Li Jinghui, Yang Haoqiang, Zhu Meiling, Zhang Pengyu, Liu Yang, Niu Yiting, Zhou Tao, Li Yanjun
Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
People's Hospital of Shanxi Province, Department of Radiotherapy of the Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China.
Clin Exp Med. 2025 Aug 12;25(1):290. doi: 10.1007/s10238-025-01838-1.
The STING signaling pathway, as a core hub connecting innate immunity and adaptive immunity, plays a complex and dynamic dual role in tumor immune regulation. This review systematically explains the multi-dimensional mechanism of this pathway in tumor occurrence and development: On the one hand, it builds a multi-level anti-tumor immune response network by activating the antigen presentation function of dendritic cells (DCs), enhancing the stemness maintenance of CD8⁺ T cells and the cytotoxic effect of natural killer cells (NK cells); on the other hand, it forms a bidirectional regulation with the malignant transformation process of tumors (such as epithelial-mesenchymal transition (EMT), angiogenesis, and metabolic reprogramming), and its direction of action highly depends on the spatiotemporal specificity of the tumor microenvironment and the level of genomic instability. Research reveals that the anti-tumor efficacy of the STING pathway is precisely regulated by the intensity of DNA damage response (DDR), mitochondrial stress state, and epigenetic regulatory network (such as the yes-associated protein/transcriptional coactivator with PDZ-binding motif-protein phosphatase 2A catalytic subunit (YAP/TAZ-PP2Ac) axis, which provides a molecular basis for the development of precise intervention strategies. Current combined treatment strategies have broken through the limitation of single-target, achieving multi-level synergy from molecular intervention to system regulation through the sequential coordination of immune checkpoint inhibitors and STING agonists, the positive feedback loop of DNA damage induced by radiotherapy (RT)/chemotherapy and innate immune activation, and tumor metabolic-immune reprogramming mediated by nanocarriers. Notably, STING activation may induce the compensatory upregulation of immune suppressive factors such as interleukin-35 (IL-35)/programmed cell death 1 ligand 1 (PD-L1), and stratified treatment strategies based on tumor heterogeneity characteristics will become the key to overcoming drug resistance. This article not only constructs a theoretical framework of "immune initiation-microenvironment remodeling-malignant transformation inhibition" in a trinity, but also marks the paradigm shift of tumor immunotherapy from single-pathway activation to multi-scale dynamic regulation, providing a route map that is both innovative and feasible for clinical translation.
STING信号通路作为连接先天免疫和适应性免疫的核心枢纽,在肿瘤免疫调节中发挥着复杂而动态的双重作用。本综述系统地阐述了该通路在肿瘤发生发展中的多维度机制:一方面,它通过激活树突状细胞(DC)的抗原呈递功能、增强CD8⁺T细胞的干性维持和自然杀伤细胞(NK细胞)的细胞毒性作用,构建多层次的抗肿瘤免疫反应网络;另一方面,它与肿瘤的恶性转化过程(如上皮-间质转化(EMT)、血管生成和代谢重编程)形成双向调节,其作用方向高度依赖于肿瘤微环境的时空特异性和基因组不稳定水平。研究表明,STING通路的抗肿瘤功效受到DNA损伤反应(DDR)强度、线粒体应激状态和表观遗传调控网络(如Yes相关蛋白/含PDZ结合基序的转录共激活因子-蛋白磷酸酶2A催化亚基(YAP/TAZ-PP2Ac)轴)的精确调控,这为精准干预策略的开发提供了分子基础。当前的联合治疗策略突破了单靶点的局限,通过免疫检查点抑制剂和STING激动剂的序贯协同、放疗(RT)/化疗诱导的DNA损伤与先天免疫激活的正反馈回路以及纳米载体介导的肿瘤代谢-免疫重编程,实现了从分子干预到系统调节的多层次协同。值得注意的是,STING激活可能诱导白细胞介素-35(IL-35)/程序性细胞死亡1配体1(PD-L1)等免疫抑制因子的代偿性上调,基于肿瘤异质性特征的分层治疗策略将成为克服耐药性的关键。本文不仅构建了“免疫启动-微环境重塑-恶性转化抑制”三位一体的理论框架,还标志着肿瘤免疫治疗从单通路激活向多尺度动态调节的范式转变,为临床转化提供了一条既创新又可行的路线图。
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