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One key mechanism is tumor targeting: by engineering genetic circuits in bacteria that respond to TME signals such as hypoxia, high lactate, or low pH (e.g., hypoxia-responsive promoters), or by expressing exogenous tumor-homing peptides (e.g., RGD), the strains selectively accumulate in tumors while minimizing invasion of healthy tissues [245]

However, patients may be required to consume a high-calorie diet to prevent excessive weight loss while on treatment

Reactive oxygen species signaling in plants

As discussed below, it is important to consider the pharmacokinetic properties of metformin when extrapolating data from in vitro studies to potential benefits when used clinically