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<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">OR</journal-id>
<journal-title-group>
<journal-title>Oncology Reports</journal-title>
</journal-title-group>
<issn pub-type="ppub">1021-335X</issn>
<issn pub-type="epub">1791-2431</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/or.2022.8346</article-id>
<article-id pub-id-type="publisher-id">OR-48-01-08346</article-id>
<article-categories>
<subj-group>
<subject>Review</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>miRNAs and the Hippo pathway in cancer: Exploring the therapeutic potential</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Arora</surname><given-names>Taruna</given-names></name>
<xref rid="af1-or-48-01-08346" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author"><name><surname>Kausar</surname><given-names>Mohd. Adnan</given-names></name>
<xref rid="af2-or-48-01-08346" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Aboelnaga</surname><given-names>Shimaa Mohammed</given-names></name>
<xref rid="af3-or-48-01-08346" ref-type="aff">3</xref></contrib>
<contrib contrib-type="author"><name><surname>Anwar</surname><given-names>Sadaf</given-names></name>
<xref rid="af2-or-48-01-08346" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author"><name><surname>Hussain</surname><given-names>Malik Asif</given-names></name>
<xref rid="af4-or-48-01-08346" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author"><name><surname>Sadaf</surname><given-names>Sadaf</given-names></name>
<xref rid="af5-or-48-01-08346" ref-type="aff">5</xref></contrib>
<contrib contrib-type="author"><name><surname>Kaur</surname><given-names>Simran</given-names></name>
<xref rid="af6-or-48-01-08346" ref-type="aff">6</xref></contrib>
<contrib contrib-type="author"><name><surname>Eisa</surname><given-names>Alaa Abdulaziz</given-names></name>
<xref rid="af7-or-48-01-08346" ref-type="aff">7</xref></contrib>
<contrib contrib-type="author"><name><surname>Shingatgeri</surname><given-names>Vyas Murti Madhavrao</given-names></name>
<xref rid="af6-or-48-01-08346" ref-type="aff">6</xref></contrib>
<contrib contrib-type="author"><name><surname>Najm</surname><given-names>Mohammad Zeeshan</given-names></name>
<xref rid="af6-or-48-01-08346" ref-type="aff">6</xref>
<xref rid="c1-or-48-01-08346" ref-type="corresp"/></contrib>
<contrib contrib-type="author"><name><surname>Aloliqi</surname><given-names>Abdulaziz A.</given-names></name>
<xref rid="af8-or-48-01-08346" ref-type="aff">8</xref>
<xref rid="c2-or-48-01-08346" ref-type="corresp"/></contrib>
</contrib-group>
<aff id="af1-or-48-01-08346"><label>1</label>Division of Reproductive Biology, Maternal &#x0026; Child Health, Department of Health Research, ICMR, MOHFW, Government of India, Ansari Nagar, New Delhi 110029, India</aff>
<aff id="af2-or-48-01-08346"><label>2</label>Department of Biochemistry, College of Medicine, University of Hail, Hail, KSA-2240, Saudi Arabia</aff>
<aff id="af3-or-48-01-08346"><label>3</label>Deanship of Preparatory Year, University of Hail, Hail, KSA-2240, Saudi Arabia</aff>
<aff id="af4-or-48-01-08346"><label>4</label>Department of Pathology, University of Hail, Hail, KSA-2240, Saudi Arabia</aff>
<aff id="af5-or-48-01-08346"><label>5</label>Department of Biotechnology, Jamia Millia Islamia, New Delhi 110025, India</aff>
<aff id="af6-or-48-01-08346"><label>6</label>School of Biosciences, Apeejay Stya University, Sohna, Haryana 122103, India</aff>
<aff id="af7-or-48-01-08346"><label>7</label>Department of Medical Laboratories Technology, College of Applied Medical Sciences, Taibah University, Medina, KSA-344, Saudi Arabia</aff>
<aff id="af8-or-48-01-08346"><label>8</label>Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia</aff>
<author-notes>
<corresp id="c1-or-48-01-08346"><italic>Correspondence to</italic>: Dr Mohammad Zeeshan Najm, School of Biosciences, Apeejay Stya University, Palwal Road, Sohna, Haryana 122103, India, E-mail: <email>biotechzeeshan@gmail.com</email></corresp>
<corresp id="c2-or-48-01-08346">Dr Abdulaziz A. Aloliqi, Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, 1 King Abdulaziz Road, Almulida, Buraydah 51542, Saudi Arabia, E-mail: <email>NULL</email></corresp>
</author-notes>
<pub-date pub-type="collection">
<month>07</month>
<year>2022</year></pub-date>
<pub-date pub-type="epub">
<day>10</day>
<month>06</month>
<year>2022</year></pub-date>
<volume>48</volume>
<issue>1</issue>
<elocation-id>135</elocation-id>
<history>
<date date-type="received"><day>13</day><month>04</month><year>2022</year></date>
<date date-type="accepted"><day>17</day><month>05</month><year>2022</year></date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2022, Spandidos Publications</copyright-statement>
<copyright-year>2022</copyright-year>
</permissions>
<abstract>
<p>Cancer is recognized as the leading cause of death worldwide. The hippo signaling pathway regulates organ size by balancing cell proliferation and cell death; hence dysregulation of the hippo pathway promotes cancer-like conditions. miRNAs are a type of non-coding RNA that have been shown to regulate gene expression. miRNA levels are altered in various classes of cancer. Researchers have also uncovered a crosslinking between miRNAs and the hippo pathway, which has been linked to cancer. The components of the hippo pathway regulate miRNA synthesis, and various miRNAs regulate the components of the hippo pathway both positively and negatively, which can lead to cancer-like conditions. In the present review article, the mechanism behind the hippo signaling pathway and miRNAs biogenesis and crosslinks between miRNAs and the hippo pathway, which result in cancer, shall be discussed. Furthermore, the article will cover miRNA-related therapeutics and provide an overview of the development of resistance to anticancer drugs. Understanding the underlying processes would improve the chances of developing effective cancer treatment therapies.</p>
</abstract>
<kwd-group>
<kwd>Hippo pathway</kwd>
<kwd>microRNAs</kwd>
<kwd>YAP</kwd>
<kwd>TAZ</kwd>
<kwd>tumorigenesis</kwd>
<kwd>drug-resistant</kwd>
</kwd-group>
<funding-group>
<award-group>
<funding-source>Deanship of Scientific Research</funding-source>
</award-group>
<funding-statement>The researcher(s) would like to thank the Deanship of Scientific Research, Qassim University for funding the publication of this project.</funding-statement>
</funding-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<label>1.</label>
<title>Introduction</title>
