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  1. Article ; Online: Toll-like receptor stimulants in processed meats promote lipid accumulation in macrophages and atherosclerosis in Apoe

    Faraj, Tola A / Edroos, Giovanna / Erridge, Clett

    Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association

    2024  Volume 186, Page(s) 114539

    Abstract: Dietary intake of processed meat is a risk factor for cardiovascular disease. However, the effects of processed meats on lipid metabolism in macrophages, a key regulator of cardiovascular risk, have remained largely unexplored. Extracts of processed ... ...

    Abstract Dietary intake of processed meat is a risk factor for cardiovascular disease. However, the effects of processed meats on lipid metabolism in macrophages, a key regulator of cardiovascular risk, have remained largely unexplored. Extracts of processed meats, but not their fresh non-processed equivalents, were found to promote a significant increase in macrophage lipid accumulation in vitro. Calibrated receptor-dependent reporter assays revealed that pro-inflammatory stimulants of Toll-like receptor (TLR)-2 and TLR4 were low or undetectable in fresh meats, but rose dramatically following chopping and storage at 4 °C. Lipid accumulation in response to processed meats correlated well with TLR-stimulant content, was significantly reduced in TLR4-deficient macrophages, and was absent in response to meats stored frozen to prevent bacterial growth. TLR-stimulation significantly increased the incorporation of
    MeSH term(s) Animals ; Mice ; Toll-Like Receptor 4/metabolism ; Atherosclerosis/metabolism ; Toll-Like Receptors/metabolism ; Macrophages/metabolism ; Meat ; Lipids ; Apolipoproteins E/metabolism ; Mice, Knockout
    Chemical Substances Toll-Like Receptor 4 ; Toll-Like Receptors ; Lipids ; Apolipoproteins E
    Language English
    Publishing date 2024-02-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 782617-5
    ISSN 1873-6351 ; 0278-6915
    ISSN (online) 1873-6351
    ISSN 0278-6915
    DOI 10.1016/j.fct.2024.114539
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Are toll-like receptors potential drug targets for atherosclerosis? Evidence from genetic studies to date.

    Nelson, Christopher P / Erridge, Clett

    Immunogenetics

    2018  Volume 71, Issue 1, Page(s) 1–11

    Abstract: Low-density lipoprotein cholesterol lowering, most notably via statin therapy, has successfully reduced the burden of coronary artery disease (CAD) in recent decades. However, the residual risk remaining even after aggressive lipid lowering has renewed ... ...

    Abstract Low-density lipoprotein cholesterol lowering, most notably via statin therapy, has successfully reduced the burden of coronary artery disease (CAD) in recent decades. However, the residual risk remaining even after aggressive lipid lowering has renewed interest in alternative targets. Anti-inflammatory drugs are thought to have much potential in this context, but side effects associated with long-term use of conventional anti-inflammatories, such as NSAIDs and glucocorticoids, preclude their use as preventive agents for CAD. Evidence from epidemiological studies and murine models of atherosclerosis suggests that toll-like receptors (TLRs) may have utility as targets for more focused anti-inflammatories, but it remains unclear if this pathway is causally related to CAD in man. Here, we review recent insight into this question gained from genetic studies of cardiovascular risk and innate immune function, focussing on the potential of Mendelian randomisation approaches based on intracellular-signalling pathways to identify and prioritise targets for drug development.
    MeSH term(s) Animals ; Atherosclerosis/drug therapy ; Atherosclerosis/etiology ; Atherosclerosis/genetics ; Genome-Wide Association Study ; Humans ; Immunity, Innate ; Mendelian Randomization Analysis ; Polymorphism, Single Nucleotide ; Quantitative Trait Loci ; Signal Transduction/physiology ; Toll-Like Receptors/antagonists & inhibitors ; Toll-Like Receptors/genetics ; Toll-Like Receptors/physiology
    Chemical Substances Toll-Like Receptors
    Language English
    Publishing date 2018-10-16
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 186560-2
    ISSN 1432-1211 ; 0093-7711
    ISSN (online) 1432-1211
    ISSN 0093-7711
    DOI 10.1007/s00251-018-1092-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Reversal of Tetracycline Resistance by Cepharanthine, Cinchonidine, Ellagic Acid and Propyl Gallate in a Multi-drug Resistant Escherichia coli.

