CITED4 is a CBP/p300-interacting transcriptional coactivator that plays multifaceted roles in both normal physiology and cancer pathogenesis. In cardiac tissue, CITED4 mediates exercise-induced physiological growth through mTOR and AKT1 signaling, promoting cardiomyocyte proliferation and hypertrophy while protecting against ischemia-reperfusion injury 1. CITED4 operates within the C/EBPB-CITED4 signaling pathway during exercise-induced cardiac adaptation 2. In cancer contexts, CITED4 promotes malignant progression across multiple tumor types. In pancreatic cancer, elevated CITED4 correlates with liver metastasis and poor prognosis, with CITED4 suppression reducing invasion and metastasis 3. CITED4 mediates gemcitabine resistance by directly upregulating BIRC2, an anti-apoptotic factor, and CITED4 knockout sensitizes tumors to chemotherapy 4. In lung adenocarcinoma, CITED4 promotes metastasis via a CITED4-CTNNB1-CLDN3 transcriptional axis 5, while HB-EGF-induced CITED4 expression drives proliferation through STAT3-dependent signaling and MYC-mediated CCND1 transactivation 6. In colorectal cancer, CITED4 knockdown decreases proliferation and modulates adherens/tight junction genes 7. Conversely, in oligodendrogliomas, CITED4 hypermethylation and transcriptional silencing associate with favorable prognosis 8, suggesting context-dependent roles in tumorigenesis.