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Contemporary mechanistic investigations have revealed that IS orchestrates sophisticated disruption of mitochondrial fission/fusion architectural dynamics, systematically impedes physiological mitochondrial biogenetic processes, interferes with mitochondrial electron transport chain functionality, while compromising mitochondrial quality control homeostatic mechanisms, fundamentally remodeling gut microbiota metabolic phenotypic expressions, illuminating the pivotal significance of microbiotamitochondria cross-talk paradigms in uremic toxin bioaccumulation phenomena (Lu et al., 2025

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Together, these effects lead to the immunogenic cell death of tumor cells and alleviate PD-L1-mediated immune evasion, which further remodels the immunosuppressive TME and triggers a robust immune response, effectively inhibiting bilateral tumor progression and metastasis [76]

Possible structures are illustrated below