Effective Regulation of Gut Microbiota With Probiotics and Prebiotics May Prevent or Alleviate COVID-19 Through the Gut-Lung Axis

Abstract

Coronavirus disease 2019 (COVID-19) can disrupt the gut microbiota balance, and patients usually have intestinal disorders. The intestine is the largest immune organ of the human body, and gut microbes can affect the immune function of the lungs through the gut-lung axis. Many lines of evidence support the role of beneficial bacteria in enhancing human immunity, preventing pathogen colonization, and thereby reducing the incidence and severity of infection. In this article, we review the possible approach of modulating microbiota to help prevent and treat respiratory tract infections, including COVID-19, and discuss the possibility of using probiotics and prebiotics for this purpose. We also discuss the mechanism by which intestinal micro-flora regulate immunity and the effects of probiotics on the intestinal micro-ecological balance. Based on this understanding, we propose the use of probiotics and prebiotics to modulate gut microbiota for the prevention or alleviation of COVID-19 through the gut-lung axis.

Gastrointestinal microbiota: A predictor of COVID-19 severity?

“…Targeting severe immune responses in COVID-19 represents the main therapeutic approach[ 151 ]. Recent studies pointed out the role of a high-fiber diet and probiotics as disease-modifying therapy in COVID-19[ 151 , 152 ]. The role of nutraceutical compounds, consisting of vitamins, dietary supplements and pro/prebiotics in COVID-19, have been reported to improve the clinical course and severity of COVID-19 disease (Table 4 ).…”

COVID‐19‐associated liver injury: Adding fuel to the flame

“…Some hepatoprotective agents such as Matrine, 187 Diammonium glycyrrhizinate enteric‐coated capsules, 188 Artemisinin, 189 Scutellariae Radix, 190 and Garlic 191 displayed anti SARS‐CoV‐2 activity, these medicines may provide ideas for the COVID‐19 treatment 192 . Some prebiotics or plant polysaccharides may reduce the risk of SARS‐CoV‐2 infection 193,194 . Besides, the use of adjuvant drugs can protect the liver and reduce secondary hepatic adverse reactions.…”

“…192 Some prebiotics or plant polysaccharides may reduce the risk of SARS-CoV-2 infection. 193,194 Besides, the use of adjuvant drugs can protect the liver and reduce secondary hepatic adverse reactions. Given that the relationship between amino acid metabolism and the liver, supplementation such as arginine, glutamine agents has been suggested to intervene in the treatment of COVID-19 to provide hepatoprotective effect.…”

Inflammatory pathways in COVID‐19: Mechanism and therapeutic interventions

“…It was found that patients infected with SARS‐CoV‐2 had significantly lower intestinal bacterial diversity and reduced relative abundance of beneficial microorganisms, such as Bifidobacteria , suggesting the use of probiotics ( Bifidobacteria , Lactobacillus , and Panibacillus ) and prebiotics (foods containing prebiotics, such as fiber, oligosaccharides, and polyphenols) to effectively modulate the intestinal microbiota and prevent or mitigate COVID‐19 through the gut–lung axis (reviewed in Refs. 235 , 236 , 237 ). However, this review will focus on summarizing the targeted drugs in the COVID‐19 inflammatory pathways, focusing on the key targets and clinical implications, and these targeted interventions may provide important reference value for COVID‐19 treatment (Figure 5 and Table 1 ).…”