    Jenic, Darko / Waller, Helen / Collins, Helen / Erridge, Clett

    Natural products and bioprospecting

    2020  Volume 11, Issue 3, Page(s) 345–355

    Abstract: Bacterial resistance to antibiotics is an increasing threat to global healthcare systems. We therefore sought compounds with potential to reverse antibiotic resistance in a clinically relevant multi-drug resistant isolate of Escherichia coli (NCTC 13400). ...

    Abstract Bacterial resistance to antibiotics is an increasing threat to global healthcare systems. We therefore sought compounds with potential to reverse antibiotic resistance in a clinically relevant multi-drug resistant isolate of Escherichia coli (NCTC 13400). 200 natural compounds with a history of either safe oral use in man, or as a component of a traditional herb or medicine, were screened. Four compounds; ellagic acid, propyl gallate, cinchonidine and cepharanthine, lowered the minimum inhibitory concentrations (MICs) of tetracycline, chloramphenicol and tobramycin by up to fourfold, and when combined up to eightfold. These compounds had no impact on the MICs of ampicillin, erythromycin or trimethoprim. Mechanistic studies revealed that while cepharanthine potently suppressed efflux of the marker Nile red from bacterial cells, the other hit compounds slowed cellular accumulation of this marker, and/or slowed bacterial growth in the absence of antibiotic. Although cepharanthine showed some toxicity in a cultured HEK-293 mammalian cell-line model, the other hit compounds exhibited no toxicity at concentrations where they are active against E. coli NCTC 13400. The results suggest that phytochemicals with capacity to reverse antibiotic resistance may be more common in traditional medicines than previously appreciated, and may offer useful scaffolds for the development of antibiotic-sensitising drugs.
    Language English
    Publishing date 2020-11-03
    Publishing country Germany
    Document type Journal Article
    ISSN 2192-2195
    ISSN 2192-2195
    DOI 10.1007/s13659-020-00280-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Reversal of Tetracycline Resistance by Cepharanthine, Cinchonidine, Ellagic Acid and Propyl Gallate in a Multi-drug Resistant Escherichia coli

    Jenic, Darko / Waller, Helen / Collins, Helen / Erridge, Clett

    Natural products and bioprospecting. 2021 June, v. 11, no. 3

    2021  

    Abstract: Bacterial resistance to antibiotics is an increasing threat to global healthcare systems. We therefore sought compounds with potential to reverse antibiotic resistance in a clinically relevant multi-drug resistant isolate of Escherichia coli (NCTC 13400). ...

    Abstract Bacterial resistance to antibiotics is an increasing threat to global healthcare systems. We therefore sought compounds with potential to reverse antibiotic resistance in a clinically relevant multi-drug resistant isolate of Escherichia coli (NCTC 13400). 200 natural compounds with a history of either safe oral use in man, or as a component of a traditional herb or medicine, were screened. Four compounds; ellagic acid, propyl gallate, cinchonidine and cepharanthine, lowered the minimum inhibitory concentrations (MICs) of tetracycline, chloramphenicol and tobramycin by up to fourfold, and when combined up to eightfold. These compounds had no impact on the MICs of ampicillin, erythromycin or trimethoprim. Mechanistic studies revealed that while cepharanthine potently suppressed efflux of the marker Nile red from bacterial cells, the other hit compounds slowed cellular accumulation of this marker, and/or slowed bacterial growth in the absence of antibiotic. Although cepharanthine showed some toxicity in a cultured HEK-293 mammalian cell-line model, the other hit compounds exhibited no toxicity at concentrations where they are active against E. coli NCTC 13400. The results suggest that phytochemicals with capacity to reverse antibiotic resistance may be more common in traditional medicines than previously appreciated, and may offer useful scaffolds for the development of antibiotic-sensitising drugs.
    Keywords Escherichia coli ; ampicillin ; antibiotic resistance ; bacterial growth ; chloramphenicol ; ellagic acid ; erythromycin ; health services ; mammals ; models ; multiple drug resistance ; phytochemicals ; propyl gallate ; tetracycline ; tobramycin ; toxicity ; trimethoprim
    Language English
    Dates of publication 2021-06
    Size p. 345-355.
    Publishing place Springer Singapore
    Document type Article
    Note NAL-AP-2-clean
    ISSN 2192-2195
    DOI 10.1007/s13659-020-00280-y
    Database NAL-Catalogue (AGRICOLA)

