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Beyond immune exclusion, immune function is actively suppressed by tumors: elevated N- acetylaspartate (NAA) production disrupts the immunological synapse in CD8 + T and NK cells (178), while FGF21 derived from cancer cells rewires cholesterol metabolism toward inducing T-cell exhaustion (155)

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The activation of insulin signaling in the liver promotes glycogenesis and suppresses gluconeogenesis through the activation of AKT and extracellular signal-regulated kinase (ERK) 13,14