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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Nat Cell Biol. Author manuscript; available in PMC 2014 April 15.
Published in final edited form as:
PMCID: PMC3987945

The Hippo pathway in organ size control, tissue regeneration and stem cell self-renewal


Precise control of organ size is crucial during animal development and regeneration. In Drosophila and mammals, studies over the past decade have uncovered a critical role for the Hippo tumour-suppressor pathway in the regulation of organ size. Dysregulation of this pathway leads to massive overgrowth of tissue. The Hippo signalling pathway is highly conserved and limits organ size by phosphorylating and inhibiting the transcription co-activators YAP and TAZ in mammals and Yki in Drosophila, key regulators of proliferation and apoptosis. The Hippo pathway also has a critical role in the self-renewal and expansion of stem cells and tissue-specific progenitor cells, and has important functions in tissue regeneration. Emerging evidence shows that the Hippo pathway is regulated by cell polarity, cell adhesion and cell junction proteins. In this review we summarize current understanding of the composition and regulation of the Hippo pathway, and discuss how cell polarity and cell adhesion proteins inform the role of this pathway in organ size control and regeneration.

Organ size regulation is a highly coordinated process involving complex mechanisms in response to physiological cues. On the organismal level, circulating factors such as hormones and insulin-like growth factors (IGF) play important roles in promoting organ size1. In contrast, physiological perturbations, such as prolonged starvation, cause profound reduction of organ size1. Additionally, an intrinsic mechanism limits organ size, which was first demonstrated in salamander limbs by classical transplantation experiments1. The underlying mechanism of organ-autonomous size determination remained largely unknown until the past decade. Extensive research led to the identification of the Hippo tumour-suppressor pathway as a key regulator of organ size in Drosophila and mammals2. It is also known that mutations of genes that are involved in patterning, cell polarity and cell adhesion cause marked alternations of organ size3. Thus, the recent finding that the Hippo pathway is regulated by cell polarity and cell adhesion proteins is a promising basis for the potential crosstalk of the Hippo pathway and cell polarity proteins in the regulation of organ size4. Several studies have also demonstrated important roles for the Hippo pathway in stem cell/progenitor cell expansion and tissue regeneration513. These findings will be discussed here.

The Hippo pathway in Drosophila

In Drosophila, the first core components of the Hippo pathway to be identified, using genetic mosaic screens, were the tumour-suppressor genes warts (wts)14,15, hippo (hpo)1620 and salvador (sav)21,22. These genes belong to the hyperplastic group of Drosophila tumour-suppressors. Mutation of these genes results in robust tissue overgrowth without alteration of cell fate determination or cell polarity. Biochemical studies revealed that Hpo directly interacts with Sav to phosphorylate and activate the complex formed by Wts and another core Hippo pathway protein, Mats16,23 (Fig. 1a). The kinase activity of Hpo is antagonized by a PP2A phosphatase complex, dSTRIPAK24. The Hippo pathway is known to limit organ size partly by transcriptional regulation of cyclin E and diap1 (refs 16,17,20,21,23), suggesting the existence of a transcriptional regulator as a downstream effector of the pathway. By performing a yeast two-hybrid screen using Wts as bait, the transcription co-activator Yorkie (Yki) was identified as a potent effector of the Hippo pathway25. Subsequent biochemical studies showed that Wts directly phosphorylates and inhibits Yki26.

Figure 1
The Hippo pathway in Drosophila and mammals. Corresponding proteins in Drosophila (a) and mammals (b) are indicated by matching colours. Arrowed or blunted ends indicate activation or inhibition, respectively. Dashed lines indicate unknown mechanisms. ...

