Summary SB 11285, a novel cell-permeable, canonical 3’,5, purine-pyrimidine cyclic dinucleotide has been developed as a potent systemically bioavailable STING agonist currently in clinical trials. The stimulator of Interferon genes (STING) pathway, crucial for cytosolic DNA sensing and innate immunity, presents a promising avenue for novel cancer immunotherapies. Discussed here is the discovery and development of SB11285, a potent activator of the STING pathway, belonging to the canonical class of 3’,5’ purine-pyrimidine (PuPy) cyclic dinucleotides (CDNs). SB11285 exhibits superior potency and cell permeability compared to non-canonical 2,3’-CDNs and demonstrates robust antitumor activity in in vivo syngeneic mouse tumor models, resulting in complete tumor regression, and durable immunological memory. Combination with checkpoint inhibitors and cytotoxic agents further enhances its efficacy. The anti-tumor effects of SB 11285 rely on the induction of CD8+ T cells, activated macrophages, and NK cells in the tumor microenvironment (TME), for efficient tumor killing and fostering profound and durable anti-tumor response. Our findings underscore the potential of functionalized canonical 3’,5’-Pu-Py CDNs, exemplified by SB11285, as safe and potent STING agonists for multiple routes of administration in cancer therapy. Currently, SB11285 administered intravenously (IV), is undergoing evaluation as the first systemically administered CDN analog in human clinical trials across various tumor types. ### Competing Interest Statement RPI, the corresponding author has declared that he was the shareholder of Spring Bank Pharmaceuticals, Inc.

Abstract Background: Agonists of the Stimulator of Interferon Genes (STING) pathway have great potential in cancer immunotherapy. Activation of STING in tumor cells and/or antige- presenting cells (APCs) can induce type I Interferon production, leading to the induction of innate and adaptive immune response. We recently reported the discovery of the cyclic dinucleotide SB 11285 as a potent, first-in-class, STING agonist. Herein, we report SB 11 and SB 12 as unique linkage analogs of SB 11285. Methods: (a) Synthesis: Several linkage analogs of SB 11285 were synthesized by standard solution-phase phosphoramidite chemistry and screened for STING agonistic activity using the previously described SZ14 reporter cell lines, and SB 11 and SB 12 were identified as lead compounds., (b) Binding affinity: Differential scanning fluorimetry was used to determine binding affinity of SB 11 and 12 to wtSTING, with 2´,3´-cGAMP being used as a positive control. (c) Induction of IRF3 and NF-KB: wtTHP-1 or R232-THP1 or RAW cells carrying the respective reporter constructs were treated with SB 11 and 12 or controls for 22hrs and induction of IRF3 and NF-KB was determined as % fold-change in luminescence compared to vehicle-treated cells. (d) Induction of cytokines: PBMCs and mBMDCs were treated with SB 11 and 12 at different doses, and cell supernatants were analyzed for IFN-β, TNF-α, and RANTES by ELISA or multiplexing Luminex assays. (e) In vivo studies: Both SB 11 and 12 were tested for antitumor efficacy in CT26 syngeneic mouse tumor model after intravenous (i.v.) administration at 3mg/kg on days 1,5,9,14. Results: (i) SB 11 and 12 demonstrated high binding affinity to human wild-type and mouse STING that is evident by 16° thermal shift. (ii) SB 11 and 12 showed potent induction of (a) STING-dependent IRF3 (EC50: 0.8 and 39.7 nM) and NF-κB (EC50: 9 and 5265 nM) signaling induction in wtTHP-1 cells; (b) IRF3 (EC50: 2.6 and 317 nM) and NF-κB (EC50: 83 and 3783 nM) induction in R232-THP-1 cells; (c) IRF3 (EC50: 67 and 46 nM) in RAW macrophages. (iii) Both SB 11 and SB 12 induced STING dependent secretion of IFN-β (~10 ng/ml) in mBMDCs. (iv) In the CT26 colon carcinoma syngeneic mouse models, both SB 11 and 12 showed potent antitumor activity when administered by i.v. route with 98 and 97% TGI and 91 and 79% TGD, respectively. Conclusion: SB 11 and SB 12 showed excellent safety and antitumor activity in syngeneic mouse model when administered by i.v. route. SB 11 and SB 12 were shown to cause STING-dependent activation of IRF3 and NF-κB signaling, as well as the induction of type I IFN signature and ISGs. Further preclinical studies of systemically administered analogs SB 11 and SB 12 are in progress. Citation Format: Shenghua Zhou, Sreerupa Challa, Diane Shmidt, Leena Suppiah, Vishal Nair, Anjaneyulu Sheri, Geeta Meher, Rayomand Gimi, Seetharamaiyer Padmanabhan, Dillon Cleary, Radhakrishnan Iyer. Development of SB 11 and SB 12, structurally unique linkage analogs of SB 11285 as STING agonists for Immuno-oncology [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr B53.

