Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2010  |  Volume : 6  |  Issue : 4  |  Page : 478-481

Evaluation of natural killer cell activity in pre and post treated breast cancer patients

1 Department of Microbiology and Immunology, Kashan University of Medical Sciences, Kashan, Iran
2 Department of Microbiology and Immunology, Medical Faculty, Tarbiat modarres University, Tehran, Iran

Date of Web Publication24-Feb-2011

Correspondence Address:
Ahmad Piroozmand
Department of Microbiology and Immunology, Kashan University of Medical Sciences, Kashan
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.77110

Rights and Permissions
 > Abstract 

Aim: To evaluate natural killer (NK) cells activity in breast cancer patients and its comparison with normal individuals.
Settings and Design: Breast cancer is the most prevalent type of spontaneous tumor in humans, and NK cells are the first line defense against such tumors. There is a reverse correlation between NK activity and metastasis and reducing the tumor mass by surgery may be monitoring the NK activity. In this study, we evaluate NK activity in pre and post mastectomy patients.
Materials and Methods: Eighteen patients with invasive ductal carcinoma attended to cancer research institute were included in this study. NK cells were evaluated in pre and post mastectomy patients. PBMCs were isolated by ficoll hypaque. NK cell activity (% lysis of K562) was evaluated by flowcytometer.
Statistical Analysis Used: One way analysis of variation (ANOVA) and KruskalWallis nonparametric test were employed using SPSS software.
Results: While NK cell activity was greatly impaired in breast cancer patients (average lysis of K562 target cells: 24.4% vs. 62.5% in healthy controls, n = 18), it was found to be significantly increased after mastectomy (37.7%).
Conclusions: Mastectomy may lead to increased activity of NK cells among patients suffering from breast cancer and their increased activity may produce positive therapeutic effect.

Keywords: Breast cancer, flowcytometry, mastectomy, natural killer- Cell

How to cite this article:
Piroozmand A, Hassan ZM. Evaluation of natural killer cell activity in pre and post treated breast cancer patients. J Can Res Ther 2010;6:478-81

How to cite this URL:
Piroozmand A, Hassan ZM. Evaluation of natural killer cell activity in pre and post treated breast cancer patients. J Can Res Ther [serial online] 2010 [cited 2022 Jan 18];6:478-81. Available from: https://www.cancerjournal.net/text.asp?2010/6/4/478/77110

 > Introduction Top

Natural killer (NK) cells are the front line defense against tumor cells and act as the main component of immune system to monitor tumors, modified cells, viral infections and some fungal and bacterial infections.

These cells are one of the factors that regulate immune system as well as the function of stem cells which are involved in hematopoiesis. [1],[2],[3],[4],[5],[6],[7],[8] Thus, the process of proliferation, establishment and metastasizing of cancer is followed by a decrease in NK cell activity. Because of the significant role of NK cells in gaining natural immunity and protection against tumor and infectious agents, we can also examine the quantitative and qualitative function of these cells in blood and other lymphatic organs in order to positively evaluate prognosis and obtain an effective result. [9],[10]

In view of various studies in this field that suggest NK cell's activity decreases in patients suffering from cancer, in particular breast cancer, NK cells could be effective for evaluating the prognosis of treatment. [11]

In this study, we evaluated the level and the function of NK cells in patients attended to institute of cancer, Imam Khomeini hospital, Tehran.

 > Materials and Methods Top


Eighteen patients with breast cancer (invasive ductal carcinoma) who underwent surgical procedure were studied in Cancer Institute of ImamKhomeini hospital, Tehran. Patients with a history of chemotherapy and/or radiotherapy were excluded from the study. The mean age of patients was 51.2 ± 8.2 and the range was 3462. Patients were diagnosed pathologically to have invasive ductal carcinoma. Eighteen healthy people were also studied as the control group.

