Fig. 5.

Mechanism of resistance of CSCs to chemotherapy. CSCs possess the ability to maintain a quiescent state and reduce metabolic activity, thereby exhibiting resistance to chemotherapy. Furthermore, CSCs are capable of metabolic reprogramming, utilization of ABC transport proteins, and activation of DNA repair pathways, which allows them to evade chemotherapy. Additionally, the microenvironment plays a crucial role in supporting CSC survival. The balance between ROS and anti-apoptotic versus pro-apoptotic signals, along with exosomes secreted by tumor-associated fibroblasts, dynamically regulates CSCs