SARS-CoV-2 Enfeksiyonu ve Bağırsak-Akciğer Aksı

Yıl 2021, Cilt: 5 Sayı: 1, 26 - 36, 24.12.2021

Yonca Sevim , Özlem Persil Özkan

Öz

Koronavirüs hastalığı-2019 (COVID-19), 2019 yılının Aralık ayı sonunda Çin'in Wuhan kentinde ortaya çıkan ve şiddetli akut solunum sıkıntısı sendromu koronavirüs 2’nin (SARS-CoV-2) neden olduğu bulaşıcı bir hastalıktır. COVID-19'un solunum sıkıntısının yanı sıra ülseratif kolit ile birlikte gastrointestinal enfeksiyon ve diyare gibi diğer organları etkileyen bazı klasik olmayan semptomlarla ilişkili olduğu görülmüştür. Gastrointestinal enfeksiyon semptomları olan hastalar hastalığı çok daha şiddetli geçirmektedir ve bunun sebebinin Lactobacillus ve Bifidobacterium sayısındaki azalma ile birlikte ortaya çıkan mikrobiyal disbiyoz ile ilişkili olabileceği düşünülmektedir. SARS-CoV-2 virüsünün konak organizmaya girişi, anjiyotensin dönüştürücü enzim 2 (ACE-2) hücre reseptörü aracılığı ile gerçekleşmektedir ve ACE-2 reseptörleri gastrointestinal kanalda da eksprese edilmektedir. SARS-CoV-2 virüsü COVID-19 hastalarının özefagus, mide, duodenum, rektum ve dışkı örneklerinde tespit edilmiş, bağırsak epitel hücrelerinde viral replikasyonun yüksek olduğu gösterilmiştir. Gastarointestinal sistemin sadece SARS-CoV-2’nin vücuda giriş yolu olmadığı aynı zamanda viral aktivite ve replikasyon yeri olabileceği de düşünülmektedir. Bağırsak-akciğer aksı olarak bilinen, solunum mukozası ile bağırsak mikrobiyotası arasındaki çift yönlü etkileşimlerin, SARS-CoV-2'ye karşı sağlıklı veya patolojik bağışıklık tepkilerinde yer aldığı varsayılmaktadır. Bağırsak mikrobiyotasının modülasyonuna ve eubiosis koşullarının yeniden oluşturulmasına dayalı ek tedavilerin, COVID-19'un zararlı sonuçlarını sınırlamak için önemli bir terapötik yaklaşım olabileceği varsayılmaktadır. Bu derleme çalışmasında bağırsak akciğer ekseni ve SARS-CoV-2 virüsü enfeksiyonunda bu eksende değişen mikrobiyota ile ilgili çalışmaların sonuçları araştırılmıştır.