<p>Cancer is defined as uncontrolled cell growth in any part of the body. It accounts for &#x007E;10 million deaths in 2020 (<xref rid="b1-or-48-01-08346" ref-type="bibr">1</xref>). However, researchers are striving to establish effective cancer treatments, and microRNAs (miRNAs or miRs) and the hippo signaling pathway have just been discovered in this regard. The Hippo signaling pathway is a mechanism that regulates the organ&#x0027;s size in mammals and humans. The size of the organ is regulated by mediating cell growth, division and death (<xref rid="b2-or-48-01-08346" ref-type="bibr">2</xref>). Any dysregulation in the hippo pathway disrupts mediation, leading to the activation of the transcriptional co-activators, that is, YAP and TAZ. Their elevated levels result in escalated cell proliferation and reduced cell death, leading to tumorigenesis (<xref rid="b3-or-48-01-08346" ref-type="bibr">3</xref>).</p>
<p>miRNAs play a regulatory role and work by targeting and regulating a certain mRNA. miRNAs have oncogenic and tumor-suppressive characteristics, and their altered levels are detected in cancer. A previous study has revealed that miRNAs can function as a positive or negative regulator to modulate the core components of the hippo pathway (<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>). Furthermore, YAP and TAZ interact with the components involved in the miRNA biogenesis, and the inactivation of the Hippo pathway or constitutively expression of YAP can result in reduced miRNA biogenesis (<xref rid="b5-or-48-01-08346" ref-type="bibr">5</xref>). Understanding the interlinkage between the hippo pathway and miRNAs is crucial for figuring out the root cause of cancer. The dysregulated miRNAs and hippo pathway contribute to uncontrolled growth by regulating each other and even conferring resistance to anticancer treatments. Previous studies have highlighted the mechanism through which miRNAs and hippo regulate each other (<xref rid="b2-or-48-01-08346" ref-type="bibr">2</xref>,<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>). This provides a ray of hope for advancing treatment strategies for patients with cancer. At present, the miRNAs therapeutics are in pre-clinical and clinical trials. These therapeutics would pave the way for cancer treatment. Furthermore, it would even break the resistance developed against the anticancer drugs, thereby boosting the efficiency of the existing treatments (<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>).</p>
</sec>
<sec>
<label>2.</label>
<title>Recapitulation of the Hippo pathway</title>
<p>In mammals, the Hippo signaling pathway is a mechanism that maintains the size of the organ by controlling cell proliferation and cell death (<xref rid="b6-or-48-01-08346" ref-type="bibr">6</xref>). Previous studies revealed that the hippo pathway is linked to several cancer-like traits, including increased cell proliferation and the development of drug resistance (<xref rid="b7-or-48-01-08346" ref-type="bibr">7</xref>,<xref rid="b8-or-48-01-08346" ref-type="bibr">8</xref>). The mammalian hippo signaling pathway is described as a cascade mechanism, including the four key tumor suppressors, which are the Mammalian sterile 20-like kinase 1/2 (MST1/2), Salvador Homolog 1 (SAV1), Large tumor suppressor1/2 (LATS1/2), and MOB kinase activator 1A/B (MOB 1A/B). The cascade is initiated when the activated MST1/2-SAV1 complex phosphorylates the LATS1/2-MOB1A/B complex, resulting in its activation (<xref rid="b9-or-48-01-08346" ref-type="bibr">9</xref>). When the LATS1/2-MOB1A/B complex is activated, it causes the transcriptional co-activators YAP and TAZ to be downregulated, thus inactivating them (<xref rid="b10-or-48-01-08346" ref-type="bibr">10</xref>). The LATS1/2-MOB1A/B complex is activated and works by phosphorylating YAP/TAZ at various locations. When the LATS1/2-MOB1A/B complex is activated, it phosphorylates YAP/TAZ at numerous sites. The phosphorylation causes YAP/TAZ to have a higher binding affinity for 14-3-3 protein. This interaction aids the cytoplasmic localization of the YAP/TAZ. When Ser127 and Ser397 on YAP and Ser89 and Ser311 on TAZ are phosphorylated, the activity of both proteins is significantly reduced (<xref rid="b11-or-48-01-08346" ref-type="bibr">11</xref>&#x2013;<xref rid="b13-or-48-01-08346" ref-type="bibr">13</xref>). Phosphorylated Ser397 on YAP and Ser311 on TAZ cause ubiquitination and proteasomal degradation of YAP/TAZ (<xref rid="b12-or-48-01-08346" ref-type="bibr">12</xref>) (<xref rid="f1-or-48-01-08346" ref-type="fig">Fig. 1</xref>).</p>
<p>The absence of phosphorylation due to the dysregulated hippo pathway leads to the YAP/TAZ upregulation. The activated YAP/TAZ then moves toward the nucleus, where it interacts with Transcriptional Enhanced Associate Domain (TEAD), a transcriptional factor. YAP/TAZ and TEAD interact and bind to activate the expression of subsequent genes. Increased cell proliferation and decreased apoptosis are two cancer-like properties induced by the activated genes (<xref rid="b10-or-48-01-08346" ref-type="bibr">10</xref>,<xref rid="b14-or-48-01-08346" ref-type="bibr">14</xref>).</p>
<p>In conclusion, as the hippo pathway modulates the activation of YAP/TAZ, any disruption would elevate the levels of YAP/TAZ, thereby promoting tumorigenesis.</p>
</sec>
<sec>
<label>3.</label>
<title>Hippo pathway: regulation and cancer development</title>
<p>The hippo signaling system regulates organ size in mammals by controlling cell growth, division, survival and apoptosis (<xref rid="b15-or-48-01-08346" ref-type="bibr">15</xref>). As a result, the dysregulation in the hippo pathway can cause YAP/TAZ levels to rise. Additionally, these altered levels stimulate the activation and overexpression of associated genes such as <italic>CYR61, CTGF, MYC, and AREG</italic>, increasing cell proliferation and tumorigenesis (<xref rid="b16-or-48-01-08346" ref-type="bibr">16</xref>,<xref rid="b17-or-48-01-08346" ref-type="bibr">17</xref>). The functioning and activity of the hippo pathway involve regulation by various molecules and at different levels of the kinetic cascade (<xref rid="b18-or-48-01-08346" ref-type="bibr">18</xref>). Upstream regulators include molecules like KIBRA, RASSFs, Merlin, and hEx. They are responsible for promoting and modulating the MST1/2 activity. The Ajuba molecule, on the other hand, is classified as a negative regulator since it inhibits the phosphorylation of YAP/TAZ by downregulating the LATS1/2 by interfering with its function (<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>). &#x03B1;-catenin, ZO-2, 14-3-3, and AMOT are molecules that promote the retention of YAP/TAZ in the cytoplasm (<xref rid="b18-or-48-01-08346" ref-type="bibr">18</xref>). Their action aids in the regulation of YAP/TAZ levels.</p>
