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4.5 Reduction of arginine In ccRCC, the use of the polyethylene glycol form of arginine deaminase (ADI-PEG20) can limit tumor growth by reducing circulating levels of arginine by catabolizing it to citrulline, however this treatment may be limited by ASS1 re-expression (75).Clinical trials have demonstrated the safety, tolerability and clinical efficacy of ADI-PEG20 in reversing drug resistance in patients with arginine dystrophy tumors (78)

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