CircSETD3 interrupts the bidirectional positive feedback of ErbB3 and Akt by sponging miR-4667-5p to inhibit colorectal cancer progression and cetuximab resistance

Circular RNAs play crucial roles in tumor progression and drug resistance. We previously reported that circSETD3 is downregulated in colorectal cancer (CRC) and correlates with tumor size and metastasis; however, the precise biological functions and underlying the mechanisms of action of circSETD3 in CRC remain unclear. Therefore, in the present study, we aimed to investigate the role of circSETD3 in CRC growth, metastasis, and cetuximab resistance using in vitro and in vivo functional assays. Our results demonstrated that circSETD3 acts as a tumor suppressor in CRC progression and cetuximab resistance. Mechanistically, RNA-seq, FISH, dual-luciferase reporter assays, and ChIP assays revealed that reduced circSETD3 expression in CRC activated ErbB3 and its downstream Akt pathway. Notably, we found that the Akt pathway upregulated ErbB3 transcription via HIF1A, indicating the presence of a novel positive feedback loop between ErbB3 and Akt pathway which reinforces CRC progression and drives cetuximab resistance. Furthermore, circSETD3 deficiency in CRC triggered a feedback loop through the miR-4667-5p-RASA4 axis which was effectively suppressed by exosomal circSETD3 supplementation. Thus, our findings highlight circSETD3 to be a promising therapeutic target for inhibiting CRC progression and overcoming cetuximab resistance.