الفهرس 
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Abstract
Breast cancer is a serious life threating condition observed in women, as well as men all over the world and it is highly curable if diagnosed at an early stage .It ranks second, after lung cancer, as a cause of cancer death in women. The incidence of breast cancer is increasing on average by about 1% per year in industrialized countries and at a greater rate in developing countries.
Human tumor cells have evolved numerous strategies to avoid and escape from host
mediated antitumor immune response. Among these strategies the accumulation of regulatory T (T-reg) cells at tumor site and in the peripheral circulation has recently attracted significant attention.
The ability of Treg cells to effectively suppress functions of effector T cells responsible for antitumor responses and thus to contribute to tumor progression has been evaluated in patients with different cancers such as, for example breast cancer.
Murine and human T-reg cells were reported to express an ectonucleoside triphosphate diphosphohydrolase -1 or CD39, which is responsible for hydrolysis of exogenous adenosine triphosphate (ATP).
Angiogenesis is known to be an important part of malignant phenotype in most cancers, including breast cancer. Without new vessel formation, tumors cannot grow to more than 2 to 3 mm.
VEGF is a central regulator of angiogenesis and vasculogenesis, because it is a highly specific mitogen for endothelial cells. VEGF binds to VEGF receptors on endothelial cells, triggering endothelial cell proliferation, migration and new vessel formation. The over expression of VEGF may be an early step in a process of metastasis, a step that is involved in the angiogenic switch.
The aim of the current study was to evaluate the expression of CD39 in peripheral blood mononuclear cells (PBMCs) and VEGF serum level of breast cancer patients in correlation with disease stages. This study was conducted on 30 female with breast cancer and 10 normal females as control group.
The current study results revealed that CD39 was determined in all subjects under study using flowcytometry and VEGF was measured in all subjects under study using commercial ELISA kit.
A significant statistical correlation was found between the percentage of CD39 and the level of VEGF.
The percentage of CD39 in BC patients had a mean ± SD of (16.47 ± 7.86 %), while in the control subjects it had a mean ± SD of (5.20 ± 2.10%). Statistical analysis of these data revealed that there was highly significant increase in CD39 percentage in BC patients when compared with control subjects (p= <0.001).
The levels of serum VEGF in BC patients had a mean ± SD of (141.88 ± 95.05 Pg/ml), while in control subjects it had a mean ± SD of (50.65 ± 20.82 Pg/ml). Statistical
analysis of these data revealed that there was highly significant increase in VEGF levels in BC patients when compared with control subjects (P=<0.001).
A significant direct correlation was seen between CD39 (%) and both tumor grade, LN involvement, metastasis, tumor size and tumor stage, (P 0.011*, P =0.004*, P <0.001*, P =0.041*and P =0.003*respectively)
Moreover, CD39 expression showed a statistically significant direct correlation with serum VEGF levels (r=0.600* and P = <0.001*)
Direct correlation of serum VEGF were shown with tumor grade (P =0.013*), tumor size (P = 0.003*) and tumor stage (P = 0.016*).
There were also obvious direct correlation between serum VEGF levels and both L.N. involvement (P= 0.006*) and metastasis (P<0.001*).
Moreover, serum VEGF showed a statistically significant direct correlation with age (0.032*), ALT (0.004*), AST (0.028*), creatinine (0.002*) and ALP (0.008*).