<p>Apart from the molecular regulation, the hippo signaling pathway can be crosslinked with other signaling pathways, resulting in hippo pathway modulation and hence malignant situations. The Wnt and AMPK pathways are responsible for YAP protein downregulation. In the case of the Wnt pathway, the scaffold protein DVL acts as a link between the hippo and the Wnt signaling pathway. DVL protein comprises the nuclear export signals, which promote YAP cytoplasmic translocation (<xref rid="b19-or-48-01-08346" ref-type="bibr">19</xref>). Since it increases the phosphorylation of YAP at numerous locations, the AMPK pathway can affect the hippo pathway. AMPK also phosphorylates AMOTL1, and phosphorylated AMOTL1 stimulates the upregulation of the LATS1/2, according to a previous study (<xref rid="b20-or-48-01-08346" ref-type="bibr">20</xref>). Increased LATS1/2 activity causes YAP inactivation, which is accomplished by phosphorylation. In addition, TAZ interacts with the heteromeric Smad2/3-Smad4 complexes in the TGF-pathway, proving it to be a positive regulator. The binding results in the sustainability of Smad2/3-Smad4 complexes accumulating in the nucleus (<xref rid="b21-or-48-01-08346" ref-type="bibr">21</xref>). TAZ phosphorylation and inactivation reduce the ability of the Smad2/3-Smad4 complexes to accumulate in the nucleus, thereby altering the transcription process. TGF signaling is inhibited in the absence of TAZ, which impacts neural epithelial development (<xref rid="b22-or-48-01-08346" ref-type="bibr">22</xref>). In KRAS signaling, the protein sends signals to the cells directing the cell to grow and divide, but the <italic>KRAS</italic> gene is identified as the oncogene, meaning that upon mutation, it results in the uncontrolled growth of the cells (<xref rid="b23-or-48-01-08346" ref-type="bibr">23</xref>). Studies have shown that the YAP can be understood as the rescuer of the <italic>K-Ras4B</italic>-inhibited cells (<xref rid="b24-or-48-01-08346" ref-type="bibr">24</xref>,<xref rid="b25-or-48-01-08346" ref-type="bibr">25</xref>). The YAP, along with &#x03B2;-catenin, can induce resistance by managing the advancement of the cells to the S phase in the cell cycle (<xref rid="b16-or-48-01-08346" ref-type="bibr">16</xref>). In MAPK/ERK signaling, the YAP protein can promote the development of resistance against the MAPK/ERK kinase (MEK)-targeted inhibitor therapy (<xref rid="b26-or-48-01-08346" ref-type="bibr">26</xref>). The increased effect of the active YAP directly affects the MEK inhibitors, thereby predicting the therapeutic effect.</p>
<p>The process of hippo pathway regulation is modulated by various molecules and signaling pathways, either directly or indirectly. Therefore, any sought of disruption responsible for the altered YAP/TAZ levels would result in uncontrolled cell growth and reduced apoptosis due to activation of subsequent genes, thereby developing cancer-like properties (<xref rid="b27-or-48-01-08346" ref-type="bibr">27</xref>).</p>
</sec>
<sec>
<label>4.</label>
<title>Understanding the miRNAs</title>
<p>miRNAs belong to the class of non-coding endogenous RNA, also characterized as small single-stranded nucleotides which play a key regulatory role in various biological processes in plants and animals (<xref rid="b28-or-48-01-08346" ref-type="bibr">28</xref>,<xref rid="b29-or-48-01-08346" ref-type="bibr">29</xref>). miRNAs range from 21 to 25 nucleotides in length and work by targeting the specific mRNA by translational inhibition, degradation, or mRNA destabilization to regulate the target (<xref rid="b29-or-48-01-08346" ref-type="bibr">29</xref>,<xref rid="b30-or-48-01-08346" ref-type="bibr">30</xref>). The concept of miRNAs emerged back in 1993 when the miRNAs were first discovered in <italic>Caenorhabditis elegans (C. elegans)</italic> by Ambros and Ruvkun groups (<xref rid="b31-or-48-01-08346" ref-type="bibr">31</xref>,<xref rid="b32-or-48-01-08346" ref-type="bibr">32</xref>). Previous studies showed that in protein LIN-14, the expression was regulated by a non-coding RNA, and this modulation resulted in the defected development <italic>in Caenorhabditis elegans</italic>. The protein LIN-14 is coded by the heterochronic gene <italic>lin-14</italic>, which controls the developmental timing in <italic>C. elegans</italic> (<xref rid="b33-or-48-01-08346" ref-type="bibr">33</xref>). The discovery of miRNAs was advantageous for researchers working in the molecular biology domain. The miRNAs detected are known to be highly conserved and mainly play the regulatory role across the species (<xref rid="b34-or-48-01-08346" ref-type="bibr">34</xref>,<xref rid="b35-or-48-01-08346" ref-type="bibr">35</xref>). Researchers are still exploring the miRNAs and their role in gene regulation.</p>
<p>The majority of the miRNAs interact with the target mRNA through the 3&#x2032; untranslated region (UTR), referred to as 3&#x2032;(UTR), which promotes the suppression of expression, and the targeted mRNA is degraded (<xref rid="b36-or-48-01-08346" ref-type="bibr">36</xref>). A previous study has shown that apart from 3&#x2032;UTR, miRNAs also interact with the other regions of mRNA, such as coding sequence, gene promoters, and 5&#x2032;UTR (<xref rid="b29-or-48-01-08346" ref-type="bibr">29</xref>). MicroRNAs hold significance in mediating cell proliferation and apoptosis due to their regulatory functioning (<xref rid="b37-or-48-01-08346" ref-type="bibr">37</xref>), play a vital role in stem cell division (<xref rid="b38-or-48-01-08346" ref-type="bibr">38</xref>), and regulate differentiation, development, and tumor cell invasion (<xref rid="b28-or-48-01-08346" ref-type="bibr">28</xref>) (<xref rid="f2-or-48-01-08346" ref-type="fig">Fig. 2</xref>). Since miRNAs mediate cell growth and cell death, any dysregulation in miRNAs pattern would result in uncontrolled growth of the affected cells, thereby depicting cancer-like properties (tumorigenesis).</p>
</sec>
<sec>
<label>5.</label>
<title>Biogenesis of miRNAs</title>
