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recombinant BCG-dltA is a genetically modified strain of Bacillus Calmette-Guérin (BCG) engineered to express the dltA gene (D-alanyl carrier protein ligase). Developed by researchers at Chung-Ang University and the National Cancer Center in South Korea, this recombinant BCG strain is designed to treat BCG-unresponsive bladder cancer (BUBC) and non-muscle-invasive bladder cancer (NMIBC). The dltA gene confers resistance to cationic antimicrobial peptides (AMPs) secreted by urothelial and immune cells by D-alanylation of lipoteichoic acids, which increases the bacterial surface charge and reduces AMP binding. This modification enhances the survival, persistence, and internalization of the bacterium in bladder cancer cells, leading to increased release of antitumor cytokines (such as IL-6, IL-12, TNF-alpha, and IFN-gamma) and enhanced recruitment of immune cells like monocytes. It is administered intravesically and has been studied both as a monotherapy and in combination with immune checkpoint inhibitors like pembrolizumab.
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