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  5. Article ; Online: Stimulants of Toll-like receptor (TLR)-2 and TLR-4 are abundant in certain minimally-processed vegetables.

    Erridge, Clett

    Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association

    2011  Volume 49, Issue 6, Page(s) 1464–1467

    Abstract: Stimulants of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4 have been shown to promote insulin resistance and atherosclerosis in animal models of these diseases. As minimally processed vegetables (MPV) can contain a relatively large ... ...

    Abstract Stimulants of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4 have been shown to promote insulin resistance and atherosclerosis in animal models of these diseases. As minimally processed vegetables (MPV) can contain a relatively large bacterial load compared to other foodstuffs, we aimed to quantify the abundance of stimulants of TLR2 and TLR4 in MPV using a transfection-based bioassay calibrated with Escherichia coli LPS and the synthetic lipopeptide Pam(3)CSK(4). Of 5 classes of MPV and 3 classes of related vegetable products considered to be likely to contain a high microbial load, diced onion and bean sprouts contained the highest levels of stimulants of TLR2 (up to 18.5 μg Pam(3)CSK(4)-equivalents per g) and TLR4 (up to 11.4 μg LPS-equivalents per g). By contrast, the majority of fresh whole vegetables examined reproducibly contained minimal or undetectable levels of TLR2- or TLR4-stimulants. The accumulation of TLR-stimulants in MPVs correlated well with growth of enterobacterial spoilage organisms. In conclusion, the modern trend towards eating minimally processed vegetables rather than whole foods is likely to be associated with increased oral exposure to stimulants of TLR2 and TLR4.
    MeSH term(s) Escherichia coli/drug effects ; Escherichia coli/immunology ; Food Handling/methods ; Food Microbiology ; HEK293 Cells ; Humans ; Insulin Resistance/immunology ; Lipopolysaccharides/pharmacology ; Plant Extracts/immunology ; Plant Extracts/pharmacology ; Signal Transduction ; Toll-Like Receptor 2/drug effects ; Toll-Like Receptor 2/metabolism ; Toll-Like Receptor 4/drug effects ; Toll-Like Receptor 4/metabolism ; Transfection ; Vegetables/chemistry ; Vegetables/microbiology
    Chemical Substances Lipopolysaccharides ; Plant Extracts ; Toll-Like Receptor 2 ; Toll-Like Receptor 4
    Language English
    Publishing date 2011-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 782617-5
    ISSN 1873-6351 ; 0278-6915
    ISSN (online) 1873-6351
    ISSN 0278-6915
    DOI 10.1016/j.fct.2011.02.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Diet, commensals and the intestine as sources of pathogen-associated molecular patterns in atherosclerosis, type 2 diabetes and non-alcoholic fatty liver disease.

    Erridge, Clett

    Atherosclerosis

    2011  Volume 216, Issue 1, Page(s) 1–6

    Abstract: Stimulation of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4 has been shown to promote the development of a variety of diseases involving dysregulated metabolism, including atherosclerosis, type 2 diabetes and non-alcoholic fatty liver ... ...

