Immunohistochemical Expression and Histopathological Role of CD47 in Colorectal Cancer in Iraqi Patients




Colorectal cancer, Cluster of Differentiation 47, Immunohistochemistry, Integrin-associated protein.


Background: Bowel cancer is the most prevalent digestive system cancer and is the 4th largest cause of cancer-related death worldwide. In Iraq, colon and rectal cancer (CRC) is the 6th most common malignancy in males and the 5th in females. This cancer is sluggish in growth, which gives a window of opportunity to screen for both precursor lesions and early cancer. The Cluster of Differentiation 47 (CD47) protein is a type of transmembrane glycoproteins found on nearly all human cells, including non-hematopoietic and hematopoietic cells. CD47 promotes CRC growth by triggering angiogenesis and apoptosis of tumor cell.

Objectives: To evaluate the immunohistochemical expression of (CD47) in various colorectal samples from Iraqi patients with CRC by immunohistochemistry (IHC) assay.

Specimens and methods: A total of 45 paraffin-embedded CRC tissue specimens and clinical data were obtained from the Medical City Teaching Hospital in Baghdad and a number of private laboratories in Baghdad, Iraq. In addition, 30 control colon and rectum tissues with no significant pathology were collected from the Forensic Medicine Department for comparison purposes after taking the official approvals.

Results: The results revealed a high expression of CD47 in CRC cases, but with no significant correlation with clinicopathological features. Also, the result of figures in this study revealed negative membranous expression of CD47 (score 0), strong membranous expression of CD47 (score 3), moderately membranous expression of CD47 (score 2), and weak membranous expression of CD47 (score 1)

Conclusion: Patients with CRC had high CD47 expression, allowing tumor cells to modulate CD47SIRP inhibitory signaling and prevent immune cell attack. 


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Author Biographies

  • Fatima O. Abd alkareem, Department of Biology, College of Science, University of Baghdad. Baghdad, Iraq.

    Department of Biology, College of Science, University of Baghdad. Baghdad, Iraq

  • Ban J. Mohamad, Department of Biology, College of Science, University of Baghdad. Baghdad, Iraq.

    Department of Biology, College of Science, University of Baghdad. Baghdad, Iraq.


Mahmood AH, Zeiny SM, Mahmood AS. Serological markers “CEA test & sAPRIL test” in Iraqi patients with colon cancer. Journal of the Faculty of Medicine Baghdad. 2017;59(4):317-20

Shaukat A, Levin TR. Current and future colorectal cancer screening strategies. Nature Reviews Gastroenterology & Hepatology. 2022;19(8):521-31

Ahmed M. Colon cancer: a clinician’s perspective in 2019. Gastroenterology research. 2020; 13 (1): 1 doi: 10.14740/gr1239.

AL-Obaidy AA, AL-Hadithi HS, Mahmood AS. The value of serological markers (CA19-9 & CCSA4) in the screening and prognosis of colon cancer. Journal of the Faculty of Medicine Baghdad. 2017;59(1):93-7

Al-Rubaiaee SAT, Al-Taee TJK. Detection of BRAFV600E Biomarker in Patients with Colorectal Cancer Using Immunohistochemical Techniques/A ClinicPathological Study. Journal of the Faculty of Medicine. 2022;64(1).

Sabry SA, Ibrahem MJ, Jabarah MA. Relationship of the quality of life in capecitabine-treated colorectal cancer patients to sociodemographic characteristics and drug-related adverse effects. Journal of the Faculty of Medicine Baghdad. 2022;64(3):175-82

Aljarshawi M, Albadree H, Bahar H, Al-Imam A. Misleading Presentation of Colorectal Cancer in an Otherwise Healthy Patient. Journal of the Faculty of Medicine Baghdad. 2020;62(4):132-8 10.32007/jfacmedbagdad.6241800.

Li C, Zhao K, Zhang D, Pang X, Pu H, Lei M, et al. Prediction models of colorectal cancer prognosis incorporating perioperative longitudinal serum tumor markers: a retrospective longitudinal cohort study. BMC medicine. 2023;21(1):63

Behrens LM, van den Berg TK, van Egmond M. Targeting the CD47-SIRPα innate immune checkpoint to potentiate antibody therapy in cancer by neutrophils. Cancers. 2022;14(14):3366

Kaur S, Isenberg JS, Roberts DD. CD47 (cluster of differentiation 47). Atlas of genetics and cytogenetics in oncology and haematology. 2021;25(2):83

Jia X, Yan B, Tian X, Liu Q, Jin J, Shi J, et al. CD47/SIRPα pathway mediates cancer immune escape and immunotherapy. International journal of biological sciences. 2021;17(13):3281

Hussaini HM, Seo B, Rich AM. Immunohistochemistry and immunofluorescence. Oral Biology: Molecular Techniques and Applications: Springer; 2022. p. 439-50

Magaki S, Hojat SA, Wei B, So A, Yong WH. An introduction to the performance of immunohistochemistry. Biobanking: Methods and Protocols. 2019:289-98

Yordanov A, Shivarov V, Kostov S, Ivanova Y, Dimitrova P, Popovska S, et al. Prognostic Utility of CD47 in Cancer of the Uterine Cervix and the Sensitivity of Immunohistochemical Scores. Diagnostics. 2023; 13(1):52.