Abstract Background: Immunotherapy has emerged as a transformative approach for the treatment of cancer. Recent evidence suggests that the activation of Stimulator of Interferon Genes (STING) pathway in immune calls within the tumor microenvironment (TME) can induce the production of Interferons and cytokines that would lead to the induction of innate and adaptive immunity. We have previously disclosed the discovery and development of SB 11285 as a first-in-class synthetic cyclic dinucleotide STING agonist, which has demonstrated potent antitumor activity, when used alone or combined with other antitumor agents, in several syngeneic mouse and rat tumor models when administered by intratumoral, intravenous, or intraperitoneal routes. Presented here is the development of a controlled-release nanoparticle formulation of SB 11285 for subcutaneous administration. Methods: (a) Nanoparticle formulations of SB 11285. SB 11285-NPs were generated using Polylactic-glycolic acid copolymer (PLGA) using double emulsion and nano-precipitation methods (b) Imaging of nanoparticles: Scanning electron microscopy was performed to visualize and measure size of the nanoparticles. (c) Induction of IRF3 and NF-KB. THP-1 cells and RAW macrophages carrying dual reporter constructs were treated with either SB 11285-NPs or naked SB 11285 for 22hrs and induction of IRF3 and NF-KB was calculated as % fold-change in luminescence compared to vehicle-treated cells. (d) Induction of cytokines: PBMCs were treated with different concentrations of 11285-NPs or naked SB 11285, and cell supernatants were analyzed for IFN-β, TNF-α, and RANTES by ELISA. (e) Dendritic cell maturation assay: PBMCs were differentiated into immature dendritic cells by addition of IL4 and GM-CSF followed by treatment with either SB 11285-NP or naked SB 11285. The maturation of dendritic cells was then evaluated by analyzing expression of CD83 and CD86 by flow cytometry. Results: PLGA formulations of SB 11285 prepared by double-emulsion method with an entrapment efficiency of 30 to 40% were spherical particles with an average diameter of 800nm. The nanoparticles were stable in aqueous media with minimal release of the entrapped SB 11285. In cell-culture studies, SB 11285-NPs showed potent induction of: (a) STING-dependent IRF3 induction in THP-1 cells (EC50: 3nM) as well as RAW macrophages (EC50: 3nM); (b) secretion of IFN-β (35 pg/ml), TNF-α (800 pg/ml), and RANTES (200 pg/ml), when tested at a low concentration of 112nM; and (c) SB 11285-NPs effectively induced DC maturation that was evident by increase in CD83 and CD86 expression. Conclusion: PLGA nanoparticles of SB 11285 were successfully prepared with submicron particle size that demonstrated potent expression of STING-dependent Type I IFN and cytokines in immune cells. The nanoparticles also induced maturation of dendritic cells. In vivo evaluation is in progress. Citation Format: Sreerupa Challa, Leena Suppiah, Dillon Cleary, Anjaneyulu Sheri, Rayomand Gimi, Geeta Meher, Seetharamaiyer Padmanabhan, Sumit Shah, Pranav Bhatt, Jovita Tauro, Radhakrishnan Iyer. Nanoparticle formulation of the STING agonist SB 11285 [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr B75.