    Abstract Stimulation of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4 has been shown to promote the development of a variety of diseases involving dysregulated metabolism, including atherosclerosis, type 2 diabetes and non-alcoholic fatty liver disease. However, the origin and nature of the agents responsible for stimulating TLR2 or TLR4 signalling in these conditions remain to be clearly identified. This review summarises the evidence supporting the proposal that 'pathogen-associated molecular patterns' (PAMPs) derived from dietary and commensal sources may contribute to the chronic inflammatory processes that underpin the development of these diseases via stimulation of TLR2 and TLR4. In particular, insights gained from recent studies employing TLR-transfectant based bioassays to quantify the abundance of PAMPs in foodstuffs and specific commensal compartments are discussed. Finally, the major mechanisms by which TLR-stimulants may gain access to the circulation to promote systemic low-grade inflammation are considered.
    MeSH term(s) Animals ; Atherosclerosis/immunology ; Atherosclerosis/microbiology ; Diabetes Mellitus, Type 2/immunology ; Diabetes Mellitus, Type 2/microbiology ; Diet/adverse effects ; Fatty Liver/immunology ; Fatty Liver/microbiology ; Humans ; Immunity, Innate ; Inflammation Mediators/metabolism ; Insulin Resistance ; Intestines/immunology ; Intestines/microbiology ; Mouth/immunology ; Mouth/microbiology ; Non-alcoholic Fatty Liver Disease ; Obesity/immunology ; Obesity/microbiology ; Signal Transduction ; Toll-Like Receptor 2/metabolism ; Toll-Like Receptor 4/metabolism
    Chemical Substances Inflammation Mediators ; Toll-Like Receptor 2 ; Toll-Like Receptor 4
    Language English
    Publishing date 2011-05
    Publishing country Ireland
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 80061-2
    ISSN 1879-1484 ; 0021-9150
    ISSN (online) 1879-1484
    ISSN 0021-9150
    DOI 10.1016/j.atherosclerosis.2011.02.043
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Accumulation of stimulants of Toll-like receptor (TLR)-2 and TLR4 in meat products stored at 5 °C.

    Erridge, Clett

    Journal of food science

    2011  Volume 76, Issue 2, Page(s) H72–9

    Abstract: Unlabelled: Recent evidence suggests that exposure to stimulants of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4 may contribute to the development of atherosclerosis and insulin resistance. We showed recently that common foodsuffs can ...

    Abstract Unlabelled: Recent evidence suggests that exposure to stimulants of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4 may contribute to the development of atherosclerosis and insulin resistance. We showed recently that common foodsuffs can contain TLR-stimulants, and that the greatest concentrations were present in meat-based products. Using a recently developed quantitative bioassay, we here examined the kinetics of accumulation of TLR2- and TLR4-stimulants in a variety of meat products held at 5 °C in air or under a modified atmosphere for up to 8 d. Meat content of TLR-stimulants increased with time in each meat examined and was paralleled by growth of pseudomonads and Enterobacteriaceae, suggesting that bacterial lipopeptides and lipopolysaccharides are the likely sources of TLR2- and TLR4-stimulants, respectively. TLR-stimulants reached the highest levels (approximately 80 μg lipopeptide-equivalents per gramme and approximately 7 μg lipopolysaccharide-equivalents per gram) in meat that was minced rather than intact, and when stored in air rather than under a modified atmosphere. TLR2- and TLR4-stimulants in meat products cooked for 1 h retained approximately 20% and approximately 40% of their bioactivity, respectively. In summary, storage conditions and microbial flora critically regulate the kinetics of TLR2- and TLR4-stimulant accumulation in meat products and these may retain biological activity after cooking.
    Practical application: The novel assays presented in this work could be used to predict the potential of foodstuffs to promote inflammatory signaling in human subjects, which may be deleterious to health. These assays may also be used to monitor the historical microbial flora in food products after cooking or other forms of food processing may have rendered the original microflora nonviable.
    MeSH term(s) Animals ; Biological Assay/methods ; Cattle ; Cold Temperature ; Enterobacteriaceae/growth & development ; Food Handling ; Food Preservation/methods ; Inflammation/metabolism ; Inflammation/pathology ; Kinetics ; Lipopeptides/metabolism ; Lipopolysaccharides/metabolism ; Meat Products ; Pseudomonas/growth & development ; Swine ; Toll-Like Receptor 2/metabolism ; Toll-Like Receptor 4/metabolism ; Turkeys
    Chemical Substances Lipopeptides ; Lipopolysaccharides ; Toll-Like Receptor 2 ; Toll-Like Receptor 4
    Language English
    Publishing date 2011-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 241615-3
    ISSN 1750-3841 ; 0022-1147
    ISSN (online) 1750-3841
    ISSN 0022-1147
    DOI 10.1111/j.1750-3841.2010.02018.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The capacity of foodstuffs to induce innate immune activation of human monocytes in vitro is dependent on food content of stimulants of Toll-like receptors 2 and 4.

