Providence St. Joseph HealthProvidence St. Joseph Health Digital CommonsSociety for Immunotherapy of Cancer 2018 AnnualMeeting Posters Earle A. Chiles Research Institute Collection

11-2018

MV-626, a potent and selective inhibitor of ENPP1enhances STING activation and augments T-cellmediated anti-tumor activity in vivoJason BairdEarle A. Chiles Research Institute, Providence Portland Medical Center, Portland, OR, USA, Jason.Baird@providence.org

Gregory Dietsch

Vincent Florio

Michael Gallatin

Clayton Knox

See next page for additional authors

Follow this and additional works at: https://digitalcommons.psjhealth.org/sitc2018

Part of the Oncology Commons

This Book is brought to you for free and open access by the Earle A. Chiles Research Institute Collection at Providence St. Joseph Health DigitalCommons. It has been accepted for inclusion in Society for Immunotherapy of Cancer 2018 Annual Meeting Posters by an authorized administrator ofProvidence St. Joseph Health Digital Commons. For more information, please contact digitalcommons@providence.org.

Recommended CitationBaird, Jason; Dietsch, Gregory; Florio, Vincent; Gallatin, Michael; Knox, Clayton; Odingo, Joshua; Crittenden, Marka; and Gough,Michael J., "MV-626, a potent and selective inhibitor of ENPP1 enhances STING activation and augments T-cell mediated anti-tumoractivity in vivo" (2018). Society for Immunotherapy of Cancer 2018 Annual Meeting Posters. 7.https://digitalcommons.psjhealth.org/sitc2018/7

AuthorsJason Baird, Gregory Dietsch, Vincent Florio, Michael Gallatin, Clayton Knox, Joshua Odingo, MarkaCrittenden, and Michael J. Gough

This book is available at Providence St. Joseph Health Digital Commons: https://digitalcommons.psjhealth.org/sitc2018/7

MV-626, A Potent and Selective Inhibitor of ENPP1, Enhances STING Activation and Augments T-cell Mediated Anti-tumor Activity in Vivo

Combination of MV-626 with Radiation Abstract

MV-626 Enhances STING Responses Human Fibroblast activation •  Cells incubated with

increasing concentrations of MV-626, with or without cGAMP (12.5 µM) for partial STING pathway activation

•  IFNβ mRNA measured after cGAMP addition (RT-PCR)

MV-626 Inhibits ENPP1-Mediated Degradation of cGAMP

Radiation Dose-Dependent Response

*Jason R. Baird, PhD; #Gregory N. Dietsch, PhD, DABT; #Vincent Florio, PhD; #Michael Gallatin, PhD; #Clayton D. Knox, MD; #Joshua Odingo, PhD; *$Marka R. Crittenden, MD, PhD; *Michael J. Gough, PhD

*Earle A Chiles Research Institute, Providence Portland Medical Center, 4805 NE Glisan St, Portland OR 97213.

$The Oregon Clinic, Portland OR. #Mavupharma,5400 Carillon Point, Kirkland WA 98033

0

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Con

trol

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V-70

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µM

0.1 µM

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1.0 µM

3.0 µM

IP-1

0 (p

g/m

L)

Concentration of MV-626

Control VACV-70 3.0 µM MV-626 + VACV-70

Human PBMC activation •  VAC-70 DNA (5 µg/mL)

added to activate cGAS, which produces cGAMP

•  MV-626 added to enhance STING pathway signaling

•  IP-10 measured by ELISA at 19 hrs

STING is an endogenous sensor of cGAMP, which is synthesized by cGAS following detection of cytoplasmic DNA. STING activation leads to interferon production and activation of inflammatory pathways that facilitate cytolytic T cell priming. STING agonists administered intratumorally show potent anti-tumor efficacy in a range of preclinical models; several agonists are in clinical development. Radiation therapy also increases cytoplasmic DNA levels in cancer cells, resulting in STING activation and secretion of inflammatory cytokines. Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) is the phosphodiesterase that negatively regulates STING by hydrolyzing cGAMP. MV-626, a highly potent and selective ENPP1 inhibitor with 100% oral bioavailability in rats and mice, blocks cGAMP hydrolysis and increases STING activation in cells where cGAS is active. We hypothesize that by conditionally enhancing STING activation, ENPP1 inhibitors will facilitate development of anti-tumor cellular immune responses, particularly following radiation therapy.

The effects of ENPP1 inhibition on STING activation using cGAMP or DNA treatment of cells were assessed in vitro. Panc02-SIY tumors were implanted in C57BL/6 mice and randomized to receive 20Gy CT-guided radiation therapy, 5 daily ip doses of MV-626, or both MV-626 and radiation. Mice were followed for outcome, tumor antigen specific T cell responses and changes in the tumor immune environment. Additional studies were conducted in C57BL/6 mice bearing MC38 tumors treated with anti-PDL1, MV-626 or MV-626 + anti-PDL1.

