1. Introduction
Renal cell carcinoma (RCC) is the most common neoplasm of the kidney in adults, accounting for about 3% of all malignancies, and has the highest mortality rate of over 40% [
1,
2]. Over the past five decades, the incidence of RCC has rapidly increased, according to epidemiological data [
3,
4]. Clear cell RCC (ccRCC) is the most common type of RCC, which accounts for ~75–88% of all cases. Papillary RCC (pRCC) and chromophobe RCC (chRCC) are other common subtypes of renal cancer, with incidences of 6–15% and 2–5%, respectively [
5,
6]. At the time of diagnosis, metastases developed in approximately 20–30% of patients with RCC, and also, after curative surgery for localized RCC, another 30% of patients developed metastases in follow-up studies [
3]. The current system used to predict the prognosis of patients diagnosed with renal cancer, while based on clinicopathological parameters, does not accurately predict the natural outcome of the disease, especially in localized primary RCC. Due to this failing prognostic system, there is an urgent need to find novel molecular biomarkers that can be used for the early diagnosis and evaluation of the prognosis of RCC and even serve as key therapeutic targets [
2,
7].
MicroRNAs are conserved, small (18~22 nucleotides), non-coding RNAs that play a major role in different molecular pathways by regulating gene expression [
8,
9]. In stable microvesicles, apoptotic bodies, or membrane-free carriers, miRNAs in human body fluids (blood plasma, urine, saliva, and semen) may have diagnostic biomarker roles and also indicate the prognosis of cancer diseases [
10,
11]. Based on the expression profiles, miRNAs can be indicators in distinguishing tumorous and normal tissues, even classifying tumors by histological type [
10,
11]. Aveta et al. [
10], in a systematic summary, demonstrated that the expression panel of miRNAs is associated with a higher probability of diagnosing malignant renal masses, while other urinary miRNAs could be useful in distinguishing benign masses such as oncocytoma. According to the literature, some miRNAs, such as miR-3648, miR-489, miR-638, miR-3656, miR-3687, miR-25-5p, miR-21-5p, and miR-663b, have significant potential diagnostic value for ccRCC. Many of the identified miRNAs are associated with the regulation of the molecular signaling pathway involved in RCC tumor genesis. These miRNAs may serve as the basis for RCC therapy [
11].
miRNAs have the ability to balance between pro- and antiangiogenic processes and are able to modify the appropriate course of events in angiogenesis [
2]. For instance, some miRNAs (miR-23a, miR-21, and the miR-17-92 cluster) show pro-angiogenic properties, while others (miR-29b, miR-29c, and miR-192) prevent angiogenesis [
8,
9,
12,
13]. Earlier studies have described the role of miRNAs in tumor angiogenesis [
13]. miR-210, which was identified as a hypoxia-regulated miRNA, was shown to have been upregulated in RCC [
14]. Other studies indicated that miR-29b, a negative regulator of VEGF, also showed overexpression in RCC [
14]. In recent studies, miR-126 has been shown to be correlated with the main angiogenic marker, VEGF-A [
7]. This miRNA has also been linked to tumorigenesis in many types of cancer [
4,
7,
14]. Various reports noted that VEGF-A receptors can be controlled by miR-200, which means this miRNA may also participate in angiogenesis [
4,
7,
14]. An inverse correlation between miR-106a and miR-106b, the angiogenesis marker VEGF-A, was also found, which suggests a regulatory mechanism in this pathological condition [
7]. Based on related studies, miRNAs represent potential therapeutic targets for the treatment of pathological neovascularization-related diseases due to their influence on multiple different pathways [
15,
16].
While previous studies have illustrated the role of miRNAs in renal cancer, many of their functions are not fully understood. Despite the large number of published studies that have followed, miRNAs in kidney tumors are not yet sufficiently known to be an effective tool in the diagnosis, prognosis, and therapeutic treatment of kidney cancer. In the present study, we compared the expressions of relevant RCC miRNAs, such as hsa-miR-15b-5p, hsa-miR-99b-5p, hsa-miR-181a-5p, and other angiogenesis-related genes, in both renal tumors and adjacent normal renal tissues from patients with RCC. In addition, our investigation sought to describe specific miRNAs and their roles in the progression of the angiogenesis process of renal cancer, as well as the potential prognosis of RCC. Utilizing statistical strategies, we correlated the expression patterns of the miRNAs of interest with clinicopathological parameters, including clinical stage and histology, to confirm our findings. Lastly, we aimed to describe the interactions of miRNAs and their targets as putative representatives of renal angiogenesis. Our long-term goal is to identify angiomiRs that may function in the angiogenesis pathway and could be used as potential targets for RCC therapy in the future.