    Erridge, Clett

    The British journal of nutrition

    2011  Volume 105, Issue 1, Page(s) 15–23

    Abstract: The ingestion of fatty meals is associated with a transient, low-grade systemic inflammatory response in human subjects, involving the activation of circulating monocytes and the secretion of pro-inflammatory cytokines. However, it is not yet clear how ... ...

    Abstract The ingestion of fatty meals is associated with a transient, low-grade systemic inflammatory response in human subjects, involving the activation of circulating monocytes and the secretion of pro-inflammatory cytokines. However, it is not yet clear how different foodstuffs may promote inflammatory signalling. In a screen of forty filter-sterilised soluble extracts from common foodstuffs, seven were found to induce the secretion of TNF-α and IL-6 from human monocytes in vitro. To investigate what may differentiate inflammatory from non-inflammatory food extracts, stimulants of Toll-like receptor (TLR) 2 and TLR4 were quantified using human embryonic kidney-293 cells transfected with each TLR, and calibrated with defined bacterial lipopeptide (BLP) and lipopolysaccharide (LPS) standards. These assays revealed that while most foods contained undetectable levels of TLR2 or TLR4 stimulants, all TNF-α-inducing foods contained stimulants of either TLR2 (up to 1100 ng BLP-equivalent/g) or TLR4 (up to 2700 ng LPS-equivalent/g) in both the soluble and insoluble fractions. TLR stimulants were present mainly in meat products and processed foods, but were minimal or undetectable in fresh fruit and vegetables. The capacity of food extracts to induce TNF-α secretion in monocytes correlated with the content of both TLR2 (r 0·837) and TLR4 stimulants (r 0·748), and was completely abolished by specific inhibition of TLR2 and TLR4. LPS and BLP were found to be highly resistant to typical cooking times and temperatures, low pH and protease treatment. In conclusion, apparently unspoiled foodstuffs can contain large quantities of stimulants of TLR2 and TLR4, both of which may regulate their capacity to stimulate inflammatory signalling.
    MeSH term(s) Bacteria ; Cell Line ; Diet/adverse effects ; Food/adverse effects ; Food Handling ; Humans ; Inflammation/etiology ; Inflammation/metabolism ; Inflammation Mediators/metabolism ; Interleukin-6/secretion ; Kidney/cytology ; Lipopeptides/metabolism ; Lipopolysaccharides/metabolism ; Monocytes/metabolism ; Reference Values ; Signal Transduction ; Solubility ; Toll-Like Receptor 2/metabolism ; Toll-Like Receptor 4/metabolism ; Tumor Necrosis Factor-alpha/secretion
    Chemical Substances Inflammation Mediators ; Interleukin-6 ; Lipopeptides ; Lipopolysaccharides ; Toll-Like Receptor 2 ; Toll-Like Receptor 4 ; Tumor Necrosis Factor-alpha
    Language English
    Publishing date 2011-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 280396-3
    ISSN 1475-2662 ; 0007-1145
    ISSN (online) 1475-2662
    ISSN 0007-1145
    DOI 10.1017/S0007114510003004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Lysozyme promotes the release of Toll-like receptor-2 stimulants from gram-positive but not gram-negative intestinal bacteria.