Background: Cancer immunotherapy is a highly effective therapeutic option for cancer patients. However, the overall response rate with checkpoint inhibitors and other related modalities has been modest. Targeting innate immune signaling pathways that induce type I IFN production to reprogram tumor microenvironment and restore antitumor immunity represents a novel immunotherapeutic approach. We have previously reported that SB 11285 is a first-in-class synthetic cyclic dinucleotide STING agonist, which has demonstrated potent antitumor activity, when used alone or combined with other antitumor agents, in several syngeneic mouse and rat tumor models when administered by intratumoral, intravenous or intraperitoneal routes. Presented here are studies that provide additional insights into the mechanism of action of SB 11285 and analogs. Methods: (a) SB 11285 induces Type I IFN production and other cytokines in human PBMCs and PBMC-derived monocytes. PBMCs and monocytes, isolated from fresh PBMCs using pan monocyte isolation kit (Miltenyi Biotec), were stimulated with SB 11285. Type I IFNs and other cytokines were quantified using regular and multiplex ELISA assays. (b) SB 11285 directly binds STING. To address whether SB 11285 directly binds wild-type human STING, surface plasmon resonance assay was performed with a Biacore T200 device and a biotinylated SB 11285 analog (Biot-SB 11285). (c) Activity against STING polymorphs. Evaluation of SB 11285 and analogs was carried out using both SZ14 reporter cells (HEK293-derived) and HEK293T cells that stably or transiently express STING polymorphic variants. (d) Pharmacodynamic studies. Normal BALB/c mice were injected intravenously with SB 11285 or its analogs at 9 mg/kg. Serum, spleen, and liver samples were collected to quantify RANTES and TNF-α using ELISA. The expression of representative ISGs in spleen samples, including IRF7, IFIT2, and OAS1b were quantified using real-time PCR. (e) Determination of cellular uptake of SB 11285 by PBMCs. The STING agonist activity of Biot-SB 11285 in inducing type I IFN response was confirmed using SZ14 reporter cells and THP1-Dual-WT reporter cells. Human PBMCs were incubated with Biot-SB 11285 and the cellular uptake of compound by immune cells was evaluated using flow cytometry. Results and Conclusion: Our studies provide significant mechanistic insights into the STING agonistic activity of SB 11285 and analogs in that they: (a) induce Type I IFNs, other cytokines and chemokines in PBMCs and monocytes, monocyte-derived dendritic cells; (b) directly bind STING with nanomolar affinity; (c) activate multiple human STING polymorphic variants; (d) induce cytokines, chemokines, and ISGs in mice following i.v. injection; and (e) are effectively taken up by monocytes and other immune cells. SB 11285 is being advanced to human clinical trials. Citation Format: Shenghua Zhou, Sreerupa Challa, Vishal Nair, Geeta Meher, Anjaneyulu Sheri, Rayomand Gimi, Seetharamaiyer Padmanabhan, Dillon Cleary, Leena Suppiah, Diane Schmidt, Santosh Khedkar, Radhakrishnan Iyer. Mechanistic insights into the antitumor activity of SB 11285—a novel STING agonist [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr B87.

Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) kills about 1.5 million people each year and the widely used Bacille Calmette-Guérin (BCG) vaccine provides a partial protection against TB in children and adults. Because BCG vaccine evades lysosomal fusion in antigen presenting cells (APCs), leading to an inefficient production of peptides and antigen presentation required to activate CD4 T cells, we sought to boost its efficacy using novel agonists of RIG-I and NOD2 as adjuvants. We recently reported that the dinucleotide SB 9200 (Inarigivir) derived from our small molecule nucleic acid hybrid (SMNH)® platform, activated RIG-I and NOD2 receptors and exhibited a broad-spectrum antiviral activity against hepatitis B and C, Norovirus, RSV, influenza and parainfluenza. Inarigivir increased the ability of BCG-infected mouse APCs to secrete elevated levels of IL-12, TNF-α, and IFN-β, and Caspase-1 dependent IL-1β cytokine. Inarigivir also increased the ability of macrophages to kill MTB in a Caspase-1-, and autophagy-dependent manner. Furthermore, Inarigivir led to a Capsase-1 and NOD2- dependent increase in the ability of BCG-infected APCs to present an Ag85B-p25 epitope to CD4 T cells in vitro. Consistent with an increase in immunogenicity of adjuvant treated APCs, the Inarigivir-BCG vaccine combination induced robust protection against tuberculosis in a mouse model of MTB infection, decreasing the lung burden of MTB by 1-log10 more than that afforded by BCG vaccine alone. The Inarigivir-BCG combination was also more efficacious than a muramyl-dipeptide-BCG vaccine combination against tuberculosis in mice, generating better memory T cell responses supporting its novel adjuvant potential for the BCG vaccine.

SB 9200, an orally bioavailable dinucleotide, activates the viral sensor proteins, retinoic acid-inducible gene 1 (RIG-I) and nucleotide-binding oligomerization domain-containing protein 2 (NOD2) causing the induction of the interferon (IFN) signaling cascade for antiviral defense. The present study evaluated the overall antiviral response in woodchucks upon induction of immune response, first with SB 9200 followed by Entecavir (ETV) versus reduction of viral burden with ETV followed by SB 9200 immunomodulation. Woodchucks chronically infected with woodchuck hepatitis virus (WHV) were treated orally with SB 9200 (30 mg/kg/day) and ETV (0.5 mg/kg/day). Group 1 received ETV for 4 weeks followed by SB 9200 for 12 weeks. Group 2 received SB 9200 for 12 weeks followed by ETV for 4 weeks. At the end of treatment in Group 2, average reductions of 6.4 log10 in serum WHV DNA and 3.3 log10 in WHV surface antigen were observed whereas in Group 1, average reductions of 4.2 log10 and 1.1 log10 in viremia and antigenemia were noted. Both groups demonstrated marked reductions in hepatic WHV nucleic acid levels which were more pronounced in Group 2. Following treatment cessation and the 8-week follow-up, recrudescence of viral replication was observed in Group 1 while viral relapse in Group 2 was significantly delayed. The antiviral effects observed in both groups were associated with temporally different induction of IFN-α, IFN-β, and IFN-stimulated genes in blood and liver. These results suggest that the induction of host immune responses by pretreatment with SB 9200 followed by ETV resulted in antiviral efficacy that was superior to that obtained using the strategy of viral reduction with ETV followed by immunomodulation.

