癌症是全球第二大死亡原因,每年夺去约1000万人的生命。尽管手术等治疗方法取得了进展,化疗,和免疫疗法,对这些方法的抵制已经出现。多药耐药(MDR),癌细胞抵抗不同的治疗方法,破坏治疗有效性,死亡率不断上升。MDR机制包括,其中,药物灭活,减少药物摄取,增强DNA修复,和自噬等生存途径的激活。此外,MDR机制可以赋予对其他疗法如放射疗法的抗性。了解这些机制对于提高治疗效果和确定新的治疗靶标至关重要。细胞外囊泡(EV)因其在癌症进展中的作用而受到关注。包括通过蛋白质转移和遗传重编程的MDR发展。自噬,平衡蜂窝资源的过程,也影响MDR。EV和自噬的交叉进一步使对MDR的理解变得复杂。两种细胞外(外泌体,微囊泡)和细胞内(自噬)囊泡通过调节肿瘤微环境来促进治疗抗性,促进细胞通信,和调节药物加工。虽然人们对这些途径了解很多,仍有必要探索它们在预测治疗反应和理解肿瘤异质性方面的潜力.
Cancer is the second leading cause of global mortality and claims approximately 10 million lives annually. Despite advances in treatments such as surgery, chemotherapy, and immunotherapy, resistance to these methods has emerged. Multidrug resistance (MDR), where cancer cells resist diverse treatments, undermines therapy effectiveness, escalating mortality rates. MDR mechanisms include, among others, drug inactivation, reduced drug uptake, enhanced DNA repair, and activation of survival pathways such as autophagy. Moreover, MDR mechanisms can confer resistance to other therapies like radiotherapy. Understanding these mechanisms is crucial for improving treatment efficacy and identifying new therapeutic targets. Extracellular vesicles (EVs) have gathered attention for their role in cancer progression, including MDR development through protein transfer and genetic reprogramming. Autophagy, a process balancing cellular resources, also influences MDR. The intersection of EVs and autophagy further complicates the understanding of MDR. Both extracellular (exosomes, microvesicles) and intracellular (autophagic) vesicles contribute to therapy resistance by regulating the tumor microenvironment, facilitating cell communication, and modulating drug processing. While much is known about these pathways, there is still a need to explore their potential for predicting treatment responses and understanding tumor heterogeneity.