Iranian Journal of Basic Medical Sciences

Iranian Journal of Basic Medical Sciences

Resveratrol as an immune checkpoint inhibitor to enhance the efficacy of breast cancer immunotherapy

Document Type : Review Article

Authors
1 Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
2 Lombardi Compr ehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, United States
3 Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
4 Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/ijbms.2026.93534.20178
Abstract
A major goal in cancer treatment is to convert “cold” tumors into “hot” ones by altering the tumor microenvironment (TME). Breast cancer is often a cold tumor and is resistant to immunotherapy. Resveratrol is a polyphenolic compound found in grapes, with antioxidant, anti-inflammatory, and potential cardioprotective and anti-aging properties. Resveratrol promotes the conversion of immunologically cold breast tumors into hot tumors, thereby increasing the efficacy of immunotherapy. This article reviews the potential of resveratrol to convert immunologically “cold” breast tumors into “hot” tumors by modulating the TME and enhancing the efficacy of immunotherapy. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar to identify English-language articles investigating the effects of resveratrol on immune checkpoints in breast cancer. The results showed that resveratrol suppresses key cancer-promoting pathways (PI3K/Akt/mTOR, MAPK/ERK, STAT/NF-κB, and Wnt/β-catenin) and modulates the immune system. It boosts anti-tumor immunity by activating immunostimulatory cells (such as M1-TAMs, NKs, and CTLs) while simultaneously inhibiting immunosuppressive cells (such as Tregs and MDSCs). It also acts as a natural immune checkpoint inhibitor by targeting the PD-1/PD-L1 pathway. Resveratrol prevents T-cell exhaustion in “cold” tumors and reduces PD-L1 expression in “hot” tumors, thereby enhancing cytotoxic T cells’ ability to attack cancer. However, its effectiveness is limited by poor bioavailability and differences in the biological activity of its metabolites. Future clinical studies are needed to confirm these results and determine optimal therapeutic protocols for resveratrol-mediated breast cancer immunotherapy.
Keywords
Subjects

1. Chen Y, Sun J, Luo Y, Liu J, Wang X, Feng R, et al. Pharmaceutical targeting Th2-mediated immunity enhances immunotherapy response in breast cancer. J Transl Med 2022;20:615.
2. Rajabi S, Shakib H, Safari-Alighiarloo N, Maresca M, Hamzeloo-Moghadam M. Targeting autophagy for breast cancer prevention and therapy: From classical methods to phytochemical agents. Iran J Basic Med Sci. 2024;27:1475.
3. Shukla Y, Singh R. Resveratrol and cellular mechanisms of cancer prevention. Ann N Y Acad Sci 2011;1215:1-8.
4. Sadeghi M, Dehnavi S, Sharifat M, Amiri AM, Khodadadi A. Innate immune cells: Key players of orchestra in modulating tumor microenvironment (TME). Heliyon 2024; 10:e27480.
5. Eftekhari R, Esmaeili R, Mirzaei R, Bidad K, de Lima S, Ajami M, et al. Study of the tumor microenvironment during breast cancer progression. Cancer Cell Int 2017;17:1-10.
6. Hinshaw DC, Shevde LA. The tumor microenvironment innately modulates cancer progression. Cancer Res 2019;79:4557-4566.
7. Lan H-R, Du W-L, Liu Y, Mao C-S, Jin K-T, Yang X. Role of immune regulatory cells in breast cancer: Foe or friend? Int Immunopharmacol 2021;96:107627.
8. Liu W, Kuang T, Liu L, Deng W. The role of innate immune cells in the colorectal cancer tumor microenvironment and advances in anti-tumor therapy research. Front Immunol 2024;15:1407449.
9. Lei X, Lei Y, Li J-K, Du W-X, Li R-G, Yang J, et al. Immune cells within the tumor microenvironment: Biological functions and roles in cancer immunotherapy. Cancer Lett 2020;470:126-133.
10. Moeinzadeh L, Mahmoudian-Sani M-R, Purrahman D, Azghadi F, Darbandi MA. Advances in cancer immunotherapy: Strategies and innovations strategies for adoptive immunotherapy of cancer. Iran J Basic Med Sci 2025;28:1620.
