Topic: Exosomes and Cancer Drug Resistance

Despite significant advances in cancer therapy, drug resistance remains a major barrier leading to treatment failure and disease recurrence. While intrinsic resistance mechanisms within cancer cells have been extensively studied, the crucial role of the tumor microenvironment and intercellular communication is increasingly recognized. Exosomes–small, membrane-bound extracellular vesicles–have emerged as key mediators in this complex network. By shuttling diverse molecular cargos (including proteins, nucleic acids, and lipids) among tumor cells, stromal components, and immune cells, exosomes help create a microenvironment that fosters resistance. They can directly deliver resistance factors, alter drug efflux and metabolism, activate survival pathways, and promote immune evasion.

Deciphering the molecular and cellular processes underlying exosome-mediated resistance to chemotherapy, targeted agents, and immunotherapies is vital. Such insights not only help uncover biomarkers for early detection but also open avenues for therapeutic intervention, including targeting exosome biogenesis or engineering them for drug delivery.

This Special Issue invites cutting-edge research and insightful reviews that elucidate the multifaceted roles of exosomes in cancer drug resistance. We welcome studies that advance mechanistic insights and explore translational approaches to target exosome-mediated pathways for improved patient outcomes. Topics of interest include, but are not limited to:

● Molecular mechanisms of exosome-mediated resistance, includingspecific cargos such as miRNAs, lncRNAs, and proteins (e.g., P-gp, survivin);

● Modulation of the tumor microenvironment by exosomes, affecting cancer-associated fibroblasts, endothelial cells, immune cells, and extracellular matrix components;

● Exosomeroles in resistance to immunotherapy (g., ICI, CAR-T), hormone therapy, radiotherapy, and novel targeted agents;

● Exosomes as non-invasive biomarkersin liquid biopsies to predict or monitor drug resistance;

● Exosome-mediated drug efflux, sequestration,and metabolism;

● Therapeutic strategies targeting exosome biogenesis, release, or uptake, and the development of exosome-based drug delivery systems;

● Engineering exosomes to reverse resistance or enhance chemosensitivity;

● Advances and challenges in exosome isolation, characterization, and analysis,addressing heterogeneity and standardization.

Exosomes, extracellular vesicles (EVs), cancer drug resistance, tumor microenvironment, exosome engineering, therapeutic targeting