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They are among the most potent pyrogens and remain a persistent challenge in environmental, occupational, and clinical settings. This review brings together current understanding of their structure, stability, and methods of detection, while also highlighting the main routes through which humans are exposed. Evidence shows that inhalation of endotoxins, particularly in wastewater treatment plants, can impair lung function and trigger strong inflammatory responses, effects that may be intensified when combined with other agents such as glyphosate. Animal studies demonstrate damage to the gastrointestinal tract and blood exposure has been linked to wider systemic conditions, including obesity, insulin resistance, atherosclerosis, and metabolic syndrome. Endotoxins in water and wastewater further illustrate their public health relevance, as conventional treatment processes often fail to completely eliminate them. In biomedical contexts, residual endotoxins not only compromise device sterility but can also interfere with the accuracy of biomarker measurements in blood samples. Taken together, these findings emphasize the resilience of endotoxins under harsh conditions and point to the urgent need for more effective detection, sterilization, and monitoring strategies to protect both human health and the reliability of medical research.<\/jats:p>","DOI":"10.1002\/puh2.70397","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:46:18Z","timestamp":1791258378000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endotoxins and Biological Implications\u2014Review"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8141-7851","authenticated-orcid":false,"given":"Uzair","family":"Ishtiaq","sequence":"first","affiliation":[{"name":"Department of Research and Development Paktex Industries  Kamoke Pakistan"},{"name":"Department of Life Sciences University of Management and Technology  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Joly","sequence":"additional","affiliation":[{"name":"ULR7519\u2010Unit\u00e9 Transformations &amp; Agroressources Universit\u00e9 d'Artois, UniLaSalle  B\u00e9thune France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Lequart","sequence":"additional","affiliation":[{"name":"ULR7519\u2010Unit\u00e9 Transformations &amp; Agroressources Universit\u00e9 d'Artois, UniLaSalle  B\u00e9thune France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7507-5910","authenticated-orcid":false,"given":"Patrick","family":"Martin","sequence":"additional","affiliation":[{"name":"ULR7519\u2010Unit\u00e9 Transformations &amp; Agroressources Universit\u00e9 d'Artois, UniLaSalle  B\u00e9thune France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielba","family":"Morillo","sequence":"additional","affiliation":[{"name":"Ecology and Nutrition Research Group Faculty of Pharmacy and Bioanalysis University of Los Andes  M\u00e9rida Venezuela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5161-6778","authenticated-orcid":false,"given":"Janne","family":"Rojas","sequence":"additional","affiliation":[{"name":"Organic Biomolecular Research Group Research Institute Faculty of Pharmacy and Bioanalysis University of Los Andes  M\u00e9rida Venezuela"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"2.6.14 Testing of Bacterial Endotoxins","author":"Counsil of europe, European Pharmacopoeia","year":"2024"},{"key":"e_1_2_9_3_1","volume-title":"Biochemical Terminology: Derivations and Definitions of the Universal Language of Biology","author":"Mackinlay A.","year":"2022"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1098\/rsbm.1956.0016"},{"key":"e_1_2_9_5_1","volume-title":"Gram Negative Cell Wall. 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