11. Chen Y, Yu D, Qian H, Shi Y, Tao Z. CD8+ T cell-based cancer immunotherapy. J Transl Med 2024;22:394.
12. Mu Q, Najafi M. Resveratrol for targeting the tumor microenvironment and its interactions with cancer cells. Int Immunopharmacol 2021;98:107895.
13. Parvez A, Choudhary F, Mudgal P, Khan R, Qureshi KA, Farooqi H, Aspatwar A. PD-1 and PD-L1: Architects of immune symphony and immunotherapy breakthroughs in cancer treatment. Front Immunol 2023;14:1296341.
14. Barzaman K, Moradi-Kalbolandi S, Hosseinzadeh A, Kazemi MH, Khorramdelazad H, Safari E, Farahmand L. Breast cancer immunotherapy: Current and novel approaches. Int Immunopharmacol 2021;98:107886.
15. Goldberg J, Pastorello RG, Vallius T, Davis J, Cui YX, Agudo J, et al. The immunology of hormone receptor positive breast cancer. Front Immunol 2021;12:674192.
16. André F, Ciruelos E, Rubovszky G, Campone M, Loibl S, Rugo HS, et al. Alpelisib for PIK3CA-mutated, hormone receptor–positive advanced breast cancer. N Engl J Med. 2019;380:1929-1940.
17. Pu Z, Wang TB, Mou L. Revolutionizing cancer immunotherapy in solid tumor: CAR engineering and single-cell sequencing insights. Front Immunol 2023;14:1310285.
18. Yu W-D, Sun G, Li J, Xu J, Wang X. Mechanisms and therapeutic potentials of cancer immunotherapy in combination with radiotherapy and/or chemotherapy. Cancer Lett 2019;452:66-70.
19. Kang Q, He L, Zhang Y, Zhong Z, Tan W. Immune-inflammatory modulation by natural products derived from edible and medicinal herbs used in Chinese classical prescriptions. Phytomedicine 2024:155684.
20. Chen L, Musa AE. Boosting immune system against cancer by resveratrol. Phytother Res 2021;35:5514-5526.
21. Alqathama A. Natural products as promising modulators of breast cancer immunotherapy. Front Immunol 2024;15:1410300.
22. Zhang W, Li S, Li C, Li T, Huang Y. Remodeling tumor microenvironment with natural products to overcome drug resistance. Front Immunol 2022;13:1051998.
23. Messeha SS, Zarmouh NO, Soliman KF. Polyphenols modulating effects of PD-L1/PD-1 checkpoint and EMT-mediated PD-L1 overexpression in breast cancer. Nutrients 2021;13:1718.
24. Shahrokhi H, Asili J, Tayarani-Najaran Z, Boozari M. Signaling pathways behind the biological effects of tanshinone IIA for the prevention of cancer and cardiovascular diseases. Naunyn-Schmiedeberg’s Archives of Pharmacology. 2025;398:7877-7902.
25. Venkat R, Verma E, Daimary UD, Kumar A, Girisa S, Dutta U, et al. The journey of resveratrol from vineyards to clinics. Cancer Invest 2023;41:183-220.
26.Chhabra G, Singh CK, Amiri D, Akula N, Ahmad N. Recent advancements on immunomodulatory mechanisms of resveratrol in tumor microenvironment. Molecules 2021;26:1343.
27. Trung LQ, An DTT. Is resveratrol a cancer immunomodulatory molecule? Front Pharmacol 2018;9:1255.
28. Shi X-P, Miao S, Wu Y, Zhang W, Zhang X-F, Ma H-Z, et al. Resveratrol sensitizes tamoxifen in antiestrogen-resistant breast cancer cells with epithelial-mesenchymal transition features. Int J Mol Sci. 2013;14:15655-15668.
29. Li C, Xu Y, Zhang J, Zhang Y, He W, Ju J, et al. The effect of resveratrol, curcumin and quercetin combination on immuno-suppression of tumor microenvironment for breast tumor-bearing mice. Sci Rep 2023;13:13278.
