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The main mechanisms are described as follows

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Some of the studies show that inhibition of PD-1 in cancer patients reacts with gut microbiota and some species like Faecalibacterium, Bifidobacterium, Akkermansi a, etc ( Faecalibacterium, Bifidobacterium, and Akkermansia, according to several studies (Wu et al., 2009), direct DNA damage (Tsoi et al., 2017)