Research in the past years has uncovered many proteins that act upstream in the Drosophila Hippo pathway. Two apical cytoskeleton-binding proteins, Merlin (Mer) and Expanded (Ex)27, and their interacting protein Kibra2830, were found to activate the Hippo pathway. The Fat protocadherin, a cell-surface molecule, was also identified as an upstream regulator of the Hippo pathway3135. Fat activity is regulated by binding to another protocadherin, Dachsous (Ds)36, and is modulated by several proteins, such as the casein kinase Discs overgrown (Dco)37,38, the Golgiresident kinase Four-jointed (Fj)3941 and the Fat/Ds-interacting protein Lowfat (Lft)42. Fat/Hippo pathway activity may also be influenced by Decapentaplegic (Dpp) and Wingless (Wg) morphogen gradients40,41,43, which affect the expression of Fj and Ds. It has been proposed that Fat activates the Hippo pathway by regulating the protein level and localization of the protein Ex3133,35. Another study suggests that Fat may control the abundance of Wts through Dachs34,44. Recently, dJub, a LIM-domain-containing protein that physically interacts with Wts and Sav, was shown to negatively regulate Hippo signalling, although the detailed mechanism has not been delineated45. A number of proteins that determine cell polarity were also found to regulate the Hippo pathway. These include the Scribble (Scrib)–Discs large (Dlg)–Lethal giant larvae (Lgl) complex, atypical protein kinase C (aPKC) and Crumbs (Crb)4649, indicating a role of cell polarity in the regulation of Hippo signalling.

The Hippo pathway in mammals

The core components and downstream effectors of the Drosophila Hippo pathway are highly conserved in mammals: Mst1/2 (homologues of Hpo), Sav1 (Sav homologue), Lats1/2 (Wts homologues), MOBKL1A and MOBKL1B (collectively referred to as Mob1; homologues of Mats), and YAP and its paralogue TAZ (also called WWTR1; homologues of Yki) (Fig. 1b). Expression of human YAP, Lats1, Mst2 and Mob1 can rescue the phenotypes of their corresponding Drosophila mutants in vivo16,23,25,50. The core components Mst1/2 are pro-apoptotic kinases that are activated by caspase cleavage under apoptotic stress51. Sav1 interacts with Mst1/2 through the SARAH domains present in both Sav1 and Mst1/2 (ref. 52). Although Sav1 has been shown to activate Mst1/2, the underlying mechanism is unclear, but might involve regulation of Mst1 nuclear translocation53. Mst1/2 is also activated by binding to Ras association domain family (RASSF) proteins54, possibly owing to alteration of Mst1/2 subcellular localization55. In Drosophila, however, dRASSF inhibits Hpo possibly through competition with Sav for Hpo binding56 and through recruitment of the dSTRIPAK–PP2A complex24. Activation of Mst1/2 leads to phosphorylation and activation of their direct substrates, Lats1/2 (ref. 57). Mob1, which forms a complex with Lats1/2, is also phosphorylated by Mst1/2, resulting in an enhanced Lats1/2–Mob1 interaction58. Activated Lats1/2 in turn phosphorylate and inhibit YAP/TAZ transcription co-activators26,5962.

Functions of the Hippo pathway in organ size determination and tumour suppression have been confirmed in genetically engineered mouse models. For instance, liver-specific overexpression of YAP results in enlarged livers that return to their normal size after cessation of YAP expression12,26. However, sustained YAP overexpression leads to tumour formation26. Genomic amplification of YAP is also observed in human cancers and a mouse model of breast cancer63,64. Furthermore, elevated YAP protein levels and nuclear localization have been observed in multiple human cancers59,63,65, and the alterations of YAP may have prognostic value for certain human cancers66. Overexpression of TAZ, the paralogue of YAP, has been noted in human breast cancer samples and non-small-cell lung-cancer cell lines67,68. Ablation of the Hippo pathway components Mer and Sav and double knockout of Mst1/2 in mice also result in liver enlargement and tumour formation6974. Remarkably, loss of one or both copies of YAP can suppress liver expansion and tumorigenesis induced by Mer deficiency69. Aberrant Mst1/2 and Lats1/2 expression and Lats2, Sav1 and Mob1 mutation were also observed in human cancers or cancer cell lines2. Together, these studies highlight a significant role of the Hippo pathway in organ size regulation and tumorigenesis.

