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Hepatology Research 2014

doi: 10.1111/hepr.12386

Review Article

miRNA in hepatocellular carcinoma Asahiro Morishita and Tsutomu Masaki Department of Gastroenterology and Neurology, Kagawa University School of Medicine, Kagawa, Japan

Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide. Despite improvements in HCC therapy, the prognosis for HCC patients remains poor due to a high incidence of recurrence. An improved understanding of the pathogenesis of HCC development would facilitate the development of more effective outcomes for the diagnosis and treatment of HCC at earlier stages. miRNA are small, endogenous, non-coding, ssRNA that are 21–30 nucleotides in length and modulate the expression of various target genes at the post-transcriptional and translational levels. Aberrant expression of miRNA is common in various human malignancies and modulates cancer-associated genomic regions or

INTRODUCTION

M

IRNA ARE SMALL, interfering, non-coding RNA that are 21–30 nucleotides in length, and it has been predicted that there are approximately 1000 of these sequences in the human genome.1 Each miRNA negatively regulates its target genes by binding to multiple mRNA. Binding between miRNA and mRNA triggers the RNA-mediated RNAi pathway, in which the mRNA transcripts are cleaved by an miRNA-associated RNA-induced silencing complex (miRISC).2 In most animals, single-stranded miRNA act by binding to imperfectly complementary sites within the 3′untranslated regions of their target mRNA, inhibiting translation or initiating degradation via the miRISC.3 Recruitment of the miRISC can modulate the expression of targeted protein-coding genes.4,5 Surprisingly, each

Correspondence: Profesor Tsutomu Masaki, Department of Gastroenterology and Neurology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kida-gun, Kagawa 761-0793, Japan. Email: [email protected] Received 27 June 2014; revision 27 June 2014; accepted 1 July 2014.

fragile sites. As for the relationship between miRNA and HCC, several studies have demonstrated that the aberrant expression of specific miRNA can be detected in HCC cells and tissues. However, little is known about the mechanisms of miRNA-related cell proliferation and development. In this review, we summarize the central and potential roles of miRNA in the pathogenesis of HCC and elucidate new possibilities that may be useful as diagnostic and prognostic markers, as well as novel therapeutic targets in HCC. Key words: diagnostic and prognostic markers, hepatocellular carcinoma, miRNA, therapeutic target

miRNA can promote the targeting and modulation of more than 200 mRNA.6,7 In humans, a total of 2000 miRNA have been discovered.8 Although their importance is recognized in regulating protein-coding gene expression, the precise functions of miRNA remain elusive. It is now apparent that miRNA play an important role in human carcinogenesis.6,9–12 In addition, the expression of miRNA is generally downregulated in tumor tissues compared with normal tissues, indicating that a subset of miRNA act as tumor suppressors. Therefore, the discovery of miRNA has expanded our knowledge of post-transcriptional gene regulation during cancer development. Interestingly, more than half of all genes that encode miRNA are located at fragile sites or in cancer-associated regions of the genome,13 suggesting that miRNA may serve as diagnostic markers or therapeutic targets. The first report of altered miRNA expression in cancer involved a frequent chromosomal deletion and two miRNA, miRNA-15 (miR-15) and miRNA-16 (miR-16), thought to target B-cell lymphoma 2 (BCL-2), which is the anti-apoptotic factor in chronic lymphocytic leukemia.14 Recent reports have shown that miRNA are associated with the

© 2014 The Authors. 1 Hepatology Research published by Wiley Publishing Asia Pty Ltd on behalf of The Japan Society of Hepatology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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pathogenesis of various types of cancers,9–12 and these findings have increased our understanding of epigenetic modification during oncogenesis.2 Several studies have recently reported a relationship between miRNA and hepatocellular carcinoma (HCC).12,15–18 Among several miRNA implicated in HCC, including miR-21, miR-221 and miR-222, the aberrant levels of miRNA expressions were upregulated.12,16,17 However, other miRNA, including miR-122a, miR-145, miR-199a and miR-223, were decreased in HCC compared to normal tissues.15,19 Surprisingly, Huang et al. have shown that, among aberrant miRNA in HCC, miR338 affects several clinical features, such as tumor size, tumor–node–metastasis classification, vascular invasion and intrahepatic metastasis.18 These studies suggest that

the modulation of miRNA may play an important role in the progression of HCC.

