Mechanoregulation of YAP and TAZ in Cellular Homeostasis and Disease Progression

1The fate of individual cells is shaped and determined by both biochemical and biophysical factors in cellular microenvironments. While much is known about cell signaling and functional consequences in response to biochemical cues, such as nutrients, growth factors, and hormones, the impacts of biophysical modulations on tissue growth and homeostasis in health and diseases are understudied. With developments in advanced engineering substrates and apparatus to better mimic mechanics of microenvironments in native tissues, biophysical factors, such as matrix stiffness, cell-cell contacts, and local hemodynamic forces, have been appreciated for their roles in regulating cellular functions and phenotypes. However, our knowledge is rather limited for how cells sense the changes of microenvironments and transduce such mechanical stimuli to biochemical signaling cascades governing cellular responses.

2The Hippo pathway, since it was identified in Drosophila melanogaster less than two decades ago, has been extensively studied and now regarded as a master regulator of organ development, regeneration, and carcinogenesis, via integrating extrinsic and intrinsic cues that reshape cellular transcription programs. The core of the mammalian Hippo pathway is a kinase cascade consisting of the Mammalian STE20-like kinase 1/2 (MST1/2) and the Large tumor suppressor kinase 1/2 (LATS1/2). When cells are exposed to growth-inhibiting signals, MST1/2 phosphorylate LATS1/2 at their hydrophobic motif and thus activate LATS1/2, which in turn phosphorylate and inactivate two transcription factors Yes-associated protein (YAP) and Transcriptional coactivator with PDZ-binding motif (TAZ) by inducing their cytoplasmic retention and protein degradation. When the Hippo pathway is inactivated by growth-promoting signals, YAP and TAZ are dephosphorylated and thus located in the nucleus, where they bind to the TEAD family of transcription factors and drive transcription programs that promote cell proliferation, mobility, and stemness. In addition, novel Hippo kinases (e.g., MAP4Ks), accessory proteins (e.g., SAV1, NF2, and MOB1/2), and tuning machineries (e.g., the STRIPAK-PP2A complex) have been shown as indispensable components, among dozens of many other peripheral regulators that finely tune the pathway, for relaying environmental signals to the core of the Hippo pathway.

3There have been many comprehensive reviews on the Hippo pathway regulation and its biological roles as cited above. In this review, we will focus on the molecular mechanisms by which the Hippo pathway is modulated by mechanical cues in microenvironments (Figure 1). Furthermore, we will summarize the recent progress on how mechanoregulation of the Hippo pathway contributes to human disease development.

4Cells and tissues perceive microenvironmental physical forces that are generated both internally and externally. Internal forces are mainly generated by cytoskeleton dynamics (endogenous forces), while external forces result from both environment and neighbor cells (applied forces). The resulting mechanical cues, including tissue stiffness, stretch, and shear stress, modulate cell behaviors, such as cell proliferation, spreading, migration, and differentiation. The process through which biophysical forces are sensed and converted into biochemical signals that elicit responses is termed mechanotransduction. This process was typically divided into mechanosensing (the act of sensing a mechanical stimulus), mechanotransmission (the act of transmitting such a stimulus to signaling events), and mechanoresponse (the functional response of cells to the mechanical stimulus).

5Mechanosensing is usually initiated at the cell surface, where plasma membrane receptors, their associated proteins, and the plasma membrane itself sense and propagate mechanical cues to trigger signaling cascades that generate mechanoresponses. Integrins, G protein-coupled receptors, Enzyme-linked Receptors (i.e., Receptor Tyrosine Kinase), and Ion Channels can be all such “mechanosensors”. Forces applied to these receptors or on/through their ligands change configurations of the receptors, leading to enzymatic reactions and/or cytoskeleton remodeling. Our understanding of membrane-associated mechanosensors has been greatly improved in the past decade. For example, Integrins and Piezo channels, evolutionarily conserved in mammalian cells, are mechanosensitive, characterized by the activation of corresponding downstream effectors and regulation of their biological functions in response to mechanical stimuli. Besides the membrane-associated receptors, mechanical forces can be directly transmitted to the nucleus, the envelope of which responds to mechanical compression or stretch to alter transport of transcription factors and other nucleus-cytoplasm shuttling proteins, as well as remodel nucleoskeleton.

