Emerging role of ETV4 in colorectal cancer: from molecular mechanisms to clinical implications

ETV4 (ETS-transformation-specific variant 4) is a member of the ETS transcription factor family that has been extensively studied for its oncogenic functions in cancers. Here, we summarize the role and mechanisms of ETV4 in cancer biology, with a particular focus on colorectal cancer (CRC), as well as its biomarkers and therapeutic potential. As a transcription factor, ETV4 regulates the expression of target genes by recognizing the GGA(A/T) core conserved sequence. It is frequently overexpressed in pan-cancer, where its overexpression associated with poor prognosis. Upon activation by oncogenic signaling pathways (e.g., MAPK, PI3K/Akt, and WNT), ETV4 transcriptionally regulates downstream genes to promote tumor cell proliferation, invasion, migration, epithelial-mesenchymal transition (EMT), chemoresistance, metabolic reprogramming, and immune evasion. It also form a vicious positive feedback loop that continuously activates oncogenic signaling. In CRC, ETV4 is overexpressed, correlating with advanced disease, lymph node metastasis, and poor prognosis. Upon activation by oncogenic signals, ETV4 directly activate target genes (such as matrix metalloproteinases) to mediate adenoma-to-adenocarcinoma progression, proliferation, EMT, ferroptosis, invasion, metastasis, metabolic reprogramming, and tumor microenvironment remodeling in CRC. ETV4 also forms transcriptional complexes with certain epigenetic factors, such as miRNAs and p300. Moreover, ETV4 is a promising biomarker for CRC diagnosis, prognosis, and adenoma-to-adenocarcinoma progression. Targeting ETV4 or its upstream pathways represents a potential therapeutic strategy for CRC. However, there are still many unresolved issues in current research. For example, the role of ETV4 in immune evasion and tumor microenvironment remodeling remains at the descriptive stage, and the specific mechanisms by which it regulates immune cell recruitment have not yet been elucidated. Future efforts include utilizing multi-omics approaches to elucidate the mechanisms by which ETV4 shapes the CRC microenvironment and exploring the application prospects in tumor immunotherapy.