Mechanisms of YAP/TAZ/Yki inhibition

Activation of the Hippo pathway leads to phosphorylation and inhibition of YAP, TAZ and Yki transcription co-activators. In mammals, YAP and TAZ are phosphorylated by Lats1/2 in vitro and in vivo59,60,75. The mechanism of inhibition by Hippo signalling involves phosphorylation of Ser 127 in YAP or the corresponding sites in TAZ and Yki, which promotes 14-3-3 binding and subsequent cytoplasmic sequestration and inactivation26,59,60,62,76 (Fig. 2a). Indeed, mutation of Ser 127 and disruption of 14-3-3 binding activate YAP59, confirming the inhibitory nature of this phosphorylation. In Drosophila, Yki phosphorylation on two other sites by Wts similarly results in Yki inhibition, although the mechanism is yet to be determined77.

Figure 2
Mechanisms of YAP/TAZ/Yki inhibition by the Hippo pathway. (a) Phosphorylation-dependent cytoplasmic retention. Phosphorylation of YAP on Ser 127 by Lats1/2 induces 14-3-3 binding and cytoplasmic retention of YAP. The mechanism is conserved in TAZ and ...

Phosphorylation of YAP can also induce its degradation. Lats1/2 phosphorylates YAP at Ser 381, which primes YAP for subsequent phosphorylation by another kinase, possibly casein kinase 1 (CK1δ/ε), activating a phosphorylation-dependent degradation motif termed a phosphodegron. Subsequently, the E3 ubiquitin ligase SCFβ–TRCP is recruited to YAP, leading to its polyubiquitylation and degradation75 (Fig. 2c). Consistently, decreased YAP phosphorylation in sparsely cultured NIH-3T3 cells, as well as in Mst1/2-deficient mouse liver, correlates with increased YAP protein levels73,75. This mechanism is conserved in TAZ but not in Yki78, which lacks a residue equivalent to Ser 381.

YAP, TAZ and Yki can also be inhibited through protein–protein interactions that result in their cytoplasmic sequestration (Fig. 2b). Yki contains two WW domains that can interact with PPXY motifs present in Mop79 and the Hippo pathway components Ex, Wts and Hpo80,81. Recently, YAP/TAZ and angiomotin (AMOT) family proteins were shown to interact8285, resulting in YAP/TAZ localization to tight junctions and inhibition through phosphorylation-dependent and -independent mechanisms82. In addition, YAP and TAZ interact with another tight junction protein ZO-2, which was reported to increase nuclear localization of YAP and tight-junction localization of TAZ86,87. It will be important to investigate the relationship between phosphorylation and these physical interactions in YAP regulation, and whether disruption of these interactions alters organ growth.

Transcriptional regulation of Hippo pathway target genes by YAP, TAZ and Yki

The TEAD family transcription factors were found to be critical partners of YAP and TAZ in the regulation of gene expression (the Drosophila TEAD homologue Scalloped (Sd) is partner of Yki)8892. Knockdown of TEADs or disruption of the YAP–TEAD interaction abolishes YAP-dependent gene transcription and largely diminishes YAP-induced cell proliferation, oncogenic transformation and the epithelial-to-mesenchymal transition (EMT)88. In Drosophila, Sd was shown to genetically interact with Yki and to be required for Yki-induced target gene expression in vivo88,89,91,92. Intriguingly, a mutation of TEAD1 Tyr 406, which forms a hydrogen bond with YAP, results in loss of interaction with YAP and leads to the human genetic disease Sveinsson’s chorioretinal atrophy9396. Precise regulation of YAP–TEAD interaction is therefore important in maintaining normal physiology.

Several direct target genes of YAP–/TAZ–TEAD and Yki–Sd have been identified, including CTGF and Cyr61 in mammalian cells88,97, and diap1 and dMyc in Drosophila89,91,98,99. CTGF was shown to have an important role in YAP-induced proliferation and anchorage-independent growth88. In Drosophila, diap1 is essential for Yki-induced overgrowth, but is not sufficient to explain all Yki phenotypes. Recently, Yki–Sd was shown to induce transcription of dMyc, a potent promoter of ribosome biogenesis and cell growth98,99. dMyc expression also mediates a cell phenomenon induced by imbalance of Hippo pathway activity, referred to as cell competition — wherein the contact between fast- and slow-growing cells in genetic mosaics favours the positive selection and clonal expansion of fast-dividing cells at the expense of slow-dividing cells98,99. YAP also induces Myc in transgenic mouse liver26, although the mechanism remains to be investigated.

