Edward Lemmens

Direct Activation of STING in the Tumor Microenvironment Leads to Potent and Systemic Tumor Regression and Immunity

Spontaneous tumor-initiated T cell priming is dependent on IFN-β production by tumor-resident dendritic cells. On the basis of recent observations indicating that IFN-β expression was dependent upon activation of the host STING pathway, we hypothesized that direct engagement of STING through intratumoral (IT) administration of specific agonists would result in effective anti-tumor therapy. After proof-of-principle studies using the mouse STING agonist DMXAA showed a potent therapeutic effect, we generated synthetic cyclic dinucleotide (CDN) derivatives that activated all human STING alleles as well as murine STING. IT injection of STING agonists induced profound regression of established tumors in mice and generated substantial systemic immune responses capable of rejecting distant metastases and providing long-lived immunologic memory. Synthetic CDNs have high translational potential as a cancer therapeutic.

Modified STING-activating cyclic dinucleotide derivatives significantly enhance the anti-tumor activity of therapeutic vaccines

The STING signaling pathway has emerged as a central TLR-independent mediator of host innate defense in response to sensing cytosolic nucleic acids, either through direct binding of CDNs secreted by intracellular bacteria, or through binding of a structurally distinct CDN produced by a host cell receptor, cyclic GMP-AMP (cGAMP) synthase (cGAS), in response to binding cytosolic double-stranded DNA. Binding of CDNs to STING initiates a signaling cascade through the TBK-1/IRF-3 axis to induce type I interferon (IFN) and other co-regulated genes. Discovered recently, CDNs synthesized by cGAS and bacteria are structurally distinct. The cGAS product, termed non-canonical CDN, has a phosphate bridge with both 2’-5’ and 3’-5’ linkages that reportedly increases its affinity for STING by 200-fold. Here we show in a panel of human donors that the non-canonical linkage confers significantly increased activity of CDNs to activate PBMCs, as measured by expression of IFN and NF-κB dependent cytokines, as compared to CDNs with canonical 3’-5’ phosphate linkages. By conducting Immunogenicity-Structure Activity Relationship studies in vitro and in various animal models of infection and cancer, we selected synthetic derivatives of native CDNs produced by bacteria or eukaryotic cells with increased potency. CDN derivatives with sulfur atoms at non-bridging oxygens of the internucleotide phosphate bridge were resistant to digestion with phosphodiesterase. Surprisingly, R,R di-thio CDN diastereomers induced higher levels of IFN in vitro, and induced a higher magnitude of peak and memory antigen-specific CD4 and CD8 T cell responses correlated with protective immunity, as compared to either the R,S di-thio CDN diastereomer, or di-oxo CDN. CDNs based on adenosine nucleotides were comparatively independent of host cell permeabilization to activate STING signaling. We applied this finding to enhance the activity of immunotherapy regimens utilizing irradiated GM-CSF expressing tumor cell vaccines. Co-formulation with R,R dithio-c-di-AMP significantly inhibited tumor growth in several models, correlated with increased mobilization and activation of dendritic cells, increased tumor lymphocyte infiltration, and T cell immunity. Immunologic potency of CDNs was essentially lost in mice encoding a non-functional STING allele. Collectively, CDNs have high translation potential for diverse applications in clinical oncology.

Direct activation of STING in the tumor microenvironment with synthetic cyclic dinucleotide derivatives leads to potent and systemic tumor-specific immunity