30. Soto BL, Hank JA, Darjatmoko SR, Polans AS, Yanke EM, Rakhmilevich AL, et al. Anti-tumor and immunomodulatory activity of resveratrol in vitro and its potential for combining with cancer immunotherapy. Int Immunopharmacol 2011;11:1877-1886.
31. Burguin A, Diorio C, Durocher F. Breast cancer treatments: Updates and new challenges. J Pers Med 2021;11:808.
32. Mantooth SM, Abdou Y, Saez-Ibañez AR, Upadhaya S, Zaharoff DA. Intratumoral delivery of immunotherapy to treat breast cancer: Current development in clinical and preclinical studies. Front Immunol 2024;15:1385484.
33. Planes-Laine G, Rochigneux P, Bertucci F, Chrétien A-S, Viens P, Sabatier R, Gonçalves A. PD-1/PD-L1 targeting in breast cancer: The first clinical evidences are emerging—a literature review. Cancers 2019;11:1033.
34. Setordzi P, Chang X, Liu Z, Wu Y, Zuo D. The recent advances of PD-1 and PD-L1 checkpoint signaling inhibition for breast cancer immunotherapy. Eur J Pharmacol 2021;895:173867.
35. Bullock KK, Richmond A. Beyond anti-PD-1/PD-L1: improving immune checkpoint inhibitor responses in triple-negative breast cancer. Cancers. 2024;16:2189.
36. Adams S, Loi S, Toppmeyer D, Cescon D, De Laurentiis M, Nanda R, et al. Pembrolizumab monotherapy for previously untreated, PD-L1-positive, metastatic triple-negative breast cancer: Cohort B of the phase II KEYNOTE-086 study. Ann Oncol 2019;30:405-11.
37. Wu D, Tang S, Ye R, Li D, Gu D, Chen R, et al. Case Report: Long-term response to Pembrolizumab Combined with endocrine therapy in metastatic breast cancer patients with hormone receptor expression. Front Immunol 2021;12:610149.
38. Balibegloo M, Nejadghaderi SA, Sadeghalvad M, Soleymanitabar A, Nezamabadi SS, Saghazadeh A, Rezaei N. Adverse events associated with immune checkpoint inhibitors in patients with breast cancer: A systematic review and meta-analysis. Int Immunopharmacol 2021;96:107796.
39. Zhao Q, Zhang J, Xu L, Yang H, Liang N, Zhang L, et al. Safety and efficacy of the rechallenge of immune checkpoint inhibitors after immune-related adverse events in patients with cancer: A systemic review and meta-analysis. Front Immunol 2021;12:730320.
40. Su X, Li J, Xu X, Ye Y, Wang C, Pang G, et al. Strategies to enhance the therapeutic efficacy of anti-PD-1 antibody, anti-PD-L1 antibody and anti-CTLA-4 antibody in cancer therapy. J Transl Med 2024;22:751.
41. Olagunju A, Forsman T, Ward RC. An update on the use of cryoablation and immunotherapy for breast cancer. Frontiers in Immunology 2022;13:1026475.
42. Wang X, Wang L, Fekrazad R, Zhang L, Jiang X, He G, Wen X. Polyphenolic natural products as photosensitizers for antimicrobial photodynamic therapy: Recent advances and future prospects. Front Immunol 2023;14:1275859.
43. Meyer C, Brockmueller A, Buhrmann C, Shakibaei M. Prevention and co-management of breast cancer-related osteoporosis using resveratrol. Nutrients 2024;16:708.
44. Zhang L-X, Li C-X, Kakar MU, Khan MS, Wu P-F, Amir RM, et al. Resveratrol (RV): A pharmacological review and call for further research. Biomed Pharmacother 2021;143:112164.
45. Ko JH, Sethi G, Um JY, Shanmugam MK, Arfuso F, Kumar AP, et al. The role of resveratrol in cancer therapy. Int J Mol Sci 2017;18:2589.
46. Rahbardar MG, Sahebkar A. Resveratrol as a naturally occurring inflammasome modulator: Implications for health and disease. Iran J Basic Med Sci 2025;28:1301.
47. Sumimoto H, Takano A, Teramoto K, Daigo Y. RAS–mitogen-activated protein kinase signal is required for enhanced PD-L1 expression in human lung cancers. PLoS One 2016;11:e0166626.