Blood sample

About 10 ml blood was collected from the patients. Peripheral blood lymphocytes were isolated by ficollhypaque, washed thrice with RPMI1640 medium and incubated for 30 min for phagocytes adhering to the plate. [12] Effector cells like peripheral blood lymphocytes were counted via trypan blue and their viability was determined. Effector cells RPMI (1X10 5 effector cells/ml) were measured by flowcytometer. The gate of the cell was measured by FLS and PLS.

Target cells

Human erythromyeloblastoid leukemia cell line was cultured in RPMI-1640 medium with 10% FCS. The viability of K562 was measured by trypan blue (around 97% viable) and 100 μl of K562 labeled with 100 μl working solution of PI and measured by flowcytometer. The gate of the cell was measured by FLS and PLS.

Flowcytometric analysis

Natural killer cytotoxicity assay: K562 tumor cell line, was maintained in continuous suspension culture in RPMI 1640 + 10% FCS and harvested during the log phase of growth and used for the evaluation of NK activity. Cells were brought to the concentration of 1 × 10 5 ml. Effector cells were cultured from peripheral blood, washed and brought to a concentration of 5 × 10 6 , 1 × 10 7 , 2 × 10 7 cell/ml in RPMI + 10% FCS. Effector cells and K562 target cells were mixed in E/T ratio of 5:1, 10:1 and 20:1. Briefly, tubes were centrifuged for 7 min at 250 rpm at room temperature to promote conjugate formation and then placed in a water bath at 37°C for 10 min. Conjugates were then gently resuspended in RPMI and then incubated for 1.5 h at 37°C, 5% CO2. A working solution was prepared by adding 0.5 μ g/ml of propodium iodide (Sigma) in RPMI 1640 + 10% FCS as previously reported by Vitale et al. [13] for staining the DNA of the lysed cells. At the end of the incubation, 100 μl of working solution of PI was added to 100 μl of cells and analyzed by flowcytometry. Target controls were incubated at a concentration of 1 × 10 5 cells/ml in order to monitor the spontaneous death rate. The NK cytotoxicity assay was performed using a FAC Star flowcytometry (Coulter) equipped with an argon ion laser at 200 mW light output. [14] FLS and PLS were collected in linear mode.

Lysed target cell

K562 was mixed with 2 ml distilled water for 2 min for complete lyses. Target cell was then centrifuged and resuspended with RPMI, and 100 μl working solution of PI was added to 1 ml of lysed cell and measured by flowcytometer. The gate of the cell was measured by FLS and PLS. First, three distinct populations could be detected on the scatter gram, corresponding to the effector cells, live targets and dead targets. Then effectors were gated out on the basis of PLS, as previously reported, [15] and statistical analyses were performed on K562 cluster. The relative amounts of cells with lower FLS and slightly higher PLS values gave the lytic percentage of cells. A total of 10,000 events were collected for each sample. The numbers of cells in the gate of lysed target indicate the quantity of NK cell activity.

Statistical Analysis: One-way analysis of variation (ANOVA) and Kruskal-Wallis nonparametric test were employed using SPSS software.

 > Results Top

Evaluation of NK activity in pre and post surgery patients

To evaluate NK cell activity, 18 pre surgical patients were selected and compared with 18 normal people. The results in [Figure 1] show that the average activity of NK cell in post surgery was significantly (P<0.05) increased compared with pre surgery (37.7% vs 24.4%) patients, which indicates an improvement in the microenvironment of the NK cells. However, NK activity was not recovered to the normal status. A significant difference was seen between NK activity in post surgery and normal NK cell activity in normal healthy individuals (62.5%) [Figure 1].
Figure 1: Natural killer- cell activity in normal individuals and breast cancer patients pre and post surgery. Samples were 18 patients with average age of 51.2 ± 8.2 and range of 34-62