Innate immune sensing in the tumor microenvironment is a critical step in promoting tumor infiltrating lymphocytes (TILs) and spontaneous anti-tumor T cell priming. Transcriptional profiling analysis of melanoma patients has revealed that tumors with a T cell-inflamed immunophenotype are characterized by a type I IFN (IFN) transcriptional signature. Studies in mice support the notion that IFN produced by tumor-resident dendritic cells (DCs) plays a critical role in spontaneous T cell priming against tumor antigens, which is dependent upon the host STING pathway. Preliminary data using the mouse STING agonist DMXAA injected intratumorally (IT) revealed potent tumor regression and induction of a robust anti-tumor T cell response. However, DMXAA does not engage human STING, necessitating alternative pharmacologic approaches to stimulate this pathway for clinical translation. We therefore synthesized a panel of cyclic dinucleotides (CDNs) that varied by purine nucleotide base, internucleotide phosphate bridge linkage, or by substitution of non-bridging oxygen atoms in the phosphate bridge with sulfur. We screened and selected from among these compounds based on their capacity to activate all known human STING alleles expressed in stably transformed reporter cell lines, stimulate the activation of human PBMCs, and impact significant antitumor efficacy in several mouse tumor models, without significant local or systemic toxicity. Strikingly, direct IT injection of particular CDN derivative molecules into two week-established flank B16 melanoma, CT26 colon, or 4T1 breast tumors profoundly inhibited tumor growth that was durable and correlated with induction of lasting systemic antigen-specific CD8+ T cell immunity that conferred complete protection against tumor re-challenge, or significantly inhibited the growth of distal untreated tumors. Induction of cytokines, tumor antigen-specific immunity, and antitumor efficacy was entirely STING-dependent. We selected dithio-[Rp,Rp]-c[A(2,5)pA(3,5)p], a synthetic CDN molecule that has significantly higher activity than natural STING ligands, as the lead molecule for continued development. The synthetic CDN molecule described here was significantly more potent than IT TLR ligands, indicating its high translational potential as an approach to elicit effective unbiased T cell priming against an individuals unique tumor antigen repertoire.

Abstract 4573: STINGVAX - A novel tumor vaccine with cyclic dinucleotides - can induce potent anti-tumor responses in vivo.

Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DCnnCyclic dinucleotides (CDN) are ubiquitous bacterial intracellular messengers, and they have recently been shown to also function as a pathogen associated molecular pattern (PAMP) molecules that are sensed by eukaryotic host Stimulator of Interferon Genes (STING) that can activate the TBK-1/IRF-3 signaling pathway to induce type I interferon and other co-regulated genes. CDN was found to induce STING dependent augmentation of T-cell priming in multiple vaccination models, potentially by activating dendritic cells. We formulated CDN with a GM-CSF secreting tumor cell vaccine (STINGVAX) to mobilize and as well as activate dendritic cells both in vitro and in vivo. STINGVAX was tested in a stringent B16 melanoma treatment model, and we demonstrated significant reduction of tumor growth rate in vivo. STINGVAXs anti-tumor response was correlated with increased tumor infiltrating CD8 T-cells as well as increased number of p15E tumor-specific cytotoxic T-cells. STINGVAXs in vivo anti-tumor response was T-cell dependent as well as STING dependent. When we combined STINGVAX with multiple TLR 4/7/8 agonists signaling through the MyD88/TRIF pathway that is distinct from CDN/STING/TBK-1 signaling treatment of palpable B16 tumor resulted in regression of 30-60% of these non-immunogenic tumors. When the STINGVAX treated tumor microenvironment was examined, both IFNγ+CD8+ and PD-L1 was upregulated, potentially demonstrating an adaptive immune resistance mechanism which would render STINGVAX an excellent candidate to be combined with anti-PD-1 blockade. Cumulatively, STINGVAX is a novel tumor vaccine with a high potential for translation in clinical oncology.nnCitation Format: Thomas W. Dubensky, Meredith L. Leong, David B. Kanne, Edward E. Lemmens, Ken Metchette, Weiqun Liu, Marcella Fasso, Juan Fu, Joshua J. Woodward, Drew Pardoll, Daniel A. Portnoy, Young J. Kim. STINGVAX - A novel tumor vaccine with cyclic dinucleotides - can induce potent anti-tumor responses in vivo . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4573. doi:10.1158/1538-7445.AM2013-4573

Abstract A013: Favorable changes in tumor microenvironment following intravenous dosing with live attenuated Listeria monocytogenes-based immunotherapy