48. Saini KS, Loi S, de Azambuja E, Metzger-Filho O, Saini ML, Ignatiadis M, et al. Targeting the PI3K/AKT/mTOR and Raf/MEK/ERK pathways in the treatment of breast cancer. Cancer Treat Rev 2013;39:935-946.
49. Xing S, Chen S, Yang X, Huang W. Role of MAPK activity in PD-L1 expression in hepatocellular carcinoma cells. J BUON 2020;25:1875-1882.
50. Maharati A, Moghbeli M. Long non-coding RNAs as the critical regulators of PI3K/AKT, TGF-β, and MAPK signaling pathways during breast tumor progression. J Transl Med 2023;21:556.
51. Loi S, Dushyanthen S, Beavis PA, Salgado R, Denkert C, Savas P, et al. RAS/MAPK activation is associated with reduced tumor-infiltrating lymphocytes in triple-negative breast cancer: therapeutic cooperation between MEK and PD-1/PD-L1 immune checkpoint inhibitors. Clin Cancer Res. 2016;22:1499-1509.
52. Lee Y-J, Kim J. Resveratrol activates natural killer cells through Akt-and mTORC2-mediated c-Myb Up-regulation. Int J Mol Sci 2020;21:9575.
53. Chen H, Jin Z-L, Xu H. MEK/ERK signaling pathway in apoptosis of SW620 cell line and inhibition effect of resveratrol. Asian Pac J Trop Med 2016;9:49-53.
54. Boozari M, Hosseinzadeh H. Crocin molecular signaling pathways at a glance: A comprehensive review. Phytother Res 2022;36:3859-84.
55. Cetintas VB, Batada NN. Is there a causal link between PTEN deficient tumors and immunosuppressive tumor microenvironment? J Transl Med 2020;18:45.
56. Li X, Xiang Y, Li F, Yin C, Li B, Ke X. WNT/β-catenin signaling pathway regulating T cell-inflammation in the tumor microenvironment. Front Immunol 2019;10:2293.
57. Song P, Gao Z, Bao Y, Chen L, Huang Y, Liu Y, et al. Wnt/β-catenin signaling pathway in carcinogenesis and cancer therapy. J Hematol Oncol 2024;17:46.
58. Boozari M, Ebrahimi SN, Soltani S, Tayarani-Najaran Z, Emami SA, Asili J, Iranshahi M. Absolute configuration and anti-cancer effect of prenylated flavonoids and flavonostilbenes from Sophora pachycarpa: Possible involvement of Wnt signaling pathway. Bioorganic Chemistry 2019;85:498-504.
59. Tsai J-H, Hsu L-S, Lin C-L, Hong H-M, Pan M-H, Way T-D, Chen W-J. 3, 5, 4′-Trimethoxystilbene, a natural methoxylated analog of resveratrol, inhibits breast cancer cell invasiveness by downregulation of PI3K/Akt and Wnt/β-catenin signaling cascades and reversal of epithelial–mesenchymal transition. Toxicol Appl Pharmacol 2013;272:746-756.
60. Lee HS, Ha AW, Kim WK. Effect of resveratrol on the metastasis of 4T1 mouse breast cancer cells in vitro and in vivo. Nutr Res Pract 2012;6:294-300.
61. Jin W. Role of JAK/STAT3 signaling in the regulation of metastasis, the transition of cancer stem cells, and chemoresistance of cancer by epithelial–mesenchymal transition. Cells 2020;9:217.
62. Manore SG, Doheny DL, Wong GL, Lo H-W. IL-6/JAK/STAT3 signaling in breast cancer metastasis: Biology and treatment. Front Oncol 2022;12:866014.
63. Wang Y, Zhang X, Xie X, Chen W, Li M, Diao D, Dang C. Obesity and metabolic syndrome related macrophage promotes PD-L1 expression in TNBC through IL6/JAK/STAT pathway and can be reversed by telmisartan. Cancer Biol Ther 2020;21:1179-1190.
64. Ma C, Wang Y, Dong L, Li M, Cai W. Anti-inflammatory effect of resveratrol through the suppression of NF-κB and JAK/STAT signaling pathways. Acta Biochim Biophys Sin. 2015;47:207-213.
