TLR4 and endothelial dysfunction: Moreover, the dysbiosis or the leaky gut allows endotoxins such as lipopolysaccharides (LPS) to escape into the bloodstream, which bind to Toll-like receptor 4 (TLR4) on immune cells, accelerating pro-inflammatory cascades that initiate the process of systemic inflammation and endothelial dysfunction, which contribute to the development of atherosclerosis as well [10].