Fig. 5. Potential therapeutic strategies to reduce low-grade endotoxaemia.

Gut dysbiosis downregulates junction proteins, which leads to increased gut permeability and increased translocation of lipopolysaccharide (LPS) into the systemic circulation. Dietary and pharmacological interventions might improve gut barrier dysfunction by upregulating the levels of tight junction proteins and the zonula occludens protein ZO1 and thereby lower circulating LPS levels. Potential interventions include a Mediterranean diet, probiotics (live bacteria or microbial metabolites such as urolithin A), prebiotics (fermentable fibres), interventions that increase glucagon-like peptide 1 (GLP1) and GLP2 levels, and statins.