Professor Chris Lord

Deputy Head of Division: Gene Function

OrcID: 0000-0002-3226-0515

Phone: +44 20 7153 5190

Email: [email protected]

Location: Chelsea

Professor Chris Lord (Profile)

OrcID: 0000-0002-3226-0515

Phone: +44 20 7153 5190

Email: [email protected]

Location: Chelsea

Biography

Professor Chris Lord is Deputy Head of Division, Group Leader of the CRUK Gene Function Laboratory and Professor of Cancer Genomics in the Breast Cancer Now Toby Robins Research Centre at The Institute of Cancer Research, London. Much of his work focuses on exploiting genetic concepts such as synthetic lethality to identify new approaches to treating cancer and to understand the variable effectiveness of existing treatments.

Chris started his career with PhD training in disease genetics with John Todd and Richard Gardner at the University of Oxford before carrying out a Postdoctoral Fellowship with Todd at the University of Cambridge. Chris joined the ICR London as a Postdoctoral Fellow with Alan Ashworth in 2000, where he was joint first author on a paper describing the synthetic lethal interaction between BRCA-tumour suppressor genes and PARP inhibitors (Nature 2005), observations that eventually led to the use of these drugs for the treatment of breast, ovarian, prostate and pancreatic cancers.

Later, Chris exploited high-throughput genetic perturbation screens to understand a variety of cancer-related phenotypes including drug sensitivity/resistance and the identification of novel therapeutic targets (e.g. Cancer Cell 2008, Cancer Discov. 2011), a number of which are now being investigated as part of new drug development programmes. Chris has also used multiple approaches to uncover and/or understand clinically-relevant mechanisms of resistance to DNA repair inhibitors (e.g. Nat Commun. 2018, Cancer Discov. 2020) and to identify novel synthetic lethal approaches that target hard-to-treat cancers, including those with ARID1A, Rb or E-cadherin defects (e.g. Cancer Discov. 2018).

More recently, Chris has focused on using high-throughput genetic perturbation screens to understand the principles that govern the robustness of synthetic lethal interactions (e.g. Elife 2020). The impact of the work led by Lord is demonstrated by the multiple biomarkers of drug sensitivity/resistance and novel synthetic lethal approaches to the treatment of ARID1A, Rb or E-cadherin defective cancers now being assessed in clinical trials.

Disclosure information. CJL is an inventor on patents describing the use of PARP inhibitors and stands to gain from their development as part of the ICR’s “Rewards to Inventors” scheme. CJL has received research funding, honoraria, consultancy or advisory board payments from the following: Sun Pharma, Vertex Ltd., 3rd Rock, Horizon Discovery, Gerson Lehrman Group, Guidepoint, Abingworth, Astra Zeneca, Merck KGaA, Artios, Ono Pharma, Tango Therapeutics and LEK. CJL owns shares in Tango Therapeutics.

Chris Lord is a member of the Cancer Research UK Convergence Science Centre, which brings together leading researchers in engineering, physical sciences, life sciences and medicine to develop innovative ways to address challenges in cancer.

Convergence Science Centre

Types of Publications

Journal articles

Warren, M. Lord, C.J. Masabanda, J. Griffin, D. Ashworth, A (2003) Phenotypic effects of heterozygosity for a BRCA2 mutation.. Show Abstract full text

Heterozygous carriers of mutations in the BRCA2 gene have a high risk of developing breast and other cancers. In these individuals, BRCA2 appears to act as a tumour suppressor gene, in that loss of the wild type allele is frequently observed within tumours, leading to loss of BRCA2 function. Because BRCA2 functions in DNA repair via homologous recombination, this leads to genomic instability. However, it is unclear whether loss of the wild type allele is stochastic or if heterozygosity for BRCA2 mutation carries a phenotype that contributes to tumorigenic progression. Here we demonstrate that, in a specific vertebrate cell type, the chicken B cell line DT40, heterozygosity for a BRCA2 mutation has a distinct phenotype. This is characterized by a reduced growth rate, increased cell death, heightened sensitivity to specific DNA damaging agents and reduced RAD51 focus formation after irradiation. Thus in certain cell types, genome instability might be driven directly by heterozygosity for BRCA2 mutation.

Gudmundsdottir, K. Lord, C.J. Witt, E. Tutt, A.N.J. Ashworth, A (2004) DSS1 is required for RAD51 focus formation and genomic stability in mammalian cells.. Show Abstract full text

BRCA2 is a breast cancer susceptibility gene implicated in the repair of double-strand breaks by homologous recombination with RAD51. BRCA2 associates with a 70-amino-acid protein, DSS1, but the functional significance of this interaction has remained unclear. Recently, deficiency of a DSS1 orthologue in the fungus Ustilago maydis has been shown to cause a defect in recombinational DNA repair. Here we have investigated the consequences of DSS1 depletion in mammalian cells. We show that like BRCA2, DSS1 is required for DNA damage-induced RAD51 focus formation and for the maintenance of genomic stability, indicating a function conserved from lower eukaryotes to humans. However, DSS1 seems to be not required for BRCA2 or RAD51 stability or for BRCA2 and RAD51 to interact, raising the possibility that DSS1 may be required for the BRCA2-RAD51 complex to become associated with sites of DNA damage.

Iorns, E. Lord, C.J. Turner, N. Ashworth, A (2007) Utilizing RNA interference to enhance cancer drug discovery.. Show Abstract full text

With the development of RNA interference (RNAi) libraries, systematic and cost-effective genome-wide loss-of-function screens can now be carried out with the aim of assessing the role of specific genes in neoplastic phenotypes, and the rapid identification of novel drug targets. Here, we discuss the existing applications of RNAi in cancer drug discovery and highlight areas in this process that may benefit from this technology in the future.

Brough, R. Wei, D. Leulier, S. Lord, C.J. Rong, Y.S. Ashworth, A (2008) Functional analysis of Drosophila melanogaster BRCA2 in DNA repair.. Show Abstract full text

The human BRCA2 cancer susceptibility protein functions in double-strand DNA break repair by homologous recombination and this pathway is conserved in the fly Drosophila melanogaster. Although a potential Drosophila melanogaster BRCA2 orthologue (dmbrca2; CG30169) has been identified by sequence similarity, no functional data addressing the role of this protein in DNA repair is available. Here, we demonstrate that depletion of dmbrca2 from Drosophila cells induces sensitivity to DNA damage induced by irradiation or treatment with hydroxyurea. Dmbrca2 physically interacts with dmrad51 (spnA) and the two proteins become recruited to nuclear foci after DNA damage. A functional assay for DNA repair demonstrated that in flies dmbrca2 plays a role in double-strand break repair by gene conversion. Finally, we show that depletion of dmbrca2 in cells is synthetically lethal with deficiency in other DNA repair proteins including dmparp. The conservation of the function of BRCA2 in Drosophila will allow the analysis of this key DNA repair protein in a genetically tractable organism potentially illuminating mechanisms of carcinogenesis and aiding the development of therapeutic agents.

Smalley, M.J. Iravani, M. Leao, M. Grigoriadis, A. Kendrick, H. Dexter, T. Fenwick, K. Regan, J.L. Britt, K. McDonald, S. Lord, C.J. Mackay, A. Ashworth, A (2007) Regulator of G-protein signalling 2 mRNA is differentially expressed in mammary epithelial subpopulations and over-expressed in the majority of breast cancers.. Show Abstract full text

INTRODUCTION: To understand which signalling pathways become deregulated in breast cancer, it is necessary to identify functionally significant gene expression patterns in the stem, progenitor, transit amplifying and differentiated cells of the mammary epithelium. We have previously used the markers 33A10, CD24 and Sca-1 to identify mouse mammary epithelial cell subpopulations. We now investigate the relationship between cells expressing these markers and use gene expression microarray analysis to identify genes differentially expressed in the cell populations. METHODS: Freshly isolated primary mouse mammary epithelial cells were separated on the basis of staining with the 33A10 antibody and an alpha-Sca-1 antibody. The populations identified were profiled using gene expression microarray analysis. Gene expression patterns were confirmed on normal mouse and human mammary epithelial subpopulations and were examined in a panel of breast cancer samples and cell lines. RESULTS: Analysis of the separated populations demonstrated that Sca-1- 33A10High stained cells were estrogen receptor alpha (Esr1)- luminal epithelial cells, whereas Sca-1+ 33A10Low/- stained cells were a mix of nonepithelial cells and Esr1+ epithelial cells. Analysis of the gene expression data identified the gene Rgs2 (regulator of G-protein signalling 2) as being highly expressed in the Sca-1- 33A10Low/- population, which included myoepithelial/basal cells. RGS2 has previously been described as a regulator of angiotensin II receptor signalling. Gene expression analysis by quantitative real-time RT-PCR of cells separated on the basis of CD24 and Sca-1 expression confirmed that Rgs2 was more highly expressed in mouse myoepithelial/basal mammary cells than luminal cells. This expression pattern was conserved in normal human breast cells. Functional analysis demonstrated RGS2 to be a modulator of oxytocin receptor signalling. The potential significance of RGS2 expression in breast cancer was demonstrated by semi-quantitative RT-PCR analysis, data mining and quantitative real-time RT-PCR approaches, which showed that RGS2 was expressed in the majority of solid breast cancers at much higher levels than in normal human mammary cells. CONCLUSION: Molecular analysis of prospectively isolated mammary epithelial cells identified RGS2 as a modulator of oxytocin receptor signalling, which is highly expressed in the myoepithelial cells. The RGS2 gene, but not the oxytocin receptor, was also shown to be over-expressed in the majority of breast cancers, identifying the product of this gene, or the pathway(s) it regulates, as potentially significant therapeutic targets.

