CASP9 and cancer: T2DM has been shown to predispose the risk of many malignancies, such as colon and breast and other cancer types.37,38 Previous data demonstrated the anti-cancer properties of Ex-4 on cancer cell types such as breast cancer cells.39 As previously described, Ex-4 has the potential to inhibit breast cancer cell proliferation and metastasis and promote apoptosis by the modulation of effectors such as Caspase-9, Akt, and MMP-2.