Abstract Immunotherapy has recently emerged as a transformative approach for the treatment of cancer; nevertheless, many patients remain unresponsive to treatment. Recent evidence suggests that the activation of Stimulator of Interferon Genes (STING) pathway in tumor cells and/or antigen presenting cells (APCs) within the tumor microenvironment (TME) can induce type I Interferon production leading to apoptosis of tumor cells, as well as, induction of adaptive immune response (through priming of CD8+ T cells to tumor-associated antigens) thereby providing a powerful anti-cancer strategy. Therefore, therapeutic agents that activate STING signaling pathway in tumor cells and APCs in the TME are urgently needed. Herein, we describe the discovery of highly potent and selective first-in-class STING agonists for application in immuno-oncology. Methods: Using structure-guided drug design, in conjunction with published crystal structures of different cyclic dinucleotides bound to STING, a focused library of nucleotide compounds was prepared using standard phosphoramidite chemistry. The compounds were screened for induction of Interferon regulatory factor (IRF), Interferon-stimulated gene 54 (ISG54), and NF-KB using reporter assays. We used HEK293 cell line stably expressing ISG54 (ISRE)-promoter-driven firefly luciferase reporter gene for initial hit discovery and the actives were further characterized in PBMCs and THP1 cells. The IRF and NF-kB induction was calculated from % fold-change in luminescence compared to DMSO-treated cells and EC50 of the compounds were ascertained using Xlfit. Lead STING agonists were further evaluated for: (a) Binding affinity: Binding assays were conducted by Differential Scanning Fluorimetry (DSF) and Tm was calculated using Thermal Shift software, (b) Induction of pathogen recognition receptors (PRRs), ISGs and Programmed Death Ligands 1 & 2 (PDL1, PDL2) genes: THP1 cells and PBMCs were treated with various concentrations of lead compounds or 2,'3'-cGAMP or DMSO and the gene expression of different PRRs, ISGs, PDL1, and PDL2 was determined by quantitative RT-PCR using ΔΔct method, (c) Apoptosis-inducing activity: PBMCs and THP1 cells were treated with various concentrations of lead compounds, 2',3'-cGAMP, or DMSO control and the apoptotic activity was evaluated using Caspase-Glo® 3/7 Assay (Promega), and (d) In vitro anti-tumor activity: STING-dependent anti-tumor activity of lead compounds in various tumor cell lines was assessed by either high-content imaging or through Cell titer Glo® Cytotoxicity Assay (Promega). Cell survival was calculated based upon % reduction of live cells compared to DMSO control. CC50 of the compounds were generated by curve fit in Xlfit. Results: Through in vitro assays in conjunction with Structure Activity Relationship (SAR) studies, we have identified several highly potent and selective first-in-class STING agonists. A promising lead nucleotide compound SB 11285 caused STING-dependent induction of: (a) IRF with an EC50 of 2 nM that is 1000-fold more potent than the natural STING agonist 2',3'-cGAMP, (b) NF-kB with an EC50 of 200 nM that is >200-fold more potent than 2',3'-cGAMP, (c) selective apoptosis of human monocyte leukemic cell lines (CC50, 500 nM) as compared to normal PBMCs through induction of IFN, and NF-kB signaling, and (d) expression of various PRRs and ISGs including RIG-I, MDA-5, LGP2, ISG54 and OAS-1, as well as, PDL1 and PDL2. Finally, SB 11285 showed potent in vitro anti-tumor activity in multiple tumor cell lines. Conclusion: We have discovered highly potent first-in-class STING agonists that show excellent selectivity in induction of IFN, NF-KB, ISGs, and PRRs, and apoptosis of tumor-derived cell lines. The lead STING agonist SB 11285 has potent immune-modulating, as well as, anti-tumor activities and is being advanced for additional preclinical studies for application in immuno-oncology. Citation Format: Sreerupa Challa, Shenghua Zhou, Anjaneyulu Sheri, Seetharamaiyer Padmanabhan, Samantha Delaney, Geeta Meher, Dillon Cleary, Vishal Nair, Rayomand Gimi, Santosh Khedkar, Radhakrishnan Iyer. Nucleotide analogs as novel STING agonists for immuno-oncology. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2016 Oct 20-23; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2017;5(3 Suppl):Abstract nr B40.