Iorns, E. Turner, N.C. Elliott, R. Syed, N. Garrone, O. Gasco, M. Tutt, A.N.J. Crook, T. Lord, C.J. Ashworth, A (2008) Identification of CDK10 as an important determinant of resistance to endocrine therapy for breast cancer.. Show Abstract full text

Therapies that target estrogen signaling have transformed the treatment of breast cancer. However, the effectiveness of these agents is limited by the development of resistance. Here, an RNAi screen was used to identify modifiers of tamoxifen sensitivity. We demonstrate that CDK10 is an important determinant of resistance to endocrine therapies and show that CDK10 silencing increases ETS2-driven transcription of c-RAF, resulting in MAPK pathway activation and loss of tumor cell reliance upon estrogen signaling. Patients with ER alpha-positive tumors that express low levels of CDK10 relapse early on tamoxifen, demonstrating the clinical significance of these observations. The association of low levels of CDK10 with methylation of the CDK10 promoter suggests a mechanism by which CDK10 expression is reduced in tumors.

Edwards, S.L. Brough, R. Lord, C.J. Natrajan, R. Vatcheva, R. Levine, D.A. Boyd, J. Reis-Filho, J.S. Ashworth, A (2008) Resistance to therapy caused by intragenic deletion in BRCA2.. Show Abstract full text

Cells with loss of BRCA2 function are defective in homologous recombination (HR) and are highly sensitive to inhibitors of poly(ADP-ribose) polymerase (PARP), which provides the basis for a new therapeutic approach. Here we show that resistance to PARP inhibition can be acquired by deletion of a mutation in BRCA2. We derived PARP-inhibitor-resistant (PIR) clones from the human CAPAN1 pancreatic cancer cell line, which carries the protein-truncating c.6174delT frameshift mutation. PIR clones could form DNA-damage-induced RAD51 nuclear foci and were able to limit genotoxin-induced genomic instability, both hallmarks of a competent HR pathway. New BRCA2 isoforms were expressed in the resistant lines as a result of intragenic deletion of the c.6174delT mutation and restoration of the open reading frame (ORF). Reconstitution of BRCA2-deficient cells with these revertant BRCA2 alleles rescued PARP inhibitor sensitivity and HR deficiency. Most of the deletions in BRCA2 were associated with small tracts of homology, and possibly arose from error-prone repair caused by BRCA2 deficiency. Similar ORF-restoring mutations were present in carboplatin-resistant ovarian tumours from c.6174delT mutation carriers. These observations have implications for understanding drug resistance in BRCA mutation carriers as well as in defining functionally important domains within BRCA2.

Komander, D. Lord, C.J. Scheel, H. Swift, S. Hofmann, K. Ashworth, A. Barford, D (2008) The structure of the CYLD USP domain explains its specificity for Lys63-linked polyubiquitin and reveals a B box module.. Show Abstract full text

The tumor suppressor CYLD antagonizes NF-kappaB and JNK signaling by disassembly of Lys63-linked ubiquitin chains synthesized in response to cytokine stimulation. Here we describe the crystal structure of the CYLD USP domain, revealing a distinctive architecture that provides molecular insights into its specificity toward Lys63-linked polyubiquitin. We identify regions of the USP domain responsible for this specificity and demonstrate endodeubiquitinase activity toward such chains. Pathogenic truncations of the CYLD C terminus, associated with the hypertrophic skin tumor cylindromatosis, disrupt the USP domain, accounting for loss of CYLD catalytic activity. A small zinc-binding B box domain, similar in structure to other crossbrace Zn-binding folds--including the RING domain found in E3 ubiquitin ligases--is inserted within the globular core of the USP domain. Biochemical and functional characterization of the B box suggests a role as a protein-interaction module that contributes to determining the subcellular localization of CYLD.

Martin, S.A. Lord, C.J. Ashworth, A (2008) DNA repair deficiency as a therapeutic target in cancer.. Show Abstract full text

Inhibitors of DNA repair proteins have been used in cancer therapy, mostly to potentiate the effects of cytotoxic agents. However, tumor cells frequently exhibit deficiencies in the signalling or repair of DNA damage. These deficiencies probably contribute to pathogenesis of the disease, but they also present an opportunity to target the tumor. Recently, inhibitors of poly(ADP-ribose) polymerase (PARP) have been shown to be highly selective for tumor cells with defects in the repair of double-strand DNA breaks (DSBs) by homologous recombination, particularly in the context of BRCA1 or BRCA2 mutation. It seems likely that other DNA repair processes can be targeted in a similar manner. These synthetic lethal approaches highlight how an understanding of DNA repair processes can be used in the development of novel cancer treatments.

Marchiò, C. Natrajan, R. Shiu, K.K. Lambros, M.B.K. Rodriguez-Pinilla, S.M. Tan, D.S.P. Lord, C.J. Hungermann, D. Fenwick, K. Tamber, N. Mackay, A. Palacios, J. Sapino, A. Buerger, H. Ashworth, A. Reis-Filho, J.S (2008) The genomic profile of HER2-amplified breast cancers: the influence of ER status.. Show Abstract full text

Expression profiling studies have suggested that HER2-amplified breast cancers constitute a heterogeneous group that may be subdivided according to their ER status: HER2-amplified ER-positive breast carcinomas that fall into the luminal B cluster; and HER2-amplified ER-negative cancers which form a distinct molecular subgroup, known as the erbB2 or HER2 subgroup. ER-negative breast cancer differs significantly from ER-positive disease in the pattern, type, and complexity of genetic aberrations. Here we have compared the genomic profiles of ER-positive and ER-negative HER2-amplified cancers using tiling path microarray-based comparative genomic hybridization (aCGH). Validation of the differentially amplified regions was performed in an independent series of 70 HER2-amplified breast cancers. Although HER2-amplified cancers had remarkably complex patterns of molecular genetic aberrations, ER-positive and ER-negative HER2-amplified breast carcinomas shared most molecular genetic features as defined by aCGH. Genome-wide Fisher's exact test analysis revealed that less than 1.5% of the genome was significantly differentially gained or lost in ER-positive versus ER-negative HER2-amplified cancers. However, two regions of amplification were significantly associated with ER-positive carcinomas, one of which mapped to 17q21.2 and encompassed GJC1, IGFBP4, TNS4, and TOP2A. Chromogenic in situ hybridization analysis of an independent validation series confirmed the association between ER status and TOP2A amplification. In conclusion, although hormone receptor status does not determine the overall genetic profile of HER2-amplified breast cancers, specific genetic aberrations may be characteristic of subgroups of HER2 breast cancers.

Lord, C.J. McDonald, S. Swift, S. Turner, N.C. Ashworth, A (2008) A high-throughput RNA interference screen for DNA repair determinants of PARP inhibitor sensitivity.. Show Abstract full text

Synthetic lethality is an attractive strategy for the design of novel therapies for cancer. Using this approach we have previously demonstrated that inhibition of the DNA repair protein, PARP1, is synthetically lethal with deficiency of either of the breast cancer susceptibility proteins, BRCA1 and BRCA2. This observation is most likely explained by the inability of BRCA deficient cells to repair DNA damage by homologous recombination (HR) and has led to the clinical trials of potent PARP inhibitors for the treatment of BRCA mutation-associated cancer. To identify further determinants of PARP inhibitor response, we took a high-throughput genetic approach. We tested each of the genes recognised as having a role in DNA repair using short-interfering RNA (siRNA) and assessed the sensitivity of siRNA transfected cells to a potent PARP inhibitor, KU0058948. The validity of this approach was confirmed by the identification of known genetic determinants of PARP inhibitor sensitivity, including genes involved in HR. Novel determinants of PARP inhibitor response were also identified, including the transcription coupled DNA repair (TCR) proteins DDB1 and XAB2. These results suggest that DNA repair pathways other than HR may determine sensitivity to PARP inhibitors and highlight the likelihood that ostensibly distinct DNA repair pathways cooperate to maintain genomic stability and cellular viability. Furthermore, the identification of these novel determinants may eventually guide the optimal use of PARP inhibitors in the clinic.

Mackay, A. Tamber, N. Fenwick, K. Iravani, M. Grigoriadis, A. Dexter, T. Lord, C.J. Reis-Filho, J.S. Ashworth, A (2009) A high-resolution integrated analysis of genetic and expression profiles of breast cancer cell lines.. Show Abstract full text

Tumour cell lines derived from breast cancer patients constitute one of the cornerstones of breast cancer research. To characterise breast cancer cell lines at the genetic level, we have developed a full tiling path bacterial artificial chromosome (BAC) array collection for comparative genomic hybridisation (aCGH). This aCGH BAC collection covers 98% of the entire human genome at a resolution of 40-60 kbp. We have used this platform alongside an in-house produced 17 K cDNA microarray set to characterise the genetic and transcriptomic profiles of 24 breast cancer cell lines, as well as cell types derived from non-diseased breast. We demonstrate that breast cancer cell lines have genomic and transcriptomic features that recapitulate those of primary breast cancers and can be reliably subclassified into basal-like and luminal subgroups. By overlaying aCGH and transcriptomic data, we have identified 753 genes whose expression correlate with copy number; this list comprised numerous oncogenes recurrently amplified and overexpressed in breast cancer (e.g., HER2, MYC, CCND1 and AURKA). Finally, we demonstrate that although breast cancer cell lines have genomic features usually found in grade III breast cancers (i.e., gains of 1q, 8q and 20q), basal-like and luminal cell lines are characterised by distinct genomic aberrations.

