Colorectal Adenocarcinoma: A Comprehensive Narrative Review of Molecular Pathogenesis, Metabolic Vulnerabilities, and Therapeutic Potential of Sorghum Polyphenols.

Colorectal cancer (CRC) remains a formidable global health challenge, characterized by uncontrolled cell proliferation and significant socioeconomic burden. Projections anticipate a substantial increase in new cases, straining healthcare systems worldwide. CRC, the most common histological subtype, originates from gland cells lining the colon and rectum, often preceded by benign polyps. Its development is complex, influenced by sporadic, familial, and inherited factors. Sporadic cases, accounting for 70%-80%, are linked to genetic mutations and epigenetic alterations, with lifestyle factors like physical inactivity, diet, obesity, smoking, and alcohol consumption playing significant roles. Familial cases (25%) suggest shared environmental influences, while inherited conditions (5%) like familial adenomatous polyposis (FAP) and Lynch syndrome involve germline mutation with high lifetime CRC risk. The molecular pathogenesis of CRC involves genomic instability, notably chromosomal instability (CIN), microsatellite instability (MSI), and the CpG island methylator phenotype (CIMP). Mitochondria, beyond ATP production, critically influence cellular processes. The mitochondrial metabolic theory (MMT) proposes impaired oxidative phosphorylation (OxPhos) drives genomic instability. While the Warburg effect is recognized, many tumors retain functional oxidative metabolism, often relying heavily on OxPhos. Key genetic mutations like KRAS and BRAF significantly impact CRC, influencing mitochondrial metabolism and tumor progression, and are associated with different prognostic outcomes. Emerging therapeutic strategies target metabolic vulnerabilities to overcome chemoresistance. Inhibition of mitochondrial genes and key enzymes, along with modulating calcium homeostasis, shows promise. Preclinical research highlights sorghum extracts as potential therapeutic agents. High-phenolic sorghum bran extracts demonstrate anticancer action by suppressing proliferation, inducing apoptosis, and inhibiting migration and invasion. These effects involve targeting specific cancer pathways and influencing proteins like those in the Ras-ERK pathway, β-catenin, cMyc, cyclin D1, and surviving. Specific sorghum compounds like anthocyanidins, luteolin, and quercetin exhibit cytotoxicity against CRC cells, including those with KRAS and BRAF mutations. Further research is crucial to translate these preclinical findings into clinical applications, understand bioavailability, and account for individual differences in gut microbiota.