化疗抗药性是肿瘤治疗中的重大障碍，导致治疗选择有限和患者生存率降低。最近的研究揭示了一种化疗抗药性获取的新机制：通过胞外囊泡（exosomes）传递信息。胞外囊泡是多种细胞分泌的一种小囊泡，通过携带蛋白质、核酸和代谢产物，在细胞间进行关键的信息交流，影响癌细胞的行为和对治疗的反应。一种关键的抗药性机制是肿瘤的代谢重编程，即通过改变细胞的代谢途径，以支持耐药癌细胞的生存和增殖。这种代谢重编程通常包括增加糖酵解，为癌细胞提供必要的能量和构建块，以逃避化疗的影响。值得注意的是，已经发现胞外囊泡可以运输糖酵解酶，通过蛋白质组学分析确定，从而导致代谢途径重编程，促进改变葡萄糖代谢和增加乳酸产生。因此，它们对肿瘤微环境产生深远影响，促进肿瘤进展、生存、免疫逃避和药物抗性。了解这种胞外囊泡介导的细胞间通信的复杂性，可能为管理具有侵袭性糖酵解特征的癌症开辟新的治疗途径，并有助于生物标志物的开发。此外，鉴于代谢异常的复杂性，结合未来的基于胞外囊泡的靶向治疗与现有的化疗、免疫治疗和靶向治疗相结合，有望实现协同效应，克服抗性，改善癌症治疗效果。版权所有 © 2023 The Authors. 由Elsevier Ltd.发表。保留所有权利。

Chemoresistance constitute a major obstacle in cancer treatment, leading to limited options and decreased patient survival. Recent studies have revealed a novel mechanism of chemoresistance acquisition: the transfer of information via exosomes, small vesicles secreted by various cells. Exosomes play a crucial role in intercellular communication by carrying proteins, nucleic acids, and metabolites, influencing cancer cell behavior and response to treatment. One crucial mechanism of resistance is cancer metabolic reprogramming, which involves alterations in the cellular metabolic pathways to support the survival and proliferation of drug-resistant cancer cells. This metabolic reprogramming often includes increased glycolysis, providing cancer cells with the necessary energy and building blocks to evade the effects of chemotherapy. Notably, exosomes have been found to transport glycolytic enzymes, as identified in proteomic profiling, leading to the reprogramming of metabolic pathways, facilitating altered glucose metabolism and increased lactate production. As a result, they profoundly impact the tumor microenvironment, promoting tumor progression, survival, immune evasion, and drug resistance.Understanding the complexities of such exosome-mediated cell-to-cell communication might open new therapeutic avenues and facilitate biomarker development in managing cancers characterized by aggressive glycolytic features. Moreover, given the intricate nature of metabolic abnormalities combining future exosome-based-targeted therapies with existing treatments like chemotherapy, immunotherapy, and targeted therapies holds promise for achieving synergistic effects to overcome resistance and improve cancer treatment outcomes.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.