TLR4 and Cowden disease: In contrast, strains that do not produce CPS can elicit an inflammatory immune response.19 Another explanation given for the bacterium’s possible role in the generation of inflammation associated with CD is its production of the polysaccharide glucorhamnan that can induce the toll-like receptor 4 (TLR4)-dependent secretion of a pro-inflammatory cytokine tumor necrosis factor-α (TNFα) in dendritic cells.20 The bacterium is also associated with other inflammatory non-IBD conditions, such as spondylarthritis.21