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Lactobacillus rhamnosus-derived exosomes (LREs) are microbiota-derived extracellular vesicles being investigated for the treatment of therapy-resistant Head and Neck Squamous Cell Carcinoma (HNSCC). These exosomes exert anti-tumor activity by targeting both the bulk tumor population and the cancer stem cell (CSC) niche. Mechanistically, LREs induce dual cell death pathways—apoptosis and ferroptosis—while simultaneously suppressing stemness markers such as SOX2, NANOG, and CD44. They also reverse the epithelial-mesenchymal transition (EMT) phenotype, evidenced by the upregulation of E-cadherin and downregulation of Vimentin. Preclinical studies indicate that LREs exhibit synergistic effects with cisplatin and show enhanced efficacy in HPV-positive HNSCC subtypes, regardless of p53 status.
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