Breast Cancer Research and Treatment

, Volume 172, Issue 1, pp 69–82 | Cite as

Combination of anthracyclines and anti-CD47 therapy inhibit invasive breast cancer growth while preventing cardiac toxicity by regulation of autophagy

  • Yismeilin R. Feliz-Mosquea
  • Ashley A. Christensen
  • Adam S. Wilson
  • Brian Westwood
  • Jasmina Varagic
  • Giselle C. Meléndez
  • Anthony L. Schwartz
  • Qing-Rong Chen
  • Lesley Mathews Griner
  • Rajarshi Guha
  • Craig J. Thomas
  • Marc Ferrer
  • Maria J. Merino
  • Katherine L. Cook
  • David D. Roberts
  • David R. Soto-PantojaEmail author
Preclinical study



A perennial challenge in systemic cytotoxic cancer therapy is to eradicate primary tumors and metastatic disease while sparing normal tissue from off-target effects of chemotherapy. Anthracyclines such as doxorubicin are effective chemotherapeutic agents for which dosing is limited by development of cardiotoxicity. Our published evidence shows that targeting CD47 enhances radiation-induced growth delay of tumors while remarkably protecting soft tissues. The protection of cell viability observed with CD47 is mediated autonomously by activation of protective autophagy. However, whether CD47 protects cancer cells from cytotoxic chemotherapy is unknown.


We tested the effect of CD47 blockade on cancer cell survival using a 2-dimensional high-throughput cell proliferation assay in 4T1 breast cancer cell lines. To evaluate blockade of CD47 in combination with chemotherapy in vivo, we employed the 4T1 breast cancer model and examined tumor and cardiac tissue viability as well as autophagic flux.


Our high-throughput screen revealed that blockade of CD47 does not interfere with the cytotoxic activity of anthracyclines against 4T1 breast cancer cells. Targeting CD47 enhanced the effect of doxorubicin chemotherapy in vivo by reducing tumor growth and metastatic spread by activation of an anti-tumor innate immune response. Moreover, systemic suppression of CD47 protected cardiac tissue viability and function in mice treated with doxorubicin.


Our experiments indicate that the protective effects observed with CD47 blockade are mediated through upregulation of autophagic flux. However, the absence of CD47 in did not elicit a protective effect in cancer cells, but it enhanced macrophage-mediated cancer cell cytolysis. Therefore, the differential responses observed with CD47 blockade are due to autonomous activation of protective autophagy in normal tissue and enhancement immune cytotoxicity against cancer cells.


CD47 Autophagy Cytoprotection Breast cancer Cardio-oncology 



Activity of maximum concentration


Cluster of differentiation

CD47 (−)

CD47 deficient


CD47 morpholino


Concentration response curves


Dulbecco’s modified eagle medium




Damage-associated molecular patterns


Hypoxia-inducible factor 1


Signal regulatory protein alpha


Unfolded protein response


Wild type



We would like to acknowledge the statistical and editorial assistance of the Wake Forest Clinical and Translational Science Institute (WF CTSI), which is supported by NCATS, National Institutes of Health, through Grant Award Number UL1TR001420.


This work was supported by the NCI Career Development Award-K22 1K22CA181274-01A1 (DSP), Wake Forest Baptist Comprehensive Cancer Center’s NCI Cancer Center Support Grant P30CA012197 (DSP, KLC), the Intramural Research Program of the NIH/NCI (DDR) and The National Center for Advancing Translational Sciences (NCATS) (MF, CJT).

Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interest to report.

Ethical approval

Experiments in presented in this manuscript comply with the current laws of the United States of America and institutional research integrity policies. Tissue arrays from developed from tissues of human breast cancer patient sections analyzed in the Laboratory of Pathology National Cancer Institute, under approved protocol by the Institutional Review Board of the National Cancer Institute. Animal studies and procedures were approved by the Internal Animal Care and Use Committee (IACUC) of the NIH Intramural Research Program protocol # LP-012 and the Wake Forest IACUC protocol # A16-085. Other datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Supplementary material

10549_2018_4884_MOESM1_ESM.jpg (53 kb)
Supplementary material 1 (JPEG 56 KB). Supplemental Figure 1: (A) immunohistochemical staining of human mammary gland (top) and human invasive breast cancer (representative of 5 cases) with human antibody B6H12 (brown stain). (B) LDH release assay in MDA-MB-231 cells. (C)Efficiency of CD47 knock down using anti-sense morpholino treatment in tumors N = 5, *p < 0.05.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yismeilin R. Feliz-Mosquea
    • 1
  • Ashley A. Christensen
    • 1
  • Adam S. Wilson
    • 1
  • Brian Westwood
    • 1
  • Jasmina Varagic
    • 1
    • 5
  • Giselle C. Meléndez
    • 3
    • 4
    • 5
  • Anthony L. Schwartz
    • 6
  • Qing-Rong Chen
    • 7
  • Lesley Mathews Griner
    • 8
  • Rajarshi Guha
    • 8
  • Craig J. Thomas
    • 8
  • Marc Ferrer
    • 8
  • Maria J. Merino
    • 6
  • Katherine L. Cook
    • 1
    • 2
    • 4
    • 5
  • David D. Roberts
    • 6
  • David R. Soto-Pantoja
    • 1
    • 2
    • 4
    • 5
    Email author
  1. 1.Department of SurgeryWake Forest School of MedicineWinston-SalemUSA
  2. 2.Cancer BiologyWake Forest School of MedicineWinston-SalemUSA
  3. 3.Internal Medicine, Section on Cardiovascular Medicine, Pathology Section on Comparative MedicineWake Forest School of MedicineWinston-SalemUSA
  4. 4.Comprehensive Cancer CenterWake Forest School of MedicineWinston-SalemUSA
  5. 5.Cardiovascular Sciences CenterWake Forest School of MedicineWinston-SalemUSA
  6. 6.Laboratory of Pathology, Center for Cancer ResearchNational Cancer Institute, National Institutes of HealthBethesdaUSA
  7. 7.Center for Biomedical Informatics and Information Technology, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  8. 8.National Center for Advancing Translational SciencesNational Institutes of HealthBethesdaUSA

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