Colorectal cancer landscape from gut microbiota: Insights into mutations, epigenetic dysregulation, and immune microenvironment alterations.

This review explores how gut microbiota reshapes colorectal cancer (CRC) molecular landscape, driving initiation/progression via key mechanisms. Microbes/metabolites cause driver mutations (DNA damage, signaling interference) and alter epigenetics (DNA methylation, histone modifications, ncRNAs) to boost tumor cell proliferation/survival. Dysbiosis disrupts tumor immune microenvironment (TIME) by impairing immune cells and increasing immunosuppressive factors, fostering immune evasion.Integrating molecular biology, microbiology, and immunology, we show microbial changes are causal in oncogenesis, with species acting distinctly across tumor stages. These insights clarify CRC pathogenesis and support microbiota-based prevention, diagnosis, treatment. Targeting microbes/metabolites or signaling pathways could cut CRC risk, improve early detection, and boost therapy. The review highlights microbiota-targeted therapy's promise and guides future research/clinical translation.