McCarthy, A. Lord, C.J. Savage, K. Grigoriadis, A. Smith, D.P. Weigelt, B. Reis-Filho, J.S. Ashworth, A (2009) Conditional deletion of the Lkb1 gene in the mouse mammary gland induces tumour formation.. Show Abstract full text

Heterozygous germline mutations in the LKB1 (STK11) gene cause Peutz-Jeghers syndrome (PJS), an autosomal dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract and an increased risk of colorectal, breast, and other cancers. To model the role of LKB1 mutation in mammary tumourigenesis, we have used a conditional gene targeting strategy to generate a mouse in which exons encoding the kinase domain of Lkb1 were deleted specifically in the mammary gland. Mammary gland tumours developed in these mice with a latency of 46-85 weeks and occurred in the thoracic or inguinal glands. These tumours were grade 2 invasive ductal carcinomas or solid papillary carcinomas with histological features similar to those described in breast cancers arising in patients with PJS. This mouse model of Lkb1 deficiency provides a potentially useful tool to investigate the role of Lkb1 in tumourigenesis and to guide the development of therapeutic approaches.

Natrajan, R. Weigelt, B. Mackay, A. Geyer, F.C. Grigoriadis, A. Tan, D.S.P. Jones, C. Lord, C.J. Vatcheva, R. Rodriguez-Pinilla, S.M. Palacios, J. Ashworth, A. Reis-Filho, J.S (2010) An integrative genomic and transcriptomic analysis reveals molecular pathways and networks regulated by copy number aberrations in basal-like, HER2 and luminal cancers.. Show Abstract full text

Breast cancer is a heterogeneous disease caused by the accumulation of genetic changes in neoplastic cells. We hypothesised that molecular subtypes of breast cancer may be driven by specific constellations of genes whose expression is regulated by gene copy number aberrations. To address this question, we analysed a series of 48 microdissected grade III ductal carcinomas using high resolution microarray comparative genomic hybridisation and mRNA expression arrays. There were 5,931 genes whose expression significantly correlates with copy number identified; out of these, 1,897 genes were significantly differentially expressed between basal-like, HER2 and luminal tumours. Ingenuity Pathway Analysis (IPA) revealed that 'G1/S cell cycle regulation' and 'BRCA1 in DNA damage control' pathways were significantly enriched for genes whose expression correlates with copy number and are differentially expressed between the molecular subtypes of breast cancer. IPA of genes whose expression significantly correlates with copy number in each molecular subtype individually revealed that canonical pathways involved in oestrogen receptor (ER) signalling and DNA repair are enriched for these genes. We also identified 32, 157 and 265 genes significantly overexpressed when amplified in basal-like, HER2 and luminal cancers, respectively. These lists include known and novel potential therapeutic targets (e.g. HER2 and PPM1D in HER2 cancers). Our results provide strong circumstantial evidence that different patterns of genetic aberrations in distinct molecular subtypes of breast cancer contribute to their specific transcriptomic profiles and that biological phenomena characteristic of each subtype (e.g. proliferation, HER2 and ER signalling) may be driven by specific patterns of copy number aberrations.

Martin, S.A. Hewish, M. Lord, C.J. Ashworth, A (2010) Genomic instability and the selection of treatments for cancer.. Show Abstract full text

A critical link exists between DNA mutation and chromosomal rearrangements (genomic instability) and cancer development. This genomic instability can manifest itself as small changes at the nucleotide level or as gross chromosomal alterations. Mutations in the genes that encode DNA damage response proteins are responsible for a variety of genomic instability syndromes including hereditary non-polyposis colorectal carcinoma, Bloom's syndrome, ataxia-telangiectasia, BRCA-associated breast and ovarian cancers and Fanconi anaemia. Similarly, epigenetic silencing of genes associated with the maintenance of genomic stability have also been implicated in the pathogenesis of cancer. Here, we discuss how different tumours may be classified not only by tumour site but also by the type of underlying genetic instability. This type of classification may assist in the optimization of existing treatment regimens as well as informing the development of new therapeutic approaches.

Hewish, M. Lord, C.J. Martin, S.A. Cunningham, D. Ashworth, A (2010) Mismatch repair deficient colorectal cancer in the era of personalized treatment.. Show Abstract full text

The molecular and genetic subtyping of cancer has allowed the emergence of individualized therapies. This approach could potentially deliver treatments that have both increased efficacy as well as reduced toxicity. A well-defined subtype of colorectal cancer (CRC) is characterized by a deficiency in the mismatch repair (MMR) pathway. MMR deficiency not only contributes to the pathogenesis of a large proportion of CRC, but also determines the response to many of the drugs that are frequently used to treat this disease. In this Review we describe the MMR deficient phenotype and discuss how a deficiency in this DNA repair process may impact on the management of CRC, including surgery, adjuvant chemotherapy and the choice of systemic agents for the palliation of advanced disease. We also discuss how the DNA repair defect in MMR deficient CRC could be exploited in the development of novel therapeutic strategies.

Martin, S.A. McCabe, N. Mullarkey, M. Cummins, R. Burgess, D.J. Nakabeppu, Y. Oka, S. Kay, E. Lord, C.J. Ashworth, A (2010) DNA polymerases as potential therapeutic targets for cancers deficient in the DNA mismatch repair proteins MSH2 or MLH1.. Show Abstract full text

Synthetic sickness/lethality (SSL) can be exploited to develop therapeutic strategies for cancer. Deficiencies in the tumor suppressor proteins MLH1 and MSH2 have been implicated in cancer. Here we demonstrate that deficiency in MSH2 is SSL with inhibition of the DNA polymerase POLB, whereas deficiency in MLH1 is SSL with DNA polymerase POLG inhibition. Both SSLs led to the accumulation of 8-oxoG oxidative DNA lesions. MSH2/POLB SSL caused nuclear 8-oxoG accumulation, whereas MLH1/POLG SSL led to a rise in mitochondrial 8-oxoG levels. Both SSLs were rescued by silencing the adenine glycosylase MUTYH, suggesting that lethality could be caused by the formation of lethal DNA breaks upon 8-oxoG accumulation. These data suggest targeted, mechanism-based therapeutic approaches.

Lyons, P.A. Armitage, N. Lord, C.J. Phillips, M.S. Todd, J.A. Peterson, L.B. Wicker, L.S (2001) Mapping by genetic interaction - High-resolution congenic mapping of the type 1 diabetes loci Idd10 and Idd18 in the NOD mouse. full text
Farmer, H. McCabe, N. Lord, C.J. Tutt, A.N.J. Johnson, D.A. Richardson, T.B. Santarosa, M. Dillon, K.J. Hickson, I. Knights, C. Martin, N.M.B. Jackson, S.P. Smith, G.C.M. Ashworth, A (2005) Targeting the DNA repair defect in <i>BRCA</i> mutant cells as a therapeutic strategy.
Arias-Lopez, C. Lazaro-Trueba, I. Kerr, P. Lord, C.J. Dexter, T. Iravani, M. Ashworth, A. Silva, A (2006) P53 modulates homologous recombination by transcriptional regulation of the RAD51 gene.
McCabe, N. Lord, C.J. Tutt, A.N.J. Martin, N.M.B. Smith, G.C.M. Ashworth, A (2005) BRCA2-deficient CAPAN-1 cells are extremely sensitive to the inhibition of poly (ADP-Ribose) polymerase.
Friedmann, B.J. Caplin, M. Savic, B. Shah, T. Lord, C.J. Ashworth, A. Hartley, J.A. Hochhauser, D (2006) Interaction of the epidermal growth factor receptor and the DNA-dependent protein kinase pathway following gefitinib treatment.
McCabe, N. Turner, N.C. Lord, C.J. Kluzek, K. Bialkowska, A. Swift, S. Giavara, S. O'Connor, M.J. Tutt, A.N. Zdzienicka, M.Z. Smith, G.C.M. Ashworth, A (2006) Deficiency in the repair of DNA damage by homologous recombination and sensitivity to poly(ADP-ribose) polymerase inhibition.
Lord, C.J. Garrett, M.D. Ashworth, A (2006) Targeting the double-strand DNA break repair pathway as a therapeutic strategy.
Lord, C.J. Ashworth, A (2007) RAD51, BRCA2 and DNA repair: a partial resolution.
Gudmundsdottir, K. Lord, C.J. Ashworth, A (2007) The proteasome is involved in determining differential utilization of double-strand break repair pathways. full text
Rayter, S. Elliott, R. Travers, J. Rowlands, M.G. Richardson, T.B. Boxall, K. Jones, K. Linardopoulos, S. Workman, P. Aherne, W. Lord, C.J. Ashworth, A (2008) A chemical inhibitor of PPM1D that selectively kills cells overexpressing PPM1D.. Show Abstract full text

The PPM1D gene is aberrantly amplified in a range of common cancers and encodes a protein phosphatase that is a potential therapeutic target. However, the issue of whether inhibition of PPM1D in human tumour cells that overexpress this protein compromises their viability has not yet been fully addressed. We show here, using an RNA interference (RNAi) approach, that inhibition of PPM1D can indeed reduce the viability of human tumour cells and that this effect is selective; tumour cell lines that overexpress PPM1D are sensitive to PPM1D inhibition whereas cell lines with normal levels are not. Loss of viability associated with PPM1D RNAi in human tumour cells occurs via the activation of the kinase P38. To identify chemical inhibitors of PPM1D, a high-throughput screening of a library of small molecules was performed. This strategy successfully identified a compound that selectively reduces viability of human tumour cell lines that overexpress PPM1D. As expected of a specific inhibitor, the toxicity to PPM1D overexpressing cell lines after inhibitor treatment is P38 dependent. These results further validate PPM1D as a therapeutic target and identify a proof-of-principle small molecule inhibitor.