65. Sun L, Chen B, Jiang R, Li J, Wang B. Resveratrol inhibits lung cancer growth by suppressing M2-like polarization of tumor associated macrophages. Cell Immunol 2017;311:86-93.
66. Pavitra E, Kancharla J, Gupta VK, Prasad K, Sung JY, Kim J, et al. The role of NF-κB in breast cancer initiation, growth, metastasis, and resistance to chemotherapy. Biomed Pharmacother 2023;163:114822.
67. Cao Y, Yi Y, Han C, Shi B. NF-κB signaling pathway in tumor microenvironment. Frontiers in Immunology 2024;15:1476030.
68. Csaki C, Mobasheri A, Shakibaei M. Synergistic chondroprotective effects of curcumin and resveratrol in human articular chondrocytes: Inhibition of IL-1β-induced NF-κB-mediated inflammation and apoptosis. Arthritis Res Ther 2009;11:1-17.
69. Chen M, Pockaj B, Andreozzi M, Barrett MT, Krishna S, Eaton S, et al. JAK2 and PD-L1 amplification enhance the dynamic expression of PD-L1 in triple-negative breast cancer. Clin Breast Cancer 2018;18:e1205-e1215.
70. Li Y, Ganesan K, Chen J. Role of biological mediators of tumor-associated macrophages in breast cancer progression. Curr Med Chem 2022;29:5420-5440.
71. Cheuk I, Chen J, Siu M, Ho J, Lam S, Shin VY, Kwong A. Resveratrol enhanced chemosensitivity by reversing macrophage polarization in breast cancer. Clin Transl Oncol 2022:1-10.
72. Malla R, Padmaraju V, Kundrapu DB. Tumor-associated macrophages: Potential target of natural compounds for management of breast cancer. Life Sci 2022;301:120572.
73. Qi Y, Li R, Han M. Tumor-associated macrophages induce epithelial-mesenchymal transition and promote lung metastasis in breast cancer by activating the IL-6/STAT3/TGM2 axis. Int Immunopharmacol 2024;143:113387.
74. Kimura Y, Sumiyoshi M. Resveratrol prevents tumor growth and metastasis by inhibiting lymphangiogenesis and M2 macrophage activation and differentiation in tumor-associated macrophages. Nutr Cancer 2016;68:667-678.
75. Yi M, Li T, Niu M, Wu Y, Zhao Z, Wu K. TGF-β: A novel predictor and target for anti-PD-1/PD-L1 therapy. Front Immunol 2022;13:1061394.
76. Panagi M, Voutouri C, Mpekris F, Papageorgis P, Martin MR, Martin JD, et al. TGF-β inhibition combined with cytotoxic nanomedicine normalizes triple negative breast cancer microenvironment towards anti-tumor immunity. Theranostics 2020;10:1910.
77. Zhai L, Bell A, Ladomersky E, Lauing KL, Bollu L, Sosman JA, et al. Immunosuppressive IDO in cancer: Mechanisms of action, animal models, and targeting strategies. Front Immunol 2020;11:1185.
78. Bistrup A, Cabaltica C, Jalilie M, Wolfert R, Kim N. Evaluation of human secretoglobins and MIC-1 as serum diagnostic biomarkers for breast cancer. Cancer Res 2009;69:2005.
79. Passeri L, Marta F, Bassi V, Gregori S. Tolerogenic dendritic cell-based approaches in autoimmunity. Int J Mol Sci 2021;22:8415.
80. Hayashi T, Beck L, Rossetto C, Gong X, Takikawa O, Takabayashi K, et al. Inhibition of experimental asthma by indoleamine 2, 3-dioxygenase. J Clin Invest 2004;114:270-279.
81. Yin Q, Wang L, Yu H, Chen D, Zhu W, Sun C. Pharmacological effects of polyphenol phytochemicals on the JAK-STAT signaling pathway. Front Pharmacol 2021;12:716672.
82. Arumuggam N, Bhowmick NA, Rupasinghe HV. A review: phytochemicals targeting JAK/STAT signaling and IDO expression in cancer. Phytother Res 2015;29:805-817.