BIOGENESIS AND REGULATION OF miRNA

S

EVERAL STEPS ARE involved in the biogenesis of miRNA: transcription, cleavage, export, further cleavage, strand selection and interaction with mRNA (Fig. 1).20 The genes encoding miRNA are primarily transcribed by RNA polymerase II into initial transcripts that are then processed through the canonical pathway or the “mirtron” pathway to form primary miRNA transcripts (pri-miRNA) that include one or more hairpin structures.21 These pri-miRNA are capped at the 5′-end and polyadenylated at the 3′-end22 and then

Cytoplasm

Nucleus Translational repression

Genome DNA

mRNA degradation

Pol II RISC AGO

RISC formation

Transcription

AGO

Mature miRNA

Pri-miRNA Unwinding

AAAAA

m7G

Degradation

miRNA duplex Clevage Clevage

Pre-miRNA Exportin 5

Drosha

DGCR8

Export TRBP

Dicer

Figure 1 Steps in biogenesis of miRNA. The primary miRNA (pri-miRNA) is transcribed from genome DNA mainly by RNA polymerase II (Pol II). The Drosha–DGCR8 complex cleaves and splices pri-miRNA into hairpin-like miRNA precursors called pre-miRNA. These pre-miRNA are exported from the nucleus to the cytoplasm in an Exportin-5-Ran-guanosine-5′-triphosphate (GTP)-dependent manner. In the cytoplasm, Dicer and TRBP cleaves hairpin structure of pre-miRNA into mature miRNA. The processed miRNA are then loaded onto the RNA-induced silencing complex (RISC) with Argonaute (Ago2) and are guided to their mRNA targets for translational repression or mRNA degradation.

© 2014 The Authors. Hepatology Research published by Wiley Publishing Asia Pty Ltd on behalf of The Japan Society of Hepatology

Hepatology Research 2014

cleaved into approximately 70-nucleotide (nt) hairpinstructured precursors (pre-miRNA) with a 5′-phosphate and a 3′-2-nt overhang by a multiprotein complex that includes an RNase III enzyme named Drosha and a dsRNA-binding domain protein (dsRBD) named DGCR8/Pasha.23 Subsequently, exportin-5 translocates pre-miRNA from the nucleus to the cytoplasm through a Ran-guanine-triphosphate (GTP)-dependent mechanism.24 These translocated pre-miRNA are cleaved by a second RNase III endonuclease named Dicer and the dsRBD proteins TRBP/PACT.25 Finally, one strand of the pre-miRNA interacts with the Argonaute (AGO) protein and is degraded in the RNA-induced silencing complex that modulates mRNA degradation and translational repression.26 In addition to the canonical miRNA pathway, some miRNA are processed into miRNA-like molecules in a Microprocessor-independent manner, including certain snoRNA,27 tRNA28 and endogenous shRNA.29 Furthermore, more than 1 million Drosophila smallRNA sequences were recently generated using 454 pyrosequencing, and these sequences identified 14 short introns with predicted hairpin structures.30 These short introns were named “mirtrons” after analyzing their characteristics. Primary mirtron precursors include mirtronic introns and flanking exonic sequences that typically lack the lower stem (∼11 bp) that is found in miRNA, which mediates their recognition and cleavage via the Pasha (DGCR8)/Drosha complex.31 The “AG” splice acceptor of a typical mirtron adopts a 2-nt 3′-overhang for these hairpins, allowing mirtronsto enter the miRNA-processing pathway without Droshamediated cleavage.32 miRNA regulate various biological processes by modulating specific mRNA, and their expression is tightly regulated in normal cells.29,33 Each miRNA can potentially be controlled independently at the transcriptional level by various regulators or at the epigenetic level via DNA methylation.33–35 Interestingly, the regulatory elements that control protein-coding genes, such as CpG islands, TATA boxes, transcription factor II B recognition sites, initiator elements and histone modifications, are also found in the promoters of miRNA genes,36 indicating that the transcription factors are similar between protein-coding genes and miRNA. Therefore, the expression of various processing components is simultaneously regulated to modulate the activity of mature miRNA. In addition, miRNA can also autoregulate their own transcription by controlling various transcription factors in positive or negative feedback loops. The miR-200

