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Conversion is fine for most healthy younger adults, but can be less efficient in people with MTHFR genetic variants (an estimated 25 to 40% of the population carries at least one variant), people with liver function decline (more common with age), and smokers and former smokers

For example, the availability of nutrients in the TME affects the metabolic status of cancer and stromal cells, while many metabolites, such as lactate, secreted by cancer cells further promote the formation of an immunosuppressive microenvironment

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