereby decreasing the expression or activity level of the second gene.
  • the first gene has a difference in (e.g., a decrease or increase in) expression or a difference (e.g. decrease, increase or alteration) in activity level in the cancer cell, and administration of or exposure to a therapeutically effective amount of one or more therapeutic agents that cause a difference in (e.g., a decrease or increase in) in expression or activity of the second gene in the cancer or cancer cell causes inhibition or death of the cell.
  • the first gene encodes a protein that regulates the cell cycle, e.g., PPP2R2A
  • the second gene encodes a kinase, e.g.,
  • the first gene display mutations and/or deletions as compared to a healthy control.
  • the presence or absence of such mutations can be identified by assaying tissue-derived cells obtained from a subject.
  • Appropriate assays can include those involving genomic DNA, mRNA, or cDNA.
  • genomic DNA is first obtained (using any standard technique) from cells (e.g., ovarian cells) of a subject to be tested. If appropriate, cDNA can be prepared or mRNA can be obtained.
  • nucleic acids can be amplified by any known nucleic acid amplification technique (e.g., polymerase chain reaction) to a sufficient quantity and purity, and further analyzed to detect mutations.
  • genomic DNA can be isolated from a sample, and all exonic sequences, and the intron/exon junction regions including the regions required for exon/intron splicing, can be amplified into one or more amplicons and further analyzed for the presence or absence of mutations.
  • the assay is a next generation sequencing-based assay, such as FoundationOne®CDxTM or Tempus xTTM.
  • the first gene e.g., PPP2R2A
  • the second gene e.g., PKMYT1
  • the first gene and the second gene may form a synthetic lethal pair, such that inhibition or decreased expression or activity level in both the first gene and the second gene is lethal to the cell (e.g., results in apoptosis, necrosis, inhibition of proliferation, etc.), but the inhibition or decreased activity of the first gene alone or the second gene alone is not sufficient to kill the cell.
  • inhibition or decreased expression or activity of the first gene (e.g., PPP2R2A) or the second gene (e.g., PKMYT1) alone result in a reduction in viability of a cell or cell population, but the decreased expression or activity of both genes (e.g., knockdown or knockout of PPP2R2A and PKMYT1) results in a greater reduction in viability of the cell or cell population.
  • the decrease of expression or activity of PPP2R2A and PKMYT1 may act synergistically, with a greater reduction in viability than the sum of the reductions of viability from decreased expression or activity of each member of the gene pair.
  • the forced decreased expression or activity level (e.g., via knock down or knock out) of the second gene may be lethal to the cell having the deficiency in the first gene, but non-toxic or non-lethal in cells that do not have the deficiency in the first gene.
  • Such a method of treating a subject having a cancer e.g., liver or ovarian cancer
  • a cancer which cancer is associated with cancerous tissue comprising a cell having the deficiency in the first gene (e.g., PPP2R2A)
  • a single inhibitor e.g., a therapeutically effective amount of a therapeutic agent that causes a decrease in expression or activity of PKMYT1
  • a single inhibitor e.g., a therapeutically effective amount of a therapeutic agent that causes a decrease in expression or activity of PKMYT1
  • the first gene may be or encode a protein that is an upstream agonist or antagonist of the second gene, or the second gene may be or encode a protein that is an upstream agonist or antagonist of the first gene.
  • the first gene may be PPP2R2A and the second gene may be PKMYT1.
  • PPP2R2A when expressed in a normal (e.g., non-mutated) cell, can act as an indirect positive regulator of PKMYT1, which is a kinase that is an upstream regulator of various proteins within a protein signaling cascade or signal transduction pathway (see, FIGS. 1A-B).
  • PKMYT1 can interact with or regulate CDK1 and thereby affect cell cycle progression.
  • PPP2R2A In normal or non-cancerous cells, expression of PPP2R2A can positively regulate PKMYT1, thus indirectly inhibiting CDK1 and preventing uncontrolled cell cycle progression. PPP2R2A expression is also known to promote DNA repair (Cancer Res. 2012 Dec 15;72(24):6414-24.). Hence, in cells where PPP2R2A is deficient (e.g., a cell that has a mutated PPP2R2A), damaged DNA may go unrepaired, and PKMYT1 may not be inhibited, thereby causing increased expression of the downstream protein CDK1. Accordingly, PKMYT1 inhibition in PPP2R2A-deficient cells can lead to uncontrolled cell cycle progression for cells with damaged DNA and thus induce cell death.
  • the first gene may be an agonist or antagonist of another gene (or encoded protein) that regulates the second gene, or the second gene may be an agonist or antagonist of another gene or encoded protein that regulates the first gene.
  • the first gene may be an agonist or antagonist of another gene (or encoded protein) that regulates yet another gene (or encoded protein) that may regulate the second gene, or the second gene may be an agonist or antagonist of another gene (or encoded protein) that regulates yet another gene (or encoded protein) that may regulate the first gene.
  • the first or second gene may regulate another gene or protein that is at least 1, 2, 3, 4,
  • components e.g., nodes or other genes, proteins, or signal transducers upstream of the second or first gene, respectively.
  • the first gene and the second gene may regulate a subset of the same genes downstream.
  • the first gene may regulate a plurality of downstream genes, a subset of which are also regulated by the second gene.
  • the downstream genes may comprise genes important in cancer-related processes, e.g., HIPPO pathway, epithelial-to-mesenchymal transition, P13K pathway, DNA replication, cell migration, cell metastasis, etc.
  • the first gene and the second gene may be regulated by a subset of the same genes.
  • the first gene or the second gene may also be a biomarker for a cancer (e.g., liver or ovarian cancer).
  • the first gene may be PPP2R2A.
  • PPP2R2A may be lowly expressed, mutated, or otherwise deficient in a cancer cell when compared to a control cell or population of cells.
  • FIG. 2 shows a plot of frequency (Y-axis) of PPP2R2A inactivation or deficiency in different cancer types (X-axis).
  • the frequency of mutation of PPP2R2A can be as high as about 15%.
  • the frequency of mutation of PPP2R2A may be greater than 10%.
  • the deficiency of PPP2R2A leading to inactivation may include: multiple copies of the same gene, hypermethylation, deep deletion, or mutation in the PPP2R2A gene.
  • administration of or exposure to a therapeutically effective amount of one or more therapeutic agents that causes the decrease in expression or activity of PKMYT1 may result in synthetic lethality of the PPP2R2A-mutated cells.
  • the one or more therapeutic agents used to cause a difference in (e.g., a decrease or increase in) in expression or activity of the second gene may comprise a small molecule (e.g., a molecule having a molecular weight of less than 900 Daltons), a protein, an intrabody, a peptide, a ribonucleic acid (RNA) molecule, a deoxyribonucleic acid (DNA) construct, or a combination thereof (e.g., a protein-nucleic acid complex).
  • a small molecule e.g., a molecule having a molecular weight of less than 900 Daltons
  • RNA ribonucleic acid
  • DNA deoxyribonucleic acid
  • the one or more therapeutic agents may comprise a protein-nucleic acid complex, e.g., an endonuclease complex and a DNA construct.
  • the endonuclease complex comprises a clustered regularly interspaced short palindromic repeat (CRISPR) associated (Cas) protein or variant thereof (e.g., an engineered variant).
  • CRISPR clustered regularly interspaced short palindromic repeat
  • the DNA construct may be co-administered with the endonuclease complex.
  • the DNA construct may comprise an endonuclease gene.
  • the DNA construct may comprise a gene encoding for a Cas protein or variant thereof (e.g., an engineered variant).
  • the one or more therapeutic agents used to cause a difference in (e.g., a decrease or increase in) in expression or activity of a target gene comprises a small molecule inhibitor (e.g., a molecule having a molecular weight of less than 900 Daltons).