Click here to view

Evaluation of NK activity in pre and post surgery in different stages of tumor

NK activity in patients with different stages of tumor was identified as follows: two in stage I, four in stage II, five in stage III and seven in stage IV and the results are given in [Figure 2]. The activity of NK cell in various stages of disease was different and consequently there is a significant correlation between disease stages and NK cell [Figure 2]. The NK activity is gradually decreased with the increase in stage of tumor. A significant increase in natural killer activity was noticed in stage I and II post surgery compared to pre surgery.
Figure 2: The correlation between Natural killer- cell activity and various stages of tumor pre- and post- surgery. The number of patients in stage I tumor was 2, in stage II tumor was 4, in stage III tumor was 5 and in stage IV tumor was 7

Click here to view

Correlation between NK activity in pre and post surgery with patient's ages

To evaluate the correlation between NK activity and the ages of the patients, 18 patients suffering from invasive ductal carcinoma were evaluated; the patients were classified into three main age groups: group 1 (34-46), group 2 (47-53) and group 3(54-62). The results indicated that no relationship exists between NK activity and patient's ages [Figure 3].
Figure 3: The relationship between age and average Natural killer- cell activity in the breast cancer patients pre- and post- surgery

Click here to view

 > Discussion Top

The role of natural killer cells as a factor influencing solid-tumor metastasis has been investigated with great attention. The ability to eliminate circulating tumor emboli is closely associated with the level of host NK. [16],[17],[18],[19] Low NK results in increased tumor cell survival in the blood stream and metastatic pulmonary lodgment. [16]

Promotion of solid-tumor metastasis by surgery is reproducible experimentally; unfortunately, it is also thought to occur occasionally in patients who undergo extirpative solid tumor resection. [20] It is important to understand the immunological consequences of surgical intervention in the tumor-bearing host because of its potential role in host defense at this time. Further knowledge of such events may suggest means for immunomodulation in the preoperative period and the possible prevention of subsequent metastases.

NK cells were proved to be of high significance in this monitoring by several studies and there is a general reverse correlation between NK activity and progressing the metastasis of various tumors. [4] The assessments show a direct correlation between life span of tumor suppressed patients and NK cell activity. [5],[21]

The current study aimed to answer the question of whether there is an increase in NK activity due to tumor volume reduction (post surgery). The results indicated that the NK activity was significantly resumed in patients post surgery.

According to current literature, there is a significant difference between NK cell activity before and after treatment which indicates the efficient role of surgery in decreasing tumor volume and therefore removing the suppressive effect of tumor tissue on the NK cells and increasing their cytotoxicity.

Furthermore, the correlation between tumor stage and NK activity revealed that NK activity significantly decreases with the increase in tumor stages. The current study suggests that there is no correlation between the age and NK cell activity, neither in normal persons nor in individuals experiencing breast cancer. On the other hand, other studies done abroad, [5],[22],[23],[24],[25] or studies performed by Sheikhi in Iran have shown the NK activity to be 55-70 % in normal individuals based upon Chrome release method which reaches 62.5% using flowcytometry method. [21]

As a result, this method is a reliable technique for detecting normal cytotoxicity because of many advantages including reproducibility, accuracy, fast, no risk of radioisotopes and finally feasibility of concurrent qualitative and quantitative assays.

The final conclusion is that mastectomy may cause NK cells to increase their activity in persons suffering from breast cancer and promote the outcome of treatment. [26]

Finally, it is recommended that a better understanding of correlation between tumor and NK cell will achieve in light of other therapies (chemotherapy, radiotherapy, and immunotherapy).

In this way, a comprehensive data collection can act as a prognosis factor or it may be used in treatment and delaying disease proliferation.

 > Acknowledgement Top

We thank Mr. Montazeri, operator of FACS system, for her excellent assistance. We also thank all cancer center's nurses in Khomeini hospital for their valuable help in sampling.

