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. 2023 Jul 9;14(11):2128–2144. doi: 10.7150/jca.84930

Figure 3.

Figure 3

Exosomes mediate chemotherapy resistance in the donor (resistant) and the recipient (sensitive) ovarian cancer cells. In resistant/donor cells: 1) Chemotherapeutic drugs are secreted into exosomes and escape lysosome degradation. Cisplatin efflux mediated by exosomes increases, especially under hypoxic conditions. 2) Reduce the intracellular concentration of caspase3 to prevent apoptosis. 2) In sensitive/recipient cells: 1) Exosomes can transport MDR-ABC transporters (P-gp) to recipient cells to reduce intracellular drug concentration. 2) Up-regulation of Annexin A3 inhibits apoptosis and increases platinum resistance. 3) Exosomes regulate epigenetic changes by packaging DNMT1. 4) Exosomes can activate anti-apoptotic pathways through exosomes' surface-expressed receptors and transfer transcriptional factors to the recipient cells. 5) promote EMT. 6) exosomes can transfer miRNAs to recipient cells to increase chemotherapy resistance. 7)Alter signal transduction PI3K/AKT/mTOR and P38 and JNK pathways.