Turner, N.C. Lord, C.J. Iorns, E. Brough, R. Swift, S. Elliott, R. Rayter, S. Tutt, A.N. Ashworth, A (2008) A synthetic lethal siRNA screen identifying genes mediating sensitivity to a PARP inhibitor.
Lord, C.J. Iorns, E. Ashworth, A (2008) Dissecting resistance to endocrine therapy in breast cancer. full text
Lord, C.J. Ashworth, A (2008) Targeted therapy for cancer using PARP inhibitors.
Iorns, E. Lord, C.J. Ashworth, A (2009) Parallel RNAi and compound screens identify the PDK1 pathway as a target for tamoxifen sensitization. full text
McCabe, N. Cerone, M.A. Ohishi, T. Seimiya, H. Lord, C.J. Ashworth, A (2009) Targeting Tankyrase 1 as a therapeutic strategy for BRCA-associated cancer. full text
Lord, C.J. Martin, S.A. Ashworth, A (2009) RNA interference screening demystified. full text
Iorns, E. Lord, C.J. Grigoriadis, A. McDonald, S. Fenwick, K. MacKay, A. Mein, C.A. Natrajan, R. Savage, K. Tamber, N. Reis-Filho, J.S. Turner, N.C. Ashworth, A (2009) Integrated Functional, Gene Expression and Genomic Analysis for the Identification of Cancer Targets.
Lord, C.J. Ashworth, A (2009) Bringing DNA Repair in Tumors into Focus. full text
Tan, D.S.P. Lambros, M.B.K. Rayter, S. Natrajan, R. Vatcheva, R. Gao, Q. Marchio, C. Geyer, F.C. Savage, K. Parry, S. Fenwick, K. Tamber, N. Mackay, A. Dexter, T. Jameson, C. McCluggage, W.G. Williams, A. Graham, A. Faratian, D. El-Bahrawy, M. Paige, A.J. Gabra, H. Gore, M.E. Zvelebil, M. Lord, C.J. Kaye, S.B. Ashworth, A. Reis-Filho, J.S (2009) PPM1D Is a Potential Therapeutic Target in Ovarian Clear Cell Carcinomas.
Iorns, E. Martens-de Kemp, S.R. Lord, C.J. Ashworth, A (2009) CRK7 modifies the MAPK pathway and influences the response to endocrine therapy.
Oliver, A.W. Swift, S. Lord, C.J. Ashworth, A. Pearl, L.H (2009) Structural basis for recruitment of BRCA2 by PALB2.
Mendes-Pereira, A.M. Martin, S.A. Brough, R. McCarthy, A. Taylor, J.R. Kim, J.-.S. Waldman, T. Lord, C.J. Ashworth, A () Synthetic lethal targeting of <i>PTEN</i> mutant cells with PARP inhibitors.
Martin, S.A. McCarthy, A. Barber, L.J. Burgess, D.J. Parry, S. Lord, C.J. Ashworth, A () Methotrexate induces oxidative DNA damage and is selectively lethal to tumour cells with defects in the DNA mismatch repair gene <i>MSH2</i>.
Sourisseau, T. Maniotis, D. McCarthy, A. Tang, C. Lord, C.J. Ashworth, A. Linardopoulos, S (2010) Aurora-A expressing tumour cells are deficient for homology-directed DNA double strand-break repair and sensitive to PARP inhibition.. Show Abstract full text

The protein kinase Aurora-A is a major regulator of the cell cycle that orchestrates mitotic entry and is required for the assembly of a functional mitotic spindle. Overexpression of Aurora-A has been strongly linked with oncogenesis and this has led to considerable efforts at therapeutic targeting of the kinase activity of this protein. However, the exact mechanism by which Aurora-A promotes oncogenesis remains unclear. Here, we show that Aurora-A modulates the repair of DNA double-strand breaks (DSBs). Aurora-A expression inhibits RAD51 recruitment to DNA DSBs, decreases DSB repair by homologous recombination and sensitizes cancer cells to PARP inhibition. This impairment of RAD51 function requires inhibition of CHK1 by Polo-like kinase 1 (PLK1). These results identify a novel function of Aurora-A in modulating the response to DNA DSB that likely contributes to carcinogenesis and suggest a novel therapeutic approach to the treatment of cancers overexpressing this protein.

Lord, C.J. Ashworth, A (2010) Biology-driven cancer drug development: back to the future.
Dedes, K.J. Wetterskog, D. Mendes-Pereira, A.M. Natrajan, R. Lambros, M.B. Geyer, F.C. Vatcheva, R. Savage, K. Mackay, A. Lord, C.J. Ashworth, A. Reis-Filho, J.S (2010) PTEN deficiency in endometrioid endometrial adenocarcinomas predicts sensitivity to PARP inhibitors.. Show Abstract full text

PTEN (phosphatase and tensin homolog) loss of function is the most common genetic aberration in endometrioid endometrial carcinomas. In addition to its well-described role in cell signaling, PTEN is involved in the maintenance of genomic stability. Loss of PTEN function causes defects in repair of DNA double-strand breaks by homologous recombination and, therefore, sensitizes cells to inhibition of the poly(adenosine diphosphate ribose) polymerase (PARP). Here, we determined the PTEN status of eight endometrioid endometrial carcinoma cell lines and correlated it with in vitro sensitivity to the PARP inhibitor KU0058948. PTEN-deficient cells showed a significantly greater sensitivity to KU0058948 than the two endometrioid endometrial carcinoma cell lines with wild-type PTEN. The cell lines lacking PTEN expression were unable to elicit a homologous recombination damage response as assayed by RAD51 focus function (a marker of competent homologous recombination DNA repair) upon irradiation and treatment with PARP inhibitors. PTEN silencing in PTEN wild-type Hec-1b cells resulted in reduced RAD51 foci formation after DNA damage and increased sensitivity to PARP inhibition. PTEN reexpression in PTEN-null cell lines resulted in enhanced RAD51 foci formation and in relative resistance to KU0058948. Given that up to 80% of endometrioid endometrial cancers lack PTEN expression, our results suggest that PARP inhibitors may be therapeutically useful for a subset of endometrioid endometrial cancers.

Rehman, F.L. Lord, C.J. Ashworth, A (2010) Synthetic lethal approaches to breast cancer therapy.. Show Abstract full text

The promise of personalized therapy for breast cancer is that therapeutic efficacy will be increased while toxic effects are reduced to a minimum. To achieve this goal, there is now an emphasis on the design of therapies that are based not only on the clinical manifestations of the disease, but also on the underlying molecular and cellular biology of cancer. However, identifying targets for personalized therapies in breast cancer is challenging. Here, we describe how biological concepts such as synthetic lethality and oncogene addiction can be used to identify new therapeutic targets and approaches. We discuss the current clinical developments in implementing synthetic lethality therapies, and highlight new ways in which this approach could be used to target specific subsets of breast cancer.

Lambros, M.B. Natrajan, R. Geyer, F.C. Lopez-Garcia, M.A. Dedes, K.J. Savage, K. Lacroix-Triki, M. Jones, R.L. Lord, C.J. Linardopoulos, S. Ashworth, A. Reis-Filho, J.S (2010) PPM1D gene amplification and overexpression in breast cancer: a qRT-PCR and chromogenic in situ hybridization study.. Show Abstract full text

PPM1D (protein phosphatase magnesium-dependent 1δ) maps to the 17q23.2 amplicon and is amplified in ∼8% of breast cancers. The PPM1D gene encodes a serine threonine phosphatase, which is involved in the regulation of several tumour suppressor pathways, including the p53 pathway. Along with others, we have recently shown that PPM1D is one of the drivers of the 17q23.2 amplicon and a promising therapeutic target. Here we investigate whether PPM1D is overexpressed when amplified in breast cancers and the correlations between PPM1D overexpression and amplification with clinicopathological features and survival of breast cancer patients from a cohort of 245 patients with invasive breast cancer treated with therapeutic surgery followed by adjuvant anthracycline-based chemotherapy. mRNA was extracted from representative sections of tumours containing >50% of tumour cells and subjected to TaqMan quantitative real-time PCR using primers for PPM1D and for two housekeeping genes. PPM1D overexpression was defined as the top quartile of expression levels. Chromogenic in situ hybridization with in-house-generated probes for PPM1D was performed. Amplification was defined as >50% of cancer cells with >5 signals per nucleus/large gene clusters. PPM1D overexpression and amplification were found in 25 and 6% of breast cancers, respectively. All cases harbouring PPM1D amplification displayed PPM1D overexpression. PPM1D overexpression was inversely correlated with expression of TOP2A, EGFR and cytokeratins 5/6 and 17. PPM1D amplification was significantly associated with HER2 overexpression, and HER2, TOP2A and CCND1 amplification. No association between PPM1D gene amplification and PPM1D mRNA overexpression with survival was observed. In conclusion, PPM1D is consistently overexpressed when amplified; however, PPM1D overexpression is more pervasive than gene amplification. PPM1D overexpression and amplification are associated with tumours displaying luminal or HER2 phenotypes. Co-amplification of PPM1D and HER2/TOP2A and CCND1 are not random events and may suggest the presence of a 'firestorm' genetic profile.