<p>The biogenesis of miRNAs is a convoluted process. The synthesis of the miRNAs involves a two-step process wherein the first step occurs in the nucleus and the second one takes place in the cytoplasm (<xref rid="b36-or-48-01-08346" ref-type="bibr">36</xref>). The process initiates with the formation of primary miRNA (pri-miRNA), which is achieved through gene transcription. The transcription is performed by RNA polymerase II but occasionally can also be performed by RNA polymerase III (<xref rid="b39-or-48-01-08346" ref-type="bibr">39</xref>,<xref rid="b40-or-48-01-08346" ref-type="bibr">40</xref>). The primary miRNA transcript structures are 5&#x2032; capped and 3&#x2032; polyadenylation (<xref rid="b41-or-48-01-08346" ref-type="bibr">41</xref>). The cleavage of pri-miRNA is conducted through a microprocessor complex. The microprocessor complex incorporates Drosha, an RNase III enzyme that is responsible for cleaving the pri-miRNA in the nucleus, and DGCR8, a RNA binding protein (<xref rid="b3-or-48-01-08346" ref-type="bibr">3</xref>,<xref rid="b42-or-48-01-08346" ref-type="bibr">42</xref>). The microprocessor complex is responsible for cleaving the pri-miRNA as the DGCR8 recognizes the ssRNA-dsRNA junction found on pri-mi RNA. This dictates Drosha to give rise to a 60-nucleotide hairpin-like precursor miRNA (pre-miRNA) (<xref rid="b41-or-48-01-08346" ref-type="bibr">41</xref>,<xref rid="b43-or-48-01-08346" ref-type="bibr">43</xref>). The transfer of pre-miRNA from the nucleus to the cytoplasm is aided by Exportin-5-Ran-GTP. Dicer ribonuclease, which is another RNase III enzyme, cleaves the pre-miRNA in the cytoplasm. When pre-miRNA is cleaved, a miRNA duplex of 21&#x2013;23 nucleotides is formed, which includes the complementary strand and mature miRNA strand (<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>,<xref rid="b25-or-48-01-08346" ref-type="bibr">25</xref>). The mature miRNA is then integrated into the RNA-induced silencing complex (RISC), a protein complex that also includes the Argonaute (<xref rid="b44-or-48-01-08346" ref-type="bibr">44</xref>). The integration targets the 3&#x2032;UTR of mRNAs, lowering their post-transcriptional or translational levels through mRNA degradation or translational suppression (<xref rid="b45-or-48-01-08346" ref-type="bibr">45</xref>,<xref rid="b46-or-48-01-08346" ref-type="bibr">46</xref>). (<xref rid="f3-or-48-01-08346" ref-type="fig">Fig. 3</xref>).</p>
</sec>
<sec>
<label>6.</label>
<title>miRNAs: Regulation and cancer development</title>
<p>MicroRNAs are known to regulate gene expression in both plants and animals. According to a previous study, the number of miRNAs in cancer varies depending on the processes and microenvironment (<xref rid="b47-or-48-01-08346" ref-type="bibr">47</xref>). The synthesis of miRNAs is controlled at several levels, including transcription and transportation. It has been identified that SMAD proteins and DEAD-box RNA helicases play a role in miRNA maturation mediated by Drosha (<xref rid="b48-or-48-01-08346" ref-type="bibr">48</xref>,<xref rid="b49-or-48-01-08346" ref-type="bibr">49</xref>). Methyltransferase-like 3 methylates pri-miRNAs, allowing DGCR8 to recognize and process them, making them the biogenesis regulator (<xref rid="b50-or-48-01-08346" ref-type="bibr">50</xref>). KSRP also controls miRNA biogenesis by functioning as a complement to Drosha and Dicer (<xref rid="b51-or-48-01-08346" ref-type="bibr">51</xref>). Any disruption in these regulators may cause fluctuations in miRNA levels, resulting in changes in miRNA expression.</p>
<p>The altered levels of miRNAs are one cause leading to cells developing cancer-like properties as numerous miRNAs act as either tumor suppressors or tumor promoters. Thus, the altered levels of these miRNAs result in tumorigenesis. For instance, miRNA-21 and miRNA-155 are identified as miRNAs whose increased expression is observed in malignant tumors. On the other hand, the downregulation of these miRNAs has been revealed to cause controlled cell proliferation, thereby resulting in reduced tumor growth (<xref rid="b52-or-48-01-08346" ref-type="bibr">52</xref>,<xref rid="b53-or-48-01-08346" ref-type="bibr">53</xref>). Let-7 is another miRNA that acts as a tumor suppressor, and its levels are highly downregulated in case of cancer (<xref rid="b54-or-48-01-08346" ref-type="bibr">54</xref>).</p>
</sec>
<sec>
<label>7.</label>
<title>Deciphering the interlinkage of miRNAs and the Hippo pathway</title>
<p>The hippo signaling pathway is primarily responsible for regulating the size of the organ, which is achieved by mediating cell proliferation, apoptosis and regeneration (<xref rid="b55-or-48-01-08346" ref-type="bibr">55</xref>). Downregulation of the hippo pathway causes YAP/TAZ to be activated, resulting in escalated cell proliferation and reduced cell-cell adhesion leading to tumorigenesis. The miRNAs are small non-coding RNA and play a regulatory role in gene expression by targeting the specific miRNAs. In cancer, altered miRNAs level are observed due to dysregulated miRNA expression. The dysregulation of expression of miRNAs occurs due to the defective miRNAs biogenesis or the fluctuating levels of the miRNAs genes (<xref rid="b30-or-48-01-08346" ref-type="bibr">30</xref>).</p>
<p>The interlinkage between miRNAs and the hippo signaling pathway, which leads to cancer, has been proven through advances in research. The YAP and TAZ, two critical components of the hippo pathway, have been demonstrated to influence miRNA biogenesis directly, implying that they play an important role in cancer progression. On the other hand, various miRNAs can regulate key elements of the hippo pathway, resulting in cancer (<xref rid="b5-or-48-01-08346" ref-type="bibr">5</xref>). As a result, it is critical to figure out how the hippo pathway and miRNAs are linked and how they interact to figure out how to treat cancer with therapeutic approaches.</p>
</sec>
<sec>
<label>8.</label>
<title>The Hippo pathway as a regulator of miRNAs</title>
<p>The research conducted to understand the crosslinks between the hippo and miRNAs suggested that the hippo pathway functions as a regulator for miRNA synthesis in a cell density-dependent manner, implying that the regulation of the hippo pathway contributes to carcinogenesis. It operates by interfering with the microprocessor complex that forms pre-miRNA from pri-miRNA. Furthermore, because it is sensitive to cell density and disruption of the hippo pathway is a prominent hallmark of tumors, studies have revealed that it is a regulator of cell density-dependent miRNA synthesis (<xref rid="b5-or-48-01-08346" ref-type="bibr">5</xref>,<xref rid="b55-or-48-01-08346" ref-type="bibr">55</xref>,<xref rid="b56-or-48-01-08346" ref-type="bibr">56</xref>).</p>
<p>In case of lower cell density, the suppression of the hippo pathway, leads to activation of YAP, and the activated YAP moves towards the nucleus. This set of events causes the activation of subsequent genes accountable for elevated cell growth, thereby suppressing the biogenesis of miRNAs (<xref rid="b8-or-48-01-08346" ref-type="bibr">8</xref>). The cell density increases with the increase in proliferation, and this promotes the phosphorylation and cytoplasmic retention of YAP by adherens such as E-cadherin (<xref rid="b55-or-48-01-08346" ref-type="bibr">55</xref>) and &#x03B1;-catenin (<xref rid="b57-or-48-01-08346" ref-type="bibr">57</xref>). p72 (DDX17) is an accessory protein that forms part of the DROSHA-containing complex and plays a role in the pri-miRNA processing by interacting with DROSHA and DGCR8 (<xref rid="b50-or-48-01-08346" ref-type="bibr">50</xref>,<xref rid="b58-or-48-01-08346" ref-type="bibr">58</xref>). Since p72 detects the VCAUCH sequence, which is present in the 3&#x2032; flanking region of pri-miRNA, its interaction with the microprocessor enhances biogenesis (<xref rid="b5-or-48-01-08346" ref-type="bibr">5</xref>). In low density, p72 interacts with YAP rather than DROSHA and DGCR8, resulting in YAP&#x0027;s retention of p72 in the nucleus and reduced miRNA biosynthesis (<xref rid="b59-or-48-01-08346" ref-type="bibr">59</xref>). (<xref rid="f4-or-48-01-08346" ref-type="fig">Fig. 4</xref>).</p>
