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Review
. 2020 Oct 1;8(10):1514.
doi: 10.3390/microorganisms8101514.

Gut Microbiota Dysbiosis-Immune Hyperresponse-Inflammation Triad in Coronavirus Disease 2019 (COVID-19): Impact of Pharmacological and Nutraceutical Approaches

Carolina Ferreira  1   2   3 , Sofia D Viana  1   2   3   4 , Flávio Reis  1   2   3
Affiliations
Review

Gut Microbiota Dysbiosis-Immune Hyperresponse-Inflammation Triad in Coronavirus Disease 2019 (COVID-19): Impact of Pharmacological and Nutraceutical Approaches

Carolina Ferreira et al. Microorganisms. .

Abstract

Coronavirus Disease 2019 (COVID-19) is a pandemic infection caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients present a complex clinical picture that, in severe cases, evolves to respiratory, hepatic, gastrointestinal, and neurological complications, and eventually death. The underlying pathophysiological mechanisms are complex and multifactorial and have been summarized as a hyperresponse of the immune system that originates an inflammatory/cytokine storm. In elderly patients, particularly in those with pre-existing cardiovascular, metabolic, renal, and pulmonary disorders, the disease is particularly severe, causing prolonged hospitalization at intensive care units (ICU) and an increased mortality rate. Curiously, the same populations have been described as more prone to a gut microbiota (GM) dysbiosis profile. Intestinal microflora plays a major role in many metabolic and immune functions of the host, including to educate and strengthen the immune system to fight infections, namely of viral origin. Notably, recent studies suggest the existence of GM dysbiosis in COVID-19 patients. This review article highlights the interplay between the triad GM dysbiosis-immune hyperresponse-inflammation in the individual resilience/fragility to SARS-CoV-2 infection and presents the putative impact of pharmacological and nutraceutical approaches on the triumvirate, with focus on GM.

Keywords: COVID-19; SARS-CoV-2 infection; gut microbiota dysbiosis; immune hyperresponse; inflammation; pharmacological and nutraceutical approaches.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The interplay between the gut microbiota dysbiosis–immune hyperresponse–inflammation triad in Coronavirus Disease 2019 (COVID-19) and the putative influence on disease progression and response to therapies. Rather than being merely restricted to the lower respiratory tract, severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection extends to other organs, namely the gastrointestinal tract (multi-tissue infection). Influenced by the lifetime cross-modulations between the immune system and the microbiota (like a personal fingerprint), gut microbiota dysbiosis, immune hyperresponse, and an inflammatory setting are elicited under these circumstances (triad). On behalf of the intricate influence of gut microbiota (GM) on host immune effectors and subsequent inflammatory profile, GM composition and function might contribute to explain the individual resilience/fragility to COVID-19 and/or the response to therapeutics, which deserves further research.
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