2. Materials and Methods
2.1. Clinical Sample Collection
This study included patients admitted to the University of Debrecen, Department of Urology, for treatment of RCC between 2021 and 2023. Written informed consent was obtained from the medical Ethics Committee of the University of Debrecen (UD REC/IEC 4831-2017) prior to participation in the study. Tumorous specimens and adjacent normal kidney tissues were isolated from 20 patients with histologically proven kidney cancer who underwent surgical resection (mean age, 62 years; range, 46–78 years). From the collected cancer samples, all were diagnosed as primary tumors without any evidence of metastases. The clinicopathological data of the patients are shown in
Table 1.
Tumors were staged using the TNM staging system of the Union for International Cancer Control, and histological grade was determined according to World Health Organization criteria [
15]. Local invasion of the tumor cells was assessed using T staging, and lymphatic status was recorded as positive or negative. Due to the short investigation time period, follow-up with the patients was not considered. After the initial study metrics were collected, the tumor tissues were immediately frozen in liquid nitrogen and stored at −80 °C until further processing.
2.2. RNA Extraction and Quality Determination
Total RNA was extracted from tumorous kidney cancer and paired adjacent normal kidney tissues using the Qiagen RNeasy Mini isolation kit (Invitrogen, Life Technology, Carlsbad, CA, USA), according to the manufacturer’s protocol. RNA concentration and purity were determined by NanoDrop ND-1000 spectrophotometer (Nanodrop Technologies, Wilmington, DE, USA). An OD260/280 ratio of higher than 1.8 was assumed to be an indication of good RNA purity, thereby making it suitable for measuring gene expression. RNA integrity also was analyzed using the Agilent 2100 Bioanalyzer (Agilent Technologies, Santa Clara, CA, USA). Only RNA samples with 2.0 optical density at 260/230 nm were used for RT-PCR and further gene expression analyses. For further molecular biology analyses, RNA was stored at −80 °C.
2.3. TaqMan® miRNA Quantitative Real-Time PCR and Statistical Analysis
qRT-PCR was performed using TaqMan® microRNA assays (Life Technologies, Carlsbad, CA, USA). Complementary DNA (cDNA) for each miRNA of interest was synthesized from total RNA (5 ng) using the TaqMan® microRNA Reverse Transcription Reagents (Invitrogen, Life Technology, Carlsbad, CA, USA) and specific reverse transcription primers (Life Technologies, Carlsbad, CA, USA). Real-time PCR was performed with TaqMan® probes in a CFX-96 Real-time PCR System (Bio-Rad Laboratories Inc., Hercules, CA, USA) under the following conditions: denaturation at 95 °C for 10 min, followed by 40 repeating cycles of DNA polymerization at 95 °C for 30 s. The annealing step was performed at 60 °C for 1 min. All assays were performed in 96 well plates using triplicates. For each hsa-miR applied, the CT values were determined using the SDS software (version 3.1) with automatic baseline and threshold settings. RNU6 was used to normalize each target miRNA. The data were loaded into the R statistical environment (v.2.14.0, Applied Biosystem, Foster City, CA, USA) and preprocessed. Triplicate CT values were averaged and normalized to the geometric mean of RNU6, which was selected as an endogenous control based on geNorm27 and NormFinder (Department of Molecular Medicine (MOMA), Aarhus University Hospital, Aarhus N, Denmark). The normalized expression was calculated as log2|2−ΔCT|. CT values > 36 were considered to be below the limit of detection.
2.4. In Silico miRNA Analysis for Target and Pathway Prediction
In the case of hsa-miR-15b-5p, hsa-miR-99b-5p, and hsa-miR-181a-5p chosen for the study, based on literature data, an in silico study was carried out by comparing miRNA-specific targets with the help of 3 databases: miRDB, TargetScan, and Tarbase. A search for angiogenesis signaling pathway-related target proteins was the main purpose of this process. Based on the database screening results, we determined the miRNA-target interactions and performed enrichment analysis.