</sec>
<sec>
<label>9.</label>
<title>miRNAs as a regulator of the the Hippo signaling pathway</title>
<p>Depending on their environment, miRNAs are known to act as either oncogenic or tumor suppressors in certain malignancies (<xref rid="b60-or-48-01-08346" ref-type="bibr">60</xref>). According to previous findings, miRNAs positively and negatively affect the hippo pathway, implying that some oncogenic miRNAs adversely regulate the hippo pathway, resulting in cancer. By contrast, certain miRNAs regulate the hippo pathway positively, thereby maintaining the hippo pathway.</p>
<p>miR-31 and miR-135b are identified as oncogenic miRNAs, and elevated expression is observed in the case of cancer (<xref rid="b61-or-48-01-08346" ref-type="bibr">61</xref>). Overexpression of these miRNAs is one cause that results in the reduced levels of LATS1/2, which is a core component of the hippo pathway. Downregulation of LATS1/2 promotes the activation of YAP, which travels towards the nucleus and, upon reaching, interacts with the TEAD. The interaction between YAP and TEAD is the activation of the subsequent genes, thereby increasing cell proliferation and apoptosis (<xref rid="b62-or-48-01-08346" ref-type="bibr">62</xref>). miR-130 works in a feedback loop with YAP, and its increased levels are found in various types of cancer including oesophageal squamous cell carcinoma, gastric and bladder cancer (<xref rid="b63-or-48-01-08346" ref-type="bibr">63</xref>,<xref rid="b64-or-48-01-08346" ref-type="bibr">64</xref>). miR-130 is known to play a regulatory role in <italic>PTEN</italic> expression and Akt phosphorylation in cancerous cells, and the increased levels of miRNA-130 is induced by the YAP (<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>). The miR-130 negatively regulates the <italic>VGLL4</italic>, which is responsible for the downregulation of the YAP-TEAD complex in the nucleus. The consequence of the downregulation of <italic>VGLL4</italic> has increased YAP activity, thereby promoting carcinogenesis (<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>,<xref rid="b65-or-48-01-08346" ref-type="bibr">65</xref>). miR-3910 is another miRNA exhibiting oncogenic properties. It promotes cell proliferation and cell migration, and in mice, its overexpression has resulted in the formation of hepatocellular carcinoma (HCC) (<xref rid="b66-or-48-01-08346" ref-type="bibr">66</xref>). The miR-3910 negatively regulates the MST1, and its increased levels lead to the downregulation of MST1. As MST1 negatively regulates YAP, its reduced levels increase YAP levels. The absence of phosphorylation of YAP promotes the expression of the genes such as <italic>CTGF, MYC</italic> and <italic>BMI1</italic>, thereby inhibiting apoptosis and promoting tumor formation (<xref rid="b66-or-48-01-08346" ref-type="bibr">66</xref>).</p>
<p>The tumor suppressor miRNAs work as a regulator for cell proliferation and apoptosis, thereby regulating the hippo pathway by targeting either YAP or TAZ (<xref rid="b4-or-48-01-08346" ref-type="bibr">4</xref>). For example, miRNA-375 is known as a tumor suppressor, and its levels are found to be reduced in HCC. In addition, 3&#x2032; UTR of <italic>YAP1</italic> is targeted by miRNA-375, which suppresses the <italic>YAP1</italic> levels, thereby regulating the hippo pathway (<xref rid="b67-or-48-01-08346" ref-type="bibr">67</xref>). miR-186 also acts as the regulator of YAP expression by acting on the <italic>YAP1</italic> gene, which suppresses YAP (<xref rid="b68-or-48-01-08346" ref-type="bibr">68</xref>).</p>
<p>miR-137 and miR-9 are known to regulate the YAP by promoting the activity of LATS1 negatively. The increased activity of <italic>LATS1</italic> results in the phosphorylation of YAP, thereby downregulating the expression of <italic>ARE, CYR61</italic> and <italic>CTGF</italic>, which are responsible for causing gastric cancer (<xref rid="b69-or-48-01-08346" ref-type="bibr">69</xref>). miR-9-3p, which is formed by processing the 3&#x2032; arm of miR-9, has been shown to downregulate TAZ, thus regulating the pathway (<xref rid="b70-or-48-01-08346" ref-type="bibr">70</xref>). The tumor suppressor miR-129-5p has shown a direct relationship with the hippo pathway as its downregulation causes the activation of YAP/TAZ, followed by the interaction with the TEAD (<xref rid="b71-or-48-01-08346" ref-type="bibr">71</xref>). A previous study has shown the relation between the elevated miR-195 levels and YAP activity. The reduced levels of miR-195 in cancer cells show high levels of YAP, indicating the direct regulation of YAP by miR-195 (<xref rid="b72-or-48-01-08346" ref-type="bibr">72</xref>). The regulation of YAP by miR-195 demonstrates that the miRNAs regulate the hippo pathway, and the regulation of the biogenesis of miRNAs by the hippo pathway is interlinked. Together this contributes to the development of cancer-like properties and tumorigenesis.</p>
</sec>
<sec>
<label>10.</label>
<title>miRNAs therapeutics for the treatment of cancer</title>
<p>Apart from all the treatment methods available, such as chemotherapy, the use of therapeutics to eliminate cancer cells proves to be advantageous for the treatment of cancer (<xref rid="b3-or-48-01-08346" ref-type="bibr">3</xref>). Since miRNAs play a regulatory role in gene expression and their altered levels are found in various cancers, studies are at present diverted towards the therapeutics miRNAs in order to destroy the cancerous cells, as the miRNAs play a vital role in tumor formation and expansion (<xref rid="b37-or-48-01-08346" ref-type="bibr">37</xref>,<xref rid="b73-or-48-01-08346" ref-type="bibr">73</xref>). The miRNAs can target various proteins by interacting with the various target mRNA, therefore, demonstrating to be a suitable candidate for the treatment of cancer (<xref rid="b74-or-48-01-08346" ref-type="bibr">74</xref>). Because miRNAs have both oncogenic and tumor-suppressive roles in organisms, scientists are working on therapies that consist of miRNA mimics and anti-miRNAs (<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>). Mimic miRNAs mimic tumor-suppressive miRNAs and raise their levels in situations where tumor-suppressive miRNAs are low. They are non-naturally occurring oligonucleotide duplexes that mimic the function of tumor-suppressive miRNAs (<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>). Anti-miRNAs are miRNAs that serve as antagonists against oncogenic miRNAs. They have complementary sequences to the targeted miRNAs, blocking oncogenic miRNAs and lowering their overexpressed levels in malignancies (<xref rid="b76-or-48-01-08346" ref-type="bibr">76</xref>). miRNAs therapeutics are introduced in the pre-clinical models so as to improve the efficacy of therapeutics via viral vectors (<xref rid="b77-or-48-01-08346" ref-type="bibr">77</xref>), nanoparticles (<xref rid="b78-or-48-01-08346" ref-type="bibr">78</xref>) and liposome delivery (<xref rid="b79-or-48-01-08346" ref-type="bibr">79</xref>).</p>