6It was recognized a long time ago that mechanical signals during development dynamically control gene transcription programs to determine cell fate and organ growth. However, it was then unclear how these mechano-responsive transcription programs are regulated by the mechanotransduction initiated by membrane proteins and cytoskeletons. Emerging efforts have been made to elucidate the signaling cascades that link membrane mechanosensors to the nuclear transcription machinery. One such “missing” signaling cascade that has been increasingly appreciated is the Hippo pathway, though many details of mechanoregulation of this pathway remain yet to be determined.

7Two landmark studies from the Piccolo group and the Sasaki group published in 2011 opened a new avenue for us to understand how mechanical cues modulate the activities of nuclear factors that dictate transcription programs to control cell behaviors and fate. Their studies demonstrated for the first time that YAP and TAZ, the Hippo pathway effectors, are mechanotransducers to relay cytoskeletal tension to nuclei and to regulate cell functions, and more importantly, they are functionally indispensable for the biological outputs of mechanical cues. Thereafter, new nuclear factors (i.e., β-catenin, Twist) and new mechanosensitive signaling molecules, such as RAP2 and MAP4K, have been identified, thus greatly advancing our mechanistic understanding of mechanotransduction and the Hippo pathway regulation. In the following session, we will summarize the most updated knowledge of how each type of mechanical cues regulates YAP and TAZ and the biological context(s) for the corresponding regulation (Figure 2).

8The mechanical microenvironment of cells is largely determined by their neighbor cells and surrounding extracellular matrix. The difference in ECM composition leads to unique three-dimensional networks in various tissues and determines the rigidity or elasticity of substrates where cells habituate and grow. This physical characteristic of the microenvironment profoundly influences cell phenotypes, not only their morphology but also internal cytoskeleton organization and trafficking. To investigate the effect of ECM stiffness on cell functions, engineered hydrogels interfacing with ECM proteins, such as fibronectin and collagens, have widely been used as substrates to grow cells in vitro. As a result, ECM stiffness has been shown to regulate cell growth, migration, and differentiation, among many other important cell behaviors.

9It was first shown by the Piccolo group that increased ECM stiffness promotes nuclear localization of YAP and TAZ and upregulation of their target genes. Though the underlying molecular mechanisms were not fully uncovered then, they demonstrated that actin cytoskeleton tension resulting from manipulations of cell spreading and substrate rigidity constitutes the key link between ECM stiffness and YAP/TAZ activation. High ECM stiffness promotes cell spreading and subsequently leads to actin cytoskeleton tension, which in turn results in nuclear translocation of YAP/TAZ with a to-be-defined mechanism. One key player that relays stiffness signals to YAP/TAZ is RhoA GTPase, which can sense ECM stiffness through focal adhesion and in turn promote actin polymerization and stress fiber formation. Actin cytoskeleton can regulate YAP and TAZ through both Hippo-dependent and -independent pathways. On one hand, the Hippo pathway can be inactivated by actin polymerization and stress fiber formation at high ECM stiffness, and activated by relaxed actin cytoskeletons at low ECM stiffness. Phosphorylation and localization of YAP/TAZ are thus modulated by ECM stiffness through the Hippo pathway. On the other hand, the ARID1A-SWI/SNF complex binds to YAP/TAZ and thus prevents the interaction between YAP/TAZ and TEAD. Polymerized nuclear actin, under high ECM stiffness, binds to ARID1A-SWI/SNF complex, subsequently relieving its sequestration of YAP/TAZ.