  • the small molecule may be configured to decrease the expression level or activity level of the target gene alone, or the small molecule may be configured to decrease the expression level or activity level of the target gene in combination with the deficient or mutated gene (e.g., PPP2R2A in a cancer cell).
  • the small molecule may directly interact with both the first gene and the second gene.
  • the small molecule may inhibit the protein or proteins encoded by one or both of the first gene and the second gene, respectively.
  • the small molecule may inhibit an upstream effector or downstream protein in a signaling pathway in which one or both of the genes interact.
  • the small molecule inhibitor may comprise an PKMYT1 inhibitor.
  • the PKMYT1 inhibitor may be, for example, 5-((5-methoxy-2-((4- morpholinophenyl)amino)pyrimidin-4-yl)amino)-2-methylphenol, A-(2-chloro-6- methylphenyl)-2-((6-(4-(2 -hydroxy ethyl)piperazin-l -yl)-2-methylpyrimidin-4- yl)amino)thiazole-5-carboxamide (dasatinib), 4-((2,4-dichloro-5-methoxyphenyl)amino)-6- methoxy-7-(3-(4-methylpiperazin-l-yl)propoxy)quinoline-3-carbonitrile (bosutinib), N-(5- chlorobenzo[ d][l,3]dioxol-4-yl)-7-(2-(2-(2-(2-
  • the small molecule inhibitor may be configured to inhibit or decrease the expression of PKMYT1 (the gene) or the activity of protein kinase, membrane associated tyrosine/threonine 1 (a protein derived from the PKMYT1 gene), either directly or indirectly.
  • the small molecule inhibitor may inhibit the protein kinase, membrane associated tyrosine/threonine 1 protein or another protein that may be upstream or downstream of protein kinase, membrane associated tyrosine/threonine 1 in a signaling pathway, such as, but not limited to, those shown in FIGS. 1A-B.
  • the small molecule inhibitor may inhibit or otherwise decrease the expression or activity level of WEE1, CHK1, CDK1, CDK2, PPP2R2A, FOXM1, PLK1, EZH2, etc.
  • the small molecule inhibitor may comprise a WEE1 inhibitor.
  • the WEE1 inhibitor may be, for example, 6-(2,6-dichlorophenyl)-2-((4-(2- (diethylamino)ethoxy)phenyl)amino)-8-methylpyrido[2,3-d]pyrimidin-7(8H)-one (PD- 0166285), 2-allyl-1-(6-(2-hydroxypropan-2-yl)pyridin-2-yl)-6-((4-(4-methylpiperazin-1- yl)phenyl)amino)-1,2-dihydro-3H-pyrazolo[3,4-d]pyrimidin-3-one (MK-1775), 9-hydroxy-4- phenylpyrrolo[3,4-c]carbazole-1,3(2H,6H)-dione (PD-407824), 6-butyl-4-(2-chlorophenyl)- 9-hydroxypyrrolo[3,4-c]carbazole-1,3(2H,6H)-d
  • the small molecule inhibitor may be configured to inhibit or decrease the expression of WEE1 (the gene) or the activity of WEE1 G2 checkpoint kinase (a protein derived from the WEE1 gene), either directly or indirectly.
  • the small molecule inhibitor may inhibit the WEE1 G2 checkpoint kinase protein or another protein that may be upstream or downstream of WEE1 G2 checkpoint kinase in a signaling pathway, such as, but not limited to, those shown in FIG.1A.
  • the small molecule inhibitor may inhibit or otherwise decrease the expression or activity level of CDK1, CDK2, etc.
  • the small molecule inhibitor may comprise a combination of small molecule inhibitors or derivatives thereof.
  • a small molecule inhibitor may be engineered or modified for dual specificity and may decrease expression or activity of both the first gene and the second gene (e.g., PKMYT1 and PPP2R2A).
  • a combination of small molecule inhibitors e.g., a small molecule “cocktail” may be used to decrease expression or activity of the target gene (e.g., PKMYT1) alone or both the first gene and the second gene.
  • a small molecule inhibitor may be administered with another agent type (e.g., protein, RNA molecule, DNA molecule, etc.).
  • the small molecule inhibitor may be administered in any useful concentration.
  • a small molecule may be administered at a concentration of about 0.5 nanomolar (nM), about 1 nM, about 10 nM, about 20 nM, about 30 nM, about 40 nM, about 50 nM, about 60 nM, about 70 nM, about 80 nM, about 90 nM, about 100 nM, about 200 nM, about 300 nM, about 400 nM, about 500 nM, about 600 nM, about 700 nM, about 800 nM, about 900 nM, about 1 micromolar ( ⁇ M), about 2 ⁇ M, about 3 ⁇ M, about 4 ⁇ M, about 5 ⁇ M, about 6 ⁇ M, about 7 ⁇ M, about 8 ⁇ M, about 9 ⁇ M, about 10 ⁇ M.
  • nM nanomolar
  • ⁇ M micromolar
  • a small molecule may be administered at a concentration of at least about 0.5 nanomolar (nM), at least about 1 nM, at least about 10 nM, at least about 20 nM, at least about 30 nM, at least about 40 nM, at least about 50 nM, at least about 60 nM, at least about 70 nM, at least about 80 nM, at least about 90 nM, at least about 100 nM, at least about 200 nM, at least about 300 nM, at least about 400 nM, at least about 500 nM, at least about 600 nM, at least about 700 nM, at least about 800 nM, at least about 900 nM, at least about 1 micromolar ( ⁇ M), at least about 2 ⁇ M, at least about 3 ⁇ M, at least about 4 ⁇ M, at least about 5 ⁇ M, at least about 6 ⁇ M, at least about 7 ⁇ M, at least about 8 ⁇ M, at least about 9 ⁇ M, at least
  • a small molecule may be administered at a concentration of at most about 10 ⁇ M, at most about 9 ⁇ M, at most about 8 ⁇ M, at most about 7 ⁇ M, at most about 6 ⁇ M, at most about 5 ⁇ M, at most about 4 ⁇ M, at most about 3 ⁇ M, at most about 2 ⁇ M, at most about 1 ⁇ M, at most about 900 nM, at most about 800 nM, at most about 700 nM, at most about 600 nM, at most about 500 nM, at most about 400 nM, at most about 300 nM, at most about 200 nM, at most about 100 nM, at most about 90 nM, at most about 80 nM, at most about 70 nM, at most about 60 nM, at most about 50 nM, at most about 40 nM, at most about 30 nM, at most about 20 nM, at most about 10 nM, at most about 1 nM, at most about 0.5 nM,
  • the small molecule inhibitor may be configured to have higher selectivity for PKMYT1 over a similar gene (e.g., WEE1, etc.).
  • the small molecule inhibitor may have a higher selectivity for PKMYT1 over a similar gene by about 1 fold, 2 fold, 3 fold, 4 fold, 5 fold, 6 fold, 7 fold, 8 fold, 9 fold, 10 fold, 20 fold, 30 fold, 40 fold, 50 fold, 60 fold, 70 fold, 80 fold, 90 fold, 100 fold, 200 fold, 300 fold, 400 fold, 500 fold, or more.
  • the small molecule inhibitor may have a higher selectivity for PKMYT1 over a similar gene by at least 1 fold, at least 2 fold, at least 3 fold, at least 4 fold, at least 5 fold, at least 6 fold, at least 7 fold, at least 8 fold, at least 9 fold, at least 10 fold, at least 20 fold, at least 30 fold, at least 40 fold, at least 50 fold, at least 60 fold, at least 70 fold, at least 80 fold, at least 90 fold, at least 100 fold, at least 200 fold, at least 300 fold, at least 400 fold, at least 500 fold, or more.
  • one or more therapeutic agents used to cause a difference in (e.g., a decrease or increase in) expression or activity of the target gene (e.g., PKMYT1) may require a lower concentration or dosage to be delivered to a subject for therapeutic efficacy.