miRNA profiles for the treatment of HCC 3

family of miRNA plays an important role by inhibiting the expression of zinc finger E-box-binding homeobox 1 (ZEB1) and survival of motor neuron proteininteracting protein 1 (SIP1), which act as transcriptional repressors in epithelial cells, to regulate the epithelial to mesenchymal transition; however, ZEB1 and SIP1 also suppress the miR-200 family, including miR-200a and miR-200b, by binding their promoter regions.37 This result indicates that miRNA and their target molecules are tightly regulated by each other at the transcription level. Moreover, miRNA are also regulated by epigenetic processes, such as DNA methylation and specific histone deacetylation. Seventeen of the 313 human miRNA were upregulated more than threefold after treatment with the chromatin-modifying drugs 5-aza2′-deoxycytidine and 4-phenylbutyric acid. Among these miRNA, miR-127 was highly upregulated after treatment.38 In addition, inhibiting histone deacetylases rapidly downregulated 22 miRNA and upregulated five miRNA.39 Furthermore, miRNA expression is also controlled at the post-transcriptional level. A large fraction of miRNA genes are post-transcriptionally regulated, including those of the Let-7 family.40 Individual miRNA expression processed from the same pri-miRNA is occasionally different at the mature miRNA level.41 Initially during post-transcriptional regulation, miRNA are processed by Microprocessor, which consists of Drosha and the dsRNA-binding protein DGCR8 in the nucleus.23 A loss of Drosha or DGCR8 function leads to a decrease in pre-miRNA and mature miRNA.23 In the cytoplasm, pre-miRNA that are exported from the nucleus in a Ran/GTP/Exportin-5-mediated event are further regulated by the RNase III enzyme Dicer to become mature RNA.40

MIRNA EXPRESSION AND HCC DEVELOPMENT

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IRNA HAVE BEEN reported to influence the critical functions of cellular differentiation, proliferation, apoptosis, invasion and metastasis.42 The miRNA expression profiles in tumors are different from those in normal tissues and also vary according to the type of tumor. Interestingly, the direct targets of miRNA are also protein-coding genes of the cell cycle, apoptosis and metastasis in HCC.43 Recently, microarray analysis has revealed that a subset of miRNA are up- and downregulated during the development of HCC.44 Reductions in the expression of miRNA are frequently

© 2014 The Authors. Hepatology Research published by Wiley Publishing Asia Pty Ltd on behalf of The Japan Society of Hepatology

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observed in HCC, and the targets of these downregulated miRNA may be putative oncogenes. Conversely, some of the upregulated miRNA act as oncogenic miRNA in HCC and may be targets of tumor suppressor genes. miRNA are associated with various chronic liver diseases, such as alcoholic liver disease,45 non-alcoholic steatohepatitis (NASH)46–48 and viral hepatitis.49–51 In addition to these chronic diseases, miRNA are also involved in the development of HCC. In alcoholic liver disease, miR-217 induces ethanol-induced fat accumulation in hepatocytes by inhibiting the expression of SIRT1.45 The miRNA miR-126, miR-27b, miR-182, miR-183, miR-199, miR-200a, miR-214 and miR-322 were downregulated in alcohol-related HCC.51,52 The observed reduction in miR-27 in alcoholic steatohepatitis was the result of epigenetic events that occurred in response to alcohol.53 The development and exacerbation of NASH, both of which are also associated with miRNA, increase the risk of HCC. A recent study indicated that miRNA play a critical role in activating hepatic stellate cells (HSC) during the development of NASH.54 Free cholesterol was observed to accumulate due to an enhancement of both sterol regulatory elementbinding protein-2 (SREBP2) and miR-33a signaling via the inhibition of peroxisome proliferator-activated receptor-γ signaling together with HSC activation and disruption of the SREBP2-mediated cholesterolfeedback system in HSC.54 The upregulation of miR-21, which downregulates the expression of tumor suppressor phosphatase and tensin homolog (PTEN), is induced by unsaturated fatty acids in hepatocytes.46 In addition, miR-155 suppresses another tumor suppressor gene, CCAAT-enhancer-binding protein-β, and has been also shown to be upregulated in mice fed a choline-deficient amino acid-defined diet.47,48 Viral hepatitis, such as that caused by the hepatitis B virus (HBV) and hepatitis C virus (HCV), is the most frequent cause of HCC and cirrhosis.55 The 5-year cumulative risk of hepatocarcinogenesis with liver cirrhosis ranges 5–30%.55 Among HBV cases, only two miRNA, miR-210 and miR-199-3p, were observed to affect HBV gene expression and replication in an experimental model. In contrast, many cellular miRNA indirectly regulate the HBV life cycle by affecting virusrelevant cellular proteins.56 Ura et al. examined the expression of 188 miRNA in HCC and adjacent normal tissues obtained from 12 HBV positive and 14 HCV positive patients. In these groups, the expression of six miRNA was decreased in HBV patients, and that of 13