2.5. Tissue Lysate Preparation for Protein Array Analysis
Proteins from 8-8 adjacent tumorous and healthy renal cancer tissue samples were extracted with Lysis buffer 6 or Lysis buffer 17 (provided in the Proteome profiler Human Angiogenesis Array Kit (ARY007, Bio-Techne, McKinley, MN, USA). After incubating and rocking at 4 °C for 30 min, the samples were centrifuged at 14,000× g for 5 min, supernates were transferred into clean tubes and subjected to protein quantification. The total protein content of the samples was quantified by the Bradford Method. During isolation and quantification, samples were kept on ice to avoid degradation and stored at −80 °C.
For each membrane supplied in the kit, 300 µg of protein extract was used for Human Angiogenesis Array analysis. Proteins were mixed with a Detection Antibody Cocktail (supplied) and incubated at room temperature for one hour. The sample/antibody mixture was then added to the array membranes and incubated overnight at 4 °C. The next day, all of the membranes were washed with 1x Wash Buffer (supplied) three times, then incubated with Streptavidin-HRP at room temperature for 30 min on a rocking platform shaker. Following incubation, the arrays were washed three times with a washing buffer, and the signal of the protein spots was visualized by chemiluminescence measurement using the reagent supplied in the kit. ChemiDoc Imaging System (Bio-Rad, Hercules, CA, USA) was used for the membrane visualization and for the quantification of band density. The intensity score of each duplicated array spot was measured with the Image Lab software (version 5.2.1., Bio-Rad, Hercules, CA, USA), and the average intensity was calculated by subtracting the average background signal. The fold change was obtained by comparing the tumorous tissue samples with the normal samples (indicated as a value of 1). The identity and the respective coordinates of all antibodies on the arrays can be found in the
“Supplementary Material” provided in the kit (ARY007).
2.6. Reverse Transcription PCR (RT-PCR)
cDNA was synthesized from 250 ng of RNA from each sample using the Tetro cDNA Synthesis Kit (Bioline, London, UK) according to the manufacturer’s guidelines. The RT-PCR reaction was performed in a 20 μL volume using random hexamers (
Table S1). The run consisted of 35 cycles (95 °C for 15 s, 60 °C for 30 s, 72 °C for 10 s, and 72 °C for two minutes). To test for contamination, RT-NTC was incorporated into the reaction.
2.7. Quantitative Real-Time PCR (qRT-PCR)
qRT-PCR was conducted using the iTaqTM Universal SYBR
® Green Supermix (Bio-Rad Laboratories Inc., Hercules, CA, USA). The reaction was performed in a CFX-96 Real-Time System (Bio-Rad Laboratories Inc., Hercules, CA, USA) in a final volume of 20 µL. 10 min of preheating at 95 °C was followed by 45 cycles at 95 °C for 15 s and 60–65 °C for 1 min. The oligo sequences and the primer-specific annealing temperatures used for the real-time qPCR are listed in
Table S3 (each reaction was performed in triplicate). Following this, the relative value of mRNA was determined by the C
T technique using threshold cycle times for each mRNA. Triplicate C
T values were averaged and normalized to the average Cp mean of GAPDH, which were selected as endogenous control. The normalized expression was calculated as log2|2
−ΔCT|.
2.8. Statistical Analysis
2.8.1. Statistical Analysis of the Expression of hsa-miRNAs in Tumorous and Adjacent Healthy Kidney Cancer Tissues
Using the TaqMan miRNA assay (Life Technology, Carlsbad, CA, USA), hsa-miR-15b-5p, hsa-miR-99b-5p, and hsa-miR-181a-5p expression levels were quantified. For statistical analysis, two-way ANOVA with Sidak multiple comparison tests were used based on GraphPad Prism 9.5.1 for Windows (GraphPad Software Inc., La Jolla, CA, USA).
2.8.2. Statistical Analysis of the Correlation of the miRNAs Expression Level with Pathological Grades of the Patients
The relationship between the miRNA expression and the pathological grade of the patients was investigated in three ways, i.e., with and without identifying outliers (in the last case, using the ROUT method with two different levels of “aggressiveness”, Q = 1% and Q = 5%) in the miRNA expression data. For each dataset, the correlation coefficient (r) between variables (expression and grade) was calculated using Spearman’s (nonparametric) method. The precision of the correlation was characterized by a 95% CI of r. If the correlation was found to be statistically significant, linear regression was performed, and its precision was visualized by the 95% confidence bands around the related best-fit straight line.
