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Inflammation : High levels of inflammation in the brain are linked to increased blood-brain barrier (BBB) permeability [5] Stress : Acute stress activates brain mast cells that secrete proinflammatory cytokines [6] Bacterial infections : Bacteria in the brain increase MMP activity, which may induce the breakdown of the BBB [7] Toxins : LPS induces inflammation [8] Mold toxins : Mold toxins and mold components trigger inflammation and increase oxidative damage in the brain [9] High-fat , high-calorie diet : High-fat diets may increase oxidative damage, hypoxia, and inflammation in the brain [10] Leaky gut : Changes in the gut have been associated with BBB permeability [11, 12] Liver damage : In acute liver failure, the damaged liver releases MMP9 into the bloodstream, which may damage tight junctions [13] Diabetes or high blood sugar : Changes in glucose levels cause oxidative stress and inflammation [14] Disrupted sleep -wake cycle : Chronic sleep disturbance decreases glucose transport across the BBB and increases inflammation [15] Anything that triggers oxidative stress in glial cells and pericytes: Oxidative stress damages the BBB and causes structural and integrity problems [16, 17] Hypoxia : Hypoxia is a condition where there is not enough oxygen available

Inhibition of the activity of MAO by carotenoids leads to the elevation of the level of the monoamine and the reduction of oxidative stress load on the cells 81

Key Points Lyme arthritis was recognized as a separate entity from rheumatoid arthritis because of geographic clustering of children in Lyme, Connecticut, USA, who were thought to have juvenile rheumatoid arthritis

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