10To date, our mechanistic understanding of how ECM stiffness regulates YAP/TAZ remains incomplete as emerging players have been reported. ECM stiffness can be sensed by cells through focal adhesions, as cells use integrin to pull integrin ligands in the ECM. In addition to common integrin ligands such as collagens and fibronectin, an ECM proteoglycan, Agrin, also act as an extracellular mediator of matrix mechanotransduction to regulate YAP/TAZ via integrins, its specific membrane receptor LRP4, and the actin cytoskeleton. Similarly, matricellular protein thrombospondin-1, acts through integrin-1 and the Hippo pathway, but not actin cytoskeleton, to activate YAP/TAZ. Besides signaling through integrin/focal adhesion, plasma membrane protein Caveolin-1 (CAV-1) also play a critical role in mechanoregulation of YAP/TAZ. CAV1 loss promotes the interaction between YAP and the 14-3-3 protein YWHAH in an F-actin-dependent but Hippo-independent manner.

11Besides membrane proteins, signaling transducers like small GTPases and protein kinases also mediate stiffness signals to the Hippo pathway. Small GTPases, such as RhoA and RAC1, have been demonstrated for their roles as molecular switches for stiffness sensing. Another GTPase, RAP2, also senses stiffness cues from focal adhesions, as ECM stiffness modulates the GDP/GTP loading status of RAP2. Active/GTP-loading RAP2 activates non-canonical Hippo kinases MAP4K4/6/7 by direct binding to their hydrophobic motif leading to LATS activation and YAP/TAZ inhibition. JNK is also an important mediator of stiffness sensing for YAP/TAZ regulation in epithelial cells. Stiffness-activated JNK can phosphorylate LIMD1, which directly binds to LATS1/2 and reduces their kinases activities, eventually leading to activation of YAP/TAZ.

12Almost all adherent cells, in vitro or in vivo, experience physical forces transmitted between cells and across tissues, and one of the most common forces in animals is tension caused by mechanical stretch. For example, when cells undergo tissue growth or disease progression, the increase in ECM stiffness generates a static tension that stretches cells. Such kind of stretch forces, as previously discussed, modulate cell behaviors via a YAP/TAZ-dependent mechanism. In addition to ECM stiffening, stretching forces from external sources, such as tissue mechanical strain and artificial cell stretching devices, are able to regulate cell functions through the interplay of the Hippo pathway. Moreover, recent research has linked YAP dysregulation to malfunction of the cardiovascular system caused by pressure overload, suggesting a critical regulatory role of the Hippo-YAP/TAZ pathway in cells in response to various magnitudes of stretch force.

13Static stretch activates YAP/TAZ by suppressing capping and severing proteins of F-actins. Additionally, the stretch force applied to the nucleus may decrease the mechanical restriction of nuclear pores, thus facilitating nuclear transport of YAP/TAZ. The linker of nucleoskeleton and cytoskeleton (LINC) complex, which transfers cytoskeletal strain to the nucleus, is a key player for mechanical stretch to activate YAP/TAZ in this process.

14Cyclic stretch has also been reported to activate YAP/TAZ by suppression of the Hippo pathway, even in cells on soft matrices. In Drosophila, the physiological mechanical strain can drive activation and nuclear localization of YAP/TAZ homolog Yki in Drosophila follicular epithelium to promote cell proliferation, via inactivating the LATS1/2 homolog Warts. The novel Hippo kinase Msn plays a critical role in sensing mechanical stretch in Drosophila gut. Mechanical stretch dissociates Msn from the plasma membrane and thus prevents phosphorylation and activation of Msn by the Tao kinase, which in turn activates expansion of Drosphila gut stem cells and leads to intestinal hyperproliferation.

