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We have engineered a tumor-targeted, microbial immunotherapy platform called STACT (Salmonella Typhimurium (Attenuated) and Checkpoint Therapy). The platform strain has been engineered to increase tumor-specific enrichment, reduce immunosuppressive inflammation and enhance tolerability. Upon phagocytosis by tumor-resident immune cells, the microbe delivers plasmid DNA, which can either encode inhibitory microRNAs to knockdown immune targets of interest, or encode immuno-modulatory cDNA expression cassettes, alone or in specific combinations. The STACT platform strain is over 10,000-fold attenuated for virulence due to disruptions in the msbB and purI genes, that result in the detoxification of the surface LPS and purine/adenosine auxotrophy, respectively. The STACT platform strain required addition of exogenous adenosine or purines at concentrations found in the tumor micro-environment, but not in healthy tissue for replication in vitro. The STACT platform strain was unable to replicate significantly in infected macrophage cell lines, but was able to colonize tumors in mice and deliver functional plasmids. This strain was further engineered by precise genome deletions of the fljB and fliC genes, encoding the bacterial flagellar subunits that are strong TLR5 agonists and induce inflammasome-mediated pyroptosis in macrophages. Deletion of the flagellin genes prevented bacterial cell motility but did not affect tumor-specific colonization after IV administration, and tumor enrichment was observed at levels over 100,000 times greater than in spleens. A plasmid maintenance system was engineered by deletion of the chromosomal asd gene and complementation of the asd gene on a copy-number optimized plasmid to ensure plasmid maintenance in vivo. The asd system allowed for significantly improved plasmid retention in vivo without antibiotic selection. Furthermore, the vector incorporates immunostimulatory CpG motifs into the strain to help promote a TLR9-mediated adaptive immune response to tumor antigens. A library of inhibitory RNAi’s against a set of immuno-modulatory targets, including TREX1, PD-L1, and TGF-beta were screened for optimal knockdown of gene expression by qPCR and western blot. Pairwise combinatorial knockdown of specific targets was also observed in human cells. IV administration of STACT encoding TGF-beta RNAi demonstrated significant tumor growth inhibition in a subcutaneous tumor model. STACT is a highly attenuated microbial immunotherapy platform engineered to deliver immunomodulatory molecules to phagocytic cells in the tumor microenvironment after systemic administration. This platform can be engineered to knock down combinations of immune checkpoints or express immunostimulatory genes in a single therapeutic modality. Citation Format: Chris S. Rae, Marina Besprozvannaya, John Faulhaber, Anastasia M. Makarova, Beverly King, Laura Hix Glickman, Christopher D. Thanos, Justin Skoble. STACT: A novel tumor-targeting, systemically-administered delivery platform capable of targeting intractable pathways and precise immunomodulation of the tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4782.

Systemic delivery of STING agonists to tumor-resident myeloid cells will be required to elicit optimal type I interferon-mediated anti-tumor immunity in a metastatic disease setting. To this end, we have generated a microbial-based immunotherapy (STACT- Salmonella Typhimurium (Attenuated) Checkpoint Therapy) that utilizes a highly attenuated, clinically developed strain that is specifically enriched in tumors after intravenous administration. The strain has been modified to reduce pro-inflammatory TLR signaling in order to limit its immunosuppressive microbial profile and significantly improve its therapeutic index. An inhibitory microRNA to TREX1 was designed and introduced into the STACT strain. TREX1 is a 3′ exonuclease immune checkpoint that degrades cytosolic DNA, thereby preventing it from binding cGAS and activating the STING pathway. Mutations in human TREX1 cause a type I interferonopathy known as Aicardi-Goutières syndrome and autoimmune chilblain lupus. Systemic delivery of small-molecule inhibitors targeting TREX1 are intractable due to its ubiquitous expression in healthy tissue. We have engineered our systemically administered therapy to specifically deliver RNAi against TREX1 to the myeloid compartment of the tumor microenvironment, rather than to the inflammatory TNFα- and IL-6-producing stromal compartment. This enables targeted cGAS/STING induction of type I interferon, thereby promoting optimal T cell priming against tumor neoantigens. STACT-TREX1 was evaluated for therapeutic efficacy in several tumor models, including CT26 and MC38 colon carcinoma models, and B16.F10 melanoma. A high degree of tumor-specific colonization of STACT-TREX1 therapy was observed after a single intravenous tail vein administration, with 100,000-fold enrichment detected in tumor tissue relative to spleen and liver. The therapy was well tolerated, with very low TNFα and IL-6 serum cytokines detected. In multiple flank tumor models, potent tumor growth inhibition and complete tumor regressions were observed as a monotherapy. Efficacy was CD8-dependent, and cured mice were protected from tumor re-challenge. Importantly, immune correlates post-treatment demonstrated a significant shift away from the recruitment of microbe-induced innate myeloid populations, and towards type I interferon-induced adaptive immunity. This novel therapeutic approach will allow for systemic delivery of a STING pathway agonist that induces type I interferon specifically in tumor-resident myeloid cells, inducing potent adaptive anti-tumor immunity in solid tumors that are refractory to existing immunotherapies. Citation Format: Anastasia M. Makarova, Alexandre Iannello, Chris S. Rae, Beverly King, Marina Besprozvannaya, John Faulhaber, Justin Skoble, Christopher D. Thanos, Laura Hix Glickman. STACT-TREX1: A systemically-administered STING pathway agonist targets tumor-resident myeloid cells and induces adaptive anti-tumor immunity in multiple preclinical models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5016.