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Although seemingly inefficient, the pathway also produces reduced nicotinamide adenine dinucleotide to reduce methemoglobin, glucose-6-phosphate to drive the pentose phosphate shunt to make nicotinamide adenine dinucleotide phosphate to reduce glutathione and protect against oxidation of hemoglobin, cytoskeletal protein, and membrane lipids, as well as the Rapoport-Luebering shunt to generate 2,3-diphosphoglycerate (2,3-DPG

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By leveraging acidic environments, enzymatic activity, or reductive microenvironments, the linker cleaves within tumor tissues to release the payload, achieving efficient targeted drug delivery