In vitro, MV-626 blocks ENPP1-mediated hydrolysis of cGAMP and enhances STING activation by DNA-mediated cGAS activation or exogenous cGAMP. Therapeutic doses of MV-626 were well tolerated in mice, with no evidence of toxicity or clinically-significant increases in systemic cytokine levels. Systemic administration of MV-626 monotherapy caused tumor growth delay. MV-626 combined with radiation therapy significantly increased overall survival, and most animals achieved durable tumor cures. Additional studies in the MC38 model confirmed MV-626 activity. Studies characterizing effects of MV-626 in the tumor microenvironment are underway.

Results

Methods

Background

STING Pathway is a Central Mediator of Anti-Tumor Immune Response

Immunogenic Death(spontaneous or induced)

Checkpoint Inhibitors

RadiationPARPi Chemo

CAR-T

TAATumor-derived DNAand cGAMP

cGAS

cGAMP

STING

IRF-3

cytokines

Activation& Maturation

DC’s DC’s

CD8 T cellsTAA-Presentation& T Cell Activation

Proliferation& Tumor Infiltration

Tumor

MV-626 Shows Monotherapy Activity and Enhances anti-PD-L1 Efficacy in MC38 Tumor Model

Conclusions These data demonstrate the potent and selective ENPP1 inhibitor

MV-626, when delivered orally or IP, augments STING activation in vitro and enhances immune responses to tumors in vivo. We demonstrate for the first time that, in combination with radiation therapy or anti-PDL1 mAb treatment, ENPP1 inhibition improves outcomes and cures tumors in preclinical models through changes in the tumor immune environment. The loss of this efficacy in IFN receptor knockout mice confirms STING-pathway mechanism of action, and the ability of the majority of MV-626 treated mice to reject tumor rechallenge indicates that MV-626 drives disseminated, durable, adaptive immune response. These translational studies demonstrate a novel approach to STING pathway modulation and form the foundation for clinical development of an ENPP1 inhibitor as a cancer immunotherapy.

Future Directions • Role of host STING activation and CD8 T cells • Additional profiling of tumor antigen specific

responses • Evaluate distal tumor responses • Clinical translation – biomarker identification

AcknowledgementsThis work was supported by a research grant from Mavupharma, Inc.

Immune Environment Changes

CD3

SSC

CD8

CD4

SIY-pentamer

CD8

Live cells CD3+ T cells Antigen specific

Splee

nTD

LNTu

mor

i) Identification of antigen-specific T cells

34%

36%

8%

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RTMV626

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CD

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CD

8

Live cells CD3+ T cells Antigen specific

Sple

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34%

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RTMV626

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CD

4

SIY-pentamer

CD

8

Live cells CD3+ T cells Antigen specific

Sple

enTD

LNTu

mor

i) Identification of antigen-specific T cells

34%

36%

8%

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RTMV626

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Syngeneic Panc02 Tumor Model

Single flank inoculation

MV-626 (60 mg/kg QD IP x5)

Tumors grown for 7 days

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- 6/6 mice treated w/MV-626 + RT were cured by day 28- All 6 cured mice were rechallenged at day 80- 4/6 mice rejected the rechallenge, indicating durable anti-tumor immunity

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WT and Interferon Receptor (IFNAR) KO Mice

WT, MV-626 + RT IFNAR KO, MV-626 + RT

- Loss of MV-626 efficacy in IFNAR KO mice indicates a type 1 IFN-dependent MOA

-  MAVU-626 was dosed at 50 mg/kg PO QD on days 15 -36; data presented as mean +/- SEM -  Anti-PD-L1 mAb (10 mg/kg) was dosed twice weekly x 6 doses beginning on day 14-  Only anti-PD-L1 + 50 mg/kg MAVU-626 group had survival with p<0.05 vs vehicle (Wilcoxon; no animals were censored)

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P=0.025

CD3

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Live cells CD3+ T cells Antigen specific

Splee

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NTRTMV626RT+MV626

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MV-626

20Gy

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22Gy

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18Gy

17Gy

CT isocenter Segmentation Treatment dose

PARAMETER MV-626 ENPP1 Ki (human)US034-0004515-Q01andUS034-004516-Q01 ~5 nM

ENPP1 Ki (mouse) ~18 nM Solubility 11 µM Mouse PK: Clearance 1.68 ml/min/kg Mouse PK: terminal half life 8.8 hours Rat PK: Clearance (mL/min/kg) 1.8 ml/min/kg Rat PK: terminal half life 6.7 hours Oral bioavailability 100% rat , 100% mouse Selectivity vs canonical PDEs (1-12) >500

• Nanostring profiling of immune changes in the tumor and LN

• Evaluation of ENPP1 inhibition with other anti-cancer agents that produce immunogenic tumor cell death

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