So the identified molecular mechanisms of exosome-mediated chemo-resistance mainly include several aspects (Fig. 3): 1) exporting drugs out of cells via exosomes; 2) drug transporters; 3) transferring annexin A3 between cancer cells5; 4) mediating chemotherapy resistance by increasing DNMT139; 5) regulate apoptosis; 6) promote EMT40; 7) transfer miRNAs to sensitive cancer cells27, 41, 42; 8) alter transduction signals. The gene discussed is ANXA3; the disease is cancer.