At the genus level, Faecalibacterium was significantly enriched in the healthy control and R groups (p = .0010), Figure 1 (b–1) consistent with previous reports regarding CTLA-4 and PD-L1 blockade.6,17 Meanwhile, members of the genus Streptococcus, which are involved in the development of metabolic disorders, diabetes, and colon cancer,18 was more abundant in the NR group (p = .0091), Figure 1 (b–1). Here, CTLA4 is linked to metabolic disease.