This pattern aligns with typical disease patterns of IBD, characterized by phases of low activity and intermittent exacerbation.61 One speculation is that since both PLC and PFO toxins are regulated by quorum sensing,62–64 when conditions are favourable, colonized C. perfringens can replicate quickly to achieve a quorum, releasing multiple toxins capable of injuring various cell types.65 Without a quorum, toxins are not produced. Here, HSPG2 is linked to inflammatory bowel disease.