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This observation can be explained by a redox imbalance due to the failure to recycle PPP metabolites for the generation of a sufficient amount of NADPH, which would subsequently expose the liver to oxidative damage and pro-tumorigenic inflammation
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In MM, lactate has been shown to induce the expansion of M-MDSCs and Tregs via non-GPR81 pathways, thereby reshaping the local immunosuppressive niche ( + PMN-MDSCs into the TME, which subsequently inhibit the function of CD8 + T cells (49)
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