Role of TLR4 in the gut-brain axis in Parkinson's disease: a translational study from men to mice

Gut. 2019 May;68(5):829-843. doi: 10.1136/gutjnl-2018-316844. Epub 2018 Dec 15.


Objective: Recent evidence suggesting an important role of gut-derived inflammation in brain disorders has opened up new directions to explore the possible role of the gut-brain axis in neurodegenerative diseases. Given the prominence of dysbiosis and colonic dysfunction in patients with Parkinson's disease (PD), we propose that toll-like receptor 4 (TLR4)-mediated intestinal dysfunction could contribute to intestinal and central inflammation in PD-related neurodegeneration.

Design: To test this hypothesis we performed studies in both human tissue and a murine model of PD. Inflammation, immune activation and microbiota composition were measured in colonic samples from subjects with PD and healthy controls subjects and rotenone or vehicle-treated mice. To further assess the role of the TLR4 signalling in PD-induced neuroinflammation, we used TLR4-knockout (KO) mice in conjunction with oral rotenone administration to model PD.

Results: Patients with PD have intestinal barrier disruption, enhanced markers of microbial translocation and higher pro-inflammatory gene profiles in the colonic biopsy samples compared with controls. In this regard, we found increased expression of the bacterial endotoxin-specific ligand TLR4, CD3+ T cells, cytokine expression in colonic biopsies, dysbiosis characterised by a decrease abundance of SCFA-producing colonic bacteria in subjects with PD. Rotenone treatment in TLR4-KO mice revealed less intestinal inflammation, intestinal and motor dysfunction, neuroinflammation and neurodegeneration, relative to rotenone-treated wild-type animals despite the presence of dysbiotic microbiota in TLR4-KO mice.

Conclusion: Taken together, these studies suggest that TLR4-mediated inflammation plays an important role in intestinal and/or brain inflammation, which may be one of the key factors leading to neurodegeneration in PD.

Keywords: brain/gut interaction; colonic microflora; inflammation; short chain fatty acids.

MeSH terms

  • Animals
  • CD3 Complex / metabolism
  • Case-Control Studies
  • Colon / metabolism
  • Colon / microbiology
  • Colon / pathology*
  • Disease Models, Animal
  • Dysbiosis / etiology
  • Dysbiosis / metabolism
  • Dysbiosis / pathology
  • Humans
  • Mice
  • Mice, Inbred C57BL
  • Mice, Knockout
  • Parkinson Disease / etiology*
  • Parkinson Disease / metabolism
  • Parkinson Disease / pathology
  • Toll-Like Receptor 4 / physiology*


  • CD3 Complex
  • Toll-Like Receptor 4