Natural Killer (NK) cells are innate lymphocytes that mediate anti-tumor and anti-viral responses. NK cells comprise 5-15% of all lymphocytes in human peripheral blood, and can be also found in spleen, liver, bone marrow and lymph nodes. NK cells do not express polymorphic clonotypic receptors, such as T-cell receptors (TCR) or B-cell receptors (BCR). In contrast, the activation of their cytolytic functions is prompted by the engagement of receptors that recognize invariable ligands on the surface of a target cell1,2.
Resting human NK cells isolated from peripheral blood can survive for several days in culture medium supplemented with human serum. Activation of NK cells by cytokines such as IL-15 or IL-2 drives the cells to proliferation and to an increase of their killing ability, amongst other effects3,4,5. Several studies have shown a direct correlation between NK cell activation and changes in their metabolic activity6. These metabolic changes are destined to meet the particular requirements of the cells in terms of energy and biosynthesis.
Aerobic cells and organisms obtain energy through a series of chemical reactions that involve the catabolism and oxidation of carbohydrates, fat and proteins. Through a combination of glycolysis, the tricarboxylic acid (TCA) cycle and oxidative phosphorylation, eukaryotic cells meet the majority of their ATP demand and obtain intermediates required as building blocks for macromolecules essential for cell growth and proliferation. The process of glycolysis (Figure 1A) starts with the entry of glucose in the cell. In the cytosol, glucose is phosphorylated and transformed into pyruvate (with a net production of 2 molecules of ATP per glucose molecule), which can be reduced to lactate or transported into the mitochondria to be transformed into Acetyl-CoA and enter the TCA cycle. The TCA cycle continues cycling fueled with more molecules of Acetyl-CoA and produces CO2 (that eventually will diffuse outside the cell and, by reacting with H2O in the medium, will generate carbonic acid that will lead to the acidification of the medium) and NADH, the molecule in charge of donating electrons to the electron transport chain (ETC). The electrons travel through different protein complexes and are finally accepted by oxygen. These complexes (I, III and IV) also pump H+ from the mitochondrial matrix into the intermembrane space. As a consequence of the electrochemical gradient generated, the H+ will enter again to the matrix through the complex V (ATP-synthase), investing the potential energy accumulated into the generation of ATP.
Both glycolysis and mitochondrial respiration can be blocked at different points by using inhibitors. The knowledge and usage of these inhibitors was the basis for the development of the extracellular flux assay. By measuring two simple parameters in real time such as pH and oxygen, the extracellular flux analyzer infers the rate of glycolysis and mitochondrial respiration in a 96-well plate. The glycolysis stress test is performed in a basal medium without glucose (Figure 1B)7. The first measurements of the extracellular acidification rate (ECAR) are indicative of glycolysis-independent acidification. It is referred to as non-glycolytic acidification and correlates with CO2 produced by the TCA that, as explained before, combines with H2O in the medium to generate H+ (TCA-linked ECAR). The first injection is glucose to induce glucose utilization and boost glycolysis. The second injection combines both rotenone, a Complex I inhibitor, and antimycin A, a Complex III inhibitor together, to block the ETC. Cells respond to this dramatic decrease in mitochondrial ATP production by activating glycolysis to maintain cellular ATP levels, and this represents the amount of glycolysis that is not used by the cell in the basal state but could be potentially recruited in response to increases in ATP demand (compensatory glycolysis). The third injection is the glucose analog 2-Deoxyglucose (DG), which competes with glucose as a substrate for the enzyme hexokinase. The product of this phosphorylation, 2-deoxyglucose-6-phosphate cannot be transformed into pyruvate, and therefore glycolysis is blocked, which lowers the ECAR to its minimum. The ECAR measured at this point includes other sources of extracellular acidification that are not attributed to glycolysis or respiratory activity as well as any residual glycolysis not fully inhibited by 2-DG (post 2-DG-acidification).
The mitochondrial stress test is performed in a medium with glucose (Figure 1C)8. The first measurements of the oxygen consumption rate (OCR) correspond to the base line of mitochondrial respiration (basal respiration). The first injection is oligomycin, which inhibits the return of protons through the ATP synthase (complex V), blocking ATP synthesis and thus rapidly hyperpolarize the mitochondrial membrane, which prevents further proton pumping through respiratory complexes, and leads to a decrease in OCR. The comparison between the baseline respiration and the value given by addition of oligomycin represents the ATP-linked respiration. The remaining oligomycin-insensitive rate of oxygen consumption is called proton leak, which represents the flow of protons through the lipid bilayer or proteins in the inner mitochondrial membrane such as the adenine nucleotide translocase9. The second injection is the uncoupler 2,4-dinitrophenol (DNP), an ionophore that induces a massive entry of H+ into the mitochondrial matrix, which leads to depolarization of the mitochondrial membrane and disruption of mitochondrial ATP synthesis. Cells respond to the dissipation of the proton-motive force by increasing the rate of electron transport and oxygen consumption to maximum levels in a futile attempt to recover membrane potential (maximal respiratory capacity). The difference between the maximal respiratory capacity and the basal respiration is the spare respiratory capacity of the cell, which represents the amount of respiration that is not used by the cell to generate ATP in the basal state but could be potentially recruited in response to increases in ATP demand or under conditions of stress8. The third injection is a combination of rotenone and antimycin A. This injection completely stops the ETC and OCR decreases to its lowest level, with the remaining oxygen consumption being non-mitochondrial (caused by NADPH-oxidases, etc.).
Changes in metabolic pathways could somehow predict the functioning of NK cells, as it has been suggested that continuous activation of NK cells with cytokines in vitro could lead to NK cell exhaustion by the study of different metabolic pathways10,11. The correlation between NK cell metabolic status and function is very important from the point of view of cancer immunotherapy. In this field, activation of NK cells with infusion of IL-15, alone or in combination with monoclonal therapeutic antibodies have been tested in order to improve tumor cell killing12,13,14. The knowledge of the metabolic status of the NK cells in response to these treatment strategies would provide a valuable predictor of NK cell activation status and killing function.
The study of metabolic pathways in other myeloid and lymphoid cells such as monocytes, T and B cells has been described15 and optimized methods have been published16. In this protocol we provide a method that combines both an NK isolation protocol that yields high numbers of pure and viable NK cells and an optimized protocol to measure metabolic activity using an extracellular flux analyzer. Here we show that this is a valid method for the study of metabolic changes in resting and IL-15 activated human NK cells. For the extracellular flux assay, parameters such as cell number and drug concentrations have been tested and optimized. Compared with other respirometric methods, the extracellular flux analyzer is fully automated and able to test in real time, with very low quantities of cells, up to 92 samples simultaneously, and thus allows high throughput screenings (with multiple samples and replicates) in a relatively quick manner17.
This method can be used by researchers interested in assessing NK cell function by studying NK cell metabolism. It could be applied as well to cells activated by other cytokines, antibodies or soluble stimuli.