Furthermore, the virulence factors of BEVs are implicated in Alzheimer’s disease, colitis, and dysbiosis of the intestinal microbiota.24-26Aggregatibacter actinomycetemcomitans is implicated in aggressive forms of periodontitis, and OMVs derived from A. actinomycetemcomitans can deliver biologically active virulence factors (CDT, OmpA) into human gingival fibroblasts (HGFs) and can activate nucleotide-binding oligomerization domain-containing protein 1 (NOD1) and 2 (NOD2), thus triggering an excessive innate immune response27-29 (Figure 1A). This evidence concerns the gene NOD1 and early-onset autosomal dominant Alzheimer disease.