Results Cdc42 is indispensable for enteroid survival. Cdc42 ΔIEC mice with constitutive IEC-specific Cdc42 ablation via Villin-Cre were viable (28). However, crypts isolated from Cdc42 ΔIEC mice did not develop into enteroids in medium containing EGF, Noggin, and R-Spondin (ENR). Within 24 hours after seeding, all Cdc42 ΔIEC crypts were growth arrested (Supplemental Figure 1A; supplemental material available online with this article; https://doi.org/10.1172/jci.insight.135923DS1). Because this growth deficit could be secondary to abnormal development by Cdc42 ΔIEC intestinal epithelia, we used Villin-CreER to delete Cdc42 from mature Cdc42 fl/fl Villin-CreER (Cdc42 iKO) enteroids. Forty-eight hours after 4-hydroxytamoxifen (4-OHT) addition, the epithelial buds in over 60% of Cdc42 iKO enteroids regressed, with cell death and cellular debris (Figure 1, A and B; and Supplemental Figure 1B). After 72 hours, 95% of Cdc42 iKO enteroids accumulated significant amounts of propidium iodide, indicative of massive cell death (Figure 1B), which was further corroborated by elevated numbers of cleaved caspase-3-positive cells (Figure 1C) and a loss of over 90% live enteroid cells quantified by the CellTiter-Glo 3D Cell Viability Assay (Figure 1D). Viable enteroids were not detected at 5 days after Cdc42 deletion, and the growth of WT (WT) enteroids was not affected by 4-OHT over this time period (Figure 1, AD). Thus, maintenance of enteroid growth in ENR medium absolutely was dependent upon Cdc42 expression. Cdc42 is required for and sufficient to promote EGF/MAPK signaling ex vivo. We first suspected a disrupted Wnt signaling in Cdc42-deficient enteroids; therefore, we tried to rescue the growth of Cdc42-deficient enteroids by enhancing canonical Wnt signaling via the glycogen synthase kinase-3β inhibitor CHIR99021. However, we failed to observe a reversing effect on death (Supplemental Figure 1C), suggesting that canonical Wnt pathway was not the primary pathway affected by Cdc42 deficiency. Treating serum-starved human Caco2 cells with EGF ligands (EGF and TGF-α), canonical Wnt ligand (Wnt3a), or Noggin activated Cdc42 GTPase activities within minutes (Supplemental Figure 1D), suggesting that multiple ISC growth factors could act through Cdc42 machinery. These results led us to conduct an unbiased proteomic search for Cdc42-regulated survival signaling. Parallel mass spectrometry was done on canonical Cdc42 (V1) and its splicing variant (V2), both of which were 3xFlag-tagged and transfected into HEK293 cells. Proteomic analysis of Cdc42 V1 and V2 immunoprecipitates identified an overlapped interactome, where the 5 top functional clusters mapped to cell cycle, cell division, clathrin-coated endocytosis, mitosis, and MAPK cascade components (P < 0.001, Figure 1E and Supplemental Figure 1, E and F). The identification of a clathrin and MAPK interactome components suggests that Cdc42 may control MAPK activation through clathrin-dependent endocytic EGFR signaling (37-41). EGF stimulates rapid receptor-mediated endocytosis that ...