Abstract Background: Immunotherapy has recently emerged as a transformative approach for the treatment of cancer; nevertheless, many patients remain unresponsive to treatment. It is being recognized that induction of type I interferons (IFN) and interferon-stimulated genes (ISGs) in tumor cells and within the tumor microenvironment (TME) is essential for modulating the host-immune response and inducing apoptosis of tumor cells. Furthermore, the antigen-presenting cells within TME can cause induction of adaptive immune response, through priming of CD8+ T cells and tumor killing. Importantly, the DNA released from damaged cells and cancer cells can be sensed by cyclic GMP-AMP synthase (cGAS) leading to the synthesis of cyclic-GMP-AMP (2',3'-cGAMP), a second messenger that activates Stimulator of Interferon Genes (STING) pathway resulting in the production of type I IFN and ISGs. The cumulative effects of activation of innate and adaptive immune response can result in potent anti-cancer effects. Therefore, therapeutic agents that activate the cGAS-STING signaling pathway in tumor cells and TME are urgently needed. Herein, we describe the discovery of novel potent, first-in-class small molecules for application in immuno-oncology. Methods: Using structure-guided drug design, in conjunction with published crystal structures of cyclic dinucleotides bound to STING, a focused library of dinucleotide compounds was synthesized using phosphoramidite chemistry and evaluated for: (a) Induction of IFN signaling: The compounds were screened for the induction of Interferon regulatory factor (IRF), ISG54, and NF-κB using reporter assays. We used HEK293 cell line (SZ14) stably expressing ISG54 (ISRE)-promoter-driven firefly luciferase reporter gene for screening and the active compounds were further characterized in THP1 cells and human primary PBMCs. The IRF, ISG54, and NF-κB induction was calculated from % fold-change in luminescence compared to DMSO-treated cells and EC50s of the compounds were ascertained to identify active compounds, (b) Expression of IFN-β and IRF7 in THP1 cells: THP1 cells were treated with active compounds or controls for 22hrs. RNA was extracted and the expression of IFN-β, IRF7, was ascertained using semi-quantitative RT-PCR, (c) Induction of pathogen recognition receptors (PRRs) including RIG-I, MDA5, LGP2, and OAS-1 and ISG54: THP1 cells and PBMCs were treated with active compounds, 2',3'-cGAMP (control), or DMSO and the gene expression of different PRRs, ISGs, was determined by quantitative RT-PCR using ΔΔct method, (d) Induction of cGAS-STING signaling using reporter assays: HEK293 cells stably expressing ISG54 were transfected with plasmids encoding human cGAS (wild-type, or K384A, K400A, or K411A mutants) and treated with active compounds, poly (dA:dT) (positive control), or DMSO for 21 hrs. ISG54 induction was calculated as fold-change in luminescence compared to DMSO-treated controls. (e) Cytotoxicity assays: THP1 cells were treated with active compounds or DMSO control with Lipofectamine and cytotoxicity assessed using the CellTiter-Glo® Luminescent assays. Cytotoxicity was calculated from %-fold change in luminescence compared to DMSO-treated sample. Results: Through in vitro assays in conjunction with Structure Activity Relationship studies, we have identified potent compounds that activate cGAS-STING signaling pathway for induction of IRF, IFN, and NF-κB. These compounds also cause induction of expression of PRRs, including RIG-I, MDA5, LGP2, as well as, ISG54 and OAS-1. Conclusion: We have discovered potent, first-in-class agents that cause induction of IFN, NF-κB, ISGs, and PRRs. Further optimization and preclinical evaluation of the compounds for application in immuno-oncology is underway. Citation Format: Shenghua Zhou, Sreerupa Challa, Seetharamaiyer Padmanabhan, Anjaneyulu Sheri, Samantha Delaney, Geeta Meher, Dillon Cleary, Rayomand Gimi, Santosh Khedkar, Radhakrishnan Iyer. Novel dinucleotides that activate STING signaling for immuno-oncology. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2016 Oct 20-23; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2017;5(3 Suppl):Abstract nr B39.