15In mammals, cyclic stretch is known to act through thrombospondin-1/RAP2 in blood vessel cells to activate YAP and promote vascular remodeling. Thrombospondin-1 acts via integrin αvβ1 to form focal adhesions and promotes nuclear shuttling of YAP by inactivating the RAP2 GTPase, results in vascular remodeling in response to the pulsatile blood flow and pressure. It is worth mentioning that externally applied mechanical stretch and ECM stiffening shared many mechanosensing machineries, such as RAP2 and Msn/MAP4Ks, to regulate YAP/TAZ activities. It would be important to understand how these universal machineries work in concert with cell-specific mechanosensors (e.g., VEGFR2 in endothelial cells) to control mechanoresponses of cells in future.

16Cell-cell contact inhibition is the phenomenon that cells avoid proliferating as they achieve convergence in monolayers. During carcinogenesis, transformed cells slowly lose this character. Loss of contact inhibition allows the transformed cells to overcome physical restraint and in many cases contributes to cancer cell aggressiveness. Contact-dependent signaling is one of the first extracellular stimuli discovered to regulate the Hippo pathway. Direct contact between normal cells activates the Hippo kinases, thus leading to phosphorylation and cytoplasmic retention of YAP/TAZ, triggering cell cycle arrest and/or autophagy. In contrast, hypophosphorylation and nuclear localization of YAP/TAZ have been associated with loss of contact inhibition of cancer cells resulting from somatic mutations.

17Various mechanisms have been proposed to explain how cell-cell contact inhibition modulates activities and localization of YAP/TAZ. These mechanisms can be roughly grouped into two types. The first one usually involves cis-interaction of cell membrane proteins at high confluence. For example, for tight junctions (TJs) form between cells, angiomotin (AMOT) complex at TJs is activated and transmit the antiproliferative signal from TJs to YAP via two independent mechanisms: AMOT can directly bind to YAP and thus sequester YAP at TJs, and/or AMOT can activate Merlin/NF2 to trigger LATS1/2-dependent YAP phosphorylation. In addition to TJs, adherens junctions (AJs) protein E-cadherin, in confluent cells, trans-dimerize and subsequently stimulate MST1/2-LATS1/2 kinase cascade to inhibit activities of YAP/TAZ. PTPN14, a protein tyrosine phosphatase, can inhibit YAP transactivation activity through a direct interaction in response to cell confluence. The other type of mechanisms involves cell geometry and actin cytoskeleton remodeling. High cell density, as well as low ECM stiffness, reduces adhesive area and alters cell shape, which leads to inactivation of RhoA and subsequent reduction of stress fiber of actin cytoskeleton, which can inactivate YAP/TAZ through both Hippo kinases-dependent and -independent mechanisms. Spectrin has been recognized as a key cytoskeletal protein that restricts YAP/TAZ activity in response to mechanical cues, such as cell-cell contact inhibition, through remodeling actin cytoskeleton particularly at cortical areas of cells. Loss of Spectrin proteins results in hyperactivation of YAP/TAZ, likely by elevating cortical myosin II activity, leading to cell over-proliferation even when cells confluence is reached in both mammals and Drosophila.

18Shear stress, a fluid frictional force, is another major mechanical stimulus maintaining tissue homeostasis. Indeed, one of the most studied cell types in mechanotransduction is vascular endothelial cells (ECs), lining in the innermost layer of blood vessels. ECs are constantly subjected to shear stress from blood flow, and it is well recognized that ECs are able to sense and respond to changes in flow direction, pulsatility, and magnitude of shear stress via mechanosensors and mechanosensitive signaling pathways. As a result, endothelial phenotypes are highly associated with local blood flow patterns and distinct in different regions of the vascular tree. Three recent studies independently confirmed that flow patterns modulate endothelial phenotypes through regulation of YAP/TAZ activities: unidirectional laminar flow suppresses YAP/TAZ activities to keep ECs quiescent and inert to inflammatory cells, while disturbed oscillatory flow activates YAP/TAZ to promote a pro-proliferative and -inflammatory EC phenotype.

