Abstract Introduction Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest epithelial malignancies. The high death rate caused by PDAC results from complex factors, including difficulties in diagnosing early-stage disease, increased metastatic potential, and resistance to traditional therapies. Mucin1 (MUC1) is one of the transmembrane mucins typically expressed on the apical surface of epithelial cells but is not apically restricted and upregulated dramatically in pancreatic cancer cells. Our study showed that MUC1CT positive EVs promote tumor cell proliferation and migration in vitro, in vivo tumor growth, and metastasis. Moreover, MUC1 increases glucose metabolism in pancreatic cancer cell to resistance gemcitabine though stabilizing HIF-1α. However, the role of MUC1 in gemcitabine resistance has not been well studied and understood. Methods We used CRISPR-Cas9 to knockout MUC1 in pancreatic cancer cells to investigate MUC1 effects on chemotherapy resistance. EVs were isolated from MUC1 positive cells and MUC1 knockout cells by a sequence of centrifugation and ultracentrifugation steps. Proteomics and liquid chromatography-mass spectrometry-based metabolomics were performed to identify specific proteins and metabolites in MUC1-associated EVs. To evaluate the cargo of MUC1+ EVs and MUC1- EVs on chemotherapy resistance, 13C- labeled glucose with metabolomics was applied to trace glucose-related metabolites when the cells were treated with or without gemcitabine and EVs. Results We identified that MUC1 increased gemcitabine resistance in pancreatic cancer cells. MUC1 positive EVs could increase gemcitabine resistance in MUC1 knockout cells. Unique protein cargo in MUC1-positive EVs was enriched in DNA replication and DNA repair pathways. Phosphogluconate dehydrogenase (PGD) was packaged in MUC1-positive EVs, which helped glucose-derived ribose to increase MUC1 knockout cell gemcitabine resistance. Metabolomics in EVs showed that pyrimidine and purine nucleotides biosynthetic pathway-related metabolites are enriched in MUC1-positive EVs. Uridine is one of the important metabolites in MUC1-positive EVs. Our data showed that the pentose phosphate pathway (PPP) and pyrimidine metabolism were involved in MUC1- positive EV-induced gemcitabine resistance. Citation Format: Ying Huang, Dezhen Wang, Chunbo He, Bo Tu, Kamiya Mehla, Pankaj K. Singh, Michael A. Hollingsworth. MUC1 positive extracellular vesicles play an important role on gemcitabine resistance in PDAC [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr C034.