<p>Researchers have been working on miRNA therapies for years, but only a few have progressed to the stage of clinical trials. Due to the variability of miRNA expression, the most significant challenge is to identify the miRNA targets and creat a delivery mechanism that is not hazardous (<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>). miRNA therapies are now being examined and could be beneficial to patients with cancer in the future. In addition, because miRNAs have been proven to regulate the hippo pathway, researchers can employ treatments to break the resistance to anticancer therapies induced by the dysregulated hippo pathway, demonstrating application in carcinogenesis. A few miRNAs therapeutics under pre-clinal and clinical trials are listed in <xref rid="tI-or-48-01-08346" ref-type="table">Table I</xref> (<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>,<xref rid="b80-or-48-01-08346" ref-type="bibr">80</xref>).</p>
</sec>
<sec>
<label>11.</label>
<title>miRNAs, Hippo and resistance to anticancer drugs</title>
<p>miRNAs are accountable for regulating gene expression, and the altered levels of miRNAs are detected in patients who have cancer. Since miRNAs also regulate the genes that directly influence the response of cells when anticancer drugs are administered, the dysregulated levels result in the development of resistance against the anticancer drugs, thereby affecting the therapeutic effect of the drug (<xref rid="b81-or-48-01-08346" ref-type="bibr">81</xref>). The component of the Hippo pathway, that is, the YAP and TAZ, are involved in imparting resistance against the anticancer drugs. The elevated levels of YAP/TAZ result in the altered levels of the various proteins and pathways, thereby affecting the normal cascade. This alteration results in the development of resistance to anticancer drugs. For example, the elevated levels of TAZ result in increased multidrug resistance protein, which results in the development of resistance against Paclitaxel (an anticancer drug) (<xref rid="b3-or-48-01-08346" ref-type="bibr">3</xref>).</p>
<p>Previous studies have also highlighted the role of the Hippo pathway in the therapeutic effect, as the dysregulated pathway results in resistance against the drugs (<xref rid="b3-or-48-01-08346" ref-type="bibr">3</xref>,<xref rid="b8-or-48-01-08346" ref-type="bibr">8</xref>). As the miRNAs mediate the hippo pathway, it is crucial to deeply analyze the crosslinking between the hippo pathway and miRNAs and how this can affect the resistance against the anticancer drugs to develop effective treatment strategies. The miRNAs, its target hippo component, and which drug&#x0027;s therapeutic action is affected in specific cancer (<xref rid="b82-or-48-01-08346" ref-type="bibr">82</xref>) are listed in <xref rid="tII-or-48-01-08346" ref-type="table">Table II</xref> (<xref rid="b83-or-48-01-08346" ref-type="bibr">83</xref>&#x2013;<xref rid="b87-or-48-01-08346" ref-type="bibr">87</xref>).</p>
</sec>
<sec>
<label>12.</label>
<title>miR-21</title>
<p>miR-21 is an oncogenic miRNA, and its increased levels are observed in different types of cancer, including breast, cervical and colon cancer (<xref rid="b88-or-48-01-08346" ref-type="bibr">88</xref>). Doxorubicin is a therapeutic drug administered to treat various types of cancer. It promotes cell apoptosis by binding with topoisomerase II thereby inhibiting its enzymatic activity (<xref rid="b89-or-48-01-08346" ref-type="bibr">89</xref>). Studies have shown that in the case of breast cancer, the increased levels of miR-21 promote resistance against the anticancer drug as the miR-21 downregulates the PTEN expression (<xref rid="b83-or-48-01-08346" ref-type="bibr">83</xref>,<xref rid="b84-or-48-01-08346" ref-type="bibr">84</xref>). Furthermore, increased miR-21 levels result in the downregulation of <italic>RUNX1</italic>. As <italic>RUNX1</italic> inhibits the YAP expression, its downregulation results in the YAP activation. The upregulation of YAP promotes the partial actuation of the MAPK pathway, which results in tumorigenesis (<xref rid="b3-or-48-01-08346" ref-type="bibr">3</xref>). This, along with altered levels of YAP, results in the development of resistance against doxorubicin. By administering anti-miRNAs, the levels of miR-21 would be regulated, breaking the doxorubicin resistance. Studies have indicated that trastuzumab resistance has a similar sequence of events, apart from doxorubicin resistance. Trastuzumab is a chemotherapeutic medication that inhibits cancer cell growth by binding to the HER2 protein (<xref rid="b90-or-48-01-08346" ref-type="bibr">90</xref>). Resistance to the anticancer medicine trastuzumab develops due to overexpression of miRNA and decreased expression of <italic>PTEN</italic>. Overexpression of YAP and TEAD enhances treatment resistance in breast cancer, and increased miRNA levels boost YAP activation (<xref rid="b91-or-48-01-08346" ref-type="bibr">91</xref>). Trastuzumab resistance can be minimized by using antisense miRNA-21 oligonucleotides to maintain the levels of miR-21, which regulates the levels of YAP and so reduces resistance against trastuzumab to some extent (<xref rid="b84-or-48-01-08346" ref-type="bibr">84</xref>).</p>
</sec>
<sec>
<label>13.</label>
<title>miR-135a/b</title>