83. Noh KT, Chae SH, Chun SH, Jung ID, Kang HK, Park Y-M. Resveratrol suppresses tumor progression via the regulation of indoleamine 2, 3-dioxygenase. Biochem Biophys Res Commun 2013;431:348-53.
84. Gualdoni GA, Fuchs D, Zlabinger GJ, Gostner JM. Resveratrol intake enhances indoleamine-2, 3-dioxygenase activity in humans. Pharmacol Rep 2016;68:1065-1068.
85. Fujimura T, Mahnke K, Enk AH. Myeloid derived suppressor cells and their role in tolerance induction in cancer. J Dermatol Sci 2010;59:1-6.
86. Saed SM, Abbas S, El Ansary MS, Abdelfattah W, Maurice KK, Mohamed ME, Koptan DMT. Phenotypic analysis of circulating myeloid derived suppressor cells and their subpopulations in egyptian females with breast cancer: A single-centre case-control study. APJCP 2024;25:257.
87. Zhao Y, Shao Q, Zhu H, Xu H, Long W, Yu B, et al. Resveratrol ameliorates Lewis lung carcinoma‐bearing mice development, decreases granulocytic myeloid‐derived suppressor cell accumulation and impairs its suppressive ability. Cancer Sci 2018;109:2677-26786.
88. Parker KH, Sinha P, Horn LA, Clements VK, Yang H, Li J, et al. HMGB1 enhances immune suppression by facilitating the differentiation and suppressive activity of myeloid-derived suppressor cells. Cancer Res 2014;74:5723-5733.
89. Malabadi RB, Sadiya M, Kolkar KP, Mammadova SS, Chalannavar RK, Baijnath H, et al. Triple negative breast cancer (TNBC): Signalling pathways-role of plant-based inhibitors. Res J Biol Pharm 2024;10:028-71.
90. Han X, Zhao N, Zhu W, Wang J, Liu B, Teng Y. Resveratrol attenuates TNBC lung metastasis by down-regulating PD-1 expression on pulmonary T cells and converting macrophages to M1 phenotype in a murine tumor model. Cell Immunol 2021;368:104423.
91. Hamaidi I, Kim S. Sirtuins are crucial regulators of T cell metabolism and functions. Exp Mol Med 2022;54:207-215.
92. Craveiro M, Cretenet G, Mongellaz C, Matias MI, Caron O, de Lima MCP, et al. Resveratrol stimulates the metabolic reprogramming of human CD4+ T cells to enhance effector function. Sci Signal 2017;10:eaal3024.
93. Yang M, Li Z, Tao J, Hu H, Li Z, Zhang Z, et al. Resveratrol induces PD-L1 expression through snail-driven activation of Wnt pathway in lung cancer cells. J Cancer Res Clin Oncol 2021;147:1101-13.
94. He J, Qiu N, Zhou X, Meng M, Liu Z, Li J, et al. Resveratrol analog, triacetylresveratrol, a potential immunomodulator of lung adenocarcinoma immunotherapy combination therapies. Front Oncol 2023;12:1007653.
95. Zhang Q, Yang C, Gao X, Dong J, Zhong C. Phytochemicals in regulating PD‐1/PD‐L1 and immune checkpoint blockade therapy. Phytother Res 2024;38:776-796.
96. Zong Y, Deng K, Chong WP. Regulation of Treg cells by cytokine signaling and co-stimulatory molecules. Front Immunol 2024;15:1387975.
97. Yang Y, Paik JH, Cho D, Cho J-A, Kim C-W. Resveratrol induces the suppression of tumor-derived CD4+ CD25+ regulatory T cells. Int Immunopharmacol 2008;8:542-547.
98. Espinoza JL, Trung LQ, Inaoka PT, Yamada K, An DT, Mizuno S, et al. The repeated administration of resveratrol has measurable effects on circulating T‐cell subsets in humans. Oxid Med Cell Longev 2017;2017:6781872.
99. Wang B, Sun J, Li X, Zhou Q, Bai J, Shi Y, Le G. Resveratrol prevents suppression of regulatory T-cell production, oxidative stress, and inflammation of mice prone or resistant to high-fat diet–induced obesity. Nutr Res 2013;33:971-981.