Torres JA, Brito ABC, Silva VSe, Messias IM, Braun AC, Ruano APC, et al. CD47 Expression in Circulating Tumor Cells and Circulating Tumor Microemboli from Non-Small Cell Lung Cancer Patients Is a Poor Prognosis Factor. International Journal of Molecular Sciences. 2023;24(15):11958

Murata Y, Saito Y, Kotani T, Matozaki T. CD 47‐signal regulatory protein α signaling system and its application to cancer immunotherapy. Cancer Science. 2018;109(8):2349-57

Sugimura-Nagata A, Koshino A, Inoue S, Matsuo-Nagano A, Komura M, Riku M, et al. Expression and prognostic significance of CD47–SIRPA macrophage checkpoint molecules in colorectal cancer. International Journal of Molecular Sciences. 2021;22(5):2690

Tian L, Xu B, Teng K-Y, Song M, Zhu Z, Chen Y, et al. Targeting Fc receptor-mediated effects and the “Don't Eat Me” signal with an oncolytic virus expressing an anti-CD47 antibody to treat metastatic ovarian cancer. Clinical Cancer Research. 2022;28(1):201-14

Melo Garcia L, Barabé F. Harnessing macrophages through the blockage of CD47: implications for acute myeloid leukemia. Cancers. 2021;13(24):6258

Feng M, Jiang W, Kim BY, Zhang CC, Fu Y-X, Weissman IL. Phagocytosis checkpoints as new targets for cancer immunotherapy. Nature Reviews Cancer. 2019;19(10):568-86

Dizman N, Buchbinder EI. Cancer therapy targeting CD47/SIRPα. Cancers. 2021; 13(24):6229

Chen Y, Klingen TA, Aas H, Wik E, Akslen LA. CD47 and CD68 expression in breast cancer is associated with tumor‐infiltrating lymphocytes, blood vessel invasion, detection mode, and prognosis. The Journal of Pathology: Clinical Research. 2023;9(3):151-64

Fujiwara-Tani R, Sasaki T, Ohmori H, Luo Y, Goto K, Nishiguchi Y, et al. Concurrent expression of CD47 and CD44 in colorectal cancer promotes malignancy. Pathobiology. 2019;86(4):182-9

Sudo T, Takahashi Y, Sawada G, Uchi R, Mimori K, Akagi Y. Significance of CD47 expression in gastric cancer. Oncology letters. 2017;14(1):801-9

Hu T, Liu H, Liang Z, Wang F, Zhou C, Zheng X, et al. Tumor-intrinsic CD47 signal regulates glycolysis and promotes colorectal cancer cell growth and metastasis. Theranostics. 2020;10(9):4056 doi: 10.7150/thno.40860.

Zhao Q, Cai Q, Yu S, Ji J, Zhu Z, Yan C, et al. Combinatorial Analysis of AT-Rich Interaction Domain 1A and CD47 in Gastric Cancer Patients Reveals Markers of Prognosis. Frontiers in cell and developmental biology. 2021; 9:745120

Ji K, Zhang Y, Jiang S, Sun L, Zhang B, Hu D, et al. SIRPα blockade improves the antitumor immunity of radiotherapy in colorectal cancer. Cell Death Discovery. 2023;9(1):180

Peng Y, Qiu B, Tan F, Xu J, Bie F, He H, et al. TIGIT/CD47 dual high expression predicts prognosis and is associated with immunotherapy response in lung squamous cell carcinoma. Thoracic Cancer. 2022; 13(14):2014-23

Bang S, Jee S, Son H, Cha H, Park H, Myung J, et al. CD47 Expression in Non-Melanoma Skin Cancers and Its Clinicopathological Implications. Diagnostics. 2022;12(8):1859

Yuan J, He H, Chen C, Wu J, Rao J, Yan H. Combined high expression of CD47 and CD68 is a novel prognostic factor for breast cancer patients. Cancer Cell International. 2019; 19:1-12

Kang JC, Chen JS, Lee CH, Chang JJ, Shieh YS. Intratumoral macrophage counts correlate with tumor progression in colorectal cancer. Journal of surgical oncology. 2010;102(3):242-8

Yuan J, Shi X, Chen C, He H, Liu L, Wu J, et al. High expression of CD47 in triple negative breast cancer is associated with epithelial‑mesenchymal transition and poor prognosis. Oncology Letters. 2019; 18(3):3249-55

Colorectal cancer; Cluster of Differentiation 47; Immunohistochemistry; Integrin associated protein




How to Cite

O. Abd alkareem F, J. Mohamad B. Immunohistochemical Expression and Histopathological Role of CD47 in Colorectal Cancer in Iraqi Patients. J Fac Med Baghdad [Internet]. 2024 Jul. 1 [cited 2024 Jul. 13];66(2):122-8. Available from:

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