<p>miRNAs fall into the category of both oncogenic miRNAs and tumor suppressor miRNAs. The research has highlighted that increased levels of miR-135a/b are detected in the case of lung cancer (<xref rid="b92-or-48-01-08346" ref-type="bibr">92</xref>). Cisplatin is identified as a therapeutic drug utilized to treat various types of cancer. It works by binding to the DNA upon entry into the cell and causing damage to the DNA leading to apoptosis (<xref rid="b93-or-48-01-08346" ref-type="bibr">93</xref>). The increased levels of miR-135a/b result in the progression of resistance against cisplatin as the miR-135b targets <italic>Mcl1</italic>, which leads to the hampering of the apoptosis process (<xref rid="b94-or-48-01-08346" ref-type="bibr">94</xref>). miR-135 is also known to regulate the hippo pathway negatively by downregulating the LATS1/2, which results in increased levels of the YAP, leading to cancer-like properties. The upregulation of YAP also aids in the development of resistance and its progression against cancer drugs. Regulation of miR-135a/b through therapeutics, that is, by anti-miRNAs, would help maintain the miR-135a/b levels, which would, in turn, maintain the YAP levels leading to a reduction in the chemoresistance.</p>
</sec>
<sec>
<label>14.</label>
<title>miR-9</title>
<p>MiR-9 has been identified as a tumor suppressor, with lower levels reported in ovarian and breast cancer. The medications doxorubicin and cisplatin, which function by destroying DNA, are routinely used to treat ovarian cancer. Certain DNA damage repair enzymes, on the other hand, fix the damage, allowing the cell to survive (<xref rid="b81-or-48-01-08346" ref-type="bibr">81</xref>). The downregulation of miR-9 is one of the ways malignant cells develop resistance. In ovarian cancer, miR-9 targets DNA damage repair-related enzyme genes such as BRCA1, preventing BRCA1 action (<xref rid="b86-or-48-01-08346" ref-type="bibr">86</xref>). In addition, the miR-9 stimulates the phosphorylation of YAP by upregulating the LATS1/2, acting as a positive regulator of the hippo pathway. As a result, miR-9 levels are lowered in patients with cancer. The reduced miR-9 levels can decrease LATS1/2, which ultimately leads to the increased expression of cancer-promoting factors, that is, YAP and TAZ, and can result in tumorigenesis (<xref rid="b69-or-48-01-08346" ref-type="bibr">69</xref>). The hyperactivation of YAP/TAZ is also one cause resulting in resistance to anticancer drugs. The regulation of miR-9 levels via therapeutics would result in the dephosphorylation of YAP, leading to increased efficacy of the anticancer drugs.</p>
</sec>
<sec>
<label>15.</label>
<title>miR-338-3p</title>
<p>miR-338-3p works as a tumor suppressor and its levels are detected to be reduced in case of HCC. Sorafenib is identified as a kinase inhibitor and works by targeting and blocking the enzymes and proteins found in and on the surface of cancerous cells to inhibit their growth (<xref rid="b95-or-48-01-08346" ref-type="bibr">95</xref>). The miR-338-3p inhibits the Hypoxia-inducible factor-1 (<italic>HIF-1</italic>), which is the mediator of the hypoxia signaling pathway, which results in increased cell apoptosis (<xref rid="b88-or-48-01-08346" ref-type="bibr">88</xref>). The lower levels of miR-338-3p result in the upregulation of HIF-1&#x03B1;, which results in tumor growth and the development of sorafenib resistance (<xref rid="b96-or-48-01-08346" ref-type="bibr">96</xref>&#x2013;<xref rid="b98-or-48-01-08346" ref-type="bibr">98</xref>). miR-338-3p also directly acts on the TAZ and inhibits it, reducing its levels. The increased levels of YAP and TAZ promote resistance to anticancer drugs. The maintained levels of miR-338-3p would help to break the resistance against sorafenib, thereby increasing the efficiency.</p>
</sec>
<sec sec-type="conclusion">
<label>16.</label>
<title>Conclusion</title>
<p>Researchers have been able to broaden horizons in the field of cancer thanks to their understanding of miRNAs. The role of microRNAs in cancer progression and carcinogenesis has been identified. The Hippo pathway and miRNA have been identified to be interconnected, and their dysregulation may contribute to carcinogenesis.</p>
<p>It was attempted to establish the interlinkage of miRNAs and the hippo pathway using potential information in the present review and relate it to treatment resistance in cancer. Researchers may be able to manage difficult-to-treat drug resistance linked with cancer with an improved understanding of the crosslink. The studies and clinical trials involving miRNA and the hippo pathway remain in their early phases, and there is markedly more to learn. The relationship between miRNAs and the hippo pathway is complicated and requires further research. Researchers will be able to unravel the origin of cancer and design successful treatment techniques in the near future with a thorough understanding of the underlying molecular process and study of crosstalks.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>Not applicable.</p>
</ack>
<sec sec-type="data-availability">
<title>Availability of data and materials</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Authors&#x0027; contributions</title>
<p>MZN, TA, MAK, SMA and SK collaboratively helped in curating the recent studies. AAA, MZN and S guided in analyzing the curated data. SA, VMS and AAE prepared the figures and tables.</p>
</sec>
<sec>
<title>Ethics approval and consent to participate</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Patient consent for publication</title>
<p>Not applicable.</p>
</sec>
<sec sec-type="COI-statement">
<title>Competing interests</title>
<p>The authors declare that they have no competing interests.</p>
</sec>
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<floats-group>
<fig id="f1-or-48-01-08346" position="float">
<label>Figure 1.</label>
<caption><p>Hippo signaling pathway mechanism in mammals. In mammals the core components of the hippo pathway regulate the expression of the transcriptional co-activators YAP and TAZ thereby maintaining the balance between cell proliferation and apoptosis.</p></caption>
<graphic xlink:href="or-48-01-08346-g00.jpg"/>
</fig>
<fig id="f2-or-48-01-08346" position="float">
<label>Figure 2.</label>
<caption><p>Regulatory role of miRNA. MiRNAs are known to play a regulatory role and works by regulating various components which helps in mediating the cell proliferation and apoptosis. miRNA or miR, microRNA.</p></caption>
<graphic xlink:href="or-48-01-08346-g01.tiff"/>
</fig>
<fig id="f3-or-48-01-08346" position="float">
<label>Figure 3.</label>
<caption><p>Biogenesis of miRNA. The biogenesis of miRNA is followed to a set of events starting from the formation of the pri-miRNA to the cleavage of the pre-miRNA so as to get mature miRNA which would bind to the targeted mRNA. miRNA or miR, microRNA.</p></caption>
<graphic xlink:href="or-48-01-08346-g02.jpg"/>
</fig>
<fig id="f4-or-48-01-08346" position="float">
<label>Figure 4.</label>
