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Similarly, Liebmann et al

Protein therapeutic molecules, including antibodies (Schmitt and Greten, 2021), metabolism-blocking proteins (Liu et al., 2017), enzymes (Yu et al., 2024), and apoptosis-inducing agents (Hu and Kavanagh, 2003) have also been successfully combined with engineered bacteria for targeted therapy of tumors (Table 1)

This selectivity matters: elevated IGF-1 accelerates skeletal growth in children but has minimal impact on fracture healing or bone density restoration in adults because mature osteoblasts respond primarily to local paracrine signals, not circulating growth factors

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Schaid DJ

Be aware that these alternatives vary in absorption and reliability, and many have limited evidence supporting consistent systemic effects