Hepatology Research 2014

miRNA was reduced in HCV patients.57 These data suggest that there are distinct patterns in the miRNA profiles between HBV and HCV infection. Several reports demonstrated that miR-96 or miR-26 were significantly upregulated in HBV-related HCC tissues.52,58 Takazawa et al. reported comprehensive miRNA profiles using sequencing methods that provided more than 314 000 reliable reads from HCC tissue and more than 268 000 reliable reads from adjacent normal liver. Bioinformatic-based analysis revealed several miRNA altered in HCC, including miR-122, miR-21 and miR34a.59 Therefore, further studies that characterize the miRNA associated with HBV-related HCC may yield a novel therapeutic tool for HCC patients with HBV infection. In addition, miR-196 plays an important role through the inhibition of Bach1 (a basic leucine zipper mammalian transcriptional repressor) and upregulation of hemeoxygenase 1 in HCV-related HCC.60 Diaz et al. also demonstrated 18 miRNA among 2226 human miRNA that were exclusively expressed in HCV-related HCC.61 One of these 18 miRNA has been associated with networks that include p53, PTEN and retinoic acid and is involved in the pathogenesis of HCC.62,63 These data suggest that miRNA pathways are essential to the development of HCC during HCV infection.

CLINICAL SIGNIFICANCE OF MIRNA IN HCC Single nucleotide polymorphisms of miRNA and the risk of HCC

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INGLE NUCLEOTIDE POLYMORPHISMS in miRNA and their targets have been associated with an increased risk of HCC. Because miRNA must closely recognize binding sites in their target genes, a variation in even 1 nt may produce dramatic changes in the post-transcriptional regulation of target genes. Polymorphisms in miR-101-1/rs7536540,64 miR-101-2/ rs12375841,64 miR-34b/c/rs493872365 and miR-106b25-cluster/rs99988566 are positively associated with an increased risk of HCC. In contrast, miR-371–373/ rs385950167 and miR-149c/rs229283268 are negatively involved in HCC risk. However, conflicting results were obtained from several studies, such as with miR-499a/ rs374644468–70 and miR-196a-2/rs11614913.68,71–73

miRNA as biomarkers for HCC miRNA can be characterized as prognostic or diagnostic markers. Downregulation of the miRNA miR-let-7g,74 miR-22,75 miR-26,58 miR-29,76 miR-99a,77 miR-122,78

© 2014 The Authors. Hepatology Research published by Wiley Publishing Asia Pty Ltd on behalf of The Japan Society of Hepatology

Hepatology Research 2014

miRNA profiles for the treatment of HCC 5

Table 1 Downregulated miRNA in hepatocellular carcinoma miRNA

Targets

Mechanisms

References

let-7a let-7b let-7c let-7d let-7f-1 let-7g miR-1 miR-7 miR-10a miR-10b miR-15a/16 miR-21 miR-26a miR-29a miR-29b miR-29c miR-34a miR-99a miR-100 miR-101 miR-122 miR-124 miR-125a miR-125b

Caspase-3, STAT3 HMGA2 Bcl-xL, c-Myc

Apoptosis, proliferation Apoptosis, proliferation Apoptosis, proliferation, cell growth Apoptosis, proliferation Apoptosis, proliferation Apoptosis, metastasis Proliferation