Natrajan, R. Lambros, M.B. Rodríguez-Pinilla, S.M. Moreno-Bueno, G. Tan, D.S.P. Marchió, C. Vatcheva, R. Rayter, S. Mahler-Araujo, B. Fulford, L.G. Hungermann, D. Mackay, A. Grigoriadis, A. Fenwick, K. Tamber, N. Hardisson, D. Tutt, A. Palacios, J. Lord, C.J. Buerger, H. Ashworth, A. Reis-Filho, J.S (2009) Tiling path genomic profiling of grade 3 invasive ductal breast cancers.. Show Abstract full text

PURPOSE: To characterize the molecular genetic profiles of grade 3 invasive ductal carcinomas of no special type using high-resolution microarray-based comparative genomic hybridization (aCGH) and to identify recurrent amplicons harboring putative therapeutic targets associated with luminal, HER-2, and basal-like tumor phenotypes. EXPERIMENTAL DESIGN: Ninety-five grade 3 invasive ductal carcinomas of no special type were classified into luminal, HER-2, and basal-like subgroups using a previously validated immunohistochemical panel. Tumor samples were microdissected and subjected to aCGH using a tiling path 32K BAC array platform. Selected regions of recurrent amplification were validated by means of in situ hybridization. Expression of genes pertaining to selected amplicons was investigated using quantitative real-time PCR and gene silencing was done using previously validated short hairpin RNA constructs. RESULTS: We show that basal-like and HER-2 tumors are characterized by "sawtooth" and "firestorm" genetic patterns, respectively, whereas luminal cancers were more heterogeneous. Apart from confirming known amplifications associated with basal-like (1q21, 10p, and 12p), luminal (8p12, 11q13, and 11q14), and HER-2 (17q12) cancers, we identified previously unreported recurrent amplifications associated with each molecular subgroup: 19q12 in basal-like, 1q32.1 in luminal, and 14q12 in HER-2 cancers. PPM1D gene amplification (17q23.2) was found in 20% and 8% of HER-2 and luminal cancers, respectively. Silencing of PPM1D by short hairpin RNA resulted in selective loss of viability in tumor cell lines harboring the 17q23.2 amplification. CONCLUSIONS: Our results show the power of aCGH analysis in unraveling the genetic profiles of specific subgroups of cancer and for the identification of novel therapeutic targets.

de Plater, L. Lauge, A. Guyader, C. Poupon, M.-.F. Assayag, F. de Cremoux, P. Vincent-Salomon, A. Stoppa-Lyonnet, D. Sigal-Zafrani, B. Fontaine, J.-.J. Brough, R. Lord, C.J. Ashworth, A. Cottu, P. Decaudin, D. Marangoni, E (2010) Establishment and characterisation of a new breast cancer xenograft obtained from a woman carrying a germline BRCA2 mutation. full text
Martin, S.A. Lord, C.J. Ashworth, A (2010) Therapeutic Targeting of the DNA Mismatch Repair Pathway.
Graeser, M. McCarthy, A. Lord, C.J. Savage, K. Hills, M. Salter, J. Orr, N. Parton, M. Smith, I.E. Reis-Filho, J.S. Dowsett, M. Ashworth, A. Turner, N.C (2010) A marker of homologous recombination predicts pathologic complete response to neoadjuvant chemotherapy in primary breast cancer.. Show Abstract full text

PURPOSE: To assess the prevalence of defective homologous recombination (HR)-based DNA repair in sporadic primary breast cancers, examine the clincopathologic features that correlate with defective HR and the relationship with neoadjuvant chemotherapy response. EXPERIMENTAL DESIGN: We examined a cohort of 68 patients with sporadic primary breast cancer who received neoadjuvant anthracylcine-based chemotherapy, with core biopsies taken 24 hours after the first cycle of chemotherapy. We assessed RAD51 focus formation, a marker of HR competence, by immunofluorescence in postchemotherapy biopsies along with geminin as a marker of proliferative cells. We assessed the RAD51 score as the proportion of proliferative cells with RAD51 foci. RESULTS: A low RAD51 score was present in 26% of cases (15/57, 95% CI: 15%-40%). Low RAD51 score correlated with high histologic grade (P = 0.031) and high baseline Ki67 (P = 0.005). Low RAD51 score was more frequent in triple-negative breast cancers than in ER- and/or HER2-positive breast cancer (67% vs. 19% respectively; P = 0.0036). Low RAD51 score was strongly predictive of pathologic complete response (pathCR) to chemotherapy, with 33% low RAD51 score cancers achieving pathCR compared with 3% of other cancers (P = 0.011). CONCLUSIONS: Our results suggest that defective HR, as indicated by low RAD51 score, may be one of the factors that underlie sensitivity to anthracycline-based chemotherapy. Defective HR is frequent in triple-negative breast cancer, but it is also present in a subset of other subtypes, identifying breast cancers that may benefit from therapies that target defective HR such as PARP inhibitors.

Brough, R. Frankum, J.R. Costa-Cabral, S. Lord, C.J. Ashworth, A (2011) Searching for synthetic lethality in cancer.. Show Abstract full text

The incentive to develop personalised therapy for cancer treatment is driven by the premise that it will increase therapeutic efficacy and reduce toxicity. Understanding the underlying cellular and molecular basis of the disease has been extremely important in the design of these novel therapies; however, identifying new drug targets for personalised therapies remains problematic. This review describes how the biological concept of synthetic lethality has been successfully implemented to identify new therapeutic approaches and targets in models from yeast through to human cells. We also discuss how recent technical advances combined with an increased understanding of the complexity of cellular networks may facilitate therapeutic advances in the future.

Lyons, P.A. Armitage, N. Argentina, F. Denny, P. Hill, N.J. Lord, C.J. Wilusz, M.B. Peterson, L.B. Wicker, L.S. Todd, J.A (2000) Congenic mapping of the type 1 diabetes locus, Idd3, to a 780-kb region of mouse chromosome 3: identification of a candidate segment of ancestral DNA by haplotype mapping.. Show Abstract full text

Type 1 diabetes in the nonobese diabetic (NOD) mouse arises as a consequence of T cell-mediated destruction of the insulin-producing beta cells of the pancreas. Although little is known of the events that initiate and subsequently drive beta-cell destruction it is clear that the entire process is under complex genetic control. At present 19 loci have been mapped that influence the development of diabetes either at the level of initiation of insulitis or at the level of progression from insulitis to overt diabetes, or both. Previously, we have mapped one of these loci, Idd3, to a 0.35-cM interval on proximal mouse chromosome 3. In the present study we have narrowed the map position of this locus to an interval of 0.15 cM by a combination of novel congenic strains and an ancestral haplotype analysis approach. We have constructed a physical contig in bacterial artificial chromosome (BAC) clones across the minimal interval. Restriction mapping of the BAC contig placed the maximum size of the Idd3 interval at 780 kb between the markers D3Nds36 and D3Nds76. To refine further the Idd3 interval we developed a series of novel single nucleotide polymorphisms (SNPs) and carried out haplotype analysis on DNA from mouse strains known to carry either Idd3 susceptibility or protective alleles. This haplotype analysis identified a 145-kb segment of ancestral DNA between the microsatellite marker D3Nds6 and the SNP 81.3. One haplotype of this ancestral segment of DNA is found in mouse strains carrying an Idd3 susceptibility allele and another is found in mouse strains carrying an Idd3 protective allelle. Within the 780-kb congenically defined interval this 145-kb segment represents the most likely location for Idd3. The Il2 gene, which encodes the cytokine interleukin 2 (IL2), maps to this interval and is a strong candidate for Idd3. To investigate whether sequence variation exists in the promoter region of the Il2 gene, which might alter its expression, we sequenced the promoter region of the Il2 gene from mouse strains carrying either an Idd3 susceptibility or resistance allele. Two sequence variants were identified, neither of which fell in known regulatory elements within the Il2 promoter. In agreement with this observation steady-state Il2 mRNA levels showed no variation between susceptible and resistant mouse strains. These data suggest that the profound protection from diabetes seen in congenic mice carrying an Idd3 protective allele is unlikely to be due to differences in the level of expression of the Il2 gene. Instead, all of the current data support our hypothesis that Idd3 corresponds to amino acid variation at the amino terminus of Il2.

Podolin, P.L. Wilusz, M.B. Cubbon, R.M. Pajvani, U. Lord, C.J. Todd, J.A. Peterson, L.B. Wicker, L.S. Lyons, P.A (2000) Differential glycosylation of interleukin 2, the molecular basis for the NOD Idd3 type 1 diabetes gene?. Show Abstract full text

The insulin-dependent diabetes (Idd) gene, Idd3, has been localised to a 0.35 cM region of chromosome 3 containing the structural gene for the cytokine interleukin 2 (IL-2). While variation of the N-terminal amino acid sequence of IL-2 has been shown to correlate with Idd3 allelic variation, differences in induction of proliferation by IL-2 allotypes have not been detected. In the current study, we examined the electrophoretic migration of IL-2 allotypes and have found two distinct patterns, consistent with differences in glycosylation, that correlate with diabetes-resistance and susceptibility. These findings strongly suggest that IL-2 variants may be functionally distinct.

