Endotoxins (LPS) & Inflammatory Illness: Research
425 papers · Curated by Lauren Lowenstein, The Biotoxin Lady
Mold gets all the attention. Endotoxins deserve a lot more of it.
Endotoxins are lipopolysaccharides (LPS), part of the outer wall of gram-negative bacteria. When those bacteria die and break apart, the LPS ends up in the air and dust around us. Our immune system is built to react strongly to LPS (largely through a receptor called TLR4), which is why endotoxin is one of the most-used tools in inflammation research.
In a home, endotoxins tend to show up where there's moisture and organic material: plumbing leaks, sewer lines, dry P-traps, wet crawlspaces, and anywhere with water damage. In people who are genetically susceptible, ongoing exposure can keep that inflammatory cascade running. That includes markers like C4a, TGF-β1 and MMP-9, plus research on neuroinflammation.
This hub holds about 425 peer-reviewed papers on endotoxins and inflammatory illness: indoor and occupational exposure, measurement, immune signaling, and endotoxin's role alongside mold in water-damaged buildings.
If your home tests "clean" for mold and you're still sick, ask whether endotoxins have ever been checked. My Endotoxins guide covers testing, the plumber smoke test, and what to do next.
Educational only, not medical advice.
— Lauren Lowenstein, The Biotoxin Lady · Last reviewed October 19, 2026
Key facts
- Endotoxin = lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria.
- The innate immune system recognizes LPS mainly through TLR4, which triggers a strong inflammatory response.
- Plumbing and sewer-gas leaks are an often-overlooked indoor source.
- Endotoxins can be measured in settled dust, separately from mold DNA testing.
Key research papers
- Indoor dampness and mould health effects – ongoing questions on microbial exposures and allergic versus nonallergic mechanisms
Jean M. Cox‐Ganser · Clinical & Experimental Allergy · 2015
- Characterization of Airborne Molds, Endotoxins, and Glucans in Homes in New Orleans after Hurricanes Katrina and Rita
Rao CY et al. · Applied and Environmental Microbiology · 2007
- Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building
Park JH et al. · Indoor Air · 2006
- Use of surrogate markers of biological agents in air and settled dust samples to evaluate a water-damaged hospital
Rao CY et al. · Indoor Air · 2005
- Evaluation of individual-based and group-based exposure estimation of microbial agents in health effects associated with a damp building
Sook Ja Cho et al. · Journal of Exposure Science & Environmental Epidemiology · 2013
- Bacteria, molds, and toxins in water-damaged building materials
Andersson MA et al. · Applied and Environmental Microbiology · 1997
- Sick building syndrome (SBS) and exposure to water-damaged buildings: Time series study, clinical trial and mechanisms
Ritchie C. Shoemaker et al. · Neurotoxicology and Teratology · 2006
- Reduction in Asthma Morbidity in Children as a Result of Home Remediation Aimed at Moisture Sources
Kercsmar CM et al. · Environmental Health Perspectives · 2006
- Bacteria in a water-damaged building: associations of actinomycetes and non-tuberculous mycobacteria with respiratory health in occupants
Ju‐Hyeong Park et al. · Indoor Air · 2017
- Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water‐damaged building
Muge Akpinar‐Elci et al. · American Journal of Industrial Medicine · 2013
- A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings
Ritchie C. Shoemaker et al. · Neurotoxicology and Teratology · 2005
- A Review of the Mechanism of Injury and Treatment Approaches for Illness Resulting from Exposure to Water‐Damaged Buildings, Mold, and Mycotoxins
Janette Hope · The Scientific World JOURNAL · 2013
- Screening for Biomarkers of Actinobacteria Associated with Water-Damaged Buildings – Part 1
Ritchie C. Shoemaker et al. · Medical Research Archives · 2022
- [House Dust and Its Adverse Health Effects].
Atsuko Araki et al. · Nihon eiseigaku zasshi. Japanese journal of hygiene · 2018
- Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building
J.-H. Park et al. · Indoor Air · 2012
- A Novel Therapeutic Approach to Parkinson's Disease: Using Transcriptomics to Identify Unique Patterns of Gene Expression including 'Triple Positives,' Toll receptors, and Endotoxin Exposure
R Shoemaker et al. · Medical Research Archives · 2025
- Mold and endotoxin levels in the aftermath of Hurricane Katrina: a pilot project of homes in New Orleans undergoing renovation
Chew GL et al. · Environmental Health Perspectives · 2006
- Newer Molecular Methods Bring New Insights into Human- And Building-Health Risk Assessments from Water-Damaged Buildings: Defining Exposure and Reactivity, the Two Sides of Causation of CIRS-WDB Illness
R. L. Shoemaker et al. · Medical Research Archives · 2021
- Sick building syndrome (SBS) among office workers in a Malaysian university--Associations with atopy, fractional exhaled nitric oxide (FeNO) and the office environment.