Modification of the tumor microenvironment (TME) to promote immune-mediated tumor cell destruction is considered to be an essential step for effective immunotherapy. We are evaluating recombinant live-attenuated, double deleted Listeria monocytogenes (LADD) as an immunotherapy platform for the treatment of cancer in several clinical trials in diverse indications. One LADD strain, known as CRS-207, has been engineered to express the tumor-associated antigen mesothelin and is being tested in pancreatic, ovarian and mesothelioma malignancies. Using multi-dimensional immunohistochemistry of paired biopsies from three patients with mesothelioma, we demonstrate the recruitment and expansion of effector tumor-infiltrating lymphocytes, including CD8+ T cells, mature DCs, CD163− macrophages and NK cells, following two prime infusions of CRS-207. In several different syngeneic mouse tumor models, we demonstrate that treatment with LADD engineered to express endogenous tumor antigens also induced significant changes in the TME that were consistent with changes observed in cancer patients, including enhanced CD8+ T cell effector function, recruitment of critical antigen presenting cells and reduction of regulatory T cells, and these changes correlated with significant therapeutic benefit in the mouse. LADD-induced changes to the TME were required for synergistic therapeutic antitumor efficacy combined with immune checkpoint blockade, including targeting MC38 tumor-specific neoantigens. Together, these findings demonstrate that intravenous administration of recombinant LADD therapy induces favorable changes in the tumor microenvironment in mice and humans with promise for effective outcomes in human clinical trials. Citation Format: Weiwen Deng, Takahiro Tsujikawa, Nitya Nair, Thomas Hudson, Weiqun Liu, Chris S. Rae, Edward E. Lemmens, Anthony W. Desbien, William Hanson, Peter Lauer, Lisa M. Coussens, Dirk G. Brockstedt, Thomas W. Dubensky, Jr., Meredith L. Leong. Favorable changes in tumor microenvironment following intravenous dosing with live attenuated Listeria monocytogenes-based immunotherapy [abstract]. In: Proceedings of the Second CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; 2016 Sept 25-28; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(11 Suppl):Abstract nr A013.

Abstract IA10: Effective immunotherapy regimens incorporating highly active human STING-activating cyclic dinucleotide derivatives

Innate immune sensing in the tumor microenvironment is a critical step in promoting tumor infiltrating lymphocytes (TILs) and spontaneous anti-tumor T cell priming. Transcriptional profiling analysis of melanoma patients has revealed that tumors with a T cell-inflamed immunophenotype are characterized by a type I IFN (IFN) transcriptional signature. Studies in mice support the notion that IFN produced by tumor-resident dendritic cells (DCs) plays a critical role in spontaneous T cell priming against tumor antigens, which is dependent upon the host Stimulator of Interferon Genes (STING) pathway. STING mediates host innate defense by responding to cytosolic nucleic acids, either through direct binding of cyclic dinucleotides (CDNs) produced by bacteria, or through binding of a structurally distinct CDN produced by host cyclic GMP-AMP synthetase in response to cytosolic double-stranded DNA. While CDN adjuvants have been explored previously in mice, we sought to develop compounds that activate human STING. We therefore synthesized a panel of cyclic dinucleotides (CDNs) that varied by purine nucleotide base, internucleotide phosphate bridge linkage, or by substitution of non-bridging oxygen atoms in the phosphate bridge with sulfur. We screened and selected from among these compounds based on their capacity to activate all known human STING alleles expressed in stably transformed reporter cell lines, stimulate the activation of human PBMCs, and impact significant antitumor efficacy in several mouse tumor models, without significant local or systemic toxicity. Strikingly, direct IT injection of particular CDN derivative molecules into two-week established flank B16 melanoma, CT26 colon, or 4T1 breast tumors profoundly inhibited tumor growth that was durable and correlated with induction of lasting systemic antigen-specific CD8+ T cell immunity that conferred complete protection against tumor re-challenge, or significantly inhibited the growth of distal untreated tumors. Induction of cytokines, tumor antigen-specific immunity, and antitumor efficacy was entirely STING-dependent. We selected dithio-[Rp,Rp]-c[A(29,59)pA(39,59)p], a synthetic CDN molecule that has significantly higher activity than natural STING ligands, as the lead molecule for continued development. We next tested whether direct activation of STING within the tumor microenvironment would enhance the absocopal effect resulting from irradiating the CDN-treated tumor. Treatment of one tumor in mice bearing established bilateral Panc02 flank tumors, with a suboptimal dose of 10 Gy of radiotherapy (RT) in combination with IT CDN injection resulted in rapid local and systemic induction of inflammatory mediators, and vascular damage that spread through the injected tumor without causing detectable damage to normal tissues. Compared to RT alone, CDN injection resulted in significantly enhanced adaptive-immune mediated control of the contralateral tumor. The synthetic CDN molecule described here was significantly more potent than IT TLR ligands, indicating its high translational potential as an approach to elicit effective unbiased T cell priming against an individual9s unique tumor antigen repertoire. Citation Format: Laura Hix Glickman, Leticia Corrales, Sarah M. McWhirter, David B. Kanne, Kelsey E. Sivick, Jason R. Baird, Edward Lemmens, Justin J. Leong, Ken Metchette, Mark Crittenden, Michael Gough, Thomas F. Gajewski, Thomas W. Dubensky, Jr.. Effective immunotherapy regimens incorporating highly active human STING-activating cyclic dinucleotide derivatives. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Immunology and Immunotherapy: A New Chapter; December 1-4, 2014; Orlando, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2015;3(10 Suppl):Abstract nr IA10.

