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If you¡¯ve ever looked at the results of a blood test, you may have noticed a neutrophil count. Neutrophils are a common type of white blood cell that play a critical role in the immune system.

They¡¯re important to cancer patients for several reasons. Neutrophils provide a key window into an individual¡¯s health and play a crucial role in fighting infections. When your neutrophil levels are too low, it¡¯s called neutropenia and puts you at high risk for infection.

After decades of research, scientists are now starting to understand how neutrophils might play a role in cancer¡¯s spread, unlocking the keys to new treatments. We spoke with molecular and cellular oncology researcher , to learn more.

What are neutrophils?

Neutrophils are the most common type of white blood cell. They¡¯re the first responder and the first line of defense against infection. Neutrophils don¡¯t live long, so your body is constantly making new ones. The average healthy adult produces about 100 billion neutrophils every day.

What does a low neutrophil count indicate?

A low neutrophil count is known as neutropenia. It means the immune system is weakened, and the body may have a hard time fighting off infections. Chemotherapy and radiation therapy can prevent the production of neutrophils and lead to neutropenia.

How do neutrophils respond to infections?

Neutrophils have three defensive mechanisms.

• Phagocytosis: In this process, a neutrophil engulfs a pathogen-like bacteria and forms a structure called a phagosome, which eventually destroys the pathogen.
• Degranulation: In this process, neutrophils release tiny granules of cytotoxic proteins that break down and destroy the pathogen.  
• Neutrophil Extracellular Traps, or NETs: In this process, neutrophils respond to pathogens by releasing sticky webs of DNA called Neutrophil Extracellular Traps or NETs. NETs are most appropriately named because these sticky webs will entrap bacteria and kill them.

What roles do neutrophils play in cancer development?

In the past 10 years or so, there has been increasing evidence that cancer cells produce various factors that induce neutrophils to form NETs (the sticky webs) and that these NETs promote metastasis.

This understanding has empowered researchers to see glimmers of proof that NETs ¨C and the resulting metastasis ¨C have the potential to be inhibited in several different ways.

What research on neutrophils and cancer is taking place at MD Anderson?

MD Anderson scientists are looking at neutrophils in a few different ways. The Sharma Lab, led by , is researching neutrophils in infection and inflammation in cancer patients. Specifically, they¡¯re studying how certain cancer drugs change the way neutrophils make NETs, and how these NETs affect the way cancer patients respond to infections and to the drugs. Her work has also led to the important takeaway that neutrophil activation can be targeted to overcome therapy resistance. 

Meanwhile, my team is also investigating neutrophils and NETs. We¡¯ve been studying the omentum, an immune cell-rich fatty tissue that hangs from the stomach. Ovarian cancer cells are highly prone to spread to the omentum, and this spread greatly reduces the patient¡¯s odds of long-term survival. We wanted to know why. We found that NETs cause other types of immune cells in the omentum to become less effective in defending against cancer cells, making the metastasis more likely to occur. My hope is that our work will stimulate other researchers to look beyond cancer cells and investigate the effect of NETs on other types of stromal cells in the tumor microenvironment.

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