Mechanisms Leading to Gut Dysbiosis in COVID-19: Current Evidence and Uncertainties Based on Adverse Outcome Pathways

Alteration of gut microbiota has been associated with COVID-19. However, the underlying mechanisms are still not well understood. Here, we proposed three potential interconnected pathways leading to gut dysbiosis as an adverse outcome following SARS-CoV-2 presence in the gastrointestinal tract. Evidence from literature and current uncertainties are reported for each step of each proposed pathway. One pathway investigates evidence that intestinal infection by SARS-CoV-2 leads to intestinal inflammation altering the gut microbiota. Another pathway links the binding of viral S protein to angiotensin converting enzyme 2 (ACE2) to dysregulation of this receptor activity, essential in intestinal homeostasis, notably for amino acid metabolism, leading to gut dysbiosis. Additionally, SARS-CoV-2 could induce gut dysbiosis by infecting intestinal bacteria. Assessing confidence in the proposed mechanisms on current evidence permits to identify inconsistencies and knowledge gaps orienting further research and proposing potential future management.

CLERBAUX Laure-Alix;  FILLIPOVSKA Julija;  MUNOZ-PINEIRO Maria Amalia;  PETRILLO Mauro;  COECKE Sandra;  AMORIM Maria Joao;  GRENGA Lucia; 

2022-09-22

MDPI

JRC129971

2077-0383 (online),   

https://www.mdpi.com/2077-0383/11/18/5400,    https://publications.jrc.ec.europa.eu/repository/handle/JRC129971,   

10.3390/jcm11185400 (online),