19Mechanistically, the integrin–Gα13–RhoA axis was first reported to mediate the flow regulation of YAP/TAZ activities in ECs and two recent studies revealed that disturbed flow acts through integrin α5β1 to induce YAP nuclear translocation and promote the pro-atherogenic responses, via c-Abl kinase and phosphodiesterase 4D5, respectively. However, the mechanisms regarding how the flow-activated integrin signaling cascades crosstalk with Hippo kinases to modulate YAP/TAZ activities remain to be studied. In addition to the integrin-mediated mechanisms, it has been shown that short-term unidirectional laminar flow (15 dyne/cm2 for 10 min) increases the nuclear localization of YAP in a LATS1/2-independent but an angiomotin-regulated manner. Last but not the least, caveolae, the plasma membrane microdomain, is known to sense shear stress signals and have been shown to relay such mechanical cues through the Hippo pathway to facilitate mechanoregulation of YAP/TAZ. However, whether the caveolae-dependent mechanism mediates the flow regulation of endothelial phenotypes remains to be determined.

20In addition to ECs, many other cell types, such as metastatic tumor cells and mesenchymal stem cells, are known to perceive shear stress stimuli and transduce the resulting biochemical signals in regulating cellular functions. In fact, the connection between shear stress and YAP was first reported in mesenchymal stem cells, where it was shown that exposure of mesenchymal stem cells to shear stress enhances YAP expression to promote their differentiation into chondrocytes. More in vitro and in vivo studies are warranted to validate the roles of YAP/TAZ as mechanotransducers in modulating biological functions in the above-mentioned cell types.

21Mechanoregulation of YAP/TAZ plays a critical role in normal development and aging processes. For instance, it is known that physiological substrate stiffness directs human pluripotent stem cell specification by influencing cytoskeleton arrangement and intracellular tension through the YAP-TEAD complex. The behavior of limbal epithelial stem cells is strongly influenced by changes in corneal substrate stiffness, via the activation of YAP-dependent mechanotransduction pathways. Furthermore, an age-related stiffness drives YAP/TAZ-mediated pathogenic expression of ECM proteins, ultimately disrupting muscle stem cell fate.

22Emerging evidence connects YAP/TAZ dysregulation by mechanical cues to various human diseases. Although the underlying mechanisms remain to be defined in many cases, understanding of the Hippo pathway dysregulation by mechanical cues in human diseases potentially can provide us insights into new therapeutic strategies for these diseases (Figure 3).

23The cardiovascular system is subjected to continuously shifting mechanical signals, including stretch, compression, distortion, and shear. Mechanotransduction profoundly influences the development of the cardiovascular system and the regulation of physiological functions. The roles of YAP/TAZ in CVDs have been well summarized in a recent review. Aberrant activation of YAP/TAZ contributes to a variety of cardiovascular conditions: atherosclerosis, pulmonary hypertension, myocardial hypertrophy, angiogenesis, restenosis, and myocardial fibrosis, while hypoactivation of YAP/TAZ is associated with aortic aneurysms, aortic dissection, reperfusion of myocardial ischemia, and myocardial infarction. Our review will solely focus on YAP/TAZ dysregulation in mechanical cues resulting from/in pulmonary hypertension, atherosclerosis, and cardiac hypertrophy.

24Pulmonary hypertension (PH) refers to a pathophysiologic condition of increased blood pressure within the arteries of the lungs with many possible causes.

