Mesenchymal stem cell‑derived exosomes: Regulators of progression and suppression in pancreatic cancer (Review)

Pancreatic cancer is a malignant digestive tract tumor with a poor prognosis. It remains one of the most challenging malignancies due to difficulties in early diagnosis and the development of chemotherapy resistance in advanced stages. Mesenchymal stem cells (MSCs), a distinct type of non-hematopoietic stem cells, play a crucial role in the tumor microenvironment owing to their unique tumor-homing capacity and immunomodulatory properties, which are largely mediated by their derived exosomes (EXOs). EXOs derived from MSCs can regulate the growth, invasion and metastasis of pancreatic cancer through the activation of specific signaling pathways. Furthermore, they have emerged as promising drug delivery vehicles and have demonstrated potential in anti-pancreatic cancer therapy. However, within the highly fibrotic tumor microenvironment of pancreatic cancer, the functions of MSC-derived EXOs are complex and dualistic, exhibiting both tumor-suppressive and tumor-promoting effects. Understanding the precise roles of MSC-derived EXOs in pancreatic cancer is essential for the development of effective therapeutic strategies. The present review systematically summarizes the dual regulatory mechanisms of MSC-derived EXOs in pancreatic cancer, elucidates the key molecules and signaling pathways involved, and discusses their clinical potential as novel therapeutic targets or drug delivery systems.