  • PPP2R2A and PKMYT1 may be synthetic lethal, and administration of an PKMYT1 inhibitor to a subject having a cancer cell that has a deficiency in PPP2R2A may be therapeutically effective.
  • a lower dosage of PKMYT1 inhibitor may be sufficient to kill the PPP2R2A-deficient cancer cells, compared to cells (e.g., non-cancer cells) that do not have the PPP2R2A deficiency.
  • cells e.g., non-cancer cells
  • administration of a lower concentration or dosage of PKMYT1 inhibitor in selected or pre screened cancer types may be advantageous to reduce toxicity and side effects to the subject.
  • the method for treating the subject having a cancer further comprises administering to the subject a therapeutically effective amount of one or more therapeutic agents that causes a difference in (e.g., a decrease or increase in) expression or activity of PPP2R2A.
  • the method for treating the subject having a cancer further comprises administering to the subject a therapeutically effective amount of one or more therapeutic agents that causes a decrease in expression or activity of CDK1.
  • the one or more therapeutic agent used to cause a difference in (e.g., a decrease or increase in) expression or activity of the target gene comprises a DNA construct.
  • the target gene may be PKMYT1.
  • the DNA construct may comprise a guide RNA (gRNA) sequence, which may be used to direct a protein (e.g., Cas protein) to the target gene (e.g., PKMYT1).
  • the DNA construct may comprise a gRNA sequence, which may direct the protein (e.g., Cas protein) to a target gene (e.g., PKMYT1).
  • the DNA construct may comprise an RNA sequence, a DNA sequence, or a combination thereof.
  • the DNA construct comprises: (i) a first gRNA sequence, which may be used to direct an endonuclease (e.g., Cas protein) to a targeted location or gene locus for a target gene (e.g., PKMYT1) and (ii) a first sequence (e.g., a DNA sequence) corresponding to the gene (e.g., a gene replacement for PKMYT1).
  • a target gene e.g., PKMYT1
  • a first sequence e.g., a DNA sequence
  • a DNA sequence corresponding to the gene
  • other functional sequences may be included in the DNA sequence, including, but not limited to, a barcode sequence, a tag, or other identifying sequence, a primer sequence, a restriction site, a transposition site, etc.
  • the endonuclease complex may comprise an endonuclease, e.g., a Cas protein, or other nucleic acid-interacting enzyme (e.g., ligase, helicase, reverse transcriptase, transcriptase, polymerase, etc.).
  • endonuclease e.g., a Cas protein
  • nucleic acid-interacting enzyme e.g., ligase, helicase, reverse transcriptase, transcriptase, polymerase, etc.
  • the Cas protein may comprise any Cas type (e.g., Cas I, Cas IA, Cas IB, Cas IC, Cas ID, Cas IE, Cas IF, Cas IU, Cas III, Cas IIIA, Cas IIIB, Cas IIIC, Cas IIID, Cas IV, Cas IVA, Cas IVB, Cas II, Cas IIA, Cas IIB, Cas IIC, Cas V, Cas VI).
  • Cas type e.g., Cas I, Cas IA, Cas IB, Cas IC, Cas ID, Cas IE, Cas IF, Cas IU, Cas III, Cas IIIA, Cas IIIB, Cas IIIC, Cas IIID, Cas IV, Cas IVA, Cas IVB, Cas II, Cas IIA, Cas IIB, Cas IIC, Cas V, Cas VI).
  • the Cas protein may comprise other proteins (e.g., a fusion protein) and may comprise an additional enzyme that may associate with a nucleic acid molecule (e.g., ligase, transcriptase, transposase, nuclease, endonuclease, reverse transcriptase, polymerase, helicase, etc.).
  • a nucleic acid molecule e.g., ligase, transcriptase, transposase, nuclease, endonuclease, reverse transcriptase, polymerase, helicase, etc.
  • the endonuclease complex may be delivered exogenously or may be encoded in the DNA construct for transcription and translation within the cell.
  • the one or more therapeutic agents used to cause a difference in (e.g., a decrease or increase in) expression in the target gene may comprise a protein or peptide.
  • the one or more therapeutic agents may comprise an antibody, an antibody fragment, a hormone, a ligand, or an immunoglobulin.
  • the protein or peptide may be naturally occurring or may be synthetic.
  • the protein may be an engineered variant of a protein (e.g., recombinant protein), or fragment thereof.
  • the protein may be subjected to other modifications, e.g., post-translational modifications, including but not limited to: glycosylation, acylation, prenylation, lipoylation, alkylation, amidation, acetylation, methylation, formylation, butyrylation, carboxylation, phosphorylation, malonylation, hydroxylation, iodination, propionylation, S-nitrosylation, S-glutationylation, succinylation, sulfation, glycation, carbamylation, carbonylation, biotinylation, carbamylation, oxidation, pegylation, sumoylation, ubiquitination, ubiquitylation, racemization, etc.
  • post-translational modifications including but not limited to: glycosylation, acylation, prenylation, lipoylation, alkylation, amidation, acetylation, methylation, formylation, butyrylation, carboxylation, phosphorylation
  • the one or more therapeutic agents used to cause a difference in (e.g., a decrease or increase in) expression or activity of the target gene may comprise a nucleic acid molecule, e.g., an RNA molecule.
  • the RNA molecule can comprise any suitable RNA molecule and size sufficient to decrease the expression level or activity of the target gene (e.g., PKMYT1).
  • the RNA molecule may comprise a small hairpin RNA (shRNA) molecule, a small interfering RNA (siRNA), a microRNA (miRNA), or other useful RNA molecule.
  • the RNA molecule may comprise a messenger RNA (mRNA), transfer RNA (tRNA), ribosomal RNAs (rRNA), small nuclear RNA (snRNA), piwi-interacting (piRNA), non-coding RNA (ncRNA), long non-coding RNA, (IncRNA), and fragments of any of the foregoing.
  • the RNA molecule may be single-stranded, double- stranded, or partially single- or double-stranded.
  • one or more therapeutic agents are listed as examples and that a combination of therapeutic agent types may be used to treat the subject. For instance, administering one or more different types of therapeutic agents may be used to decrease the expression or activity of the target gene (e.g., PKMYT1).
  • a protein or peptide may be co-administered with a small molecule (e.g., a molecule having a molecular weight of less than 900 Daltons), an RNA molecule, a DNA molecule, or a complexed molecule (e.g., protein-nucleic acid molecule).
  • an RNA molecule may be administered with a small molecule, a DNA molecule, or a complexed molecule.
  • a small molecule may be co administered with a DNA molecule or a complexed molecule. Any of these combinations may be used to decrease the expression or activity of the target gene (PKMYT1) in a cell comprising a mutation in the first gene (e.g., PPP2R2A).
  • PPP2R2A target gene
  • FIG. 3 schematically illustrates an example workflow for determining the effect of treatment of a population of cultured cancer cells with a pair of guide RNAs targeting two different genes.
  • the treatment may comprise administration of a nucleic acid molecule to decrease the activity or expression of the first gene (e.g., PPP2R2A) and the second gene (e.g., PKMYT1).
  • the nucleic acid molecule can comprise a DNA construct, which may comprise a first gRNA sequence (sgRNA-A), a second gRNA sequence (sgRNA-B), a first DNA sequence (BC-B) and a second DNA sequence (BC-A).
  • the first DNA sequence or the second DNA sequence, or both the first and the second DNA sequences may comprise a barcode sequence.
  • the first guide sequence may have sequence homology to the first gene (e.g., PPP2R2A) and thus may target the first gene for mutagenesis by a protein (e.g., an endonuclease, e.g., Cas9)
  • the second guide sequence may have sequence homology to the second gene (e.g., PKMYT1) and thus may target the second gene for mutagenesis by a protein (e.g., an endonuclease, e.g., Cas9).
