??? ??? ???????????-?????? ????? ?????? ????????? ??? ????, ???? ?? ?????? ??????? ?????? ???????????? ?? ???????? ??? ????????? ???? ?????????? ?????. ??? ?? ????? ?????, ??? ??? ??????????? ????????????? ??????????????? - ??????? - ???????? ?? ?????????? ?????? ??? ??????????????? ???????? ????? ????? ???????????? ?????-???? ???????????. ?? ???????, ????? ??? ????? ???????? ??? ?????????? ??? ?????? ?????, ??? ??????????? ??? ?? ?????????? ????? ??? ??? ???? ??? ????????? ?? ??? ????????? ????? ??? ?????? ???????????? ????????, ????????????? ?? ???? ???? ???????? ??? ??????? ???????????? ??? ??? ?????????? ??? ??????. ??? ??????? ???? ??? ??????????? ??? ??????? ?????? ?? ???? ???????????? ?????????? ??? ??? ?????????: ????? ????????, ????????? ??? ?????, ??????? ???????????????? ??? ???????????? ????????????.

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1.1 ??????????? ?????? ??? ???????????????? ????????

??? ???????????? ????????, ????? ?????? (???????????) ???? ??????? ??????? ??? ????? "??????? ???????". ??????? ??????, ??? ??? ????? ???????? ??? ????????? ???????????, ??? ?? ?????????? ?????? ???? ?????????? ?????????????? ??? ?????? ??????????? ?????????? ??????????? ???????. ????, ? ???????? ?????? ??????????? ???? ?????? ??????? UK ??? ??? ??????? ?????? ??? 2018 ??? ???????? ???????????? ?? ?????????? - ?? ??????? ?????????? ??? ????????? ??? ????? ??? ?? ??????? ??? ????????? ???????? ?? ???????????? ??? ?????? ???? ???? ????????? ??? ??? ??? ??????'? ????? ?????????? ????, ??? ??????? ????? ???? ??????? ???????. ?? ????????? ????????? ???? ??? ??? ????????? ?? "??? ?????? ????????? ??????", ??? ???? ???? ? ????? ????????? ??? ??????????? ??????????? ???????.

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1.2 ??????????? ????????????? ??? ???????

??? ?? ??????? ??? ??????, ????? ????? ????????? ??? ? ?????? ??????? ???? ??? ????????? ??? ?????? ??? ?????? ??? ??? ??? ??? ?????, ???? ???? ?????? ??? ??? ??????????? ??? ??????????? ????????? ??? ??? ????? ??? ???????????????. ??? ??? ????????? ?????? ????? ????? ??????????? ?? ??????? ?????-6-?????? (M6P), ???? ????? ? ????? ????????? ??????? ??? ????????? ?????? ?????????. ????????? ??????? ??????? ???? ???????? ???? ???????? ??? ???????? ?????-???? ??????????: ???? ??????????? ????? ?? ?? ???????? ????????? ??? ?????????? ????????, ??????? ?? ????? ??????????? ???? ??? ??????????. ?? ????????? ??? ?????? ? ???????? ?? ? ???????????? ??? ?????????? ???????? ???????? ???? ?????, ???? ?? ????????? ??? ???? ????-?????? ????????? ??? ?????? ?? ?? ????????????? ???????????? ??? ???? ??????????? ?????.

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2.1 ???????????? ????????????: ?????????? ?? "????? ?????????" ?????? ???? ??? ???? ????

??? ????????? ?????? ???? ?????? ???? (????? ?????????? ??? ???? ???? ????????? ????? ??????? ????? ??? ?? ??????????-??????? ?????) ????????? ????? ???????? ????????? ?? ???? ??? ??? ???? ????? ???? ??? ????????? ????. ?? ??????? ?????????? ???? ???????? ???? ?????????? ???????? ???????????? ??? ??????? ??? ????????? ???? ?????? ??? ???? ????, ????? ?? ???????????? ???? ????????????? ?? ????????? M6P ??? ?????? ??? ??? ??? ?????? ???????????? ??? ?? ????. ??? "?????????-???????????" ??? ???? ????????? ?? ???????? ???? ???????? ?????????????? (GLUT), ???? ?????????? ???? ?? ????????? ?? ??????????? ???? ????????????????? ????????????, ????? ????????? ??? ??? ????????????? ???? ????? ????????????? ??? ????????? ??? ??? ?????????????? ????? ????, ????? ?????? ??????? ??? ??????? ?????? ??? ???? ???? (?????? 1).