100. Verdura S, Cuyàs E, Cortada E, Brunet J, Lopez-Bonet E, Martin-Castillo B, et al. Resveratrol targets PD-L1 glycosylation and dimerization to enhance antitumor T-cell immunity. Aging (Albany NY) 2020;12:8.
101. Malaguarnera L. Influence of Resveratrol on the Immune Response. Nutrients 2019;11:946.
102. Olkhanud PB, Damdinsuren B, Bodogai M, Gress RE, Sen R, Wejksza K, et al. Tumor-evoked regulatory B cells promote breast cancer metastasis by converting resting CD4+ T cells to T-regulatory cells. Cancer Res5. 2011;71:3505-3515.
103. Lee-Chang C, Bodogai M, Martin-Montalvo A, Wejksza K, Sanghvi M, Moaddel R, et al. Inhibition of breast cancer metastasis by resveratrol-mediated inactivation of tumor-evoked regulatory B cells. J Immunol 2013;191:4141-4151.
104. Meng X, Zhou J, Zhao C-N, Gan R-Y, Li H-B. Health benefits and molecular mechanisms of resveratrol: A narrative review. Foods 2020;9:340.
105. Li Q, Huyan T, Ye L-J, Li J, Shi J-L, Huang Q-S. Concentration-dependent biphasic effects of resveratrol on human natural killer cells in vitro. J Agric Food Chem  2014;62:10928-10935.
106. Lee Y, Shin H, Kim J. In vivo anti-cancer effects of resveratrol mediated by NK cell activation. J Innate Immun 2021;13:94-106.
107. Pan J, Shen J, Si W, Du C, Chen D, Xu L, et al. Resveratrol promotes MICA/B expression and natural killer cell lysis of breast cancer cells by suppressing c-Myc/miR-17 pathway. Oncotarget 2017;8:65743.
108. Lu CC, Chen JK. Resveratrol enhances perforin expression and NK cell cytotoxicity through NKG2D‐dependent pathways. J Cell Physiol 2010;223:343-351.
109. Clément M-Vr, Hirpara JL, Chawdhury S-H, Pervaiz S. Chemopreventive agent resveratrol, a natural product derived from grapes, triggers CD95 signaling-dependent apoptosis in human tumor cells. Blood 1998;92:996-1002.
110. Falchetti R, Fuggetta MP, Lanzilli G, Tricarico M, Ravagnan G. Effects of resveratrol on human immune cell function. Life Sci 2001;70:81-96.
111. Delmas D, Hermetet F, Aires V. PD-1/PD-L1 checkpoints and resveratrol: A controversial new way for a therapeutic strategy. Cancers 2021;13:4509.
112. Janus-Bell E, Mangin PH. The relative importance of platelet integrins in hemostasis, thrombosis and beyond. Haematologica 2023;108:1734-1747.
113. Lucas J, Hsieh T-C, Halicka HD, Darzynkiewicz Z, Wu JM. Up-regulation of PD‑L1 expression by resveratrol and piceatannol in breast and colorectal cancer cells occurs via HDAC3/p300‑mediated NF‑κB signaling. Int J Oncol 2018;53:1469-1480.
114. Hsieh TC, Wu JM. Tumor PD-L1 Induction by Resveratrol/Piceatannol May Function as a Search, Enhance, and Engage (“SEE”) Signal to Facilitate the Elimination of “Cold, Non-Responsive” Low PD-L1-Expressing Tumors by PD-L1 Blockade. Int J Mol Sci 2019;20:5969.
115. Li H, Seeram NP, Liu C, Ma H. Further investigation of blockade effects and binding affinities of selected natural compounds to immune checkpoint PD-1/PD-L1. Front Oncol 2022;12:995461.
116. Patel KR, Scott E, Brown VA, Gescher AJ, Steward WP, Brown K. Clinical trials of resveratrol. Ann N Y Acad Sci 2011;1215:161-169.
117. Brown K, Theofanous D, Britton RG, Aburido G, Pepper C, Sri Undru S, Howells L. Resveratrol for the management of human health: How far have we come? A systematic review of resveratrol clinical trials to highlight gaps and opportunities. Int J Mol Sci 2024;25:747.
