Understanding the Role of Connexins in Hepatocellular Carcinoma: Molecular and Prognostic Implications

Simple Summary Hepatocellular carcinoma represents the majority of all liver cancers and the fourth cause of cancer-related deaths worldwide. Despite the progress in diagnostic and therapeutic evaluation, its prognosis remains dismal, with mortality rates increasing per year. As the investigation of the human genome project advances, so does the deeper understanding of tumor biology, with numerous molecular biomarkers proved to play a promising role in clinical practice, in terms of diagnosis, surveillance, and the prediction of treatment efficacy. One important aspect is evaluating the potential role of new ancillary biomarkers associated with tumor invasiveness and response to available therapeutic options, which is useful in treatment monitoring and may reduce the health costs faced by standard methods.Abstract Connexins, a family of tetraspan membrane proteins forming intercellular channels localized in gap junctions, play a pivotal role at the different stages of tumor progression presenting both pro- and anti-tumorigenic effects. Considering the potential role of connexins as tumor suppressors through multiple channel-independent mechanisms, their loss of expression may be associated with tumorigenic activity, while it is hypothesized that connexins favor the clonal expansion of tumor cells and promote cell migration, invasion, and proliferation, affecting metastasis and chemoresistance in some cases. Hepatocellular carcinoma (HCC), characterized by unfavorable prognosis and limited responsiveness to current therapeutic strategies, has been linked to gap junction proteins as tumorigenic factors with prognostic value. Notably, several members of connexins have emerged as promising markers for assessing the progression and aggressiveness of HCC, as well as the chemosensitivity and radiosensitivity of hepatocellular tumor cells. Our review sheds light on the multifaceted role of connexins in HCC pathogenesis, offering valuable insights on recent advances in determining their prognostic and therapeutic potential.