A Phase IIb, randomized, multicenter study of the efficacy of GVAX pancreas vaccine and CRS-207 compared to chemotherapy or to CRS-207 alone in adults with previously-treated metastatic pancreatic adenocarcinoma (eclipse study)

Meeting abstractsnnA heterologous prime-boost vaccination strategy using GVAX pancreas vaccine and CRS-207 is showing promise in patients with metastatic pancreatic adenocarcinoma (PDA). GVAX is composed of lethally-irradiated, allogeneic pancreatic cancer cells modified to express GM-CSF and

Abstract 2566: Activation of tumor-initiated T cell priming and tumor destruction with potent STING-activating cyclic dinucleotide derivatives

Cyclic dinucleotides (CDNs) are bacterial messengers that are sensed by the host cytosolic surveillance pathway receptor, STING (Stimulator of Interferon Genes). CDN binding to STING initiates a TLR-independent signaling cascade through the TBK-1/IRF-3 axis, inducing type I interferon (IFN) and other co-regulated genes central to host innate defense. In response to binding cytosolic double-stranded DNA, a recently discovered mammalian enzyme, cyclic GMP-AMP synthase (cGAS), synthesizes CDNs that are structurally distinct from CDNs produced by bacteria. The mammalian CDN has a phosphate bridge with 2′-5′ and 3′-5′ linkages that increases its affinity for STING at least 10-fold. We show that mixed linkage (ML) CDNs were more potent activators of human PBMCs as compared to CDNs with canonical 3′-5′ phosphate linkages. Additionally, particular ML CDN derivatives with sulfur atoms at non-bridging oxygens of the internucleotide phosphate bridge were resistant to digestion by host cell phosphodiesterases, and R,R di-thio CDN diastereomers demonstrated increased potency in vitro and in vivo, as compared to either the R,S di-thio CDN diastereomer, or unmodified CDNs. Strikingly, direct injection of 2-week established flank B16 melanoma tumors with ML R,R dithio-CDN derivatives significantly and profoundly inhibited tumor growth, correlated with cytokine-mediated activation of NK and T lymphocytes, induction of antigen-specific T cell immunity and long-term survival. Anti-tumor efficacy was lost in mice encoding non-functional STING. Similar results were observed in other tumor models. These results demonstrate that CDNs have high translation potential for treatment strategies to induce activation of the tumor microenvironment, leading to effective tumor-initiated CD8+ T cell priming and anti-tumor efficacy. Citation Format: Laura Hix Glickman, David B. Kanne, Sarah M. McWhirter, Meredith L. Leong, Edward E. Lemmens, Ken Metchette, Russell E. Vance, Drew M. Pardoll, Thomas W. Dubensky. Activation of tumor-initiated T cell priming and tumor destruction with potent STING-activating cyclic dinucleotide derivatives. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2566. doi:10.1158/1538-7445.AM2014-2566