Segal Jonathan P, Mak Joyce W Y, Mullish Benjamin H, Alexander James L, Ng Siew C, Marchesi Julian R
Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
Centre for Gut Microbiota Research, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Therap Adv Gastroenterol. 2020 Nov 24;13:1756284820974914. doi: 10.1177/1756284820974914. eCollection 2020.
The novel coronavirus infection (COVID-19) caused by the SARS-CoV-2 virus has spread rapidly across the globe, culminating in major global morbidity and mortality. As such, there has been a rapid escalation in scientific and clinical activity aimed at increasing our comprehension of this virus. This volume of work has led to early insights into risk factors associated with severity of disease, and mechanisms that underpin the virulence and dynamics involved in viral transmission. These insights ultimately may help guide potential therapeutics to reduce the human, economic and social impact of this pandemic. Importantly, the gastrointestinal (GI) tract has emerged as an important organ influencing propensity to, and potentially severity of, COVID-19 infection. Furthermore, the gut microbiome has been linked to a variety of risk factors for COVID-19 infection, and manipulation of the gut microbiome is an attractive potential therapeutic target for a number of diseases. While data profiling the gut microbiome in COVID-19 infection to date are limited, they support the possibility of several routes of interaction between COVID-19, the gut microbiome, angiotensin converting enzyme 2 (ACE-2) expression in the small bowel and colon and gut inflammation. This article will explore the evidence that implicates the gut microbiome as a contributing factor to the pathogenesis, severity and disease course of COVID-19, and speculate about the gut microbiome's capability as a therapeutic avenue against COVID-19.
It has been noted that certain baseline gut profiles of COVID-19 patients are associated with a more severe disease course, and the gut microbiome impacts the disease course of several contributory risk factors to the severity of COVID-19. A protein called ACE-2, which is found in the small intestine among other sites, is a key receptor for COVID-19 virus entry; there is evidence that the gut microbiome influences ACE-2 receptor expression, and hence may play a role in influencing COVID-19 infectivity and disease severity. Furthermore, the gut microbiome plays a significant role in immune regulation, and hence may be pivotal in influencing the immune response to COVID-19. In terms of understanding COVID-19 treatments, the gut microbiome is known to interact with several drug classes being used to target COVID-19 and should be factored into our understanding of how patients respond to treatment. Importantly, our understanding of the role of the gut microbiome in COVID-19 infection remains in its infancy, but future research may potentially aid our mechanistic understanding of viral infection, and new ways in which we might approach treating it.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒引起的新型冠状病毒感染（COVID-19）已在全球迅速传播，导致全球范围内出现大量发病和死亡病例。因此，旨在加深我们对这种病毒理解的科学和临床活动迅速增加。大量的研究工作已使我们对与疾病严重程度相关的风险因素以及病毒传播中涉及的毒力和动态变化的机制有了初步认识。这些认识最终可能有助于指导潜在的治疗方法，以减少这场大流行对人类、经济和社会的影响。重要的是，胃肠道已成为影响COVID-19感染易感性和潜在严重程度的重要器官。此外，肠道微生物群与COVID-19感染的多种风险因素有关，对肠道微生物群的调控是许多疾病有吸引力的潜在治疗靶点。虽然迄今为止对COVID-19感染中肠道微生物群进行分析的数据有限，但这些数据支持了COVID-19、肠道微生物群、小肠和结肠中血管紧张素转换酶2（ACE-2）表达以及肠道炎症之间存在多种相互作用途径的可能性。本文将探讨表明肠道微生物群是COVID-19发病机制、严重程度和病程的一个促成因素的证据，并推测肠道微生物群作为对抗COVID-19的治疗途径的能力。
人们已经注意到，COVID-19患者的某些基线肠道特征与更严重的病程相关，并且肠道微生物群会影响COVID-19严重程度的几个促成风险因素的病程。一种名为ACE-2的蛋白质在小肠等部位被发现，它是COVID-19病毒进入的关键受体；有证据表明肠道微生物群会影响ACE-2受体的表达，因此可能在影响COVID-19的感染性和疾病严重程度方面发挥作用。此外，肠道微生物群在免疫调节中起重要作用，因此可能在影响对COVID-19的免疫反应方面起关键作用。在理解COVID-19治疗方面，已知肠道微生物群会与用于治疗COVID-19的几类药物相互作用，在我们理解患者对治疗的反应时应考虑到这一点。重要的是，我们对肠道微生物群在COVID-19感染中的作用的理解仍处于起步阶段，但未来的研究可能有助于我们从机制上理解病毒感染以及我们可能采取的新的治疗方法。
