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intestinalis , not included by Trenz et al

Both intrinsic factors, properties arising in the malignant cells, such as MYC amplification, PIK3CA , and TP53 mutations, and extrinsic factors, metabolic stresses imposed by the microenvironment, such as hypoxia, oxidative stress, acidosis, contribute to different metabolic programming phenotypes in metastatic breast cancer

The human GI tract is estimated to harbor approximately 100 trillion microorganisms, including bacteria, viruses, fungi, and protozoa, collectively encompassing more than 1,000 distinct species (209)

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