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2.2 ????????????: ??????????? ?? ?????? ?????????????

? ?????? ??????????? ???? ????? ????????????? ??? ??? ?????????? ??? 2023 ??? ??????? ??????? ?? ????? ??? ????????? ??????????? ????????? ??? ?????? ???? ???? ???????? ?????? ?????????? ???????. ???????????? ???? ??????? ?? ??? ??????????? ?????? ???? ???????? ??? ?????, ????? ??? ?????????? ???? ??? ??? ???????? ????? ??? ??? ??????? MYC ??????????, ??? ???? ???????????????? ???????? ????? ???????? ???????????. ?? ??????????? ???????????? ????? ?????? ?? ??????????? ??? ??????? ?????????? ??? ????? ????, ?????????? ? ????????? ????? ??? ??? ??????????? ??? ?????????? ??????????? ???????????.

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2.3 ?????? ????????: ?????????? ??? "?????????????? ?????" ??? PD-L1

??? ??? ??????????? ??? ?? ?? ????? ?????????? ??? ???????? ?? ??????? ??? ???? ??? ?????? ?????? ???????? ?????????. ???? ????? ?????????????? ????????, ????? ?? ??????? ?????????? ?? ??????? ????? ?? ??????? ???????? ??? ???????? ?????????????? ??? ????? PD-L1 ????????? ???? ??????????? ??? ???? N-???????????????? ?????????????. ??? PD-L1 ?????????, ????? ???????? ??? "???????????? ?????" ??? ??? ????? ????, ??? ??? ?????? ?? ???? ?????????????? ??? ??????????, ?????? ???????????? ??? ???????????? ??????? ???? T ????. ??? ??? ??????????? ???? ??????, ?? ???????????? ??? ????????? ??? ?????-PD-1 ?????????? ???? ???????? ?? ?????? ???????? ???? ?? 78%, ??? ???????? ?? ??? ???? ????????? (????? 2).

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3.1 ??????????? ??? ????-???????? ????????

??? ????????? ????? ?????????????, ??? ???????? ???????????? ?????-????????? ?????-??????? ???????????. ? ??????? ?????????? ??? ??????????? ?????????????? ??????? ?????? ???? ??? 20% ???????? ???????????? ??? ??????? ??? ??? ?????? ????????? ?????? ??? ?????? ?????????? ??? ??? 40%, ??? ?? ??? ???? ?????? ???? ????????? ????? ????? ??? ??????????. ???? ??? ?????????, ???? ?????? ??? ???????????? ??? ???????????, ?? ???? ???? ??? ???? ??? ?????? ??????????? ??? 2.3 ????, ????? ???????????? ????? ?????????????-??????????? ?????. ?????????????? ???????????? ????????????? ??? ?? MD ?????????? ??????? ?????? ??? ?? ??????????? ?????? ????? ??????? ??? ???????? ??? ?????? ???????? ???? ???????????? ??????? ?????? ????? ??? ???????-????????? ????? ??????? ??? ????????????????.

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3.2 ???????? ????????????? ???? ????????? ?????????????

????? ?? ???????????? ????-??????? ?????, ?????? ????????? ??????? ????? ????????????? ???????????. ?? ?????? 1 ??????? ?????? (NCT05220739) ????? ??? ?????????? ???????? ??? 2022 ??? ?????? ?? ????? ?? ????????? ?? ????????? ???? ???? ??????? ??? ?????????? ??? ?????????????? ?????? ???????. ???????????? ????? ?????? ??? ?????????? ??? ??? ???????? 5 ? ????? ?????? ????? ???? ??????????, ??? ?? ????????????? ?????? ???? (ctDNA) ??????? ??? ?????? ?????? ????? ??? ????????? ???????????. ?????, ???? ?? ????? ??? ??????? ?? 10 ?, ????? ????? 15% ???? ?? ?????????? ????????? ????? ?????, ????? ????????????? ?? ?????????????? ?? ???????????? ?? ????????? ??????.

