Restoring STING expression in soft tissue sarcoma increases activation and function of tumor-infiltrating lymphocytes.

Abstract

Sarcomas are rare, highly heterogeneous malignancies, with soft tissue sarcomas (STS) comprising nearly 80 histological subtypes. Localized STS is generally treated with surgery and radiotherapy, whereas metastatic disease relies largely on chemotherapy, which offers limited benefit. Although inflammation influences tumor development, treatment response, and prognosis, immune checkpoint inhibitors have shown minimal efficacy in sarcoma. The cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway is linked to mutational burden, genomic instability, immune cell infiltration, and therapeutic response across multiple cancer types. However, its role in sarcoma remains unclear. In a newly established cohort of STS patients, we found that STING expression in primary tumors correlates with immune cell infiltration. Using a lipid nanoparticle (LNP)-mediated delivery of CRISPR activation mRNA components, we restored STING expression in STS cells, thereby reactivating cGAS-STING signaling. This promoted T‑cell recognition and tumor cell killing in both 2D and 3D patient-derived models and enhanced responses to anti-PD-1 treatment. Together, our results show that controlled epigenetic activation of STING in STS enhances immune infiltration and tumor cell killing. Targeting STING through CRISPR activation may therefore represent a promising therapeutic strategy for STS.