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rBCG-dltA is a recombinant strain of Bacillus Calmette-Guérin (BCG), an attenuated strain of *Mycobacterium bovis*, engineered to express the *dltA* gene. The *dltA* protein is responsible for the D-alanylation of lipoteichoic acids in the bacterial cell wall, a modification that increases the cell surface's positive charge. This modification allows the bacteria to resist cationic antimicrobial peptides (AMPs) produced by the host, which are thought to contribute to BCG resistance in bladder cancer by reducing bacterial internalization. Developed primarily for the treatment of non-muscle invasive bladder cancer (NMIBC), particularly in cases unresponsive to conventional BCG therapy, rBCG-dltA has demonstrated enhanced anti-tumor activity and immunomodulatory effects in preclinical 3D bio-printed bladder cancer-on-a-chip (BCOC) models and orthotopic mouse models.
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