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3.3 ??????? ????????? ?? ???????????????????

????? ????????? ??????????? ??????? ??? ?????, ????? ?? ??? ??????? ????? ????? ?? ????????? ??? ?????-??????? ?????????????? (????????????? ?? ?????????? 5 ?????????? ??? ?????????? ??????), ????? ???? ??????? ????????????????? ??????? ??? ???????? ??????????. ????, ??? ??????? ??????????? Escherichia coli ??????????? ??????? ??????????? ??? 20 ????, ???? ????????????? ?????? ????????? ????????? ??????????? ?????? ?? ?????? $50 ???? ??????????. ??? ?????, ??? ?? ??????-?????????? ????????????????? ???????????? ??????????? ?? ???????????? ??? ??????-??????? ???????? ?? 80%, ??? ????? ????? ??? ???? ????? ???????? ????????????????.

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?????? ??? ????????????? ??? ?????????: ????? ???????? ??? ??? ????????? ??? ?????????

4.1 ??? "?????????????? ??????" ????? ??? ??????????? ???????????

?? ??? ????? ?? ???????? ??? ??????? ??? ???? ???? ???????????. ?????? ???? ???? ????? ?????? ?? ???????? ??? ????????? ????????? ???????????? (PMI) ????? ???????????? ???????-6-???????? ??? ??????????-6-????????, ????? ???????? ???????????? ??? ???????????? ?????. ?? "???????????? ????????" ?????????? ??? ?????? ????????? ??? ????? 7% ??? ????????????? ???? ???????, ????? ?????????? ?? ?????????????? ?? ??????????? ??????????????????? ???????? ????????.

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4.2 ????????? ≠ ?????: ?? ????? ??? ????????? ?????????

????? ???????? ??? ?????????? ???????? ????? ???? ??? ??? ??? ?? GRAS (????????? ???????? ??? ?????) ?????????, ????? ??? ???? ????? ??? ?????-?????? ?????????? ??? ?????-???? ?????? ?????. ????? ????????????? ????? ???????? ??? ??????????? ????-????? ???????????? ??? ???? ?? ???????????? ??????? ??????????, ??? ?? ???? ??? ??????? ??????????????? ?????????????? ????????? (????? ??? Klebsiella) ????????? ??? ????. ???? ?????????? ??? ???????? ???????? ???? ??????????? ???????????? ????????????? ??? ???????????????? ???????????????.

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4.3 ??? ????? ?????? ?????????? ????? ??? ?????????????? ???????????????

???? ??????? ??? "????-?????? ?????" ???? ????? ???????, ???? ?????? ??????? ???????????? ?? ??????????? ?????????? ??? ?????? ?????????? ????????. ?? FDA ??? ?? ??????????? ????? ??? ??????????? ????????? ????? ?? ???? ?????? ??? ????? ????????? ????????, ???????????????? ?? "???????? ??????????? ????? ???? ???????? ??????? ??????????." ???????????? ???? ???? ????????? ? ?????? ????? ??? ????? ?????????? ?? ???????? ?? ???????? ??? ????????? ??? ??????-?????????? ????????.

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?????: ?? ??????? ???? ??? ??? ????? ??????????

?? ?????-?????? ????? ??? ????????? ??? ???? ???? ?? ?????????? ?????????? ???? ??????'? ?????? ??? ?????????? ????, ???? ???? ?? ?????? ???? ????????????????????? ?????. ???? ????????????? ?????????????????? ???? ??????????? ???? ??? ??????? ??????-?????, ???? ??????????????? ????-??? ??? ?????????????? ?????????, ?? "???? ???????????" ?????? ????? ???? ???-??? ???? ???? ????????????. ????? ?? ????? ???? ???????? ????? ???????????????, ??? ??? ??????????? ??? ?? ????????? ??? ???? ??????-???????? ???????????? ??????? ???? ??????? ??? ????????????? ?? ???? ??????? ???? ?????????? ?????-????. ?????? ??? ?????? ???? ??????????: "???? ??????????? ?????? ??? ??????, ???? ???? ??? ?????-????? ???? ???? ?????????."

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