PTEN and neoplasm: Furthermore, tumor-derived exosomes facilitate immunosuppression by reprogramming glycolysis and lipid metabolism in interactions with various cells, thereby aiding in PMN formation.27,125 Investigating the mechanisms of exosomes and metabolic reprogramming can not only help in exploring the PMN but also identify novel therapeutic targets for cancer progression.126 In addition to cell-cell interactions, EVs can induce the shedding of CTCs at the primary tumor site by activating the Wnt and PTEN pathways in the early stages of metastasis.