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Multi Drug Resistant (MDR) for Cancer Management

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Multi-Drug Resistant (MDR) is an influential impediment during successful cancer management however, Customary chemotherapy has still left the most common treatment against many cancers. Genetic and epigenetic events can associate with innate or acquired MDR which often come together to make some essential biochemical alterations for MDR emersion[1]. Among numerous anti-cancer drugs, Gemcitabine (dFdC; di-fluorodeoxycytidine) is a deoxycytidine analogue with ribonucleotide reductase (RNR) inhibition ability but unfortunately barren versus MDR [2-3].
Gemcitabine sensitivity/resistance of cancer cells can't be defined by only single determinant and may be needed the contribution of several main factors such as Gemcitabine activating enzymes, stemness (Wnt signaling pathway), alterations of membrane-bound nucleoside transporters (hENT1, hCNT1 and hCNT3), Epithelial to Mesenchymal Transition, apoptosis and the main signaling pathway involved in tumorigenesis (NF-κB, PI3K-Akt), cell cycle and DNA repair (loss of p53) [4-5].
Based on several reports, stem cells are small population distributed among differentiated cells which contributed in tissue preservation[6]. In additional, the stem cells contains mature mechanisms such as resting phase (G0), antiapoptosis genes overexpression and advanced DNA damage repair process for resistance to apoptosis and drug[6-7]. Much chemotherapy is possible to fail despite mortality of main part of tumor cells for surviving of CSCs and their
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