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Studies demonstrate that LPS activates adipose tissue macrophages via TLR4 receptors, promoting the release of proinflammatory cytokines such as TNF-, which in turn induces excessive lipolysis in adipocytes, generating large quantities of free fatty acids (FFAs) ( 3.5 Hypothalamic-pituitary-ovarian axis disruption Disruption of gut microbiota leading to systemic LPS translocation not only impairs peripheral organ function but also exacerbates PCOS pathology by interfering with the neuroendocrine regulation of the HPO axis ( 4 Gut microbiota characteristics in PCOS Recent studies have shown distinct differences in gut microbial composition between PCOS and healthy controls

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The plaintiffs presented several experts who addressed different parts of the causation question