 > References Top

1.Brodt P. Tumor immunology: Three decades in review. Ann Rev Microbiol 1983;37:447-76.  Back to cited text no. 1
2.Levy S, Tempé JL, Caussade P, Aleksijevic A, Grosshans E, Mayer S, et al. Stage - related decrease in natural killer cell activity in untreated patients with mycosis fungoides. Cancer Immunol Immunother 1984;18:138-40.  Back to cited text no. 2
3.Fodstad O, Hansen CT, Cannon GB, Statham CN, Lichtenstein GR, Boyd MR. Lack of correlation between NK-activity and tumor growth control in nude mice with different immune defects. Cancer Res 1984;44:4403-8.  Back to cited text no. 3
4.Healy F, Rees RC, Hancock BW. An assessment of natural killer cell mediated cytotoxicity in patients with malignant lymphoma. Eur J Cancer Oncol 1985;21:775-83.  Back to cited text no. 4
5.Hokland M, Jacobsen N, Ellegaard J, Hokland P. Natural killer Function following allogeneic bone marrow transplantation. Transplantation 1988;45:1080-5.  Back to cited text no. 5
6.Whiteside TL, Herberman RB. The role of natural killer cells in immune surveilance of cancer. Curr Opin Immunol 1995;7:704-10.  Back to cited text no. 6
7.Smyth MJ, Thia Ky, Cretney E, Kelly JM, Snook MB, Forbes CA, et al. Perforin is a major contributor to NK cell control of tumor metastasis. J Immunol 1999;162:6658-62.  Back to cited text no. 7
8.Divino CM, Chen SH, YangW, Thung S, Brower S,Woo LC. Anti-tumor immunity induced by interleukin-12 gene therapy in a metastatic model of breast cancer is mediated by natural killer cells. Breast Cancer Res Treat 2000;60:129-34.  Back to cited text no. 8
9.Whiteside TL. Herberman RB. The role of NK cells in human disease. Clin Immunol Immunopath 1989;53:1-23.  Back to cited text no. 9
10.Mozaffari F, Lindemalm C, Choudhury A, Granstam-Bjorneklett H, Helander I, Lekander M. NK-cell and T-cell functions in patients with breast cancer: Effects of surgery and adjuvant chemo- and radiotherapy. Br J Cancer 2007;97:105-11.  Back to cited text no. 10
11.Kono K, Takahashi A, Ichihara F, Sugai H, Fujii H, Matsumoto Y. Impaired antibody-dependent cellular cytotoxicity mediated by herceptin in patients with gastric cancer. Cancer Res 2002;62:5813-7.   Back to cited text no. 11
12. Boyum A. Isolation of mononuclear cells and granulocytes from human blood. Scand J Clin Invest 1968;97:77-89.  Back to cited text no. 12
13.Vitale M, Neri LM, Comani S, Falcieri E, Rana R, Papa S. Natural Killer function in flow-cytometry. II. Evaluation of NK lytic activity by means of target cell morphological changes detected by right angle light scatter. J Immunol Methods 1989;121:115-20.  Back to cited text no. 13
14.Vitale M, Papa S, Martiani AR, Facchini A, Rizzoli R, Manzoli FA. Use of polygonal windows for physical discrimination among mononuclear subpopulation in flow cytometry. J Immunol Methods 1987;96:638.  Back to cited text no. 14
15.Papa S, Vitale M, Mariani AR, Roda P, Facchini A, Manzoli FA. Natural killer function in flow cytometry. I. Evaluation of NK lytic activity on K562 cell line. J Immunol Methods 1988;107:73-8.  Back to cited text no. 15
16.Hanna N. Expression of metastatic potential of tumor cells in young nude mice is correlated with low levels of natural killer cell-mediated cytotoxicity. Int J Cancer 1980;26:675-80.  Back to cited text no. 16
17.Hanna N. Role of natural killer cells in control of cancer metastasis. Cancer Metastasis Rev 1982;1:45-64.  Back to cited text no. 17
18.Hanna N. Inhibition of experimental tumor metastasis by selective activation of natural killer cells. Cancer Res 1982;42:1337-42.  Back to cited text no. 18
19.Manna N, Fidler IJ. Rote of natural killer cells in the destruction of circulating tumor emboli. J Nati Cancer Inst 1980;65:801-9.  Back to cited text no. 19
20.Cole WH. Dissemination of Cancer the colon. Gastroenterology 1961;41:412-4.  Back to cited text no. 20
21.Sheikhi A. The assessment of NK cell activity in cancer patients and its comparison with normal persons. PhD dissertation 1994;60-8.  Back to cited text no. 21
22.Konjeviæ G, Jurisiæ V, Spuziæ I. Association of NK cell dysfunction with changes in LDH characteristics of peripheral blood lymphocytes (PBL) in breast cancer patients. Breast Cancer Res Treat 2001;66:255-63.  Back to cited text no. 22
23.Hoek A, Van Kasteren Y, de Haan-Meulman M, Hooijkaas H, Schoemaker J, Drexhage H. Analysis of peripheral blood lymphocyte subsets, NK cells, and delayed type hypersensitivity skin test in patients with premature ovarian failure. Am J Reprod Immunol 1995;33:495-502.  Back to cited text no. 23
24.Lukac J, Kusic Z, Kordic D, Koncar M, Bolanca A. Natural killer cell activity, phagocytosis, and number of peripheral blood cells in breast cancer patients treated with tamoxifen. Breast Cancer Res Treat 1994;29:279-85.  Back to cited text no. 24
25.Konjeviæ G, Spuziæ I. The effect of sera of breast cancer patients on NK cell activity. Srp Arh Celok Lek 1995;123:227-31.  Back to cited text no. 25
26.Zarcone D, Tilden AB, Cloud G, Friedman HM, Landay A, Grossi CE. Flow cytometry evaluation of cell mediated cytotoxicity. J Immunol Methods 1986;94:247-55.  Back to cited text no. 26