25One feature of PH is remodeling of small pulmonary arteries caused by hyperproliferation of vascular smooth muscle cells (VSMCs) and myofibroblasts, leading to aberrant deposition of collagen and elastin and vascular ECM stiffening. A number of cross-sectional studies suggest that YAP/TAZ activation downstream of ECM stiffening is a key driver of PH. Vascular remodeling and stiffening activate YAP/TAZ, which then drive a transcription program that promotes ECM deposition and crosslinking and further enhances vascular remodeling and stiffening, thus constituting a forward feedback loop. Specifically, ECM stiffening activates YAP/TAZ in myofibroblasts, endothelial cells, and VSMCs and thus facilitates proliferation of these cells. Furthermore, YAP/TAZ in these cells activate genes involved in ECM synthesis (i.e., collagens) and crosslinking (i.e., lysyl oxidase). In addition, YAP/TAZ also link mechanical stimuli to dysregulated vascular metabolism associated with PH. ECM remodeling controls the expression of glutaminase by activating YAP/TAZ, leading to activation of glutaminolysis and anaplerosis, fostering PAECs and PASMCs proliferation and migration. In mouse models, LOX inhibitors dampened nuclear YAP/TAZ and improved end-stage manifestations of PH. Increased pulsatility and shear stress have been associated with YAP/TAZ activation in pulmonary vascular ECM remodeling and pulmonary adventitial myofibroblast proliferation. It is unknown, however, whether mechanical signals from increased pulsatility and shear stress alone will be sufficient to activate YAP/TAZ in the adventitial myofibroblasts in the absence of a rigid matrix.

26Atherosclerotic plaques develop preferentially at arterial bifurcations and high curvatures but not straight segments of arteries. The site-specific manner of lesion formation suggests that local hemodynamic forces acting on vessel walls play a critical role in exerting atheroprone or atheroprotective effects on vascular cells. Indeed, as discussed previously, disturbed flow, but not steady laminar flow, activates endothelial YAP/TAZ in ECs, leading to upregulations of pro-atherogenic (e.g., VCAM1) and YAP/TAZ-target genes (e.g., CTGF and CYR61) in vitro. In agreement with the in vitro findings, a higher level of YAP/TAZ activation was detected in atheroprone regions than in atheroprotective regions mouse aorta, suggesting the involvement of disturbed flow-activated YAP/TAZ in atherogenesis. In ApoE–/– mice, knockdown of YAP/TAZ expression decreases the pro-atherogenic phenotypes of vascular cells and attenuates lesion development in atheroprone regions of arteries. On the other hand, atherosclerosis is encouraged by overexpression of endothelial YAP, or systemic TAZ, or a constitutively active YAP/TAZ mutation. Taken together, these studies reassuringly uncovered the importance of YAP/TAZ as mechanotransducers in vascular cells and atherogenesis.

27Besides YAP/TAZ, hemodynamic forces activate a number of signaling pathways to regulate endothelial phenotypes associated with atherosclerosis, via other transcription factors, such as KLF2, KLF4, NRF2, HIF-1α, NF-κB, AP-1, and a few others. These transcription factors, collectively referred to mechanosensitive transcription factors (MSTFs), crosstalk with one another to regulate ECs upon exposure to hemodynamic forces, as well as control cellular responses to oxidative stress, inflammation, and metabolic programming. Understanding how YAP/TAZ work in concert with these MSTFs in endothelium homeostasis will be important for us to obtain a panoramic view of the mechanosensing signaling network in endothelial cells.

28In addition to their roles in ECs, the phenotypic switch of VSMCs from contractile to synthetic phase is regulated by YAP/TAZ activities, in response to stretch or wall stress-induced vascular remodeling. Stretching VSMCs activates their PI3K-PDK1 signaling, which then prevents the Hippo kinase cascade from inactivating YAP/TAZ.

29Cardiac hypertrophy is an adaptive response to hemodynamic overload. In the beginning, cardiac hypertrophy is beneficial because it increases the number of contractile units and reduces the ventricular wall pressure to a normal level according to Laplace’s law. However, as the adjustment is physically limited, cardiac hypertrophy will lead to heart failure.

30Experimental studies have supported the concept that mechanical cues, such as hemodynamic overload, predominantly affect cardiomyocytes (CMs) by stretching. Integrins and the cytoskeleton or sarcolemmal proteins (e.g., phospholipases, ion channels, and ion exchangers) are two main types of mechanosensors, by which hemodynamic overload is coupled to intracellular signals responsible for the hypertrophic response.