50,83,84

miR-139 miR-139-5p miR-140-5p miR-141 miR-145 miR-148a miR-152 miR-195 miR-198 miR-199a-3p miR-199a-5p miR-199b miR-200a miR-200b miR-200c miR-203 miR-214 miR-219-5p miR-222 miR-223 miR-224 miR-363-3p miR-375 miR-376a miR-429 miR-449 miR-450a miR-520b/e miR-612 miR-637 miR-1271

Bcl-xL, c-Myc, COLIA2, p16 ET-1 PIK3CD EphA4

85 51,86,87 50 50 74,88,89 90 91 92 93 94 52

CDK6, IL-6, cyclin D2, E1, E2 SPARC MMP-2 SIRT1 c-Met, CCL22 PLK1, IGF-1R PLK1 EZH2, EED, Mcl-1, Fos, Bcl-w, ADAM17, Wnt1 PIK3CA MMP11, VEGF-A,SIRT7 Mcl-1, Bcl-w, SUV39H1, SIRT7 ROCK2, c-Fos

Cell cycle Proliferation Invasion

95–97 98 99 100

Metastasis

101,102 77,103

Carcinogenesis Apoptosis, DNA methylation Apoptosis, proliferation, angiogenesis Proliferation Proliferation, metastasis, metabolism Proliferation, metastasis, angiogenesis, apoptosis, histone modification Metastasis

103 104–106 107–110 111 112,113 51,113–117

51,118,119 51

TGFβR1, FIF9, DMMT1 DLC-1 IRS1/2, IGF-1R, β-catenin c-Met, HRIP, E-cadherin, c-Myc DNMT1, GSTP1, CDH1 cyclin D1, CDK6, E2F3, LATS2

120,121 122 81,123 124–127 128

Cell cycle, tumorigenesis, apoptosis

129,130 17

mTOR, PAK4, caveolin-2 DDR1, ATG7 HDAC4

Drug resistance, cell growth Invasion, autophagy Proliferation, invasion, apoptosis Proliferation, metastasis

131–133 134,135 136 137 51 52

Surviving HDGF, β-catenin GPC3

Proliferation Cell growth, angiogenesis, metastasis Proliferation

STMN1

Proliferation

138 139–141 142 52 16 143

c-Myc ATG7, AEG-1 PIK3R1 Rab18 c-Met DNMT3a NIK, MEKK2, cyclin D1 AKT2 STAT activation GLP3

127

Autophagy Apoptosis, proliferation

144,145 146 147

Proliferation, apoptosis Proliferation Cell growth, proliferation

148 149 150,151 152 153 93

© 2014 The Authors. Hepatology Research published by Wiley Publishing Asia Pty Ltd on behalf of The Japan Society of Hepatology

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miR-124,79 miR-139,80 miR-14581 and miR-199b82 has been implicated in cell proliferation, apoptosis, angiogenesis, recurrence, shorter disease-free survival and poor prognosis (Table 1). In contrast, upregulation of miR-10b,154 miR-17-5p,155 miR-21,156 miR-135a,157 miR-155,158 miR-182,159 miR-221156 and miR-222118,156 has been associated with metastasis, angiogenesis and poor prognosis (Table 2). In addition, miRNA profiling

Hepatology Research 2014

classified HCC into three main clusters.189 These results indicate the potential value of miRNA detection for the prediction of survival in HCC. Furthermore, Yamamoto et al. reported that miR-500 was increased in the sera of HCC patients and decreased after surgical treatment.196 In addition, other miRNA, such as miR-25, miR-375 and let-7f, can be used to distinguish HCC from normal control tissue.197 Interestingly, extracellular miRNA are

Table 2 Upregulated miRNA in hepatocellular carcinoma miRNA

Targets

Mechanisms

References

miR-10a miR-17-5p miR-18a miR-21 miR-22 miR-23a miR-26a miR-30d miR-100 miR-106b miR-130b miR-135a miR-143 miR-151 miR-155 miR-181b miR-182 miR-183 miR-186 miR-200 miR-210 miR-216a miR-216a/217 miR-221 miR-221/222 miR-224 miR-301a miR-373 miR-423 miR-485-3p miR-490-3p miR-494 miR-495 miR-517a miR-519d miR-550a miR-590-5p miR-615-5p miR-657 miR-664 miR-1323

