Cited by 526interferon and immune responsesCancer Immunotherapy and BiomarkersLung Cancer Treatments and Mutations

Suppression of STING Associated with LKB1 Loss in KRAS-Driven Lung Cancer

Open access
Kitajima, Shunsuke, Ivanova, Elena, Guo, Sujuan, Yoshida, Ryohei, Campisi, Marco, Sundararaman, Shriram K., Tange, Shoichiro, Mitsuishi, Yoichiro +9 more·2019·Cancer Discovery

Published version of a preprint

Abstract

KRAS-driven lung cancers frequently inactivate TP53 and/or STK11/LKB1, defining tumor subclasses with emerging clinical relevance. Specifically, KRAS-LKB1 (KL)–mutant lung cancers are particularly aggressive, lack PD-L1, and respond poorly to immune checkpoint blockade (ICB). The mechanistic basis for this impaired immunogenicity, despite the overall high mutational load of KRAS-mutant lung cancers, remains obscure. Here, we report that LKB1 loss results in marked silencing of stimulator of interferon genes (STING) expression and insensitivity to cytoplasmic double-strand DNA (dsDNA) sensing. This effect is mediated at least in part by hyperactivation of DNMT1 and EZH2 activity related to elevated S-adenylmethionine levels and reinforced by DNMT1 upregulation. Ectopic expression of STING in KL cells engages IRF3 and STAT1 signaling downstream of TBK1 and impairs cellular fitness, due to the pathologic accumulation of cytoplasmic mitochondrial dsDNA associated with mitochondrial dysfunction. Thus, silencing of STING avoids these negative consequences of LKB1 inactivation, while facilitating immune escape. Significance: Oncogenic KRAS-mutant lung cancers remain treatment-refractory and are resistant to ICB in the setting of LKB1 loss. These results begin to uncover the key underlying mechanism and identify strategies to restore STING expression, with important therapeutic implications because mitochondrial dysfunction is an obligate component of this tumor subtype. See related commentary by Corte and Byers, p. 16. This article is highlighted in the In This Issue feature, p. 1

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Crossref · 10.1158/2159-8290.cd-18-0689

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  • Double mutation of KRAS and LKB1 genes in lung cancer results in failure to respond to immune checkpoint blockade.

    “Double mutation of KRAS and LKB1 genes in lung cancer resulted in failure to respond to immune checkpoint blockade.80”
  • STING is silenced in STK11-deficient tumors, which contributes to their low immunogenicity.

    “For example, it has been observed that STING is silenced in STK11-deficient tumors, which contributes to their low immunogenicity (12, 13).”
  • Tumor cell-intrinsic STING activity is an important contributor to antitumor immune responses.

    “recent studies have provided compelling evidence that tumor cell-intrinsic STING activity is also an important contributor34–36.”
  • The ability to target and restore STING signaling in tumor cells using epigenetic modulators provides a rationale to explore whether epigenetic reprogramming of tumor cell-intrinsic STING activity can improve the therapeutic efficacy of STING agonists.

    “Despite this common suppression, the ability to target and restore STING signaling in tumor cells using epigenetic modulators35,37 provides a rationale to explore whether epigenetic reprogramming of tumor cell-intrinsic STING activity can improve the therapeutic efficacy of STING agonists.”
  • STK11/LKB1 alterations are a major driver of primary resistance to PD-1 blockade in KRAS-mutant lung adenocarcinoma.

    “STK11/LKB1 alterations have been described as a major driver of primary resistance to PD-1 blockade in KRAS-mutant lung adenocarcinoma (31, 35).”

    From New Horizons in KRAS-Mutant Lung Cancer: Dawn After Darkness (2019) · cites this paper as [31]

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Authors
Kitajima, S., Ivanova, E., Guo, S., Yoshida, R., Campisi, M., Sundararaman, S. K., Tange, S., Mitsuishi, Y., Thai, T. C., Masuda, S., Piel, B. P., Sholl, L. M., Kirschmeier, P. T., Paweletz, C. P., Watanabe, H., Yajima, M., & Barbie, D. A.
Affiliations
  • Dana-Farber Cancer Institute (US)
  • Politecnico di Torino (IT)
  • Tokushima University (JP)
  • Juntendo University (JP)
  • Brigham and Women's Hospital (US)
  • Tisch Cancer Institute (US)
  • Brown University (US)
Corresponding author
Barbie, David A.
Venue
Cancer Discovery
Published
2019-01-01
Volume
9
Issue
1
Pages
34-45
ISSN
  • 2159-8274 (ISSN-L)
  • 2159-8290
OpenAlex
W2895058922
Cited by
526
References
25
Citations by year
2026: 61 · 2025: 78 · 2024: 76 · 2023: 81 · 2022: 80 · 2021: 75 · 2020: 53 · 2019: 22
FWCI
16.11
Type
journal article
Language
en
Open access
Locations
  • Cancer Discovery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • PORTO@Iris (submittedVersion, other-oa)
Funders
  • HHS | NIH | National Cancer Institute (NCI) (NCI-R01 CA190394-02, NIH-U01 CA2143A1-01)
  • American Association for Cancer Research (AACR) (SU2C-AACR-DT17-1)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › interferon and immune responses
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
Keywords
STING, LKB1, KRAS-mutant lung cancer, immune checkpoint inhibitor resistance, cytosolic DNA sensing, DNMT1, EZH2, S-adenosylmethionine, TBK1, mitochondrial dysfunction, mitochondrial DNA, immune evasion, p53 inactivation, STK11
MeSH terms
AMP-Activated Protein Kinase Kinases, STING Protein, Adenocarcinoma, Humans, Lung Neoplasms, Membrane Proteins, Mutation, Signal Transduction, Gene Expression Regulation, Neoplastic, Proto-Oncogene Proteins p21(ras), Protein Serine-Threonine Kinases, Gene Deletion, Cell Line, Tumor, STAT1 Transcription Factor, Interferon Regulatory Factor-3

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