  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Submicron particle docetaxel intratumoral injection in combination with anti-mCTLA-4 into 4T1-Luc orthotopic implants reduces primary tumor and metastatic pulmonary lesions
Holly Maulhardt, Alyson Marin, Holly Hesseltine, Gere diZerega
Medical Oncology. 2021; 38(9)
[Pubmed] | [DOI]
2 Differentiation of natural killer cells from induced pluripotent stem cells under defined, serum- and feeder-free conditions
Kyle B. Lupo, Jung-Il Moon, Andrea M. Chambers, Sandro Matosevic
Cytotherapy. 2021; 23(10): 939
[Pubmed] | [DOI]
3 Identification for antitumor effects of tramadol in a xenograft mouse model using orthotopic breast cancer cells
Myoung Hwa Kim, Jeong-Rim Lee, Ki-Joon Kim, Ji Hae Jun, Hye Jeong Hwang, Wootaek Lee, Seung Hyun Nam, Ju Eun Oh, Young Chul Yoo
Scientific Reports. 2021; 11(1)
[Pubmed] | [DOI]
4 Oestrogen and zoledronic acid driven changes to the bone and immune environments: Potential mechanisms underlying the differential anti-tumour effects of zoledronic acid in pre- and post-menopausal conditions
Christopher N. George, Victor Canuas-Landero, Elizavet Theodoulou, Munitta Muthana, Caroline Wilson, Penelope Ottewell
Journal of Bone Oncology. 2020; 25: 100317
[Pubmed] | [DOI]
5 Strategies for combining immunotherapy with radiation for anticancer therapy
Steven N Seyedin, Jonathan E Schoenhals, Dean A Lee, Maria A Cortez, Xiaohong Wang, Sharareh Niknam, Chad Tang, David S Hong, Aung Naing, Padmanee Sharma, James P Allison, Joe Y Chang, Daniel R Gomez, John V Heymach, Ritsuko U Komaki, Laurence J Cooper, James W Welsh
Immunotherapy. 2015; 7(9): 967
[Pubmed] | [DOI]
6 All-Trans Retinoic Acid Attenuates the Renal Interstitial Fibrosis Lesion in Rats but Not By Transforming Growth Factor-1/Smad3 Signaling Pathway
Zheng-Yi Li,Tian-Biao Zhou,Yuan-Han Qin,Li-Na Su,Hui-Ling Xu,Feng-Ying Lei
Renal Failure. 2013; 35(2): 262
[Pubmed] | [DOI]
7 Effect of Vasoactive Intestinal Peptide (VIP) on NKG2D Signal Pathway and Its Contribution to Immune Escape of MKN45 Cells
Chong Wang,Xi-Jin Zhou,Yuan-yuan Li,Juan Wan,Le-ying Yang,Guo-Hua Li
The Scientific World Journal. 2013; 2013: 1
[Pubmed] | [DOI]
8 Evaluation of cytolytic activity and phenotypic changes of circulating blood immune cells in patients with colorectal cancer by a simple preparation of peripheral blood mononuclear cells
Jae Cheol Kim,Joungbum Choi,Su Jin Lee,Yun A Lee,Young Min Jeon,Yong Won Kang,Jong Kyun Lee