The p value less than 0.05 was considered to be statistically significant. The levels of significant differences were the following: p < 0.05 (*), p < 0.0021 (**), p < 0.0002 (***), and p < 0.0001 (****). All statistical analyses were performed with GraphPad Prism 9.5.1 for Windows (GraphPad Software Inc., La Jolla, CA, USA) and Microsoft Excel 365 (Microsoft Co., Redmond, WA, USA).
4. Discussion
Angiogenesis is a complex process involving the synchronous activity of diverse pro- and anti-angiogenic factors [
5,
16,
17,
18]. It also plays a vital role in the development of RCC and its histotypes [
16,
19,
20]. The control mechanisms of angiogenesis in carcinogenesis are tightly regulated at the genetic and epigenetic levels [
16]. Gene silencing in cancer cells is mainly based on genetic variation. Epigenetic dysregulation can downregulate tumor suppressor genes or oncogene activation, playing an important role in tumor development in both the early and late stages [
16,
19,
20]. The whole regulatory mechanism of angiogenesis in RCC has not yet been extensively explored. The identification of dysregulated angiogenesis-associated genes, specific angiogenesis-related markers, and their regulating miRNAs is crucial for understanding their role in the regulation of the whole process in kidney cancer [
18,
19]. The miRNA expression profile of RCC determines new prognostic factors and serves as an explanation for the molecular mechanisms involved in disease development and progression [
2,
7]. Many of the main genes involved in the process of angiogenesis may be controlled by the activity of one or more miRNAs [
3]. Although a significant number of miRNAs have already been described in the literature, the association between miRNA expression profiles and the pathological status or prognosis of RCC has not yet been completely demonstrated [
2,
7,
13].
The roles of hsa-miR-15b-5p, hsa-miR-99b-5p, and hsa-miR-181a-5p in the process of angiogenesis also have not yet been fully elucidated. Our results that studied 20 kidney cancer and adjacent healthy control tissues clearly demonstrated that in all the samples examined, the miRNAs of interest were significantly downregulated in tumorous tissues compared to healthy adjacent pairs. A negative correlation between the expression level of miRNAs and the pathological grades of the patients was also supported by linear regression analysis. Overall, each of the miRNAs examined showed low expression in all tissue grades (grades 1, 2, and 3). In this regard, our results were consistent with studies of Redova et al., where TaqMan low-density arrays were used to identify differentially expressed miRNAs in tumorous and adjacent normal tissues of patients diagnosed with ccRCC: 73 miRNAs were downregulated, and 5 miRNAs were upregulated in tumors [
13]. Tumorous and adjacent normal tissues of patients with ccRCC have shown that miRNAs, like miR-221, miR-222, miR-130a, let-7f-1, miR-27b, miR-378, miR-210, miR-15a, miR-16-1, and miR-126 are involved in angiogenesis [
4,
7].
Looking at each of the miRNAs tested separately, we found significant downregulation of hsa-miR-15b-5p. These findings are consistent with a report made by Kumar et al., 2022 in which the tissues of patients diagnosed with non-small cell lung cancer (NSCLC) were observed to have a significant downregulation of miR-15a-5p [
21]. Kao et al., 2017 demonstrated that miR-15a directly regulate the expression of Programmed Cell Death-Ligand 1 (PD-L1) in malignant pleural mesothelioma [
22]. Other reports also described the tumor suppressor role of miR-15a [
21,
22,
23,
24]. Kumar et al. 2022 showed that extracellular vesicles overexpressing miR-15a inhibited the immune evasion of colorectal cancer cells via the Lysine-specific demethylase 4B/Homeobox protein Hox-C4/Programmed death-ligand (KDM4B/HOXC4/PD-L1) axis [
21].
In our study of tumorous kidney tissue samples, hsa-miR-99b-5p was also significantly downregulated compared to healthy adjacent paired samples. These results are consistent with the findings of Cui et al. (2012), who reported that miR-99a was remarkably downregulated in RCC, resulting in a low expression level of miR-99a, which correlated with poor survival of patients with RCC [
4,
7].
Hsa-miR-181a-5p has previously been shown to play a vital role in cancers [
25]. In the current study, analysis of hsa-miR-181a-5p showed a clear downregulation in adjacent tumorous samples, which is consistent with previous studies that demonstrated the downregulation of miR-181a-5p in aggressive human breast and colon cancers, whereas its expression level was inversely correlated with MMP-14 expression level [
25,
26].
