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Oral anaerobes generate volatile sulfur compounds (VSCs) such as hydrogen sulfide and methanethiol, which may modulate inflammatory signaling and epithelial integrity within the respiratory mucosa 195 , while organic acids and tryptophan-derived metabolites produced by oral commensals may further alter microbial colonisation patterns and host immune responses in the airways 196

The inflammatory microenvironment reduces the glutamate uptake, inducing accumulation of this excitatory amino acid and excitotoxic neurodegeneration