Journal of the Korean Surgical Society. 2013; 85(5): 230
[Pubmed] | [DOI]
9 All-trans retinoic acid attenuates the renal interstitial fibrosis lesion in rats but not by transforming growth factor-β1/smad3 signaling pathway
Li, Z.-Y. and Zhou, T.-B. and Qin, Y.-H. and Su, L.-N. and Xu, H.-L. and Lei, F.-Y.
Renal Failure. 2013; 35(2): 262-267
10 Large-scale ex vivo expansion and characterization of natural killer cells for clinical applications
Lapteva, N. and Durett, A.G. and Sun, J. and Rollins, L.A. and Huye, L.L. and Fang, J. and Dandekar, V. and Mei, Z. and Jackson, K. and Vera, J. and Ando, J. and Ngo, M.C. and Coustan-Smith, E. and Campana, D. and Szmania, S. and Garg, T. and Moreno-Bost, A. and Vanrhee, F. and Gee, A.P. and Rooney, C.M.
Cytotherapy. 2012; 14(9): 1131-1143
11 Tumor-dependent down-regulation of the ζ-chain in T-cells is detectable in early breast cancer and correlates with immune cell function
Boniface, J.D., Poschke, I., Mao, Y., Kiessling, R.
International Journal of Cancer. 2012; 131(1): 129-139
12 Tumor-dependent down-regulation of the ?-chain in T-cells is detectable in early breast cancer and correlates with immune cell function
J. De Boniface,I. Poschke,Y. Mao,R. Kiessling
International Journal of Cancer. 2012; 131(1): 129
[Pubmed] | [DOI]
13 Large-scaleex vivoexpansion and characterization of natural killer cells for clinical applications
Natalia Lapteva,April G. Durett,Jiali Sun,Lisa A. Rollins,Leslie L. Huye,Jian Fang,Varada Dandekar,Zhuyong Mei,Kimberley Jackson,Juan Vera,Jun Ando,Minhtran C. Ngo,Elaine Coustan-Smith,Dario Campana,Susann Szmania,Tarun Garg,Amberly Moreno-Bost,Frits Vanrhee,Adrian P. Gee,Cliona M. Rooney
Cytotherapy. 2012; 14(9): 1131
[Pubmed] | [DOI]
14 All-trans retinoic acid can regulate the expressions of gelatinases and apolipoprotein E in glomerulosclerosis rats
Zhou, T.-B. and Qin, Y.-H. and Ou, C. and Lei, F.-Y. and Su, L.-N. and Huang, W.-F. and Zhao, Y.-J.
Vascular Pharmacology. 2011; 55(5-6): 169-177
15 All-trans retinoic acid can regulate the expressions of gelatinases and apolipoprotein E in glomerulosclerosis rats
Tian-Biao Zhou,Yuan-Han Qin,Chao Ou,Feng-Ying Lei,Li-Na Su,Wei-Fang Huang,Yan-Jun Zhao
Vascular Pharmacology. 2011; 55(5-6): 169
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Materials and Me...>Results>Discussion>Acknowledgement>Article Figures
  In this article

 Article Access Statistics
    PDF Downloaded538    
    Comments [Add]    
    Cited by others 15    

Recommend this journal