  • Cells may be treated with a therapeutically effective amount of the DNA construct and a protein (e.g., Cas9).
  • the DNA construct may be introduced via transfection (e.g., using a liposome or other nanoparticle) or transduction (e.g., using a virus).
  • the protein may be administered using a nanoparticle or other vesicle, or by adding the protein to the cell culture media.
  • the protein e.g., Cas9 may use the sgRNA-A and sgRNA- B to direct the protein to a specific locus or location in the cell genome (e.g., at a locus of PPP2R2A and PKMYT1).
  • the protein may excise and/or replace the endogenous genes (e.g., PPP2R2A and PKMYT1). If replacing the endogenous genes, the protein (e.g., Cas9) may replace the endogenous genes with the first DNA sequence (BC-B) and the second DNA sequence (BC-A). Cells may then be cultivated for a duration of time (e.g., 7 days, 14 days,
  • the DNA from the population of cells that has been cultivated can be sequenced to establish the abundance of each of the possible pairs of guide RNA present.
  • a substantial reduction in the abundance of a specific pair of guides may suggest that that combination of gene knock-downs has a deleterious effect on the ability of those cells to proliferate.
  • only the target gene may be knocked out in a cell or population of cells, which cell comprises a deficient gene that is synthetic lethal with the target gene.
  • the treatment may comprise administration of a nucleic acid molecule to decrease the activity or expression of the target gene (e.g., PKMYT1).
  • the nucleic acid molecule can comprise a DNA construct, which may comprise a gRNA sequence (sgRNA-A) and a DNA sequence (BC-A).
  • the DNA sequence may comprise a barcode sequence, and the guide sequence may have sequence homology to the target gene (e.g., PKMYT1) and thus may target the target gene for mutagenesis by a protein (e.g., an endonuclease, e.g., Cas9).
  • a population of cells e.g., cancer cells
  • the mutation e.g., PPP2R2A mutation
  • a protein e.g., Cas9
  • the DNA construct may be introduced via transfection (e.g., using a liposome or other nanoparticle) or transduction (e.g., using a virus).
  • the protein may be administered using a nanoparticle or other vesicle, or by adding the protein to the cell culture media.
  • the protein e.g., Cas9 may use the sgRNA-A to direct the protein to a specific locus or location in the cell genome (e.g., at a locus of PKMYT1).
  • the protein may excise and/or replace the endogenous genes (e.g., PKMYT1). If replacing the endogenous genes, the protein (e.g., Cas9) may replace the endogenous genes with the DNA sequence (BC-A).
  • Cells may then be cultivated for a duration of time (e.g., 7 days, 14 days, 20 days, etc.).
  • the proliferation or viability of the cells may be measured, and in some instances, compared to a control population of cells (e.g., non-mutant PPP2R2A cells).
  • the DNA from the population of cells that has been cultivated can be sequenced to establish the abundance of each of the possible guide RNAs present. A substantial reduction in the abundance of a specific guide may suggest that that gene knock-down has a deleterious effect on the ability of those cells to proliferate.
  • Guide RNAs that reduce the proliferation of PPP2R2A mutant cells, but not wild type cells, may be considered to have synthetic lethality with PPP2R2A.
  • the deficient gene that is synthetic lethal with the target gene is the gene encoding one of the subunits of PP2A.
  • the PP2A subunit is selected from the group consisting of 65 kDa regulatory subunit A alpha (PPP2R1 A), 65 kDa regulatory subunit A beta (PPP2R1B), 55 kDa regulatory subunit B alpha (PPP2R2A), 55 kDa regulatory subunit B beta (PPP2R2B), 55 kDa regulatory subunit B gamma (PPP2R2C), 55 kDa regulatory subunit B delta (PPP2R2D), 72/130 kDa regulatory subunit B (PPP2R3A), 48 kDa regulatory subunit B (PPP2R3B), regulatory subunit B” subunit gamma (PPP2R3C), regulatory subunit B’ (PPP2R4), 56 kDa regulatory subunit alpha (PPP2R5A
  • compositions for treating a cancer comprising a formulation comprising (i) at least one therapeutic agent and (ii) an excipient, wherein the at least one therapeutic agent is present in an amount that is effective to cause a difference in (e.g., a decrease or increase in) expression or activity of protein kinase, membrane associated tyrosine/threonine 1 (PKMYT1) following administration or exposure to the subject, wherein the excipient stabilizes the at least one therapeutic agent or provides therapeutic enhancement of the at least one therapeutic agent following administration or exposure to the subject as compared to the at least one therapeutic agent being administered to the subject in absence of the excipient, and wherein the cancer is associated with cancerous tissue comprising a cell that has a difference in (e.g., a decrease or increase in) expression or a difference (e.g. decrease, increase or alteration) in activity level of Protein Phosphatase 2 (PP2A)
  • the cancerous tissue is breast tissue, pancreatic tissue, uterine tissue, bladder tissue, colorectal tissue, prostate tissue, liver tissue, or ovarian tissue. In some cases, the cancerous tissue is liver tissue. In some case, the cancerous tissue is ovarian tissue.
  • the at least one therapeutic agent used to cause a difference in (e.g., a decrease or increase in) expression or activity of PKMYT1 may comprise a small molecule (e.g., a molecule having a molecular weight of less than 900 Daltons), a protein, a peptide, a ribonucleic acid (RNA) molecule, a deoxyribonucleic acid (DNA) construct, or a combination thereof (e.g., a protein-nucleic acid complex).
  • the at least one therapeutic agent may comprise a protein-nucleic acid complex, e.g., an endonuclease complex and a DNA construct.
  • the endonuclease complex comprises a clustered regularly interspaced short palindromic repeat (CRISPR) associated (Cas) protein or variant thereof (e.g., an engineered variant).
  • CRISPR clustered regularly interspaced short palindromic repeat
  • the DNA construct may be co administered with the endonuclease complex.
  • the DNA construct may comprise an endonuclease gene.
  • the DNA construct may comprise a gene encoding for a Cas protein or variant thereof (e.g., an engineered variant).
  • the DNA construct may be transcribed and translated by the cell using the cell’s own machinery (e.g., polymerases, ribosomes, etc.).
  • the at least one therapeutic agent used to cause a difference in (e.g., a decrease or increase in) expression or activity of PKMYT1 comprises a small molecule inhibitor (e.g., a molecule having a molecular weight of less than 900 Daltons).
  • the small molecule may be configured to decrease the expression level or activity level of the target gene alone, or the small molecule may be configured to decrease the expression level or activity level of the PKMYT1 and PPP2R2A.
  • the small molecule may directly interact with PKMYT1, or PKMYT1 and PPP2R2A.
  • the small molecule may inhibit the protein or proteins encoded by PKMYT1 alone, or the combination of PKMYT1 and PPP2R2A, respectively.
  • the small molecule may inhibit an upstream effector or downstream protein in a signaling pathway in which PKMYT1 or PPP2R2A interact.
  • the small molecule inhibitor may comprise an PKMYT1 inhibitor.
  • the PKMYT1 inhibitor may be, for example, dasatinib, saracatinib, pelitinib, tyrphostin AG 1478, PD-0166285, PD-173952, PD-173955, or PD-180970.
  • the small molecule inhibitor may be configured to inhibit or decrease the expression of PKMYT1 (the gene) or the activity of protein kinase, membrane associated tyrosine/threonine 1 (a protein derived from the PKMYT1 gene) directly or indirectly.
  • the small molecule inhibitor may inhibit the protein kinase, membrane associated tyrosine/threonine 1 protein or another protein that may be upstream or downstream of protein kinase, membrane associated tyrosine/threonine 1 in a signaling pathway, such as, but not limited to, those shown in FIGS.1A-B.
  • the small molecule inhibitor may comprise a WEE1 inhibitor.
