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From the evolutionary perspective, the formation of the unusual D-malate intermediate prevents the direct channeling of malate into the TCA cycle which requires the presence of one further enzyme (MDH)

Agarwal S ., Rao A.V ., 2000

TABLE 1 Standard MM treatment options, per 2024 NCCN Clinical Practice Guidelines ( 3 Anti-myeloma activity of plant-derived compounds Natural compounds have constituted a large portion of new drugs developed within the past 4 decades (Newman and Cragg, 2020), and extensive research has shown that natural compounds display anticancer properties and the ability to overcome drug-induced resistance (Talib et al., 2021)

If too hydrophilic, the drug cannot cross the lipid cell membrane