31Hemodynamic overload includes two forms: pressure overload and volume overload. Endogenous YAP is a crucial mediator of hypertrophy in response to volume overload, which regulates CM growth and survival in the adult mouse myocardium in response to myocardial ischemic injury. It was believed that compensatory cardiomyocyte hypertrophy is at least partially regulated by Yap1 after chronic myocardial infarction and a Yap1 deficit impairs the growth response to stress in heart, contributing to worsened operation. In response to pressure overload, endogenous YAP is triggered in CMs through a RhoA-dependent mechanism. Heterozygous YAP depletion inhibited hypertrophy, but increased fibrosis and apoptosis, and decreased cardiac functions. These findings highlight YAP as a potential target for myocardial infarction and hypertension.

32Inflammation and wound-healing process following tissue injury and/or an idiopathic disease induce profibrotic responses, including abnormal ECM synthesis and deposition by fibroblasts and tissue stiffening and thickening. Such changes in structural and mechanical properties of the tissue are usually irreversible and lead to the formation of scar tissue, also known as fibrosis. The physical features of fibrotic tissues, together with the unresolved inflammation, continuously stimulate fibroblasts, resulting in pathological accumulation of ECM components and permanent tissue damage.

33YAP/TAZ serve as critical mechanotransducers in fibroblasts, coordinating profibrotic responses in various tissues, such as hepatic fibrosis, pulmonary fibrosis, kidney fibrosis, cardiovascular fibrosis, and others. The initial increase in ECM stiffness activates YAP/TAZ in fibroblasts, encouraging the development of profibrotic mediators and excessive deposition of ECM components. This results in progressive tissue stiffening, thereby forming an activation feed-forward loop to promote tissue fibrosis. Moreover, YAP/TAZ act as a molecular link between fibrosis and cancer. Fibrotic ECM stimulates cell proliferation and changes cell polarity, thereby promoting tumor development and growth. Various studies have assessed the efficacy of inhibiting YAP/TAZ activity as a new therapeutic strategy to reverse fibrosis, and the results of those have unfolded a promise of YAP/TAZ-targeting therapies for organ fibrosis.

34MSDs refers to diseases that affect the muscles, bones, and joints, which mainly tendinitis, carpal tunnel syndrome, osteoarthritis (OA), rheumatoid arthritis (RA), etc.

35Mechanical load has been shown to activate YAP by increasing the expression of nuclear accumulation of YAP. Hyperactivation of YAP by sustained mechanical overload or YAP overexpression alone is sufficient to induce skeletal muscle hypertrophy. Besides responding to mechanical load, YAP/TAZ play a crucial role in muscle cell stemness and myogenesis. However, more studies are required as their atrophic roles of YAP/TAZ in muscle cells have also been reported, and more details about the connection between mechanical stimuli and YAP/TAZ signaling would further improve our understanding of the roles YAP/TAZ in mechanotransduction and muscle homeostasis.

36OA is mainly caused by mechanical overload, and it has been reported that YAP is both necessary and adequate to preserve cartilage homeostasis in OA. A few recent studies demonstrated that suppressing YAP activity is effective in attenuating OA progression. However, research is still lacking on how the mechanical forces, especially compression and hydrostatic pressure, regulate Hippo-YAP/TAZ pathway in chondrocytes in healthy cartilage and during OA development.

37The biophysical factors in the tumor microenvironment play a pivotal role in disease progression and treatment outcomes. Common physical features that hinder cancer treatment, including solid stresses, interstitial fluid pressure, stiffness, and tumor microarchitecture, have been nicely reviewed by Nia HT, Munn LL, and Jain RK very recently. It has long been known that the changes in tumor microenvironment trigger signaling pathways to fuel cancer progression, immune blockade, and cancer resistance to therapy. Among the mechanosensitive pathways, the dysregulation of the Hippo-YAP signaling plays a central role in tumor development as it has been connected to most of the physical features in tumors. Emerging efforts have been made to elucidate the molecular mechanisms by which mechanical properties of various tumor types act through YAP/TAZ to promote cancer pathology.