Lyons, P.A. Hancock, W.W. Denny, P. Lord, C.J. Hill, N.J. Armitage, N. Siegmund, T. Todd, J.A. Phillips, M.S. Hess, J.F. Chen, S.L. Fischer, P.A. Peterson, L.B. Wicker, L.S (2000) The NOD Idd9 genetic interval influences the pathogenicity of insulitis and contains molecular variants of Cd30, Tnfr2, and Cd137.. Show Abstract full text

Previous analyses of NOD mice have shown that some genes control the development of both insulitis and diabetes, while other loci influence diabetes without reducing insulitis. Evidence for the existence of a gene only influencing diabetes, Idd9 on mouse chromosome 4, is provided here by the development of a novel congenic mouse strain, NOD.B10 Idd9. NOD.B10 Idd9 mice display profound resistance to diabetes even though nearly all develop insulitis. Subcongenic analysis has demonstrated that alleles of at least three B10 genes, Idd9.1, Idd9.2, and Idd9.3 are required to produce Idd9-mediated diabetes resistance. Candidate genes with amino acid differences between the NOD and B10 strains have been localized to the 5.6 cM Idd9.2 interval (Tnfr2, Cd30) and to the 2.0 cM Idd9.3 interval (Cd137).

Lord, C.J. Howlett, S. Lyons, P.A. Peterson, L.B. Wicker, L.S. Todd, J.A (2001) The murine type 1 diabetes loci, Idd1, Idd3, Idd5, Idd9, and Idd17/10/18, do not control thymic CD4-CD8-/TCRalphabeta+ deficiency in the nonobese diabetic mouse.. full text
Cordell, H.J. Todd, J.A. Hill, N.J. Lord, C.J. Lyons, P.A. Peterson, L.B. Wicker, L.S. Clayton, D.G (2001) Statistical modeling of interlocus interactions in a complex disease: rejection of the multiplicative model of epistasis in type 1 diabetes.. Show Abstract full text

In general, common diseases do not follow a Mendelian inheritance pattern. To identify disease mechanisms and etiology, their genetic dissection may be assisted by evaluation of linkage in mouse models of human disease. Statistical modeling of multiple-locus linkage data from the nonobese diabetic (NOD) mouse model of type 1 diabetes has previously provided evidence for epistasis between alleles of several Idd (insulin-dependent diabetes) loci. The construction of NOD congenic strains containing selected segments of the diabetes-resistant strain genome allows analysis of the joint effects of alleles of different loci in isolation, without the complication of other segregating Idd loci. In this article, we analyze data from congenic strains carrying two chromosome intervals (a double congenic strain) for two pairs of loci: Idd3 and Idd10 and Idd3 and Idd5. The joint action of both pairs is consistent with models of additivity on either the log odds of the penetrance, or the liability scale, rather than with the previously proposed multiplicative model of epistasis. For Idd3 and Idd5 we would also not reject a model of additivity on the penetrance scale, which might indicate a disease model mediated by more than one pathway leading to beta-cell destruction and development of diabetes. However, there has been confusion between different definitions of interaction or epistasis as used in the biological, statistical, epidemiological, and quantitative and human genetics fields. The degree to which statistical analyses can elucidate underlying biologic mechanisms may be limited and may require prior knowledge of the underlying etiology.

Brook, F.A. Evans, E.P. Lord, C.J. Lyons, P.A. Rainbow, D.B. Howlett, S.K. Wicker, L.S. Todd, J.A. Gardner, R.L (2003) The derivation of highly germline-competent embryonic stem cells containing NOD-derived genome.. Show Abstract full text

It would be extremely advantageous to the analysis of disease mechanisms in the spontaneous mouse model of type 1 diabetes, the nonobese diabetic (NOD) strain, if genes in this strain could be modified in vivo using embryonic stem (ES) cells and homologous recombination. However, a NOD ES cell line with adequate germline transmission has not yet been reported. We report the development of highly germline-competent ES cell lines from the F1 hybrid of NOD and 129 for use in NOD gene targeting. Consequently, we developed ES cell lines derived from (NOD x 129)F1 x 129 backcross 1 mice, which were intercrossed to select for homozygosity of particular regions of NOD genome known to contain disease loci.

Penha-Gonçalves, C. Moule, C. Smink, L.J. Howson, J. Gregory, S. Rogers, J. Lyons, P.A. Suttie, J.J. Lord, C.J. Peterson, L.B. Todd, J.A. Wicker, L.S (2003) Identification of a structurally distinct CD101 molecule encoded in the 950-kb Idd10 region of NOD mice.. Show Abstract full text

Genes affecting autoimmune type 1 diabetes susceptibility in the nonobese diabetic (NOD) mouse (Idd loci) have been mapped using a congenic strain breeding strategy. In the present study, we used a combination of BAC clone contig construction, polymorphism analysis of DNA from congenic strains, and sequence mining of the human orthologous region to generate an integrated map of the Idd10 region on mouse chromosome 3. We found seven genes and one pseudogene in the 950-kb Idd10 region. Although all seven genes in the interval are Idd10 candidates, we suggest the gene encoding the EWI immunoglobulin subfamily member EWI-101 (Cd101) as the most likely Idd10 candidate because of the previously reported immune-associated properties of the human CD101 molecule. Additional support for the candidacy of Cd101 is the presence of 17 exonic single-nucleotide polymorphisms that differ between the NOD and B6 sequences, 10 causing amino acid substitutions in the predicted CD101 protein. Four of these 10 substitutions are nonconservative, 2 of which could potentially alter N-linked glycosylation. Considering our results together with those previous reports that antibodies recognizing human CD101 modulate human T-cell and dendritic cell function, there is now justification to test whether the alteration of CD101 function affects autoimmune islet destruction.

Houlihan, S.J. Simpson, S.H. Cave, A.J. Flook, N.W. Hurlburt, M.E. Lord, C.J. Smith, L.L. Sternberg, H.H (2009) Hypertension treatment and control rates: chart review in an academic family medicine clinic.. Show Abstract full text

OBJECTIVE: To characterize hypertension management in an academic family medicine clinic. DESIGN: Cross-sectional chart review. SETTING: Academic family medicine clinic in Edmonton, Alta. PARTICIPANTS: A total of 210 patients with 1 or more visits for hypertension during the previous 3 years. MAIN OUTCOME MEASURES: Patient characteristics, current antihypertensive therapies, most recent blood pressure measurements, and compelling indications according to the 2006 Canadian Hypertension Education Program recommendations. RESULTS: A total of 185 subjects (88%) were prescribed antihypertensive medications, and 89 (42%) had controlled hypertension. Younger subjects, people with diabetes, and people not receiving antihypertensive medication therapy appeared less likely to have controlled hypertension. There were 76 subjects (36%) prescribed 1 antihypertensive medication, 65 subjects (31%) prescribed 2 antihypertensive medications, and 44 (21%) prescribed 3 or more antihypertensive medications. Angiotensin-converting enzyme inhibitors were prescribed for 51% of the subjects, diuretics for 47%, beta-blockers for 27%, calcium channel blockers for 23%, angiotensin receptor blockers for 20%, and alpha-blockers for 1%. CONCLUSION: Hypertension treatment and control rates in this academic family medicine clinic appear to be better than those in the general population. Following the principles of a continuous quality improvement process, this information will serve as an important foundation for identifying areas to improve hypertension management in the clinic.

Martin, S.A. Hewish, M. Sims, D. Lord, C.J. Ashworth, A (2011) Parallel high-throughput RNA interference screens identify PINK1 as a potential therapeutic target for the treatment of DNA mismatch repair-deficient cancers.. Show Abstract full text

Synthetic lethal approaches to cancer treatment have the potential to deliver relatively large therapeutic windows and therefore significant patient benefit. To identify potential therapeutic approaches for cancers deficient in DNA mismatch repair (MMR), we have carried out parallel high-throughput RNA interference screens using tumor cell models of MSH2- and MLH1-related MMR deficiency. We show that silencing of the PTEN-induced putative kinase 1 (PINK1), is synthetically lethal with MMR deficiency in cells with MSH2, MLH1, or MSH6 dysfunction. Inhibition of PINK1 in an MMR-deficient background results in an elevation of reactive oxygen species and the accumulation of both nuclear and mitochondrial oxidative DNA lesions, which likely limit cell viability. Therefore, PINK1 represents a potential therapeutic target for the treatment of cancers characterized by MMR deficiency caused by a range of different gene deficiencies.

Lord, C.J. Bohlander, S.K. Hopes, E.A. Montague, C.T. Hill, N.J. Prins, J.B. Renjilian, R.J. Peterson, L.B. Wicker, L.S. Todd, J.A (1995) Mapping the diabetes polygene Idd3 on mouse chromosome 3 by use of novel congenic strains.. Show Abstract full text

Development of novel congenic mouse strains has allowed us to better define the location of the diabetogenic locus, Idd3, on Chromosome (Chr) 3. Congenic strains were identified by use of published and newly developed microsatellite markers, their genomes fingerprinted by a rapid, fluorescence-based approach, and their susceptibility to type 1 diabetes evaluated. The maximum interval containing Idd3 is now approximately 4 cM.

Denny, P. Lord, C.J. Hill, N.J. Goy, J.V. Levy, E.R. Podolin, P.L. Peterson, L.B. Wicker, L.S. Todd, J.A. Lyons, P.A (1997) Mapping of the IDDM locus Idd3 to a 0.35-cM interval containing the interleukin-2 gene.. Show Abstract full text

Currently, 16 loci that contribute to the development of IDDM in the NOD mouse have been mapped by linkage analysis. To fine map these loci, we used congenic mapping. Using this approach, we localized the Idd3 locus to a 0.35-cM interval on chromosome 3 containing the Il2 gene. Segregation analysis of the known variations within this interval indicated that only one variant, a serine-to-proline substitution at position 6 of the mature interleukin-2 (IL-2) protein, consistently segregates with IDDM in crosses between NOD and a series of nondiabetic mouse strains. These data, taken together with the immunomodulatory role of IL-2, provide circumstantial evidence in support of the hypothesis that Idd3 is an allelic variation of the Il2 gene, or a variant in strong linkage disequilibrium.