<caption><p>Hippo Pathway as regulator of miRNA biogenesis. miRNA biogenesis is regulated by the Hippo pathway through various set of events and abnormality of Hippo pathway can affect the miRNA biogenesis which results in tumorigenesis. miRNA or miR, microRNA.</p></caption>
<graphic xlink:href="or-48-01-08346-g03.jpg"/>
</fig>
<table-wrap id="tI-or-48-01-08346" position="float">
<label>Table I.</label>
<caption><p>miRNA therapeutics under pre-clinical and clinical trials.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="bottom">Drug Name</th>
<th align="center" valign="bottom">Targeted miRNA</th>
<th align="center" valign="bottom">Category of therapeutics</th>
<th align="center" valign="bottom">Target cancer</th>
<th align="center" valign="bottom">Stage of trials</th>
<th align="center" valign="bottom">Clinical trial number</th>
<th align="center" valign="bottom">(Refs.)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">-</td>
<td align="left" valign="top">miR-10b</td>
<td align="left" valign="top">Anti-miRNA</td>
<td align="left" valign="top">Glioblastoma, breast cancer</td>
<td align="left" valign="top">Trails in pre-clinical models</td>
<td align="left" valign="top">-</td>
<td align="center" valign="top">(<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>)</td>
</tr>
<tr>
<td align="left" valign="top">-</td>
<td align="left" valign="top">miR-200 family</td>
<td align="left" valign="top">Mimic-miRNA</td>
<td align="left" valign="top">Lung cancer, Breast cancer, Ovarian cancer</td>
<td align="left" valign="top">Trails in pre-clinical models</td>
<td align="left" valign="top">-</td>
<td align="center" valign="top">(<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>)</td>
</tr>
<tr>
<td align="left" valign="top">MRX34</td>
<td align="left" valign="top">miR-34</td>
<td align="left" valign="top">Mimic-miRNA</td>
<td align="left" valign="top">Various solid tumors such as liver cancer, lymphoma</td>
<td align="left" valign="top">Phase-I: Terminated</td>
<td align="left" valign="top">NCT01829971</td>
<td align="center" valign="top">(<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>,<xref rid="b80-or-48-01-08346" ref-type="bibr">80</xref>)</td>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Phase I: Withdrawn</td>
<td align="left" valign="top">NCT02862145</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">MesomiR-1</td>
<td align="left" valign="top">miR-16</td>
<td align="left" valign="top">Mimic-miRNA</td>
<td align="left" valign="top">Lung cancer</td>
<td align="left" valign="top">Phase I: Completed</td>
<td align="left" valign="top">NCT02369198</td>
<td align="center" valign="top">(<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>,<xref rid="b80-or-48-01-08346" ref-type="bibr">80</xref>)</td>
</tr>
<tr>
<td align="left" valign="top">Miravirsen</td>
<td align="left" valign="top">miR-122</td>
<td align="left" valign="top">Anti-miRNA</td>
<td align="left" valign="top">Lung cancer</td>
<td align="left" valign="top">Phase I:</td>
<td align="left" valign="top">NCT01646489</td>
<td align="center" valign="top">(<xref rid="b75-or-48-01-08346" ref-type="bibr">75</xref>,<xref rid="b80-or-48-01-08346" ref-type="bibr">80</xref>)</td>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Status: Complete</td>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Phase II:</td>
<td align="left" valign="top">NCT02508090</td>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Status: Complete</td>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Phase II:</td>
<td align="left" valign="top">NCT02452814</td>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Status: Complete</td>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Phase II:</td>
<td align="left" valign="top">NCT01200420</td>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Status: Complete</td>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Phase II: Unknown</td>
<td align="left" valign="top">NCT01872936</td>
<td/>
</tr>
<tr>
<td/>
<td/>
<td/>
<td/>
<td align="left" valign="top">Phase II: Unknown</td>
<td align="left" valign="top">NCT01727934</td>
<td/>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1-or-48-01-08346"><p>miR, microRNA.</p></fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tII-or-48-01-08346" position="float">
<label>Table II.</label>
<caption><p>miRNA and Hippo Pathway components affecting therapeutics in different cancers.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="bottom">miRNA</th>
<th align="center" valign="bottom">Expression in tumour</th>
<th align="center" valign="bottom">Affected component of the Hippo pathway</th>
<th align="center" valign="bottom">Dysregulation of the Component</th>
<th align="center" valign="bottom">Resistance to Drug</th>
<th align="center" valign="bottom">Cancer</th>
<th align="center" valign="bottom">(Refs.)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">miR-21</td>
<td align="left" valign="top">Increased</td>
<td align="left" valign="top">YAP</td>
<td align="left" valign="top">Upregulation</td>
<td align="left" valign="top">Doxorubicin, Trastuzumab</td>
<td align="left" valign="top">Breast cancer</td>
<td align="center" valign="top">(<xref rid="b83-or-48-01-08346" ref-type="bibr">83</xref>,<xref rid="b84-or-48-01-08346" ref-type="bibr">84</xref>)</td>
</tr>
<tr>
<td align="left" valign="top">miR-135a/b</td>
<td align="left" valign="top">Increased</td>
<td align="left" valign="top">LATS1/2</td>
<td align="left" valign="top">Downregulation</td>
<td align="left" valign="top">CDDP</td>
<td align="left" valign="top">Lung cancer</td>
<td align="center" valign="top">(<xref rid="b85-or-48-01-08346" ref-type="bibr">85</xref>)</td>
</tr>
<tr>
<td/>
<td/>
<td align="left" valign="top">YAP</td>
<td align="left" valign="top">Upregulation</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="top">miR-9</td>
<td align="left" valign="top">Decreased</td>
<td align="left" valign="top">LATS1/2</td>
<td align="left" valign="top">Upregulation</td>
<td align="left" valign="top">Doxorubicin, CDDP</td>
<td align="left" valign="top">Ovarian cancer</td>
<td align="center" valign="top">(<xref rid="b86-or-48-01-08346" ref-type="bibr">86</xref>)</td>
</tr>
<tr>
<td/>
<td/>
<td align="left" valign="top">YAP</td>
<td align="left" valign="top">Downregulation</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="top">miR-338-3p</td>
<td align="left" valign="top">Decreased</td>
<td align="left" valign="top">TAZ</td>
<td align="left" valign="top">Downregulation</td>
<td align="left" valign="top">Sorafenib</td>
<td align="left" valign="top">Hepatocellular cancer</td>
<td align="center" valign="top">(<xref rid="b87-or-48-01-08346" ref-type="bibr">87</xref>)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn2-or-48-01-08346"><p>miR, microRNA.</p></fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</article>
