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In addition, local hypoxic, acidic, and low-glucose environments further augment energy metabolism reprogramming in tumor cells, which not only upregulates antiapoptotic proteins, including protein kinase B (Akt) and hexokinase 2 (HK2) but also inhibits the proliferation of T lymphocytes, facilitating tumor cell immune escape [198]

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This condition, known as insulin resistance, is a key step in the development of type 2 diabetes