Barnardo, M.C. Bunce, M. Lord, C.J. Welsh, K.I (1997) HLA-B*5603: sequence of a novel hybrid allele comprising B*56 and B*4601 segments.. full text
Podolin, P.L. Denny, P. Lord, C.J. Hill, N.J. Todd, J.A. Peterson, L.B. Wicker, L.S. Lyons, P.A (1997) Congenic mapping of the insulin-dependent diabetes (Idd) gene, Idd10, localizes two genes mediating the Idd10 effect and eliminates the candidate Fcgr1.. Show Abstract full text

The development of autoimmune diabetes in the nonobese diabetic (NOD) mouse is under the control of multiple insulin-dependent diabetes (Idd) genes. The Idd3 gene, originally defined as a broad peak of linkage on mouse chromosome 3, was subsequently identified as two genes, Idd3 and Idd10, separated by at least 20 cM. The resistance alleles of Idd3 and Idd10 individually confer only partial protection from diabetes but, in combination, result in profound resistance to disease due to an epistatic genetic interaction. In this study, we used newly developed congenic strains to further localize Idd10. Surprisingly, we found that Idd10 itself comprises at least two linked loci: Idd10 and the newly designated Idd17. Idd17 was localized to a 1.1-cM region between D3Mit26 and D3Mit40, proximal to Fcgr1, a candidate gene encoding the high affinity Fc receptor for IgG. Idd10 was localized to a 10-cM region between D3Mit213 and D3Mit106, distal to Fcgr1. Thus, Fcgr1 was excluded as a candidate for either Idd10 or Idd17, despite the fact that the NOD strain expresses a mutant form of the receptor. Interestingly, although Idd10 and Idd17 participate in a genetic interaction with each other, Idd10 but not Idd17 participates in the genetic interaction with Idd3. Our study on chromosome 3 begins to reveal the extent of the polygenic nature of autoimmune diabetes, and demonstrates that the use of congenic strains is an effective mapping strategy, even in the dissection of multiple, linked genes with subtle effects.

Podolin, P.L. Denny, P. Armitage, N. Lord, C.J. Hill, N.J. Levy, E.R. Peterson, L.B. Todd, J.A. Wicker, L.S. Lyons, P.A (1998) Localization of two insulin-dependent diabetes (Idd) genes to the Idd10 region on mouse chromosome 3.. Show Abstract full text

Multiple genes control the development of autoimmune diabetes both in humans and in the nonobese diabetic (NOD) strain of mouse. Previously, three insulin-dependent diabetes (Idd) genes, Idd3, Idd10, and Idd17, were localized to mouse Chromosome (Chr) 3. The B10- or B6-derived resistance alleles at Idd10 and Idd3 together provide the NOD mouse with nearly complete protection from diabetes. In the present study, the 10.2-cM region encoding Idd10 was defined further with newly developed congenic strains. A locus, located in the centromeric 2.1 cM of the 10.2 cM region, contributed to the Idd10 trait. However, this locus did not account for the full effect of Idd10, suggesting the presence of a second gene in the distal portion of the 10.2-cM region. This second gene is designated as Idd18 and is localized to a 5.1-cM region. The resolution of the originally defined Idd3 locus into at least four separate loci, Idd3, Idd10, Idd17, and Idd18, illustrates the complex polygenic nature of diabetes.

Ashworth, A. Lord, C.J. Reis-Filho, J.S (2011) Genetic interactions in cancer progression and treatment.. Show Abstract full text

As cancer cell genomes are unveiled at a breathtaking pace, the genetic principles at play in cancer are emerging in all their complexity, prompting the assessment of classical genetic interaction models. Here, we discuss the implications of these findings for cancer progression and heterogeneity and for the development of new therapeutic approaches.

Cerone, M.A. Burgess, D.J. Naceur-Lombardelli, C. Lord, C.J. Ashworth, A (2011) High-throughput RNAi screening reveals novel regulators of telomerase.. Show Abstract full text

Telomerase is considered an attractive anticancer target on the basis of its common and specific activation in most human cancers. While direct telomerase inhibition is being explored as a therapeutic strategy, alternative strategies to target regulators of telomerase that could disrupt telomere maintenance and cancer cell proliferation are not yet available. Here, we report the findings of a high-throughput functional RNA interference screen to globally profile the contribution of kinases to telomerase activity (TA). This analysis identified a number of novel telomerase modulators, including ERK8 kinase, whose inhibition reduces TA and elicited characteristics of telomere dysfunction. Given that kinases represent attractive drug targets, we addressed the therapeutic implications of our findings, such as demonstrating how limiting TA via kinase blockade could sensitize cells to inhibition of the telomere-associated protein tankyrase. Taken together, our findings suggest novel combinatorial approaches to targeting telomere maintenance as a strategy for cancer therapy.

Rajan, N. Elliott, R. Clewes, O. Mackay, A. Reis-Filho, J.S. Burn, J. Langtry, J. Sieber-Blum, M. Lord, C.J. Ashworth, A (2011) Dysregulated TRK signalling is a therapeutic target in CYLD defective tumours.. Show Abstract full text

Individuals with germline mutations in the tumour-suppressor gene CYLD are at high risk of developing disfiguring cutaneous appendageal tumours, the defining tumour being the highly organised cylindroma. Here, we analysed CYLD mutant tumour genomes by array comparative genomic hybridisation and gene expression microarray analysis. CYLD mutant tumours were characterised by an absence of copy-number aberrations apart from LOH chromosome 16q, the genomic location of the CYLD gene. Gene expression profiling of CYLD mutant tumours showed dysregulated tropomyosin kinase (TRK) signalling, with overexpression of TRKB and TRKC in tumours when compared with perilesional skin. Immunohistochemical analysis of a tumour microarray showed strong membranous TRKB and TRKC staining in cylindromas, as well as elevated levels of ERK phosphorylation and BCL2 expression. Membranous TRKC overexpression was also observed in 70% of sporadic BCCs. RNA interference-mediated silencing of TRKB and TRKC, as well as treatment with the small-molecule TRK inhibitor lestaurtinib, reduced colony formation and proliferation in 3D primary cell cultures established from CYLD mutant tumours. These results suggest that TRK inhibition could be used as a strategy to treat tumours with loss of functional CYLD.

Rajan, N. Burn, J. Langtry, J. Sieber-Blum, M. Lord, C.J. Ashworth, A (2011) Transition from cylindroma to spiradenoma in CYLD-defective tumours is associated with reduced DKK2 expression.. Show Abstract full text

Patients carrying heterozygous germline truncating mutations in the CYLD gene develop multiple primary hair follicle-related tumours. A highly patterned tumour, termed cylindroma, and a highly disorganized tumour, termed spiradenoma, may both develop in the same patient. Furthermore, histological features of both tumour types have been described within the same tumour specimen. We used three-dimensional computer-aided reconstruction of these tumours to demonstrate contiguous growth of cylindromas into spiradenomas, thus suggesting a transition between the two tumour types. To explore factors that may influence cutaneous tumour patterning, genome-wide transcriptomic analysis of 32 CYLD-defective tumours was performed. Overexpression of the Wnt/β-catenin signalling pathway was observed relative to normal perilesional tissue. Morphometric analysis was used to investigate the relationship between Wnt pathway-related gene expression and tumour organization. This revealed an association between reduced Dickkopf 2 (DKK2-a negative regulator of the Wnt/β-catenin signalling pathway) expression and loss of tumour patterning. Reduced DKK2 expression was associated with methylation of the DKK2 gene promoter in the majority of tumour samples assayed. RNA interference-mediated silencing of DKK2 expression in cylindroma primary cell cultures caused an increase in colony formation, cell viability, and anchorage-independent growth. Using these data, we propose a model where epigenetic programming may influence tumour patterning in patients with CYLD mutations.

Wilkerson, P.M. Dedes, K.J. Wetterskog, D. Mackay, A. Lambros, M.B. Mansour, M. Frankum, J. Lord, C.J. Natrajan, R. Ashworth, A. Reis-Filho, J.S (2011) Functional characterization of EMSY gene amplification in human cancers.. Show Abstract full text

The 11q13-q14 locus is frequently amplified in human cancers, with a complex structure harbouring multiple potential oncogenic drivers. The EMSY gene has been proposed as a driver of the third core of the 11q13-q14 amplicon. This gene encodes a protein reported to be a BRCA2-binding partner, which when over-expressed would lead to impairment of BRCA2 functions and could constitute a mechanism for BRCA2 inactivation in non-hereditary breast and ovarian cancers. We hypothesized that if EMSY amplification abrogates BRCA2 functions, cells harbouring this aberration would be unable to elicit competent homologous recombination DNA repair and, therefore, may have increased sensitivity to genotoxic therapies and potent PARP inhibitors. Microarray-based comparative genomic hybridization of cell lines from distinct tumour sites, including breast, ovary, pancreas, oesophagus, lung and the oral cavity, led to the identification of 10 cell lines with EMSY amplification and 18 without. EMSY amplification was shown to correlate with EMSY mRNA levels, although not all cell lines harbouring EMSY amplification displayed EMSY mRNA or protein over-expression. RNA interference-mediated silencing of EMSY did not lead to a reduction in cell viability in tumour models harbouring EMSY amplification. Cell lines with and without EMSY amplification displayed a similar ability to elicit RAD51 foci in response to DNA damaging agents, and similar sensitivity to cisplatin and olaparib. Taken together, this suggests that EMSY is unlikely to be a driver of the 11q13-q14 amplicon and does not have a dominant role in modulating the response to agents targeting cells with defective homologous recombination.