  • the WEE1 inhibitor may be, for example, 6-(2,6-dichlorophenyl)-2-((4-(2- (diethylamino)ethoxy)phenyl)amino)-8-methylpyrido[2,3-d]pyrimidin-7(8H)-one (PD- 0166285), 2-allyl-1-(6-(2-hydroxypropan-2-yl)pyridin-2-yl)-6-((4-(4-methylpiperazin-1- yl)phenyl)amino)-1,2-dihydro-3H-pyrazolo[3,4-d]pyrimidin-3-one (MK-1775), 9-hydroxy-4- phenylpyrrolo[3,4-c]carbazole-1,3(2H,6H)-dione (PD-407824), 6-butyl-4-(2-chlorophenyl)- 9-hydroxypyrrolo[3,4-c]carbazole-1,3(2H,6H)-d
  • the small molecule inhibitor may be configured to inhibit or decrease the expression of WEE1 (the gene) or the activity of WEE1 G2 checkpoint kinase (a protein derived from the WEE1 gene), either directly or indirectly.
  • WEE1 the gene
  • WEE1 G2 checkpoint kinase a protein derived from the WEE1 gene
  • the small molecule inhibitor may inhibit the WEE1 G2 checkpoint kinase protein or another protein that may be upstream or downstream of WEE 1 G2 checkpoint kinase in a signaling pathway, such as, but not limited to, those shown in FIG. 1A.
  • the small molecule inhibitor may inhibit or otherwise decrease the expression or activity level of CDK1, CDK2, etc.
  • the small molecule inhibitor may comprise a combination of small molecule inhibitors or derivatives thereof.
  • a small molecule inhibitor may be engineered or modified for dual specificity and may decrease expression or activity of both PKMYT1 and PPP2R2A.
  • a combination of small molecule inhibitors e.g., a small molecule “cocktail”
  • a small molecule inhibitor may be administered with another therapeutic agent type (e.g., protein, RNA molecule, DNA molecule, etc.).
  • the small molecule inhibitor may be administered in any useful concentration.
  • a small molecule may be administered at a concentration of about 0.5 nanomolar (nM), about 1 nM, about 10 nM, about 20 nM, about 30 nM, about 40 nM, about 50 nM, about 60 nM, about 70 nM, about 80 nM, about 90 nM, about 100 nM, about 200 nM, about 300 nM, about 400 nM, about 500 nM, about 600 nM, about 700 nM, about 800 nM, about 900 nM, about 1 micromolar ( ⁇ M), about 2 ⁇ M, about 3 ⁇ M, about 4 ⁇ M, about 5 ⁇ M, about 6 ⁇ M, about 7 ⁇ M, about 8 ⁇ M, about 9 ⁇ M, about 10 ⁇ M.
  • nM nanomolar
  • ⁇ M micromolar
  • a small molecule may be administered at a concentration of at least about 0.5 nanomolar (nM), at least about 1 nM, at least about 10 nM, at least about 20 nM, at least about 30 nM, at least about 40 nM, at least about 50 nM, at least about 60 nM, at least about 70 nM, at least about 80 nM, at least about 90 nM, at least about 100 nM, at least about 200 nM, at least about 300 nM, at least about 400 nM, at least about 500 nM, at least about 600 nM, at least about 700 nM, at least about 800 nM, at least about 900 nM, at least about 1 micromolar ( ⁇ M), at least about 2 ⁇ M, at least about 3 ⁇ M, at least about 4 ⁇ M, at least about 5 ⁇ M, at least about 6 ⁇ M, at least about 7 ⁇ M, at least about 8 ⁇ M, at least about 9 ⁇ M, at least
  • a small molecule may be administered at a concentration of at most about 10 ⁇ M, at most about 9 ⁇ M, at most about 8 ⁇ M, at most about 7 ⁇ M, at most about 6 ⁇ M, at most about 5 ⁇ M, at most about 4 ⁇ M, at most about 3 ⁇ M, at most about 2 ⁇ M, at most about 1 ⁇ M, at most about 900 nM, at most about 800 nM, at most about 700 nM, at most about 600 nM, at most about 500 nM, at most about 400 nM, at most about 300 nM, at most about 200 nM, at most about 100 nM, at most about 90 nM, at most about 80 nM, at most about 70 nM, at most about 60 nM, at most about 50 nM, at most about 40 nM, at most about 30 nM, at most about 20 nM, at most about 10 nM, at most about 1 nM, at most about 0.5 nM,
  • a range of concentrations may be used, e.g., between 22 nM-1 ⁇ M. Where more than one small molecule is used, the concentrations may be the same of different for each small molecule used. As described elsewhere herein, a lower concentration or dosage of the one or more therapeutic agents to inhibit PKMYT1 may be therapeutically effective in cancers that comprise a cell having a PPP2R2A deficiency, as compared to non-deficient cancer cells.
  • the composition may further comprise at least one therapeutic agent present in an amount that is effective in causing a difference in (e.g., a decrease or increase in) expression or activity of PPP2R2A.
  • the method for treating the subject having a cancer further comprises administering to the subject a therapeutically effective amount of one or more therapeutic agents that causes a difference in (e.g., a decrease or increase in) expression or activity of CDK1.
  • the one or more therapeutic agent used to cause a difference in (e.g., a decrease or increase in) expression PKMYT1 comprises a DNA construct.
  • the DNA construct may comprise a guide RNA (gRNA) sequence, which may be used to direct a protein (e.g., Cas protein) to the PKMYT1.
  • the DNA construct may comprise a gRNA sequence, which may direct the protein (e.g., Cas protein) to PKMYT1.
  • the DNA construct may comprise an RNA sequence, a DNA sequence, or a combination thereof.
  • the DNA construct comprises: (i) a first gRNA sequence, which may be used to direct an endonuclease (e.g., Cas protein) to a targeted location or gene locus for PKMYT1 and (ii) a sequence (e.g., a DNA sequence) corresponding to the PKMYT1 gene (e.g., a gene replacement for PKMYT1).
  • a sequence e.g., a DNA sequence
  • DNA sequences e.g., a DNA sequence
  • other functional sequences may be included in the DNA sequence, including, but not limited to, a barcode sequence, a tag, or other identifying sequence, a primer sequence, a restriction site, a transposition site, etc.
  • the endonuclease complex may comprise an endonuclease, e.g., a Cas protein, or other nucleic acid-interacting enzyme (e.g., ligase, helicase, reverse transcriptase, transcriptase, polymerase, etc.).
  • endonuclease e.g., a Cas protein
  • nucleic acid-interacting enzyme e.g., ligase, helicase, reverse transcriptase, transcriptase, polymerase, etc.
  • the Cas protein may comprise any Cas type (e.g., Cas I, Cas IA, Cas IB, Cas IC, Cas ID, Cas IE, Cas IF, Cas IU, Cas III, Cas IIIA, Cas IIIB, Cas IIIC, Cas IIID, Cas IV, Cas IVA, Cas IVB, Cas II, Cas IIA, Cas IIB, Cas IIC, Cas V, Cas VI).
  • Cas type e.g., Cas I, Cas IA, Cas IB, Cas IC, Cas ID, Cas IE, Cas IF, Cas IU, Cas III, Cas IIIA, Cas IIIB, Cas IIIC, Cas IIID, Cas IV, Cas IVA, Cas IVB, Cas II, Cas IIA, Cas IIB, Cas IIC, Cas V, Cas VI).
  • the Cas protein may comprise other proteins (e.g., a fusion protein) and may comprise an additional enzyme that may associate with a nucleic acid molecule (e.g., ligase, transcriptase, transposase, nuclease, endonuclease, reverse transcriptase, polymerase, helicase, etc.).
  • a nucleic acid molecule e.g., ligase, transcriptase, transposase, nuclease, endonuclease, reverse transcriptase, polymerase, helicase, etc.
  • the endonuclease complex may be delivered exogenously or may be encoded in the DNA construct for transcription and translation within the cell.
