BackgroundAngiogenesis and sorafenib resistance are the main obstacles to the treatment of advanced/recurrent hepatocellular carcinoma (HCC).MethodsThree HCC cell lines, HepG2 and Hep3B, and sorafenib-resistant HuH7, and xenografts in nude mice were used as experimental models. A cohort of 126 HCC patients and a cohort of 34 advanced recurrent HCC patients receiving sorafenib therapy were used to indicate the clinical significance.ResultsMortalin regulated the phosphorylated-modification of cancer associated proteome, causing the angiogenesis and sorafenib resistance in HCC cells. For one of the molecular mechanisms, via regulating the PI-3K/Akt, mortalin activated the VEGF/VEGFR2 and β-Catenin/Bcl-XL/anti-apoptosis signaling. Treatment the sorafenib resistant xenografts with sorafenib combining with mortalin knockdown facilitated the sorafenib-inhibited tumor growth and angiogenesis, and enhanced the apoptosis. Mortalin was a potential risk factor of HCC, predicting poor prognosis and sorafenib resistance. We finally revealed that, caffeic acid (CaA, C9H8O4) could bind to and induce the ubiquitination degradation of mortalin, leading to the inhibition of PI-3K/Akt, VEGF/VEGFR2, and β-Catenin/Bcl-XL/anti-apoptosis signal pathways.ConclusionsMortalin, which regulated the phosphorylated-modification of cancer associated proteome, caused angiogenesis and sorafenib resistance, and was a competitive risk factor of HCC. CaA could be recognized as a novel chemical inhibitor, targeting mortalin in HCC.