TNF and Cowden disease: AIEC is able to survive in macrophages, induces the production of TNF-α, and promotes granulomatous inflammatory responses.[122] In a prospective cohort study involving patients with CD, colonization by AIEC was observed to be associated with an increased presence of R gnavus, another bacterium deeply implicated in the development of CD.[123] Nonetheless, the in vivo pathogenesis of AIEC and any specific genes pertaining to AIEC remain poorly understood, necessitating further research to elucidate the precise mechanisms underlying its pathogenicity.