Similarly, in hepatocellular carcinoma (HCC), hypoxia-induced integrin β4 (ITGB4) activates the TGF-β/Smad pathway, promoting lactate secretion that transforms hepatic stellate cells (HSCs) into CAFs marked by elevated α-SMA and vimentin expression [81]. This evidence concerns the gene ITGB4 and hepatocellular carcinoma.