118. Erdogan CS, Vang O. Challenges in analyzing the biological effects of resveratrol. Nutrients 2016;8:353.
119. Mishra S, Amatya SB, Salmi S, Koivukangas V, Karihtala P, Reunanen J. Microbiota and extracellular vesicles in anti-PD-1/PD-L1 therapy. Cancers 2022;14:5121.
120. Li F, Han Y, Wu X, Cao X, Gao Z, Sun Y, et al. Gut microbiota-derived resveratrol metabolites, dihydroresveratrol and lunularin, significantly contribute to the biological activities of resveratrol. Front Nutr 2022;9:912591.
121. Luo B, An Q, Lei J, Tan D, Liu X, Li H, et al. Resveratrol amplifies the anti-tumor effect of α-PD-1 by altering the intestinal microbiome and PGD2 content. Gut Microbes 2025;17:2447821.
122. Ramírez-Garza SL, Laveriano-Santos EP, Marhuenda-Muñoz M, Storniolo CE, Tresserra-Rimbau A, Vallverdú-Queralt A, Lamuela-Raventós RM. Health effects of resveratrol: Results from human intervention trials. Nutrients 2018;10:1892.
123. Shaito A, Posadino AM, Younes N, Hasan H, Halabi S, Alhababi D, et al. Potential adverse effects of resveratrol: A literature review. Int J Mol Sci 2020;21:2084.
124. Truong VL, Jun M, Jeong WS. Role of resveratrol in regulation of cellular defense systems against oxidative stress. Biofactors 2018;44:36-49.
125. Pezzuto JM, Kondratyuk TP, Ogas T. Resveratrol derivatives: A patent review (2009–2012). Expert Opin Ther Pat 2013;23:1529-1246.
126. Alsaikhan F. The synergistic effect of resveratrol and curcumin on oncogenic lncRNA MAPT-IT1 and ferroptosis-related genes in breast cancer. Naunyn Schmiedebergs Arch Pharmacol 2025:1-18.
127. Ding B, Li J, Yan J-L, Jiang C-Y, Qian L-B, Pan J. Resveratrol contributes to NK cell-mediated breast cancer cytotoxicity by upregulating ULBP2 through miR-17-5p downmodulation and activation of MINK1/JNK/c-Jun signaling. Front Immunol 2025;16:1515605.
128. Gao Y, Wang YY, Di Wang B, Hu QY, Jiang JR, Feng B, et al. Mechanism of action of resveratrol affecting the biological function of breast cancer through the glycolytic pathway. World J Oncol 2025;16:375.
129. Li P, Liang Y, Ma X. Functional role of resveratrol in inducing apoptosis in breast cancer subtypes via inhibition of intracellular fatty acid synthase. Molecules 2025;30:2891.
130. Toliopoulos IK, Simos YV, Oikonomidis S, Karkabounas SC. Resveratrol diminishes platelet aggregation and increases susceptibility of K562 tumor cells to natural killer cells. Indian J Biochem Biophys 2013;50:14-8.
131. Chen L, Yang S, Liao W, Xiong Y. Modification of antitumor immunity and tumor microenvironment by resveratrol in mouse renal tumor model. Cell Biochem Biophys 2015;72:617-625.
132. Zhu W, Qin W, Zhang K, Rottinghaus GE, Chen Y-C, Kliethermes B, Sauter ER. Trans-resveratrol alters mammary promoter hypermethylation in women at increased risk for breast cancer. Nutr Cancer 2012;64:393-400.
133. Lin C-C, Chin Y-T, Shih Y-J, Chen Y-R, Chung Y-Y, Lin C-Y, et al. Resveratrol antagonizes thyroid hormone-induced expression of checkpoint and proliferative genes in oral cancer cells. J Dent Sci
2019;14:255-262.
134. Pradhan R, Paul S, Acharya SS, Sinha S, Dash SR, Kundu CN. Nano formulated Resveratrol inhibits PD-L1 in oral cancer cells by deregulating the association between tumor associated macrophages and cancer associated fibroblasts through IL-6/JAK2/STAT3 signaling axis. J Nutr Biochem 2024;125:109568.

Articles in Press, Accepted Manuscript
Available Online from 19 August 2026