Extracellular vesicles: General features and usefulness in diagnosis and therapeutic management of colorectal cancer

Figure 5 Mechanisms of extracellular vesicles-mediated chemoresistance in colorectal cancer treatment. Extracellular vesicles (EVs) released either by colorectal cancer (CRC) or cancer activated fibroblasts cells can cooperate to promote cytotoxic drugs or targeted therapies resistance. These processes are mainly mediated by lncRNAs such as urothelial carcinoma-associated 1 that stimulate mTOR and STAT3 signaling, and by Wnt proteins or miRNAs targeting Wnt signaling pathway leading to CRC cell acquisition of stemness features. EVs can also trap targeted anti-epidermal growth factor receptor antibodies reducing their bioavailability and further action on CRC cells. TC: Tumor cells; CAF: Cancer activated fibroblasts; DOX: Doxycycline; 5-FU: 5-fluorouracil; OXA: Oxaliplatin.