Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

The Cancer Stem Cell Marker CD44 Play Key Roles in Immune Suppression/Evasion, Drug Resistance, Epithelial-Mesenchymal Transition, and Metastasis in Several Human Cancers

Version 1 : Received: 24 January 2021 / Approved: 25 January 2021 / Online: 25 January 2021 (12:23:49 CET)

A peer-reviewed article of this Preprint also exists.

Kevin Dzobo and Musalula Sinkala.OMICS: A Journal of Integrative Biology.May 2021.313-332. Kevin Dzobo and Musalula Sinkala.OMICS: A Journal of Integrative Biology.May 2021.313-332.


One of the most used markers of cancer stem cells in several cancers, including colorectal cancer and breast cancer, is CD44. CD44 is a glycoprotein that traverses the cell membrane and binds to many ligands including hyaluronan resulting in activation of signaling cascades. Several reports have shown conflicting data on the expression of CD44 and that the expression depends on modes of investigations and subtypes of cancers. In addition, the correlation between CD44 expression and drug resistance, immune infiltration, EMT, metastasis and patients prognosis in several cancer types remains unclear. This study investigated CD44 expression in several cancers and explored its relationship with tumorigenesis using various publicly available databases, including The Cancer Genome Atlas, GEPIA, Oncomine, Genomics of Drug Sensitivity in Cancer and Tumor Immune Estimation Resource. Our analysis reveals that CD44 is differentially expressed in different cancers. CD44 expression is significantly associated with cancer patients’ survival in gastric, pancreatic and colorectal cancers. In addition, CD44 expression is closely linked with immune infiltration and immune suppressive features in pancreatic, colon adenocarcinoma and stomach cancer. High CD44 expression was significantly correlated with the expression of drug resistance-, EMT- and metastasis- linked genes. Tumors expressing high CD44 have higher mutation burden and afflict older patients than tumors expressing low CD44. Cell lines expressing high CD44 are more resistant to anti-cancer drugs compared to those expressing low CD44. Protein-protein interaction investigations and functional enrichment analysis showed that CD44 interacts with gene products related to cell-substrate adhesion, migration, platelet activation, and cellular response to stress. KEGG pathway analysis revealed that these genes play key roles in biological adhesion, cell component organization, locomotion, G-α-signaling and the response to stimulus. Overall, this investigation reveals that CD44 play significant roles in tumorigenesis, can be used as a prognostic biomarker in several cancers and can be therapeutically targeted in cancer therapy.


CD44; Cancer Stem Cells; Tumorigenesis; Drug Resistance; Immune Markers; Epithelial to Mesenchymal Transition; Therapeutic Targeting


Biology and Life Sciences, Anatomy and Physiology

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