The study of Yulin Lai et al. [
25] demonstrated that miR-181a-5p is upregulated in RCC tissues and cell lines and is associated with cell migration, proliferation, and apoptosis in RCC. Thus, miR-181a-5p may function as an oncogene or tumor suppressor via one or more signaling pathways in certain types of tumors [
25,
26].
Angiogenesis is a multistage process where new blood vessels develop from pre-existing vessels as a result of an angiogenic stimulus [
5,
25]. In addition, the reduced oxygen concentration induces the accumulation of HIF and leads to the increased expression of VEGF. Accumulation of HIF, VEGF, PDGF, and FGF is associated with increased angiogenesis and the metastatic potential of RCC [
4,
7,
16,
18,
27,
28]. Upon binding to its receptors, VEGFR-1, VEGFR-2, and VEGFR-3, VEGF-A mediates intracellular signaling mechanisms in ECs. VEGFR-2 has been mainly attributed to angiogenesis, while VEGFR-1 inhibits angiogenic processes by maintaining VEGFR-2 levels. VEGFR-3, a receptor for VEGF-C, is involved in vascularization in the early embryonic phase. (
Figure 8) [
2]. The expression of all three receptors in analyzed samples is one of the results that may underline the ongoing angiogenesis [
2,
12,
29].
The expression of VEGF also promotes the dysregulation in the expression of further angiogenesis-related genes, such as MMPs and their inhibitor proteins, TIMP-1 and TIMP-2. VHL/HIF1 signaling leads to increased levels of cyclic adenosine monophosphate (cAMP) response element binding protein (CREB), a transcription factor that upregulates the expression of pro-angiogenic miRNAs by promoting the expression of VEGF [
2,
4,
12,
29,
30,
31,
32,
33].
In silico analysis of three distinct miRNA databases clearly revealed common targets that might play a role in angiogenesis: HIF-1α, VEGF, FGF-1, MMPs, and TIMPs [
34] (
Figure 9). In our study, the expression of these targets was screened at the protein level and analyzed at the mRNA level. Reduced oxygen concentration primarily induces the accumulation of HIF1-α and leads to the increased expression of VEGF-A [
2,
29,
31,
34]. In the human RCC specimens investigated, we observed a significant increase in the expression of VEGF-A in tumorous tissues compared to adjacent healthy tissue samples. This increase correlates with the increased expression of related proteins, like ANG, which also intensively contributes to kidney cancer angiogenesis [
35]. Based on these results, we postulate that in the samples studied, the initial steps of angiogenesis would not particularly be controlled by miRNAs, but rather, the hypoxic environment induces the expression of the tested miRNAs. We assume that through miRNA-target interaction, the increased VEGF-A and HIF-1α levels directly regulate the expression of the miRNAs analyzed. This increase could be the main reason behind miRNA downregulation [
26]. The downregulated miRNAs, hsa-miR-15b-5p, hsa-miR-99b-5p, and hsa-miR-181a-5p, through specific miRNA-target interactions may later take over the role of epigenetic regulation of angiogenesis in early primary tumors (
Figure 9). We also hypothesize that the tested miRNAs possibly function as angiomiRs, promoting the progression of angiogenesis through the formation of new vessels [
4,
8,
23]. Most likely, a specific interaction of all three studied miRNAs with potent inducers of angiogenesis, such as ANG and VEGF, might lead to the development of new blood vessels. They interact with endothelial and smooth muscle cells, which allow them to infiltrate, proliferate, and form tubular structures (
Figure 8 and
Figure 9) [
2,
29,
32,
33,
34,
36]. Considering the expression pattern of VEGF in the examined samples, we may assert that mainly the upregulated VEGF could be a key regulator in the formation of new blood vessels and downregulation of miRNAs [
2,
29]. According to Chun-Yan Sun [
9], hsa-miR-15a acts as a putative tumor suppressor by targeting the oncogene B-cell lymphoma (BCL-2), which has been implicated in apoptosis and proliferation. It was shown that ectopic overexpression of miR-15a led to decreased pro-angiogenic activity of cancer cells, and miR-15a plays a substantial role in the tumorigenesis, at least in part, by the modulation of angiogenesis through targeting VEGF-A [
9]. The relationship between the expression of Programmed cell death 1 ligand 1 (PD-L1) and VEGF, MMP-9, and KI-67 was studied earlier in glioma [
8,
23]. The expression rate of PD-L1 positively correlated with the tumor grade and VEGF status, suggesting that PD-L1 has a function in angiogenesis and proliferation [
24]. Many other studies have reported that lower expression of miR-15a correlates with poor prognosis in many types of cancer [
21]. It has also been demonstrated that the deregulation of miR-99a is involved to a certain extent in the biology of RCC by directly targeting the mTOR pathway. This suggests that miR-99a could be a promising target for diagnostic and therapeutic purposes in RCC [
4,
23,
24,
27].
