Abstract 2483: Detection of STING-induced immune activation via [18F]FDG-PET imaging
Authors: Lee Hailey R. , Abt Evan R. , Rashid Khalid , Creech Amanda L. , Liang Keke , Wei Liu , Cho Arthur , Hugo Willy , Donahue Timothy R. , Czernin Johannes , Radu Caius G. , Le Thuc M. 
Published: June 2022

Abstract
Stimulator of interferon genes (STING) coordinates innate and adaptive immune responses by mediating type I interferon and NF-κB signaling and is therefore a promising cancer immunotherapy target. While first generation STING agonists have advanced to multiple clinical trials, their application is restricted to intratumoral administration and these agents have shown limited therapeutic efficacy. In contrast, recently developed second generation STING agonists allow for systemic administration and have been shown to exert highly potent anti-tumor effects in animal models of cancer. However, STING is expressed in a wide array of cell types and tissues, and the effects of systemic activation of this pattern recognition receptor are poorly understood. This highlights the need for the development of pharmacodynamic companion biomarkers that can be used to guide the clinical development of newly developed systemic STING agonists. Here, we show that systemic administration of the STING agonist diABZI triggers alterations in glucose metabolism in immune cells which can be detected non-invasively using [18F]Fluorodeoxyglucose (FDG) and positron emission tomography (PET). Accordingly, systemic STING activation significantly upregulated [18F]FDG uptake in secondary lymphoid organs, such as the spleen and lymph nodes, as indicated by PET imaging in vivo and confirmed by gamma counter measurements of isolated splenocytes ex vivo. Importantly, STING agonist-induced changes in [18F]FDG uptake in the spleen and lymph nodes were highly predictive of therapeutic responses to STING agonist mono- and combination therapies in animal models of pancreatic cancer. Using single-cell RNA sequencing we found that systemic STING activation triggers profound transcriptional alterations in T and B lymphocytes indicative of a metabolic shift towards enhanced glycolysis. We then explored whether metabolic alterations indicated by increased [18F]FDG uptake are associated with changes in the functional phenotypes of T and B cells. We found that systemic STING activation induced the upregulation of the early activation marker CD69 and immune checkpoint ligand PD-L1. Furthermore, CD69 and PD-L1 upregulation occurred in a STING agonist dose-dependent manner that correlated with [18F]FDG uptake as measured non-invasively by PET. In interferon receptor knockout mice, CD69 and PD-L1 expression was partially attenuated; however, [18F]FDG uptake was still induced following STING activation, suggesting that an interferon-independent mechanism mediates the observed glycolytic switch in lymphocytes. In summary, [18F]FDG-PET provides a novel non-invasive and widely applicable pharmacodynamic biomarker which has potential to guide and accelerate the clinical development of systemic STING agonist-based immunotherapies in immunologically cold malignancies.
Citation Format: Hailey R. Lee, Evan R. Abt, Khalid Rashid, Amanda L. Creech, Keke Liang, Liu Wei, Arthur Cho, Willy Hugo, Timothy R. Donahue, Johannes Czernin, Caius G. Radu, Thuc M. Le. Detection of STING-induced immune activation via [18F]FDG-PET imaging [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2483.