Lipopolysaccharide (LPS) is a virulence factor present on F. nucleatum, which is recognized by Toll-like receptors to activate the TLR4/MYD88 pathway, leading to nuclear factor-κB (NF-κB) activation64 and release of inflammatory cytokines such as TNF-α, IL-6, IL-8, IL-18.64,66,74,76,83,84 IL8 was upregulated in MSI-H CRC.64 Inflammation reduces the enzymatic activity of mismatch repair (MMR) proteins and causes MLH1 silencing, leading to MSI.85 The potential F. nucleatum associated mechanisms involved in the pathogenesis of serrated neoplasm is presented in Figure 3. Here, MLH1 is linked to colorectal carcinoma.