SMAD4 Suppresses Colitis-associated Carcinoma Through Inhibition of CCL20/CCR6-mediated Inflammation

Gastroenterology. 2022 Nov;163(5):1334-1350.e14. doi: 10.1053/j.gastro.2022.07.016. Epub 2022 Jul 19.


Background & aims: We previously reported that colon epithelial cell silencing of Smad4 increased epithelial expression of inflammatory genes, including the chemokine c-c motif chemokine ligand 20 (CCL20), and increased susceptibility to colitis-associated cancer. Here, we examine the role of the chemokine/receptor pair CCL20/c-c motif chemokine receptor 6 (CCR6) in mediating colitis-associated colon carcinogenesis induced by SMAD4 loss.

Methods: In silico analysis of SMAD4, CCL20, and CCR6 messenger RNA expression was performed on published transcriptomic data from human ulcerative colitis (UC), and colon and rectal cancer samples. Immunohistochemistry for CCL20 and CCR6 was performed on human tissue microarrays comprising human UC-associated cancer specimens, Mice with conditional, epithelial-specific Smad4 loss with and without germline deletion of the Ccr6 gene were subjected to colitis and followed for up to 3 months. Tumors were quantified histologically, and immune cell populations were analyzed by flow cytometry and immunostaining.

Results: In human UC-associated cancers, loss of epithelial SMAD4 was associated with increased CCL20 expression and CCR6+ cells. SMAD4 loss in mouse colon epithelium led to enlarged gut-associated lymphoid tissues and recruitment of immune cells to the mouse colon epithelium and stroma, particularly T regulatory, Th17, and dendritic cells. Loss of CCR6 abrogated these immune responses and significantly reduced the incidence of colitis-associated tumors observed with loss of SMAD4 alone.

Conclusions: Regulation of mucosal inflammation is central to SMAD4 tumor suppressor function in the colon. A key downstream node in this regulation is suppression of epithelial CCL20 signaling to CCR6 in immune cells. Loss of SMAD4 in the colon epithelium increases CCL20 expression and chemoattraction of CCR6+ immune cells, contributing to greater susceptibility to colon cancer.

Keywords: Colorectal Cancer; Inflammation; Inflammatory Bowel Disease; SMAD4.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Carcinoma*
  • Chemokine CCL20 / metabolism
  • Colitis* / complications
  • Colitis-Associated Neoplasms*
  • Humans
  • Inflammation
  • Ligands
  • Mice
  • RNA, Messenger
  • Receptors, CCR6 / genetics
  • Smad4 Protein / genetics
  • Smad4 Protein / metabolism


  • Receptors, CCR6
  • Chemokine CCL20
  • Ligands
  • RNA, Messenger
  • SMAD4 protein, human
  • Smad4 Protein
  • CCR6 protein, human
  • CCL20 protein, human
  • CCR6 protein, mouse