Tumor blood vessels play an important role in tumor progression and metastasis. We previously reported that tumor endothelial cells (TEC) exhibit several altered phenotypes compared with normal endothelial cells (NEC). For example, TEC have chromosomal abnormalities and are resistant to several anticancer drugs. Furthermore, TEC contain stem cellâlike populations with high aldehyde dehydrogenase (ALDH) activity (ALDH
high
TEC). ALDH
high
TEC have proangiogenic properties compared with ALDH
low
TEC. However, the association between ALDH
high
TEC and drug resistance remains unclear. In the present study, we found that ALDH mRNA expression and activity were higher in both human and mouse TEC than in NEC. Human NEC:human microvascular endothelial cells (HMVEC) were treated with tumorâconditioned medium (tumor CM). The ALDH
high population increased along with upregulation of stemârelated genes such as multidrug resistance 1, CD90, ALP, and Octâ4. Tumor CM also induced sphereâforming ability in HMVEC. Plateletâderived growth factor (PDGF)âA in tumor CM was shown to induce ALDH expression in HMVEC. Finally, ALDH
high
TEC were resistant to fluorouracil (5âFU) in vitro and in vivo. ALDH
high
TEC showed a higher grade of aneuploidy compared with that in ALDH
low
TEC. These results suggested that tumorâsecreting factor increases ALDH
high
TEC populations that are resistant to 5âFU. Therefore, ALDH
high
TEC in tumor blood vessels might be an important target to overcome or prevent drug resistance.