SMAD4

Chr 18AD

SMAD family member 4

Also known as: DPC4, JIP, MADH4, MYHRS

This gene encodes a member of the Smad family of signal transduction proteins. Smad proteins are phosphorylated and activated by transmembrane serine-threonine receptor kinases in response to transforming growth factor (TGF)-beta signaling. The product of this gene forms homomeric complexes and heteromeric complexes with other activated Smad proteins, which then accumulate in the nucleus and regulate the transcription of target genes. This protein binds to DNA and recognizes an 8-bp palindromic sequence (GTCTAGAC) called the Smad-binding element (SBE). The protein acts as a tumor suppressor and inhibits epithelial cell proliferation. It may also have an inhibitory effect on tumors by reducing angiogenesis and increasing blood vessel hyperpermeability. The encoded protein is a crucial component of the bone morphogenetic protein signaling pathway. The Smad proteins are subject to complex regulation by post-translational modifications. Mutations or deletions in this gene have been shown to result in pancreatic cancer, juvenile polyposis syndrome, and hereditary hemorrhagic telangiectasia syndrome. [provided by RefSeq, May 2022]

GeneReviewsOMIMResearchGenerating clinical summary…

Primary Disease Associations & Inheritance

Juvenile polyposis/hereditary hemorrhagic telangiectasia syndromeMIM #175050
AD
Myhre syndromeMIM #139210
AD
Pancreatic cancer, somaticMIM #260350
Polyposis, juvenile intestinalMIM #174900
AD
UniProtColorectal cancer

Clinical highlights

Gene-disease validity (ClinGen)
pulmonary arterial hypertension · ADDisputedevidence questions this relationship3 gene-disease associations curated in total
Interpreting a novel variant
Curated mechanisms (Gene2Phenotype) include both loss of function and gain of function. Which applies is variant-dependent — do not assume a null variant is, or isn’t, the pathogenic class without checking the specific variant.Curated gene-level mechanism — a prior for triage, not a per-variant call.
7
Active trials
609
Pubs (1 yr)
P/LP submissions
P/LP missense
0.22
LOEUF· LoF intol.
Multiple*
Mechanism· G2P
📖
GeneReview available — SMAD4
Authoritative clinical overview · Recommended first read
Open GeneReview ↗

Population Genetics & Constraint

gnomAD v4 — loss-of-function & missense intolerance

Dual constrained — LoF & missense intolerant
LoF Constraint?
0.22LOEUF
pLI 0.999
Z-score 4.59
OE 0.07 (0.030.22)
Highly constrained

Highly LoF-intolerant (top ~10% of genes)

Missense Constraint?
4.13Z-score
OE missense 0.34 (0.290.40)
107 obs / 312.5 exp
Constrained

Highly missense-constrained (top ~0.1%)

Observed / Expected Ratios?
LoF OE?0.07 (0.030.22)
00.351.4
Missense OE?0.34 (0.290.40)
00.61.4
Synonymous OE?0.93
01.21.6
LoF obs/exp: 2 / 28.4Missense obs/exp: 107 / 312.5Syn Z: 0.58

ClinVar Variant Classifications

0 submitted variants in ClinVar

Protein Context — Lollipop Plot

SMAD4 · protein map & ClinVar variants

Showing all ClinVar variants across the protein. Search a specific variant to highlight its position.

Clinical Trials

Active and recruiting trials from ClinicalTrials.gov

Pancreas Cancer

Prospective Cohort Study of Pancreatic Cancer Patients Treated With Proton Beam Therapy

ENROLLING BY INVITATION
NCT04466189National Cancer Center, KoreaStarted 2018-09-21
Hereditary Hemorrhagic Telangiectasia

Cardiac Evaluation in Hereditary Hemorrhagic Telangiectasia

NOT YET RECRUITING
NCT07101575Fondazione Policlinico Universitario Agostino Gemelli IRCCSStarted 2025-08-05
Transthoracic echocardiography
Metastatic Colorectal Cancer

Cetuximab and Envafolimab Plus mFOLFOXIRI as First-line Treatment for RAS/BRAF Wild-type, MSS, Unresectable Left-side Metastatic Colorectal Cancer

RECRUITING
NCT05959356Phase PHASE2Sun Yat-sen UniversityStarted 2023-11-09
Cetuximab + Envafolimab + mFOLFOXIRICetuximab + mFOLFOX6
Pancreas Cancer

ctDNA Assay in Patients With Resectable Pancreatic Cancer

RECRUITING
NCT05052671University of OklahomaStarted 2022-05-25
Lynch SyndromeLi Fraumeni SyndromePTEN Hamartoma Syndrome

Video Capsule Examination in Patients With Lynch Syndrome

RECRUITING
NCT06712095Phase NARoyal Marsden NHS Foundation TrustStarted 2024-03-04
Video capsule investigation
Borderline Resectable Pancreatic Ductal AdenocarcinomaResectable Pancreatic Ductal Adenocarcinoma

SMAD4 Tailored Neoadjuvant Therapy for the Treatment of Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma, SMART-PANC Trial

NOT YET RECRUITING
NCT07748611Phase PHASE2Northwestern UniversityStarted 2027-02-03
Biospecimen CollectionComputed TomographyElectronic Health Record Review
BRCA1 MutationPOLD1 Gene MutationCDKN2A Mutation

An Intervention to Increase Genetic Testing in Families Who May Share a Gene Mutation Related to Cancer Risk and An Intervention to Help Patients and Their Primary Care Providers Stay Up-to-date About Uncertain Genetic Test Results

RECRUITING
NCT05420064Phase NAMemorial Sloan Kettering Cancer CenterStarted 2022-12-01
Intervention Arm At-risk Relative/ARR ContactsMyGene PortalStandard of Care