Despite a major role for TEADs in YAP/TAZ function, other transcription factors containing PPXY motifs are known to interact with the WW domains of YAP/TAZ. These include Smad1, RUNX, ErbB4 and p73 for YAP100104, and RUNX, PPARγ, Pax3, TBX5 and TTF-1 for TAZ105109. The interaction of YAP with Smad1 is believed to be important for BMP-mediated maintenance of pluripotency of mouse embryonic stem cells104. YAP and TAZ also bind Smad2/3 through the coiled-coil region, and this interaction is believed to dictate the subcellular localization of Smad2/3 (refs 85,110). YAP also interacts with p73, a p53 family pro-apoptotic transcription factor, to induce expression of genes such as Bax, puma and PML111. However, there are contradictory reports on the role of the Hippo pathway in activating112 or inhibiting61 this activity. Recently, YAP was also shown to interact with β-catenin and induce expression of canonical Wnt target genes such as Sox2 and Snai2 in mouse heart tissue113.

bantam microRNA is a target gene of the Hippo pathway and promotes cell survival and proliferation114,115. Homothorax (Hth) and Teashirt (Tsh) are two transcription factors mediating bantam expression anterior to the morphogenetic furrow116. In addition, the expression of bantam is also directly induced by a transcriptional complex formed by Yki and Mad, an effector of the Drosophila Dpp signalling pathway117. The existence of a bantam counterpart and the functions of Hth and Tsh homologues in the Hippo pathway in mammals remain to be investigated.

YAP, TAZ and Yki also induce many other genes directly or indirectly. In Drosophila, Yki induces: cycE (ref. 21) and E2F1 (ref. 92), which may be involved in cell-autonomous regulation of cell proliferation; the EGFR (epidermal growth factor receptor) ligands Vein, Keren and Spitz11,118 and the Jak–Stat pathway ligands Unpaired1/2/3 (Upd1/2/3)811, which might mediate non-cell-autonomous functions of the Hippo pathway; and the Hippo pathway genes Ex, Kibra, Crb, and Fj27,29,34,119, which may constitute a signal feedback loop. In mammals, YAP and TAZ also induce the expression of AREG118 and FGF1 (ref. 60), which may also mediate non-cell-autonomous functions of the Hippo pathway. However, the mechanisms underlying the induction of these genes, including the responsible transcription factors, are mostly unclear.

Regulation of the Hippo pathway by cell polarity and cell adhesion complexes

In Drosophila, mutations of several genes that are involved in cell polarity and cell junction lead to massive overgrowth. The Dlg–Lgl–Scrib protein complex localizes to the basal–lateral membrane of epithelial cells, where it is required for the lateral exclusion of apical proteins, including the Par3–Par6–aPKC complex and the Crb–Stardust (Sdt)–PATJ complex. Interestingly, Lgl mutations lead to nuclear translocation of Yki and upregulation of Hippo pathway target genes in Drosophila epithelium47. Expression of dominant-negative aPKC rescued the tissue overgrowth in Lgl-mutant tissues47. In zebrafish, Scrib was shown to interact genetically with and suppress the activity of the YAP homologue during embryonic kidney development120. The tumour-suppressor function of the Dlg–Lgl–Scrib complex is possibly conserved in mammals, as depletion of Scrib in mammary epithelium results in disruption of apoptosis inhibition by cell polarity, and induction of dysplasia in vivo that progresses to tumours after long latency121. It would be interesting to determine whether the mammalian Hippo pathway mediates the tumour-suppressor function of the Dlg–Lgl–Scrib complex.

