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. 2022 Jan 28;20:14. doi: 10.1186/s12964-021-00816-w

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 3 — The mechanism of action of anti-PD-1/PD-L1 drugs and the potential mechanism underlying the exosomal PD-L1-mediated resistance to anti-PD-L1 drugs. ① Anti-PD-1/PD-L1 drugs can interact with PD-1/PD-L1, free T cells from the checkpoint block, and restore immune responses. ② and ③ Exo-PD-L1 is thought to contribute to resistance during immunotherapy through two mechanisms. In one, exo-PD-L1 binds to anti-PD-L1 monoclonal antibody (mAb), leading to PD-L1 exposure on the tumor surface (②); in the other, Although anti-PD-L1 mAb can interact with PD-L1 on the surface of tumor, exo-PD-L1 can directly interact with PD-1 on the surface of T cells to inhibit immunity (③)