Rovillain, E. Mansfield, L. Lord, C.J. Ashworth, A. Jat, P.S (2011) An RNA interference screen for identifying downstream effectors of the p53 and pRB tumour suppressor pathways involved in senescence.. Show Abstract full text

BACKGROUND: Cellular senescence is an irreversible cell cycle arrest that normal cells undergo in response to progressive shortening of telomeres, changes in telomeric structure, oncogene activation or oxidative stress and acts as an important tumour suppressor mechanism. RESULTS: To identify the downstream effectors of the p53-p21 and p16-pRB tumour suppressor pathways crucial for mediating entry into senescence, we have carried out a loss-of-function RNA interference screen in conditionally immortalised human fibroblasts that can be induced to rapidly undergo senescence, whereas in primary cultures senescence is stochastic and occurs asynchronously. These cells are immortal but undergo a rapid irreversible arrest upon activation of the p53-p21 and p16-pRB pathways that can be readily bypassed upon their inactivation. The primary screen identified 112 known genes including p53 and another 29 shRNAmirs targetting as yet unidentified loci. Comparison of these known targets with genes known to be up-regulated upon senescence in these cells, by micro-array expression profiling, identified 4 common genes TMEM9B, ATXN10, LAYN and LTBP2/3. Direct silencing of these common genes, using lentiviral shRNAmirs, bypassed senescence in the conditionally immortalised cells. CONCLUSION: The senescence bypass screen identified TMEM9B, ATXN10, LAYN and LTBP2/3 as novel downstream effectors of the p53-p21 and p16-pRB tumour suppressor pathways. Although none of them has previously been linked to cellular senescence, TMEM9B has been suggested to be an upstream activator of NF-κB signalling which has been found to have a causal role in promoting senescence. Future studies will focus on determining on how many of the other primary hits also have a casual role in senescence and what is the mechanism of action.

Barber, L.J. Rosa Rosa, J.M. Kozarewa, I. Fenwick, K. Assiotis, I. Mitsopoulos, C. Sims, D. Hakas, J. Zvelebil, M. Lord, C.J. Ashworth, A (2011) Comprehensive genomic analysis of a BRCA2 deficient human pancreatic cancer.. Show Abstract full text

Capan-1 is a well-characterised BRCA2-deficient human cell line isolated from a liver metastasis of a pancreatic adenocarcinoma. Here we report a genome-wide assessment of structural variations and high-depth exome characterization of single nucleotide variants and small insertion/deletions in Capan-1. To identify potential somatic and tumour-associated variations in the absence of a matched-normal cell line, we devised a novel method based on the analysis of HapMap samples. We demonstrate that Capan-1 has one of the most rearranged genomes sequenced to date. Furthermore, small insertions and deletions are detected more frequently in the context of short sequence repeats than in other genomes. We also identify a number of novel mutations that may represent genetic changes that have contributed to tumour progression. These data provide insight into the genomic effects of loss of BRCA2 function.

Loveday, C. Turnbull, C. Ramsay, E. Hughes, D. Ruark, E. Frankum, J.R. Bowden, G. Kalmyrzaev, B. Warren-Perry, M. Snape, K. Adlard, J.W. Barwell, J. Berg, J. Brady, A.F. Brewer, C. Brice, G. Chapman, C. Cook, J. Davidson, R. Donaldson, A. Douglas, F. Greenhalgh, L. Henderson, A. Izatt, L. Kumar, A. Lalloo, F. Miedzybrodzka, Z. Morrison, P.J. Paterson, J. Porteous, M. Rogers, M.T. Shanley, S. Walker, L. Breast Cancer Susceptibility Collaboration (UK), . Eccles, D. Evans, D.G. Renwick, A. Seal, S. Lord, C.J. Ashworth, A. Reis-Filho, J.S. Antoniou, A.C. Rahman, N (2011) Germline mutations in RAD51D confer susceptibility to ovarian cancer.. Show Abstract full text

Recently, RAD51C mutations were identified in families with breast and ovarian cancer. This observation prompted us to investigate the role of RAD51D in cancer susceptibility. We identified eight inactivating RAD51D mutations in unrelated individuals from 911 breast-ovarian cancer families compared with one inactivating mutation identified in 1,060 controls (P = 0.01). The association found here was principally with ovarian cancer, with three mutations identified in the 59 pedigrees with three or more individuals with ovarian cancer (P = 0.0005). The relative risk of ovarian cancer for RAD51D mutation carriers was estimated to be 6.30 (95% CI 2.86-13.85, P = 4.8 × 10(-6)). By contrast, we estimated the relative risk of breast cancer to be 1.32 (95% CI 0.59-2.96, P = 0.50). These data indicate that RAD51D mutation testing may have clinical utility in individuals with ovarian cancer and their families. Moreover, we show that cells deficient in RAD51D are sensitive to treatment with a PARP inhibitor, suggesting a possible therapeutic approach for cancers arising in RAD51D mutation carriers.

Tanas, M.R. Sboner, A. Oliveira, A.M. Erickson-Johnson, M.R. Hespelt, J. Hanwright, P.J. Flanagan, J. Luo, Y. Fenwick, K. Natrajan, R. Mitsopoulos, C. Zvelebil, M. Hoch, B.L. Weiss, S.W. Debiec-Rychter, M. Sciot, R. West, R.B. Lazar, A.J. Ashworth, A. Reis-Filho, J.S. Lord, C.J. Gerstein, M.B. Rubin, M.A. Rubin, B.P (2011) Identification of a disease-defining gene fusion in epithelioid hemangioendothelioma.. Show Abstract full text

Integrating transcriptomic sequencing with conventional cytogenetics, we identified WWTR1 (WW domain-containing transcription regulator 1) (3q25) and CAMTA1 (calmodulin-binding transcription activator 1) (1p36) as the two genes involved in the t(1;3)(p36;q25) chromosomal translocation that is characteristic of epithelioid hemangioendothelioma (EHE), a vascular sarcoma. This WWTR1/CAMTA1 gene fusion is under the transcriptional control of the WWTR1 promoter and encodes a putative chimeric transcription factor that joins the amino terminus of WWTR1, a protein that is highly expressed in endothelial cells, in-frame to the carboxyl terminus of CAMTA1, a protein that is normally expressed only in brain. Thus, CAMTA1 expression is activated inappropriately through a promoter-switch mechanism. The gene fusion is present in virtually all EHEs tested but is absent from all other vascular neoplasms, demonstrating it to be a disease-defining genetic alteration. A sensitive and specific break-apart fluorescence in situ hybridization assay was also developed to detect the translocation and will assist in the evaluation of this diagnostically challenging neoplasm. The chimeric WWTR1/CAMTA1 transcription factor may represent a therapeutic target for EHE and offers the opportunity to shed light on the functions of two poorly characterized proteins.

Brough, R. Frankum, J.R. Sims, D. Mackay, A. Mendes-Pereira, A.M. Bajrami, I. Costa-Cabral, S. Rafiq, R. Ahmad, A.S. Cerone, M.A. Natrajan, R. Sharpe, R. Shiu, K.-.K. Wetterskog, D. Dedes, K.J. Lambros, M.B. Rawjee, T. Linardopoulos, S. Reis-Filho, J.S. Turner, N.C. Lord, C.J. Ashworth, A (2011) Functional viability profiles of breast cancer.. Show Abstract full text

UNLABELLED: The design of targeted therapeutic strategies for cancer has largely been driven by the identification of tumor-specific genetic changes. However, the large number of genetic alterations present in tumor cells means that it is difficult to discriminate between genes that are critical for maintaining the disease state and those that are merely coincidental. Even when critical genes can be identified, directly targeting these is often challenging, meaning that alternative strategies such as exploiting synthetic lethality may be beneficial. To address these issues, we have carried out a functional genetic screen in >30 commonly used models of breast cancer to identify genes critical to the growth of specific breast cancer subtypes. In particular, we describe potential new therapeutic targets for PTEN-mutated cancers and for estrogen receptor-positive breast cancers. We also show that large-scale functional profiling allows the classification of breast cancers into subgroups distinct from established subtypes. SIGNIFICANCE: Despite the wealth of molecular profiling data that describe breast tumors and breast tumor cell models, our understanding of the fundamental genetic dependencies in this disease is relatively poor. Using high-throughput RNA interference screening of a series of pharmacologically tractable genes, we have generated comprehensive functional viability profiles for a wide panel of commonly used breast tumor cell models. Analysis of these profiles identifies a series of novel genetic dependencies, including that of PTEN-null breast tumor cells upon mitotic checkpoint kinases, and provides a framework upon which additional dependencies and candidate therapeutic targets may be identified.

Vaughan, S. Coward, J.I. Bast, R.C. Berchuck, A. Berek, J.S. Brenton, J.D. Coukos, G. Crum, C.C. Drapkin, R. Etemadmoghadam, D. Friedlander, M. Gabra, H. Kaye, S.B. Lord, C.J. Lengyel, E. Levine, D.A. McNeish, I.A. Menon, U. Mills, G.B. Nephew, K.P. Oza, A.M. Sood, A.K. Stronach, E.A. Walczak, H. Bowtell, D.D. Balkwill, F.R (2011) Rethinking ovarian cancer: recommendations for improving outcomes.