To ascertain whether pancreatic cancer cells modify the equilibrium between immunosuppressive and immune effector cells in an SMAD4-dependent manner and whether any imbalance is mediated by soluble factors or Exo, PBMCs were cultured for four days in complete, Exo enriched and Exo free non conditioned (NC) and conditioned media (CM) obtained from BxPC3 and BxPC3-SMAD4+ cells. The gene discussed is SMAD4; the disease is familial pancreatic carcinoma.