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Front Immunol. 2015 May 15;6:223. doi: 10.3389/fimmu.2015.00223. eCollection 2015.

Stress induces endotoxemia and low-grade inflammation by increasing barrier permeability.

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Institute of Medical Psychology, Charité University Medicine , Berlin , Germany ; Natura Foundation , Numansdorp , Netherlands.
Natura Foundation , Numansdorp , Netherlands.


Chronic non-communicable diseases (NCDs) are the leading causes of work absence, disability, and mortality worldwide. Most of these diseases are associated with low-grade inflammation. Here, we hypothesize that stresses (defined as homeostatic disturbances) can induce low-grade inflammation by increasing the availability of water, sodium, and energy-rich substances to meet the increased metabolic demand induced by the stressor. One way of triggering low-grade inflammation is by increasing intestinal barrier permeability through activation of various components of the stress system. Although beneficial to meet the demands necessary during stress, increased intestinal barrier permeability also raises the possibility of the translocation of bacteria and their toxins across the intestinal lumen into the blood circulation. In combination with modern life-style factors, the increase in bacteria/bacterial toxin translocation arising from a more permeable intestinal wall causes a low-grade inflammatory state. We support this hypothesis with numerous studies finding associations with NCDs and markers of endotoxemia, suggesting that this process plays a pivotal and perhaps even a causal role in the development of low-grade inflammation and its related diseases.


endotoxemia; endotoxin; inflammation; intestinal permeability; lipopolysaccharide; stress; tight junction

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