Crb is another cell polarity protein that regulates the Drosophila Hippo pathway46,48,49. The intracellular domain of Crb contains a juxtamembrane FERM-binding motif (FBM) and a carboxy-terminal PDZ-binding motif (PBM). The PBM is important for polarity formation122, whereas the FBM regulates Hippo-pathway-dependent proliferation and apoptosis by promoting apical localization of the upstream component Ex46,48,49. Thus, Crb regulates cell polarity and tissue growth through distinct mechanisms. In addition, it seems that the functions of the Dlg–Lgl–Scrib complex in cell polarity and tissue growth are also separable47,123. It is therefore important to determine whether, and how, the two functions of these proteins are coupled to regulate tissue homeostasis.

In mammalian cells, Hippo pathway activation is triggered in part by cell–cell contact. In tissue culture, high cell density induces YAP phosphorylation and cytoplasmic translocation59. And in mouse blastocysts, YAP is nuclear in outer layer cells, and cytoplasmic in the inner blastocyst layer cells124. Consistently, it has been observed that disruption of cell–cell junctions in epithelium results in the nuclear localization of YAP and TAZ85. Collectively, these studies suggest that maintenance of cell–cell junctions is important for mammalian Hippo pathway function.

Recent studies shed some light into the mechanisms of YAP/TAZ regulation by cell–cell contact. First, a tight-junction protein complex, composed of the AMOT family proteins, PALS1, PATJ/MPDZ and Lin7, was found to interact with YAP and TAZ8285. This interaction inhibits YAP and TAZ by promoting their localization to tight junctions and their phosphorylation by the Hippo pathway. In addition, α-catenin was shown to interact with YAP125,126, possibly through a 14-3-3 protein, in a phosphorylation-dependent manner126. This interaction may prevent YAP dephosphorylation by PP2A and results in YAP inhibition126. Thus, it is possible that the tight junction and adherens junction are critically important for relaying cell contact signals to the Hippo pathway. Such a hypothesis needs to be further investigated.

The Hippo pathway in tissue regeneration, and stem cell self-renewal and expansion

The Hippo pathway was initially thought to limit organ size by inhibiting proliferation and promoting apoptosis1620. However, emerging evidence suggests that the Hippo pathway may also regulate stem cell and progenitor cell self-renewal and expansion. For instance, YAP and TAZ regulate embryonic stem cell self-renewal in response to TGFβ/BMP (transforming growth factor beta/bone morphogenetic protein) signalling104,110. In addition, YAP is inactivated during mouse embryonic stem cell differentiation and activated in induced pluripotent stem (iPS) cells5. YAP knockdown in mouse embryonic stem cells leads to loss of pluripotency, whereas ectopic expression of YAP prevents embryonic stem cell differentiation5.

Additionally, the Hippo pathway also regulates tissue-specific progenitor cells. YAP expression is generally restricted to the progenitor cells in normal mouse intestines, and transgenic expression of YAP in mouse intestines causes a marked expansion of the progenitor cell compartment12. Activation of YAP–TEAD also results in the expansion of neural progenitor cells in a chicken neural tube model13. Similarly, YAP expression expands basal epidermal progenitors in mouse skin and inhibits their terminal differentiation127. In contrast, conditional knockout of YAP or knock-in of a TEAD-binding-deficient YAP mutant in mouse skin leads to decreased proliferation of basal cells, thinner epidermis and failure of skin expansion126. Consistently, adult liver stem cells known as oval cells accumulate in Mst1/2-, Sav1- and Mer-knockout mice liver7073. It should be noted that these genetic manipulations are applied at the whole organ level and not specifically to the progenitor cell compartment. However, the contribution of progenitor cell expansion in YAP-induced organ overgrowth is likely to be tissue-dependent. For instance, overgrown hearts induced by Sav1 knockout showed excessive proliferation in cardiomyocytes but normal proliferation level of cardiac progenitors113. In addition, in certain cancers, such as a subtype of medulloblastomas, YAP expression is highly elevated in the perivascular cancer stem cell compartment128.