Fang-Lee Lim et al. · The Science of the total environment · 2015
- Ex Vivo Cytokine Release and Pattern Recognition Receptor Expression of Subjects Exposed to Dampness: Pilot Study to Assess the Outcome of Mould Exposure to the Innate Immune System
Stefanie Punsmann et al. · PLoS ONE · 2013
- The biocontaminants and complexity of damp indoor spaces: more than what meets the eyes
Thrasher J et al. · Toxicology and Industrial Health · 2009
- Bioaerosols in Eastern Canadian Dairy Barns Using Tie- and Free-Stall Housing
Keven Bergeron et al. · Applied Engineering in Agriculture · 2024
- Dustborne and airborne Gram-positive and Gram-negative bacteria in high versus low ERMI homes
Atin Adhikari et al. · The Science of The Total Environment · 2014
- Use of a robotic sampling platform to assess young children’s exposure to indoor bioaerosols
Wang Z et al. · Indoor Air · 2012
- Dampness in buildings and health (DBH): report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden
Bornehag G et al. · Indoor Air · 2004
- Introduction to Chronic Inflammatory Response Syndrome (CIRS)
Andrew Heyman et al. · 2023
- Treatable metabolic and inflammatory abnormalities in Post COVID Syndrome (PCS) define the transcriptomic basis for persistent symptoms: Lessons from CIRS
Ritchie C. Shoemaker et al. · Medical Research Archives · 2021
- The Evolution of Chronic Inflammatory Response Syndrome (CIRS) and the Biotoxin Pathway
Ritchie C. Shoemaker et al. · 2023
- Overview of Personal Occupational Exposure Levels to Inhalable Dust, Endotoxin, β(1→3)-Glucan and Fungal Extracellular Polysaccharides in the Waste Management Chain
Wouters IM et al. · The Annals of Occupational Hygiene · 2006
- Exposures in the Indoor Environment and Prevalence of Allergic Conditions in the United States of America
Janvier Gasana et al. · International Journal of Environmental Research and Public Health · 2021
- Association between indoor microbiome exposure and sick building syndrome (SBS) in junior high schools of Johor Bahru, Malaysia
Xi Fu et al. · The Science of The Total Environment · 2021
- Acute Effect of Glucan-Spiked Office Dust on Nasal and Pulmonary Inflammation in Guinea Pigs
Straszek SP et al. · Journal of Toxicology and Environmental Health · 2007
- Biological contaminants in the indoor air environment and their impacts on human health
Pradeep Kumar et al. · Air Quality Atmosphere & Health · 2021
- Molds and mycotoxins indoors II: Toxicological perspective
Shakil A. Saghir et al. · Archives of Clinical Toxicology · 2025
- Airborne mold and endotoxin concentrations in New Orleans, Louisiana, after flooding, October through November 2005
Solomon GM et al. · Environmental Health Perspectives · 2006
- Indoor PM 2.5 from occupied residences in Sweden caused higher inflammation in mice compared to outdoor PM 2.5
Aneta Wierzbicka et al. · Indoor Air · 2022
- Exposure to bioaerosol in the residential environment
Anna Kozajda et al. · Medycyna Pracy · 2024
- Exposure assessment and analysis for biological agents
Martinez KF et al. · Grana · 2004
- Fungal Fragments as Indoor Air Biocontaminants
Gorny RL et al. · Applied and Environmental Microbiology · 2002
- The weight of leptin in immunity
La Cava A et al. · Nature reviews. Immunology · 2004
- Hypersensitivity pneumonitis: a historical, clinical, and radiologic review
Hirschmann J et al. · Radiographics · 2009
- Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance
Philip A. Kern et al. · American Journal of Physiology-Endocrinology and Metabolism · 2001
- The interleukin-17 cytokine family: critical players in host defence and inflammatory diseases
Pappu R et al. · Immunology · 2011
- Detection of AirborneStachybotrys chartarumMacrocyclic Trichothecene Mycotoxins on Particulates Smaller than Conidia
Brasel TL et al. · Applied and Environmental Microbiology · 2005
- VEGF delivery with retrogradely transported lentivector prolongs survival in a mouse ALS model
Azzouz Mimoun et al. · Nature · 2004
- Adipose Tissue as an Endocrine Organ
Rexford S. Ahima et al. · Trends in Endocrinology and Metabolism · 2000
- The nervous system and innate immunity: the neuropeptide connection
Brogden KA et al. · Nature Immunology · 2005
- Targeting melanocortin receptors as a novel strategy to control inflammation
Catania A et al. · Pharmacological Reviews · 2004
- Multiple Cytokines and Acute Inflammation Raise Mouse Leptin Levels: Potential Role in Inflammatory Anorexia
Pasha Sarraf et al. · The Journal of Experimental Medicine · 1997
- Matrix metalloproteinases as modulators of inflammation and innate immunity
Parks WC et al. · Nature reviews. Immunology · 2004
- Leptin regulates proinflammatory immune responses
S. Loffreda et al. · The FASEB Journal · 1998
- Hypoxia-Inducible Factor 1α in the Glaucomatous Retina and OpticNerve Head
Texel G et al. · Archives of Ophthalmology · 2004
- Differential Cytokine Production and Toll-Like Receptor Signaling Pathways by Candida albicans Blastoconidia and Hyphae
Chantal A. A. van der Graaf et al. · Infection and Immunity · 2005
- From the Th1/Th2 Paradigm towards a Toll-Like Receptor/T-Helper Bias
Netea Mihai G. et al. · Antimicrobial Agents and Chemotherapy · 2005
- Anti-inflammatory actions of the neuroimmunomodulator α-MSH
Lipton JM et al. · Immunology Today · 1997
- Exaggerated neuroinflammation and sickness behavior in aged mice after activation of the peripheral innate immune system
Godbout JP et al. · The FASEB Journal · 2005
- Air- and Dustborne Mycoflora in Houses Free of Water Damage and Fungal Growth
Hormer WE et al. · Applied and Environmental Microbiology · 2004
- The von Hippel–Lindau Protein, Vascular Endothelial Growth Factor, and Kidney Cancer
Daniel J. George et al. · New England Journal of Medicine · 2003
- Occurrence of Toxigenic Aspergillus versicolor Isolates and Sterigmatocystin in Carpet Dust from Damp Indoor Environments
Engelhart S et al. · Applied and Environmental Microbiology · 2002
- The Leptin Receptor Activates Janus Kinase 2 and Signals for Proliferation in a Factor-Dependent Cell Line
Nico Ghilardi et al. · Molecular Endocrinology · 1997