  • the at least one therapeutic agent used to cause a difference in (e.g., a decrease or increase in) expression in PKMYT1 may comprise a protein or peptide.
  • the one or more therapeutic agent may comprise an antibody, an antibody fragment, a hormone, a ligand, or an immunoglobulin.
  • the protein or peptide may be naturally occurring or may be synthetic.
  • the protein may be an engineered variant of a protein (e.g., recombinant protein), or fragment thereof.
  • the protein may be subjected to other modifications, e.g., post-translational modifications, including but not limited to: glycosylation, acylation, prenylation, lipoylation, alkylation, amidation, acetylation, methylation, formylation, butyrylation, carboxylation, phosphorylation, malonylation, hydroxylation, iodination, propionylation, S-nitrosylation, S-glutationylation, succinylation, sulfation, glycation, carbamylation, carbonylation, biotinylation, carbamylation, oxidation, pegylation, sumoylation, ubiquitination, ubiquitylation, racemization, etc.
  • post-translational modifications including but not limited to: glycosylation, acylation, prenylation, lipoylation, alkylation, amidation, acetylation, methylation, formylation, butyrylation, carboxylation, phosphorylation
  • the at least one therapeutic agent used to cause a difference in (e.g., a decrease or increase in) expression or activity of PKMYT1 may comprise a nucleic acid molecule, e.g., an RNA molecule.
  • the RNA molecule can comprise any suitable RNA molecule and size sufficient to decrease the expression level or activity of PKMYT1, and, in some instances, PPP2R2A.
  • the RNA molecule may comprise a small hairpin RNA (shRNA) molecule, a small interfering RNA (siRNA), a microRNA (miRNA), or other useful RNA molecule.
  • the RNA molecule may comprise a messenger RNA (mRNA), transfer RNA (tRNA), ribosomal RNAs (rRNA), small nuclear RNA (snRNA), piwi- interacting (piRNA), non-coding RNA (ncRNA), long non-coding RNA, (IncRNA), and fragments of any of the foregoing.
  • the RNA molecule may be single-stranded, double- stranded, or partially single- or double-stranded.
  • the therapeutic agents e.g., peptides, RNA molecules, protein-nucleic acid complexes
  • the composition may comprise one or more different types of therapeutic agents that may be used to decrease the expression or activity of PKMYT1.
  • a protein or peptide may be co-administered with a small molecule (e.g., a molecule having a molecular weight of less than 900 Daltons), an RNA molecule, a DNA molecule, or a complexed molecule (e.g., protein-nucleic acid molecule).
  • an RNA molecule may be administered with a small molecule, a DNA molecule, or a complexed molecule.
  • a small molecule may be co-administered with a DNA molecule or a complexed molecule.
  • the composition may also comprise an excipient.
  • the excipient may comprise a substance, which substance may be used to confer a property to the therapeutic agent or agents used to decrease the expression or activity level of PKMYT1.
  • the excipient may comprise a substance for stabilization of the therapeutic agent.
  • the excipient may comprise a substance for bulking up a solid, liquid, or gel formulation of the therapeutic agent.
  • the substance may confer a therapeutic enhancement to the therapeutic agent (e.g., by enhancing solubility).
  • the substance may be used to change a property of the composition, such as the viscosity.
  • the substance may be used to change a property of the therapeutic agent, e.g., bioavailability, absorption, hydrophilicity, hydrophobicity, pharmacokinetics, etc.
  • the excipient may comprise a binding agent, anti-adherent agent, a coating, a disintegrant, a glidant (e.g., silica gel, talc, magnesium carbonate), a lubricant, a preservative, a sorbent, a sweetener, a vehicle, or a combination thereof.
  • the excipient may comprise a powder, a mineral, a metal, a sugar (e.g.
  • saccharide or polysaccharide a sugar alcohol
  • a naturally occurring polymer e.g., cellulose, methylcellulose
  • synthetic polymer e.g., polyethylene glycol or polyvinylpyrrolidone
  • an alcohol e.g., ethanol, ethanol, styrene, ethylene glycol or polyvinylpyrrolidone
  • a thickening agent e.g., a starch
  • a macromolecule e.g., lipid, protein, carbohydrate, nucleic acid molecule
  • One or more therapeutic agents may be delivered to a subject (e.g., in vivo ), or to a cell or population of cells from a subject (e.g., ex vivo or in vivo).
  • the one or more therapeutic agents may be delivered to a subject in one or more delivery vesicles, such as a nanoparticle.
  • the nanoparticle may be any suitable nanoparticle and may be a solid, semi-solid, semi- liquid or a gel.
  • the nanoparticle may be a lipophilic and amphiphilic particle.
  • a nanoparticle may comprise a micelle, liposome, exosome, or other lipid-containing vesicle.
  • the nanoparticle may be configured for targeted delivery to a certain cell or cell type (e.g., cancer cell).
  • the nanoparticle may be decorated with any number of ligands, e.g., antibodies, nucleic acid molecules (e.g., ribonucleic acid (RNA) molecules or deoxyribonucleic acid (DNA) molecules), proteins, peptides, which may specifically bind to a certain cell or cell type (e.g., cancer cell).
  • ligands e.g., antibodies, nucleic acid molecules (e.g., ribonucleic acid (RNA) molecules or deoxyribonucleic acid (DNA) molecules), proteins, peptides, which may specifically bind to a certain cell or cell type (e.g., cancer cell).
  • the one or more therapeutic agents may be delivered using viral approaches.
  • the one or more therapeutic agents may be administered using a viral vector.
  • the one or more therapeutic agents may be encapsulated in a virus for delivery to a cell, population of cells, or the subject.
  • the virus can be an adeno-associated virus (AAV), a retrovirus, a lentivirus, a herpes simplex virus, or other useful virus.
  • AAV adeno-associated virus
  • retrovirus a retrovirus
  • lentivirus a lentivirus
  • herpes simplex virus or other useful virus.
  • the virus may be engineered or may be naturally occurring.
  • the one or more therapeutic agents may be delivered to a subject (e.g., human patient) or a body of the subject (e.g., at the tumor site) using a single or variety of approaches.
  • the one or more therapeutic agents may be delivered or administered orally, intravenously, intraperitoneally, intratumorally, subcutaneously, topically, transdermally, transmucosally, or through another administration approach.
  • the one or more therapeutic agents may be delivered to the subject enterally.
  • the one or more therapeutic agents may be administered to the subject orally, nasally, rectally, sublingually, sub-labially, buccally, topically, or through an enema.
  • the one or more therapeutic agents may be formulated into a tablet, capsule, drop or other formulation.
  • the formulation may be configured to be delivered enterally.
  • the one or more therapeutic agents may be delivered to the subject parenterally.
  • the one or more therapeutic agents may be administered via injection into a location of the subject.
  • the location may comprise the central nervous system, and the one or more therapeutic agents may be delivered epidurally, intracerebrally, intracerebroventricularly, etc.
  • the location may comprise the skin, and the one or more therapeutic agents may be delivered epicutaneously.
  • the one or more therapeutic agents may be formulated in a transdermal patch, which can deliver the one or more therapeutic agents to the skin of a subject.
  • the one or more therapeutic agents may be delivered sublingually and/or bucally, extra-amniotically, nasally, intra-arterially, intra- articularly, intravavemously, intracardiacally, intradermally, intralesionally, intramuscularly, intraocularly, intraosseously, intraperitoneally, intrathecally, intrauterinely, intravaginally, intravenously, intravesically, intravitreally, subcutaneously, trans-dermally, perivascularly, transmucosally, or through another route of administration.
  • the one or more therapeutic agents may be delivered topically.
  • the one or more therapeutic agents may be formulated into an aerosol, pill, tablet, capsule (e.g., asymmetric membrane capsule), pastille, elixir, emulsion, powder, solution, suspension, tincture, liquid, gel, dry powder, vapor, droplet, ointment, patch, or a combination thereof.
