Immunohistochemical Expression of CD44 as Cancer Stem Cells Marker in a Sample of Iraqi Patients with Colorectal Carcinoma

Abstract

Colorectal cancer is one of the most frequent malignancies in the world, and it is also one of the most deadly. Distant metastases and recurrence frequently cause patient death. Cancer stem cells (CSCs) play a crucial role in colorectal cancer spread and relapse. CSCs are a type of cancer cell that can self-renew, divide indefinitely, and differentiate in multiple directions. CD44, CD133, CD24, EpCAM, LGR5, and ALDH are some cell surface markers used to identify colorectal CSCs. They are highly tumorigenic, chemoresistant, and radioresistant, making them important in colorectal cancer metastasis and recurrence as well as disease-free survival. The current study included 60 Iraqi male patients. They were assigned into three groups. Group I consisted of 20 newly diagnosed colorectal cancer patients, group II consisted of 20 relapsed patients who were treated with chemotherapy and were cured, but the tumor relapsed, and group III consisted of 20 patients who demonstrated resistance to chemotherapy treatment. All clinicopathological markers were analyzed, and they demonstrated a higher tumor grade in group II compared to the other groups and a difference in age between groups. CD44 expression was higher in groups II and III than in group I, with some Immunohistochemical slides showing no typical colorectal cancer cells but positive for CD44, indicating the existence of cancer stem cells. Similar results were reported in the resistance group. The findings could be explained by the fact that strong CD44 expression indicates a large number of cancer stem cells, which are important in tumor relapse and treatment resistance. CD44 may be used as a biomarker for cancer stem cells as a findings of these results, allowing for their detection and aiding in the process of tailoring therapy for these cells within the tumor mass, minimizing tumor relapse and chemotherapy resistance.