    Erridge, Clett

    Gut microbes

    2010  Volume 1, Issue 6, Page(s) 383–387

    MeSH term(s) Animals ; Cell Line ; Cell Wall/chemistry ; Cell Wall/immunology ; Cell Wall/metabolism ; Gene Expression Profiling ; Gram-Negative Bacteria/chemistry ; Gram-Negative Bacteria/immunology ; Gram-Positive Bacteria/chemistry ; Gram-Positive Bacteria/immunology ; Humans ; Macrophages/immunology ; Macrophages/metabolism ; Mice ; Muramidase/metabolism ; NF-kappa B/metabolism ; Toll-Like Receptor 2/agonists ; Toll-Like Receptor 2/metabolism ; Tumor Necrosis Factor-alpha/metabolism
    Chemical Substances NF-kappa B ; Toll-Like Receptor 2 ; Tumor Necrosis Factor-alpha ; Muramidase (EC 3.2.1.17)
    Language English
    Publishing date 2010-12-31
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1949-0984
    ISSN (online) 1949-0984
    DOI 10.4161/gmic.1.6.13726
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Regulation of low-density lipoprotein cholesterol by intestinal inflammation and the acute phase response.

    Herbert, Karl E / Erridge, Clett

    Cardiovascular research

    2017  Volume 114, Issue 2, Page(s) 226–232

    Abstract: Systemic inflammation, induced by disease or experimental intervention, is well established to result in elevated levels of circulating triglycerides, and reduced levels of high-density lipoprotein-cholesterol (HDL-C), in most mammalian species. However, ...

    Abstract Systemic inflammation, induced by disease or experimental intervention, is well established to result in elevated levels of circulating triglycerides, and reduced levels of high-density lipoprotein-cholesterol (HDL-C), in most mammalian species. However, the relationship between inflammation and low-density lipoprotein-cholesterol (LDL-C) concentrations is less clear. Most reports indicate that systemic inflammation, as observed during sepsis or following high dose experimental endotoxaemia, lowers total, and LDL-C in man. However, isolated reports have suggested that certain inflammatory conditions are associated with increased LDL-C. In this review, we summarize the emerging evidence that low-grade inflammation specifically of intestinal origin may be associated with increased serum LDL-C levels. Preliminary insights into potential mechanisms that may mediate these effects, including those connecting inflammation to trans-intestinal cholesterol efflux (TICE), are considered. We conclude that this evidence supports the potential downregulation of major mediators of TICE by inflammatory mediators in vitro and during intestinal inflammation in vivo. The TICE-inflammation axis therefore merits further study in terms of its potential to regulate serum LDL-C, and as a readily druggable target for hypercholesterolaemia.
    MeSH term(s) Acute-Phase Reaction/blood ; Acute-Phase Reaction/drug therapy ; Acute-Phase Reaction/immunology ; Acute-Phase Reaction/microbiology ; Animals ; Anti-Inflammatory Agents/pharmacology ; Cholesterol, HDL/blood ; Cholesterol, LDL/blood ; Enteritis/blood ; Enteritis/drug therapy ; Enteritis/immunology ; Enteritis/microbiology ; Enterocytes/drug effects ; Enterocytes/immunology ; Enterocytes/metabolism ; Enterocytes/microbiology ; Gastrointestinal Microbiome ; Humans ; Hypolipidemic Agents/pharmacology ; Inflammation Mediators/blood ; Intestine, Small/drug effects ; Intestine, Small/immunology ; Intestine, Small/metabolism ; Intestine, Small/microbiology ; Triglycerides/blood
    Chemical Substances Anti-Inflammatory Agents ; Cholesterol, HDL ; Cholesterol, LDL ; Hypolipidemic Agents ; Inflammation Mediators ; Triglycerides
    Language English
    Publishing date 2017-12-05
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80340-6
    ISSN 1755-3245 ; 0008-6363
    ISSN (online) 1755-3245
    ISSN 0008-6363
    DOI 10.1093/cvr/cvx237
    Database MEDical Literature Analysis and Retrieval System OnLINE

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