Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Immunology Program, University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.
J Immunother Cancer. 2021 Aug;9(8). doi: 10.1136/jitc-2021-003246.
BACKGROUND: Intratumoral injection of cyclic dinucleotide (CDN) agonists of the stimulator of interferon genes (STING) pathway engages innate immune activation and priming of adaptive immune effectors to foster local and distal tumor clearance. Despite proven therapeutic efficacy in preclinical models, a thorough understanding of how CDNs reprogram suppressive myeloid stroma in mouse and man is lacking. METHODS: Here, we perform deep transcript-level and protein-level profiling of myeloid-derived suppressor cells and M2 macrophages following stimulation with CDNs of ascending potency. Additionally, we leverage orthotopic (KPC) derived models of pancreatic adenocarcinoma (PDAC) to determine the capacity for locally administered CDNs to sensitize PDAC to immune checkpoint blockade. We use bioluminescent in vivo imaging and 30-parameter flow cytometry to profile growth kinetics and remodeling of the tumor stroma post-therapy. RESULTS: Highly potent synthetic STING agonists repolarize suppressive myeloid populations of human and murine origin in part through inhibition of Myc signaling, metabolic modulation, and antagonism of cell cycle. Surprisingly, high-potency synthetic agonists engage qualitatively unique pathways as compared with natural CDNs. Consistent with our mechanistic observations, we find that intratumoral injection of the highest activity STING agonist, IACS-8803, into orthotopic pancreatic adenocarcinoma lesions unmasks sensitivity to checkpoint blockade immunotherapy. Dimensionality reduction analyses of high parameter flow cytometry data reveals substantial contributions of both myeloid repolarization and T cell activation underlying the in vivo therapeutic benefit of this approach. CONCLUSIONS: This study defines the molecular basis of STING-mediated myeloid reprogramming, revealing previously unappreciated and qualitatively unique pathways engaged by CDNs of ascending potency during functional repolarization. Furthermore, we demonstrate the potential for high potency CDNs to overcome immunotherapy resistance in an orthotopic, multifocal model of PDAC.
背景:环状二核苷酸(CDN)激动剂是干扰素基因刺激物(STING)通路的内源性免疫激活剂和适应性免疫效应物的启动子,可促进局部和远处肿瘤清除。尽管在临床前模型中已证明其治疗效果,但人们对 CDN 如何重塑小鼠和人类中的抑制性髓样基质缺乏全面了解。
方法:在这里,我们对 CDN 刺激后髓源性抑制细胞和 M2 巨噬细胞进行了深度转录水平和蛋白水平的分析。此外,我们利用胰腺导管腺癌(PDAC)的原位(KPC)衍生模型,确定局部给予 CDN 使 PDAC 对免疫检查点阻断敏感的能力。我们使用生物发光体内成像和 30 参数流式细胞术来分析治疗后肿瘤基质的生长动力学和重塑。
结果:高活性合成 STING 激动剂通过抑制 Myc 信号、代谢调节和细胞周期拮抗作用,部分重极化人源和鼠源抑制性髓样细胞群体。令人惊讶的是,与天然 CDN 相比,高活性合成激动剂采用了定性上独特的途径。与我们的机制观察一致,我们发现,将最高活性的 STING 激动剂 IACS-8803 注入原位胰腺导管腺癌病变中,可使肿瘤对检查点阻断免疫治疗敏感。高参数流式细胞术数据的降维分析显示,髓样细胞重极化和 T 细胞激活对该方法的体内治疗益处有很大贡献。
结论:这项研究定义了 STING 介导的髓样细胞重编程的分子基础,揭示了在功能重极化过程中,活性逐渐增强的 CDN 所涉及的以前未被认识到的和定性独特的途径。此外,我们证明了高活性 CDN 在 PDAC 的原位、多灶模型中克服免疫治疗耐药性的潜力。
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