  • the one or more therapeutic agents may be formulated in a gel or polymer and delivered via a thin film.
  • the one or more therapeutic agents may be delivered to the subject using a targeted delivery approach (e.g., for targeted delivery to the tumor site) or using a delivery approach to increase uptake of a cell of the one or more therapeutic agents.
  • the delivery approach may comprise magnetic drug delivery (e.g., magnetic nanoparticle- based drug delivery), an acoustic targeted drug delivery approach, a self-microemulsifying drug delivery system, or other delivery approach.
  • the one or more therapeutic agents may be formulated for targeted delivery or for increased uptake of a cell.
  • the one or more therapeutic agents may be formulated with another agent, which may improve the solubility, hydrophobicity, hydrophilicity, absorbability, half-life, bioavailability, release profile, or other property of the one or more therapeutic agents.
  • the one or more therapeutic agents may be formulated with a polymer which may control the release profile of the one or more therapeutic agents.
  • the one or more therapeutic agents may be formulated as a coating or with a coating (e.g., bovine submaxillary mucin coatings, polymer coatings, etc.) to alter a property of the one or more therapeutic agents (e.g., bioavailability, pharmacokinetics, etc.).
  • the one or more therapeutic agents may be formulated using retrometabolic drug design.
  • the one or more therapeutic agents may be assessed for metabolic effects in a cell, and a new formulation comprising a derivative (e.g., chemically synthesized alternative or engineered variant) may be designed to change a property of the one or more therapeutic agents (e.g., to increase efficacy, minimize undesirable side effects, alter bioavailability, etc.).
  • a derivative e.g., chemically synthesized alternative or engineered variant
  • Valuable biomarkers in cancer cells can be mined from literature and public data, and further refinement of candidates can be performed using, for example, considerations such as multi-omics analysis, evaluation of tumor type (e.g. primary tumor), cell lines, target tractability, biomarker prevalence, etc.
  • PPP2R2A and PKMYTl may be identified as valuable biomarkers due to, for example, higher frequency of PPP2R2A in cancer cells compared to non-cancer cells and higher expression levels of PKMYT1 in cancer cells compared to non-cancer cells.
  • LAML acute myeloid leukemia
  • ACC bladder urothelial carcinoma
  • LGG brain lower grade glioma
  • BRCA breast invasive carcinoma
  • CESC cervical squamous cell carcinoma and endocervical adenocarcinoma
  • cholangiocarcinoma CHOL
  • LCML chronic myelogenous leukemia
  • COAD adenocarcinoma
  • GBM glioblastoma multiforme
  • HNSC kidney chromophobe
  • KICH kidney renal clear cell carcinoma
  • KIRC kidney renal papillary cell carcinoma
  • LIHC liver hepatocellular carcinoma
  • LIHC lung adenocarcinoma
  • LAD lung squamous cell carcinoma
  • LEC lymphoid neoplasm diffuse large B-cell lymphoma
  • FIG. 2 shows a plot of frequency (Y-axis) of PPP2R2A inactivation or deficiency in different cancer types (X-axis).
  • the frequency of mutation of PPP2R2A can be as high as about 15%.
  • the frequency of mutation of PPP2R2A may be greater than 10%.
  • the deficiency of PPP2R2A leading to inactivation may include: hypermethylation, deep deletion, or mutation in the PPP2R2A gene.
  • FIG. 5 shows a plot of the expression level of PKMYT1 in cancer versus normal (non-cancer) cells (Y-Axis, displayed as fold change) in various cancer types (X-Axis).
  • Y-Axis normal (non-cancer) cells
  • X-Axis normal (non-cancer) cells
  • FIGS. 5-6 demonstrate that PKMYT1 may be more highly expressed in various cancer types.
  • Further screening of PPP2R2A and PKMYT1 as a possible synthetic lethal pair may be performed. For instance, the expression level of PKMYT1 across a population of cells that have inactive or deficient PPP2R2A may be compared to the expression level of PKMYT1 across a population of cells that have a normal or wild-type genotype or phenotype of PPP2R2A.
  • FIG. 1 the expression level of PKMYT1 across a population of cells that have inactive or deficient PPP2R2A may be compared to the expression level of PKMYT1 across a population of cells that have a normal or wild-type genotype or phenotype of PPP2R2A.
  • PKMYT1 is more essential than for the population of cells having the wild-type PPP2R2A; that is, PKMYT1 knockdown is more lethal in the PPP2R2A-deficient cells than in the wild-type cells.
  • PKMYT1-PPP2R2A synthetic lethality may be tested experimentally.
  • the PKMYT1 and PPP2R2A genes may be knocked down or knocked out of a cell’s genome using a combinatorial genetics CRISPR approach (e.g., combinatorial genetics en masse (CombiGEM)).
  • a DNA construct may be generated.
  • the DNA construct may comprise a PKMYT1 gRNA to direct an endonuclease (e.g., a Cas protein) to the PKMYT1 gene, as well as a PPP2R2A gRNA to direct an endonuclease (e.g., a Cas protein) to the PPP2R2A gene.
  • the PKMYT1 gRNA and PPP2R2A gRNA may comprise a sequence homologous or complementary to a sequence on the endogenous PKMYT1 gene and PPP2R2A gene, respectively.
  • the DNA construct may also comprise replacement genes to replace PKMYT1 and PPP2R2A in the genome (e.g., dysfunctional sequences, random DNA sequences).
  • Control DNA constructs may also be generated. For example, to determine if the gene pair is synthetic lethal, it may be important to monitor the effect of disrupting PKMYT1 and PPP2R2A individually as well as the combination of the gene pair. Moreover, it may be important to monitor the effect of a negative control, in which a DNA construct comprising an ineffective gRNA e.g., non-specific gRNA as a “non-cutting” control for one or both genes may be constructed. Another example of a negative control construct may comprise a vehicle control. In some cases, a positive control may also be used.
  • the positive control may comprise, for instance, a DNA construct comprising a gRNA for a polymerase (e.g., an RNA polymerase, e.g., POLR2D), which can demonstrate that knockout (and the delivery mechanisms of doing so) of a gene that is essential for cell viability or proliferation results in lethality.
  • a polymerase e.g., an RNA polymerase, e.g., POLR2D
  • a polymerase e.g., an RNA polymerase, e.g., POLR2D
  • knockout of two genes known to be a synthetic lethal pair e.g., methylthioadenosine phosphorylase (MTAP) and protein arginine methyltransferase 5 (PRMT5)
  • MTAP methylthioadenosine phosphorylase
  • PRMT5 protein arginine methyltransferase 5
  • the DNA constructs may then be introduced to cancer (e.g., liver or ovarian cancer) cells, which may comprise cells from a primary source (e.g., isolated from a tumor or cancer) or a cell line.
  • An endonuclease e.g., Cas9
  • the Cas9 may then replace, edit, or delete the PKMYT1 and PPP2R2A genes in the treated cells, and in some cases, replace the PKMYT1 and PPP2R2A genes in the genomes with the replacement genes in the DNA constructs.
  • Proliferation or viability of the cells may then be monitored over time to determine the effectiveness of the treatment.
  • the viability of the cells may be normalized or compared to a negative control or control population of cells that are not treated.
  • a sensitive florescence PrestoBlue assay based on production of resorufm (blue) from a substrate (colorless) by metabolically active cells was developed to quantify viable cells. Briefly, test plates were started with seeding 18,000 cells per well in a 96 well plate. The cells were transduced with a viral volume between 2- 10 ⁇ L per well, depending on the viral titers obtained for achieving greater than 90% transduction. After 32 h post- transduction, media was changed to antibiotic (Puromycin) containing media and antibiotic was maintained for the rest of the assay. On Day 3 the plate was split and reseeded to an amount previously qualified to reach confluency in 14 days.
