2'3'-cyclic GMP-AMP (cGAMP) is characterized as an intracellular second messenger that is synthesized in response to cytosolic dsDNA and activates the innate immune STING pathway. Our previous discovery of its extracellular hydrolase ENPP1 hinted at the existence of extracellular cGAMP. Here, using mass spectrometry, we detected that cGAMP is continuously exported as a soluble factor by an engineered cell line but then efficiently cleared by ENPP1, explaining why it has escaped detection until now. By developing potent, specific, and cell impermeable ENPP1 inhibitors, we detected that cancer cells continuously export cGAMP in culture at steady state and at higher levels when treated with ionizing radiation (IR). In tumors, depletion of extracellular cGAMP using a neutralizing protein decreased tumor-associated immune cell infiltration in a tumor cGAS and host STING dependent manner. Depletion of extracellular cGAMP also abolished the curative effect of IR. Boosting extracellular cGAMP by ENPP1 inhibitors synergizes with IR to shrink tumors in mice. In conclusion, extracellular cGAMP is an anticancer immunotransmitter that could be stimulated and harnessed to treat less immunogenic cancers.
Cancer cells initiate an innate immune response by synthesizing and exporting the small molecule immunotransmitter cGAMP, which activates the anti-cancer Stimulator of Interferon Genes (STING) pathway in the host. An extracellular enzyme, ectonucleotide pyrophosphatase phosphodiesterase 1 (ENPP1), hydrolyzes cGAMP and negatively regulates this anti-cancer immune response. Small molecule ENPP1 inhibitors are much needed as tools to study basic biology of extracellular cGAMP and as investigational cancer immunotherapy drugs. Here, we surveyed structure-activity relationships around a series of cell-impermeable and thus extracellular-targeting phosphonate inhibitors of ENPP1. Additionally, we solved the crystal structure of an exemplary phosphonate inhibitor to elucidate the interactions that drive potency. This study yielded several best-in-class compounds with Ki < 2 nM and excellent physicochemical and pharmacokinetic properties. Finally, we demonstrate that an ENPP1 inhibitor delays tumor growth in a breast cancer mouse model. Together, we have developed ENPP1 inhibitors that are excellent tool compounds and potential therapeutics. J.A.C., M.S., and L.L. designed the study. J.A.C., Y.A.S., and R.E.M. performed enzyme assays and analyzed the data. V.B. performed mouse experiments. J.A.B. and D.F. determined the crystal structure. J.A.C., M.S., and L.L. wrote the paper. All authors discussed the findings and commented on the manuscript. Competing interestsM.S. and L.L. are scientific cofounders of Angarus Therapeutics, which has exclusive licensing rights to patents PCT/US2018/50018 and PCT/US2020/015968. J.A.C., V.B., M.S., and L.L. are inventors on patents PCT/US2018/50018 and PCT/US2020/015968.
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