EphA4; CADM1 p38 pathway ER1a PTEN; RHOB; PDCD4 Era, IL-1a PGC-1a, G6PC IL-6, CyclinD2, E2 GNAI2 PLK1 APC TP53INP1 FOXM1, MTSS1 FNDC3B FAK, RhoGDIA SOCS1, DKK1, APC, PTEN TIMP3 MTSS1 AKAP12 AKAP12 NRF2 pathway VMP1 TSLC1 PTEN, SMAD7 p27, p57, Arnt, CDK inhibitors p27, DDIT4 Atg5, Smad4, autophagy, API-5 Gax PPP6C p21/waf1 MAT1, LIN28B ERCIC3 MCC MAT1, LIN28B

EMT, metastasis Migration Proliferation Metastasis, drug resistance Carcinogenesis Gluconeogenesis Tumor growth, metastasis Invasion, metastasis Carcinogenesis Proliferation Cell growth, self-renewal Metastasis Metastasis Migration Proliferation; tumorigenesis Tumorigenesis, metastasis Metastasis Carcinogenesis Carcinogenesis Carcinogenesis Metastasis Carcinogenesis EMT, drug resistance Apoptosis, proliferation, angiogenesis Tumorigenesis Tumorigenesis, autophagy Metastasis Cell cycle Cell growth Cell growth, EMT EMT Tumorigenesis Tumorigenesis, metastasis Tumorigenesis, metastasis Proliferation, invasion, apoptosis Proliferation, invasion, metastasis Metastasis, proliferation Proliferation, migration Proliferation Tumorigenesis, metastasis Proliferation

92,154

p21, PTEN, AKT3, TIMP2 CPEB4 TGF-β RII IGF-II TLE1, NF-κB MAT1, LIN28B

160 49 12,48 161 162 96,97 163 17 164 165 157 166 167,168 48,169,170 171 159 172 172 173 174 175 176 177–179 180 181,182 183 184 185 186 187 188 186 189 190 191 192 193 194 186 195

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Hepatology Research 2014

stable in circulation, indicating that miRNA may serve as useful diagnostic markers for HCC.

miRNA as targets for HCC treatment Because miRNA function as oncogenes or tumor suppressors, alterations in these miRNA influence the malignant phenotypes of HCC cells. In tumor tissues, miRNA associated with tumor suppressors are downregulated during tumorigenesis, tumor development and metastasis. These miRNA may be potential therapeutic targets, and strategies for miRNA replacement therapies have been developed using miR-26a,95 miR122198 and miR-124111 in a HCC mouse model. In contrast, inhibition of miR-221 lengthened survival, reduced the nodule number and retarded tumor development.177,199 Furthermore, no toxicity was observed when miRNA-targeted therapy was used to treat HCC in a mice model. miRNA have been also shown to affect the sensitivity of tumors to anticancer drugs. Several reports have indicated that miRNA profiles are dramatically altered following metformin treatment for various cancers: gastric cancer,200 esophageal cancer201 and HCC.202 Interestingly, overexpression of miR-21203 and miR-181b171 induced resistance to interferon–5fluorouracil combination therapy and doxorubicin treatment in HCC. In contrast, Bai et al. demonstrated that restoring expression of the tumor suppressive miR122 makes HCC cells more sensitive to sorafenib via the downregulation of multidrug resistance genes.

CONCLUSION

M

IRNA ARE BEING considered as new biomarkers and potential therapeutic targets for HCC. To date, many miRNA have been identified as regulators of various target genes during HCC development. In addition, although miRNA-based therapy is not currently used in the clinic, its innovative applications are growing in various fields. However, the details regarding targetable miRNA and the mechanisms of miRNAinduced anticancer effects remain unclear. Further analyses and new technology for miRNA research will elucidate novel concepts in the pathogenesis of HCC. Consequently, analyzing miRNA profiles and their signaling pathways offers deeper insights into the treatment options for HCC.

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miRNA in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide. Despite improvements in HCC therapy, the prognosis for HCC patie...
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