Colorectal cancer is one of the leading causes of
cancer-related deaths worldwide. In Saudi Arabia,
colorectal cancer is more aggressive and presents at younger age, warranting new treatment strategies. Role of TGFβ/Smad4 signaling pathway in initiation and progression of
colorectal cancer is well documented. This study examined the role of TGFβ/Smad4 signaling pathway in a large cohort of Saudi patients with
colorectal cancer, followed by in vitro analysis to dissect the dual role of TGFβ on inducing epithelial-to-mesenchymal transition (EMT) and apoptosis. Our study demonstrated high frequency of Smad4 alterations with low expression of
Smad4 protein identifying a subgroup of aggressive
colorectal cancer to be an independent marker for poor prognosis. Functional studies using
colorectal cancer cells show that TGFβ induces Smad4-dependent EMT followed by apoptosis. Induction of mesenchymal transcriptional factors, Snail1 and Zeb1, was essential for TGFβ-induced apoptosis. Our results indicate that KLF5 acts as an oncogene in
colorectal cancer cells regardless of Smad4 expression and inhibition of KLF5 is requisite for TGFβ-induced apoptosis. Furthermore, TGFβ/Smad4 signal inhibits the transcription of KLF5 that in turn switches Sox4 from
tumor promoter to suppressor. A high incidence of Smad4 alterations were found in the Saudi patients with
colorectal cancer. Functional study results indicate that TGFβ induces Smad4-dependent EMT followed by apoptosis in
colorectal cancer cells.