e14616 Background: The activation of innate and adaptive immunity via Stimulator of Interferon Genes (STING) signaling is a potentially transformative immuno-therapeutic strategy in cancer. We report here in vivo efficacy and safety studies of SB 11285. Methods: Tumor Growth Inhibition (TGI) and Tumor Growth Delay (TGD) studies in syngeneic mouse models were initiated when mean tumor volume (MTV) reached 100mm3: A20 Lymphoma: (10 animals/Group); (A) Saline; (B) 100µg SB 11285, intratumoral (i.t.), days 3,4,6,8,10; (C) 100mg/kg Cyclophosphamide, intraperitoneal (i.p), days 1,2; and (D) combination of cyclophosphamide+SB 11285. CT26 Colon Carcinoma experimental design is shown in Table. Re-challenge study was initiated in tumor-free animals in A20 lymphoma model on day 73, and monitored for an additional 45 days. Presence of activated immune cells intumor tissues was evaluated by immuno-histochemistry. Cytokine response was evaluated in serum after a single i.p. injection of SB 11285 at 10mg/kg. Maximum Tolerated Dose (MTD) in mice was determined by daily i.p. injection of SB 11285 for 10 days. Results: A20 model: % TGI in the treatment groups were—A, 0; B, 86; C, 98, and D, 93; % TGD, day 70: A, 0; B, 64; C, 156; D, 288. In D, day 73, 90% of animals remained tumor-free. CT26 model: Table 1 shows MTV on day 19 and %TGD on day 43; Re-challenge study. All animals from the SB 11285-treated groups remained completely tumor-free on day 45 compared to control group (MTV,1666 mm3); Immuno-histochemistry of SB 11285-treated groups, revealed the infiltration of CD8+T and NK cells into tumor and surrounding tissues; Cytokine analysis did not show systemic inflammatory response; MTD of SB 11285 was 16 mg/kg/day. Conclusions: SB 11285, a novel STING agonist, showed very potent, and highly durable immune response-mediated anti-tumor activity. SB 11285 was well tolerated, safe, and is being advanced to IND-enabling studies. [Table: see text]

SB 9200, an oral prodrug of the dinucleotide SB 9000, is being developed for the treatment of chronic hepatitis B virus (HBV) infection and represents a novel class of antivirals. SB 9200 is thought to activate the viral sensor proteins, retinoic acid-inducible gene 1 (RIG-I) and nucleotide-binding oligomerization domain-containing protein 2 (NOD2) resulting in interferon (IFN) mediated antiviral immune responses in virus-infected cells. Additionally, the binding of SB 9200 to these sensor proteins could also sterically block the ability of the viral polymerase to access pre-genomic RNA for nucleic acid synthesis. The immune stimulating and direct antiviral properties of SB 9200 were evaluated in woodchucks chronically infected with woodchuck hepatitis virus (WHV) by daily, oral dosing at 15 and 30 mg/kg for 12 weeks. Prolonged treatment resulted in 2.2 and 3.7 log10 reductions in serum WHV DNA and in 0.5 and 1.6 log10 declines in serum WHV surface antigen from pretreatment level with the lower or higher dose of SB 9200, respectively. SB 9200 treatment also resulted in lower hepatic levels of WHV nucleic acids and antigen and reduced liver inflammation. Following treatment cessation, recrudescence of viral replication was observed but with dose-dependent delays in viral relapse. The antiviral effects were associated with dose-dependent and long-lasting induction of IFN-α, IFN-β and IFN-stimulated genes in blood and liver, which correlated with the prolonged activation of the RIG-I/NOD2 pathway and hepatic presence of elevated RIG-I protein levels. These results suggest that in addition to a direct antiviral activity, SB 9200 induces antiviral immunity during chronic hepadnaviral infection via activation of the viral sensor pathway.

Tuberculosis is a major cause of death in mankind and drug resistant tuberculosis has posed a problem for therapy. Immunotherapy is an option for better control of tuberculosis. We discovered two types of novel SMNH compounds which were active as adjuvants since they activated respectively NOD2 and TLR-7 receptors in macrophages. Since these cytosolic pattern recognition pathways lead to bactericidal mechanisms, we tested the efficacy of the SMNHs to activate macrophages to kill mycobacteria. Methods: Human THP1 macrophages were treated with either NOD-2 (SB44, SB44-1) or TLR-7 (SB9922) SMNH followed by infection with M. tuberculosis. Three days later macrophages were lysed and plated for bacterial counts. Cytokines from BMs were estimated using sandwich ELISA and autophagic markers were evaluated using monodansyl cadaverine and fluorescence microscopy. Results: Both NOD2 and TLR-7 activating SMNH compounds reduced the numbers of M. tuberculosis in human macrophages by 1-log10 over 3 days of culture. These SMNHs also reduced the numbers of M. tuberculosis within mouse BMs between 1-2log10 over 3 days. SMNHs activated autophagic processes in macrophages underscoring a new mechanism to kill intracellular M. tuberculosis. Since the main scaffold of SB44 has been used as an adjuvant in human trials, we anticipate that SB44 and SB9922 like compounds can be used as adjuncts to drugs for treating ongoing infections of M. tuberculosis in humans.