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doi: 10.1038/nbt.3122 52 PhilipsJ.RabaeyK.LovleyD

It can also be transferred between cells to surrounding or distant recipient cells, where it exerts ectopic effects that induce metabolic abnormalities, increase therapeutic resistance, facilitate immune evasion, and promote metastatic dissemination

For instance, the Singapore Chinese Health Study, demonstrated a dose-dependent relationship between the number of cigarettes smoked and the risk of HCC (81)