Indirectly via upregulation of the expression of platinum resistance related genes: such as signaling genes, DNA repair enzymes, drug efflux transporters, and EMT transcription factors. (17)Increases glycolysis and acidic waste production, which results in increased multidrug transporter expression and cisplatin resistance. Knockdown of HIF-1a reduces cisplatin resistance by redirecting aerobic glycolysis in resistant cancer cells towards mitochondrial oxidative phosphorylation, leading to cell death through overproduction of reactive oxygen species (ROS). (19). This evidence concerns the gene HIF1A and cancer.