38Loss of cell-cell contact inhibition and unchecked cell growth are hallmarks of cancer, and the Hippo pathway is known to mediate contact inhibition and cell proliferation. Indeed, dysregulation of the Hippo signaling and hyperactivation of YAP/TAZ not only abolish the cell cycle regulation, as a result of losing contact inhibition, but also promote the transformation of mammary epithelial cells. As the tumor grows, the changes in mechanical properties of the microenvironment continuously contribute to cancer progression and malignancy. Numerous studies have documented that stiff substrates activate YAP/TAZ to increase primary cancer cell growth, migration, and chemotherapy resistance. Furthermore, it has been shown that Ras signaling-mediated oncogenic transformation of normal cells requires a stiff and/or fibrotic microenvironment.

39Mechanistically, the ECM-activated YAP/TAZ regulates the expression of various cytoskeletal regulators in cancer-associated fibroblasts and increases intracellular isometric tension, thus forming a forward feedback loop to enhance the tumor microenvironmental rigidity and support cancer cell growth and invasion. It is speculated that YAP/TAZ hyperactivation is required for cancer cells to overdrive the mechanical checkpoints for growth. In addition to cancer cells and cancer-associated fibroblasts, ECM stiffening during tumor progression induces vascular cell growth and allows blood vessel infiltration, potentially through the Agrin-YAP-dependent mechanism. Indeed, it has recently been shown that the increases in tissue rigidity at metastatic sites enhance cancer angiogenesis and elevate their resistance to anti-angiogenesis therapy.

40Cancer cells migrate and metastasize in blood and lymphatic vessels. Therefore, it would be important to know the flow regulation of YAP/TAZ in cancer cells. It has been reported that fluid shear stress induces YAP/TAZ activation to promote cancer cell migration and proliferation, suggesting a causative role of YAP/TAZ activation in cancer metastasis. In this regard, modulation of Hippo-YAP/TAZ signaling may represent a novel strategy for anti-metastasis therapies. In addition, the role of YAP/TAZ-mediated mechanosensing in tumorigenesis may be more complex and multi-functions in context-dependent manners and therefore worth further exploring. For example, a recent study in mice showed that activation of the YAP/TAZ in peritumoral normal hepatocytes suppressed liver tumor growth via cell competition mechanism against tumor cells. It would be important to elucidate the exact roles of YAP-dependent mechanoresponses in physical interaction between normal and tumor cells in future studies.

41Research in the last decade has established an indispensable role of the Hippo-YAP pathway in mechanobiology of tissue growth and homeostasis, although more research is still needed to finely define biological roles and molecular mechanisms for specific pathogenesis processes. Many studies have implicated that the Hippo pathway may serve as a signaling integration hub through interpreting both mechanical and biochemical cues. One recent study worth particularly mentioning is from Barry Thompson group. They reported that mechanically induced Yki nuclear shuttling requires growth factors-activated PI3K-AKT signaling in Drosophila. This coordination of the force-regulated Yki signaling and the PI3K-AKT signaling couples cell polarity and tissue mechanics to nutritional cues in tissue growth control. Future investigation into the crosstalk between YAP-mediated mechanotransduction and biochemical cues in the disease microenvironment will be crucial for us to obtain a more comprehensive knowledge of pathogenesis associated with dysregulated tissue mechanics. Moreover, it will be also important to understand how the Hippo-YAP pathway works in concert with other mechanosensing mechanisms (e.g., KLFs, MRTF-SRF, TWIST, and β-catenin) to generate a singular but context-specific mechanoresponse in cells. Furthermore, as industrial and academic efforts are emerging for developing YAP-targeting agents, testing such agents in animal models of diseases associated with mechano-dysregulation will likely lead to novel therapies.

42XC, K-CW, and ZM worked together to conceive and draft the manuscript. All authors contributed to the article and approved the submitted version.

43The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.