Hypoxia-inducible factor-1α, another key player in vasculature formation, upregulates other pro-angiogenic factors, which showed a higher expression in tumorous tissues compared to normal adjacent tissue samples in our study. We can assume that the miRNAs examined contribute to the sprouting process of angiogenesis, and additionally, the expression of these miRNAs would lead to increased expression of VEGF and HIF-1α [
8,
34]. Nevertheless, hypoxia plays a key role in angiogenesis by decreasing the degradation of the transcription factor HIF-1α by ubiquitination, resulting in the induction of the expression of pro-angiogenic factors, e.g., VEGF-A [
2,
36].
During angiogenesis, new blood vessels develop from the existing endothelial lined vessels, contributing to the degradation of the vascular basement membrane and remodeling of the extracellular matrix (ECM), which is aided by the participation of MMPs. Specific MMPs enhance angiogenesis by helping detach pericytes from vessels undergoing angiogenesis. In addition, MMPs can also contribute negatively to angiogenesis through the generation of endogenous angiogenesis inhibitors [
2,
29,
37,
38].
In our study, we observed the co-expression of specific MMPs and TIMPs, namely MMP-9/MMP-2 and TIMP-1/TIMP-2. Regarding MMPs, a slight decrease was observed in the expression of MMP-9, and the level of TIMP-1 was increased; however, lower levels of MMP-2 and TIMP-2 were detected in tumorous tissues compared to adjacent healthy tissue samples. MMPs have been suggested to participate in disruption, tumor neovascularization, and the development of metastases. On the other hand, tissue inhibitors of metalloproteinases (TIMPs) inhibit MMPs’ activity [
31,
38].
Considering the whole process of angiogenesis in the RCC samples studied, the pathway associated with the actions of MMPs may be due to hsa-miR-15b-5p, hsa-miR-99b-5p, hsa-miR-181a-5p as they exert their role in their interactions as tumor suppressors with MMPs, especially with MMP-9 and MMP-2 (
Figure 9). With the formation of a new vascular basement membrane and remodeling of the ECM taking place during angiogenesis in RCC, miRNAs might play a specific role in the degradation of the extracellular matrix, thus inhibiting new vessel formation [
2,
15,
18,
29].
Earlier studies have shown that upregulation of specific MMP, such as MMP-14 (MT1-MMP), is associated with poor prognosis in cancer patients. It was also indicated that in aggressive human breast and colon cancer, miR-181a-5p was significantly downregulated, and its levels were inversely correlated with the expression of MMP-14. In clinical specimens, higher MMP-14 expression was observed at the invasive front of tumors where miR-181a-5p was already downregulated relative to adjacent normal cells [
26]. We may also assume that similarly to the study by Yiyi [
26], miRNAs examined in our study slightly decrease the expression level of MMP-9. The increased level of TIMP-1 inhibits the activity of MMPs, while the low level of TIMP-2 most likely tries to stabilize the activity of MMPs, promoting ahead cell invasion and angiogenesis [
2,
26,
29]. It is also worth noting that all these [
12,
24] assumptions would be fulfilled in the case of developed metastases of RCC. However, nephrectomy and resection of the tumorous part of the kidney diagnosed with RCC would prevent patients from developing this pathological stage.
In the literature, it was also found that hsa-miR-181a expression is upregulated in gliomas [
8,
14,
15]. In a previous study connected to human colorectal carcinoma (CRC), a high miR-181a expression level was significantly related to the worse survival of colorectal carcinoma patients and was negatively associated with the overall survival of CRC patients with advanced liver metastases [
8,
26]. All of these findings suggest that the miRNAs examined in this study regulate the process of angiogenesis through their putative targets, which affects the clinical outcome of the patients. This assumption is supported by the statistical correlation observed between miRNAs and the pathological grades of patients in our investigation.
In summary, comparing our results with earlier findings that are already well established, we conclude that the miRNAs examined in our study might have a possible tumor suppressor role. However, the downregulation of studied miRNAs connects them through specific targets to the pathway that initiates angiogenesis in primary kidney cancer tissues.