The Hippo pathway was recently shown to be involved in tissue regeneration. In the Drosophila midgut, Yki expression is largely restricted to intestinal stem cells (ISC)10. Under resting conditions, Yki is mostly localized to the cytoplasm and seems to be inactive10. In contrast, Yki displays increased nuclear localization and reporter activity, and has an important and cell-autonomous role in ISC proliferation in response to injury9,10. Interestingly, the Hippo pathway also has a non-cell-autonomous function during regeneration8,9,11. In response to damage, the Hippo pathway is inactivated in enterocytes, a differentiated cell type in the Drosophila midgut, resulting in Yki activation and subsequent expression of Upd1/2/3 (refs 8,9,11), as well as EGFR ligands11. This results in increased ISC proliferation in a non-cell-autonomous manner. Yki activation in enterocytes and in wing discs (where Yki also plays a role in regeneration6) seems to involve JNK signalling8,129.

In mammals, there is also evidence for a role of YAP in tissue regeneration. Intestinal damage markedly induces YAP expression, and loss of YAP severely impairs dextran sodium sulfate-induced intestinal regeneration7. In the mouse liver, Yap knockout causes a defect in bile duct development69. Interestingly, most adult mouse biliary ductal epithelial cells express Sox9 and these cells make a significant contribution to liver regeneration after injury as shown by lineage tracing130. It remains to be determined whether ablation of YAP also results in compromised liver regeneration, and more importantly, whether the Hippo pathway activity is regulated during regeneration in mammals.

Conclusions and perspectives

Extensive studies in the past decade have elucidated the importance of the Hippo pathway in organ size control and regeneration in both Drosophila and mammals. Several mechanisms have been proposed, and it is clear that cell adhesion and polarity complexes play a key role in Hippo pathway regulation. YAP and Yki may promote organ size and regeneration by inducing stem cell and progenitor cell proliferation through both cell-autonomous and non-cell-autonomous mechanisms (Fig. 3a). In addition, inactivation of the Hippo pathway may block cell-cycle exit, leading to hyperplasia and differentiation defects53 (Fig. 3b). The Hippo pathway can also inhibit proliferation and promote apoptosis in non-stem cells/non-progenitor cell types (Fig. 3c). Lastly, an imbalance of Hippo pathway activity in neighbouring cells may induce cell competition through differential expression of dMyc in Drosophila98,99 (Fig. 3d). How these mechanisms fit into organ size regulation and regeneration in vivo is yet to be determined.

Figure 3
Mechanisms of the Hippo pathway in regulation of organ size and regeneration. Hexagons denote differentiated cells and circles denote stem/progenitor cells. Blue colour indicates wild-type and yellow colour indicates Hippo-pathway mutant cells. (a) Hippo ...

Despite these insights into the critical role of this pathway in stem cell expansion and tissue regeneration, many important questions await answers. These include the role and mechanism of cell polarity and cell adhesion proteins in sensing organ size to regulate the Hippo pathway and the position of the Hippo pathway in the known signalling networks regulating cell proliferation, apoptosis and stem cell function. In addition, the mechanism by which upstream regulators of the Hippo pathway are integrated to initiate or terminate signalling is not yet fully understood. Importantly, Hippo pathway dysregulation in cancer remains to be fully elucidated. The Hippo–YAP pathway holds great promise as a target in cancer therapy and regenerative medicine. Insights into the upstream regulators and downstream targets of this pathway, and their mechanism of regulation, are crucial in translating our basic knowledge of this pathway into therapeutic designs.


We apologize for those primary works that we could not cite due to space constraints. Research in the lab of K.L.G. is supported by grants from NIH and CIRM.



The authors declare that they have no competing financial interests.

Contributor Information

Bin Zhao, Life Sciences Institute, Zhejiang University, Hangzhou, Zhejiang 310058, China. Department of Pharmacology and Moores Cancer Center, University of California at San Diego, La Jolla, California 92093-0815, USA.

Karen Tumaneng, Department of Pharmacology and Moores Cancer Center, University of California at San Diego, La Jolla, California 92093-0815, USA.

Kun-Liang Guan, Department of Pharmacology and Moores Cancer Center, University of California at San Diego, La Jolla, California 92093-0815, USA.


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