  • antibiotic Puromycin
  • a total of 8 constructs were prepared for each gene pair tested: 2 sgRNA each for Gene A, paired with NTC (sgl, sg2), 2 sgRNA each for Gene B, paired with NTC (sgl, sg2), 4 sgRNA combinations (1,1; 1,2; 2,1; 2,2).
  • FIGS. 8A-B show example data of a CRISPR-based approach to knock out PKMYT1 and PPP2R2A.
  • FIG. 8A illustrates bar plots of cell viability as a function of the DNA construct introduced.
  • the DNA constructs can be used for knockout and can comprise: (i) a dual-negative control (NTC) sequence, (ii) a polymerase (POL2) sequence as a positive control for knockout of an essential gene, (iii) a MTAP sequence for knockout, (iv) a PRMT5 sequence for knockout, (v) MTAP and PRMT5 sequences for knockout, which can serve as a positive synthetic lethal control, (vi) PPP2R2A sequences for knockout, (vii) PKMYT1 sequences for knockout, and (viii) PPP2R2A and PKMYT1 sequences for dual knockout.
  • NTC dual-negative control
  • POL2 polymerase
  • the positive control sequence can be a DNA construct comprising a dysfunctional RNA polymerase gene (e.g., POLR2D gene) to replace the endogenous POLR2D gene, or the DNA construct may be configured to knock down or knock out a polymerase gene.
  • the positive control sequence may be used, for example, to determine that the DNA constructs function as expected, e.g., that knock out of a gene essential for DNA replication, and thus cell proliferation, results in decreased cell viability.
  • the viability of the treated cells can be normalized to a negative control (e.g., non-treated cells, or cells treated with DNA constructs comprising scrambled gRNA or comprising normal copies of PKMYT1 and PPP2R2A).
  • a negative control e.g., non-treated cells, or cells treated with DNA constructs comprising scrambled gRNA or comprising normal copies of PKMYT1 and PPP2R2A.
  • NTC negative control group of cells
  • POL2 where the cells are treated with a DNA construct to knockout a polymerase, results in dramatically decreased normalized viability, as expected.
  • the positive control (MTAP-PRMT5) where the cells are treated with a DNA construct to knockout MTAP and PRMT5, also results in decreased viability compared to the negative control groups.
  • FIG. 8B illustrates another example of bar plots of cell viability as a function of the DNA construct introduced.
  • the viability can be measured as a percentage of viable cells compared to a negative control.
  • the DNA constructs can be used for knockout and can comprise: (i) a dual-negative control (NTC) sequence, (ii) a polymerase (POL2) sequence as a positive control for knockout of an essential gene, (iii) a MTAP sequence for knockout, (iv) a PRMT5 sequence for knockout, (v) MTAP and PRMT5 sequences for knockout, which can serve as a positive synthetic lethal control, (vi) a PPP2R2A sequences for knockout, (vii) a PKMYT1 sequences for knockout, and (viii) PPP2R2A and PKMYT1 sequences for dual knockout.
  • NTC dual-negative control
  • POL2 polymerase
  • the viability of the treated cells can be normalized to a negative control (e.g., non-treated cells, or cells treated with DNA constructs comprising scrambled gRNA or comprising normal copies of PKMYT1 and PPP2R2A). Similar to FIG. 8A, the negative control group of cells (NTC) in FIG. 8B has viability that is highest amongst the tested groups.
  • the positive control (POLR2D) where the cells are treated with a DNA construct to knockout a polymerase, results in dramatically decreased normalized viability, as expected.
  • the positive control (MTAP-PRMT5), where the cells are treated with a DNA construct to knockout MTAP and PRMT5, also results in decreased viability compared to the negative control groups, as well as single gene knockouts of MTAP or PRMT5 alone.
  • the cells that are treated with a single gene knockout either PPP2R2A or PKMYT1, also show reduced viability compared to the negative control group.
  • FIG. 9 illustrates another example of bar plots of cell viability as a function of the DNA construct introduced in a colony-forming assay (e.g.- clonogeneic assay).
  • the viability can be measured as a percentage of viable cells compared to a negative control.
  • the DNA constructs can be used for knockout and can comprise: (i) a negative control (NTC) sequence, (ii) a first sgRNA PPP2R2A sequence for knockout, (iii) a second sgRNA PPP2R2A sequence for knockout, (iv) a first sgRNA PKMYT1 sequence for knockout, (v) a second sgRNA PKMYT1 sequence for knockout, (vi) a first sgRNA PPP2R2A sequence and a first sgRNA PKMYT1 sequence for dual knockout, (vii) a first sgRNA PPP2R2A sequence and a second sgRNA PKMYT1 sequence for dual knockout, (viii) a second sgRNA PPP2R2A sequence and a first sgRNA PKMYT1 sequence for dual knockout, and (ix) a second sgRNA PPP2R2A sequence and a second sgRNA PKMYT1 sequence
  • the viability of the treated cells can be normalized to a negative control (e.g., non-treated cells, or cells treated with DNA constructs comprising scrambled gRNA or comprising normal copies of PKMYT1 and PPP2R2A). Similar to FIGS. 8A-B, the negative control group of cells (NTC) in FIG. 9 has viability that is highest amongst the tested groups.
  • the cells that are treated with a single gene knockout, either PPP2R2A or PKMYT1 show reduced viability compared to the negative control group. Knock out of PPP2R2A and PKMYT1 results in significantly lower viability than the single-knockout of PPP2R2A or the single-knockout of PKMYT1.
  • Huhl has a homozygous deletion of PPP2R2A.
  • PKMYT1 deletion is expected to be lethal irrespective of PPP2R2A CRISPR KO.
  • PKMYT1 knockout alone shows strong cell killing in Huhl cells which have an endogenous deletion of the PPP2R2A gene locus (FIG. 10).
  • the strength of the synthetic lethal interaction of PPP2R2A-PKMYT1 is summarized for 4 different cell lines, including the colorectal cancer cell line HCT116, in Table 1
  • PKMYT1 Inhibition of PKMYT1 by small molecule inhibitors can replicate the findings of CRISPR-mediated knockout of PKMYT1.
  • PPP2R2A expression is reduced using CRISPR knockout and small molecule drugs are subsequently applied to the cells (Table 5, FIG. 12).
  • Control cells are also used where PPP2R2A is not knocked out. It is observed that when PPP2R2A is knocked out in a cell line the PKMYT1 inhibitors show increased potency.
  • PPP2R2A and PKMYT1 may be a synthetic lethal pair.
  • treatment of PPP2R2A-deficient cells with a therapeutically effective amount of one or more therapeutic agents that cause decreased activity level or expression of PKMYT1 may be a viable treatment option.

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WO2025242880A1 (en) 2024-05-24 2025-11-27 My-T Bio Limited Therapeutic compounds and their use
WO2026057598A1 (en) 2024-09-10 2026-03-19 My-T Bio Limited Therapeutic compounds as pkmyt1 inhibitors and their use
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RS56680B1 (sr) * 2012-11-28 2018-03-30 Merck Sharp & Dohme Kompozicije i postupci za lečenje kancera
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WO2023177356A3 (en) * 2022-03-18 2023-11-02 Engine Biosciences Pte. Ltd. Compounds and method for pkmyt1 inhibition
WO2025215188A1 (en) 2024-04-11 2025-10-16 My-T Bio Limited Therapeutic compounds and their use as inhibitors of pkmyt1
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WO2025242880A1 (en) 2024-05-24 2025-11-27 My-T Bio Limited Therapeutic compounds and their use
WO2026057598A1 (en) 2024-09-10 2026-03-19 My-T Bio Limited Therapeutic compounds as pkmyt1 inhibitors and their use
WO2026057597A1 (en) 2024-09-10 2026-03-19 My-T Bio Limited Pkmyt1 inhibitors and their use

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