Anahtar Kelimeler

COVID-19, mikrobiyota, bağırsak-akciğer aksı, SARS-CoV-2, probiyotikler

Destekleyen Kurum

Yok

Teşekkür

Yok

Kaynakça

• Panyod S, Ho CT, Sheen LY. Dietary therapy and herbal medicine for COVID-19 prevention: A review and perspective. J Tradit Complement Med. 2020;(10):420-427.
• Huang C, Wang y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
• World Health Organization Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/ Erişim tarihi: 01.08.2021.
• Information for Clinicians on Investigational Therapeutics for Patients with COVID-19, Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html Erişim tarihi: 15.05.2021.
• Subedi L, Tchen S, Gaire BP, et al. Adjunctive nutraceutical therapies for COVID-19. Int J Mol Sciences. 2021;22:2-16.
• Din AU, Mazhar M, Waseem M, et al. SARS-CoV-2 microbiome dysbiosis linked disorders and possible probiotics role. Biomedicine & Pharmacotherapy. 2021;133:110947.
• Donaldson GP, Lee SM, Mazmanian SK. Gut biogeography of the bacterial microbiota. Nat Rev Microbiol. 2016;14(1):20–32.
• Li M, Wang B, Zhang M, et al. Symbiotic gut microbes modulate human metabolic phenotypes. Proc Natl Acad Sci. 2008;105:2117–22.
• Dhar D, Mohanty A. Gut microbiota and Covid-19 possible link and implications. Virus Research. 2020;285:198018. doi:10.1016/j.virusres.2020.198018
• Zhang D, Li S, Wang N, Tan H-Y, Zhang Z, Feng Y. The cross-talk between gut microbiota and lungs in common lung diseases. Front Microbiol. 2020;11:301.
• Keely S, Talley NJ, Hansbro PM. Pulmonary-intestinal cross-talk in mucosal inflammatory disease. Mucosal Immunol. 2012;5(1):7–18.
• Trompette A, Gollwitzer ES, Yadava K, et al. Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nat Med. 2014;20:159–66.
• Wang H, Dai W, Feng X, et al. Microbiota composition in upper respiratory tracts of healthy children in Shenzhen, China, differed with respiratory sites and ages. BioMed Res Int. 2018;6515670.
• Ichinohe T, Pang IK, Kumamoto Y, et al. Microbiota regulates immune defense against respiratory tract influenza A virus infection. Proc Natl Acad Sci. 2011;108:5354–9.
• Groves HT, Higham SL, Moffatt MF, Cox MJ, Tregoning JS. Respiratory viral infection alters the gut microbiota by inducing inappetence. mBio. 2020;11(1):e03236-19.
• Grayson MH, Camarda LE, Hussain S-RA, et al. Intestinal microbiota disruption reduces regulatory T cells and increases respiratory viral infection mortality through increased IFNg production. Front Immunol. 2018;9:1587.
• V Fanos, MC Pintus, R Pintus, MA Marcialis, Lung microbiota in the acute respiratory disease: from coronavirus to metabolomics. Journal of Pediatric Neonatal Individualized Medicine. 2020;9(1):e090139.
• Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin. Med. Lond. 2020:124–127. doi:10.7861/clinmed.2019- coron.
• Dickson RP, Arbor A. The microbiome and critical illness. Lancet Respir. Med. 2017;4(1):59–72.
• Dickson RP, Singer BH, Newstead MW, et al. Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome. Nat Microbiol. 2016;1:16113.
• Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the Novel Coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS Coronavirus. J Virol. 2020;94:e00127–20.
• Harmer D, et al. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett. 2002;532(1–2):107–110.
• Sencio V, Machado MG, Trottein F. The lung–gut axis during viral respiratory infections: the impact of gut dysbiosis on secondary disease outcomes. Mucosal Immunology. 2021;14:296–304.
• Leung WK, To K-F, Chan PKS, et al. Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Gastroenterology. 2003;125:1011–7.
• de Oliveira GLV, Oliveira CNS, Pinzan CF, de Salis LVV, Cardoso CRB. Microbiota modulation of the gut-lung axis in COVID-19. Front. Immunol. 2021;12:635471.
• Chen Y, Chen L, Deng Q, et al. The presence of SARS-CoV-2 RNA in the feces of COVID-19 patients. J Med Virol 2020;92:833– 40.
• Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020;115:766–73.
• Jin X et al, Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002-1009.
• Ong J, Young BE, Ong S. COVID-19 in gastroenterology: a clinical perspective. Gut. 2020;69:1144–1145. doi: 10.1136/gutjnl-2020-321051
• Abt MC, Osborne LC, Monticelli LA. Commensal bacteria calibrate the activation threshold of innate antiviral immunity. Immunity. 2012;37:158–70.
• Bradley KC, Finsterbusch K, Schnepf D, et al. Microbiota-driven tonic interferon signals in lung stromal cells protect from Influenza virus infection. Cell Rep. 2019;28:245–256.e4.
• Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158:1831–1833.
• Lucas C, Wong P, Klein J, et al. Longitudinal analyses reveal immunological misfiring in severe COVID19. Nature. 2020;584:463–9.
• Viana SD, Nunes S, Reis F. ACE2 imbalance as a key player for the poor outcomes in COVID-19 patients with age-related comorbidities – Role of gut microbiota dysbiosis. Ageing Res Rev. 2020;62:101123.
• Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203:631–7.
• Zhang H, Kang Z, Gong H, et al. Digestive system is a potential route of COVID-19: an analysis of single-cell coexpression pattern of key proteins in viral entry process. Gut. 2020;69:1010–8.
• Lee KH, Gordon A, Shedden K, et al. The respiratory microbiome and susceptibility to influenza virus infection. PLoS One. 2019;14:e0207898. doi: 10.1371/journal.pone.0207898
• Edouard S, Million M, Bachar D, et al. The nasopharyngeal microbiota in patients with viral respiratory tract infections is enriched in bacterial pathogens. Eur J Clin Microbiol Infect Dis. 2018;37:1725–33.
• Gu S, Chen Y, Wu Z, et al. Alterations of the gut microbiota in patients with COVID-19 or H1N1 Influenza. Clin Infect Dis. 2020;75(10):2669-78.
• Zuo T, Zhang F, Lui GCY, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Gastroenterology. 2020;159:944–55.e8.
• Geva-Zatorsky N, Sefik E, Kua L, et al. Mining the human gut microbiota for ımmunomodulatory organisms. Cell. 2017;168:928–43.e11.
• Zuo T, Liu Q, Zhang F, et al. Depicting SARS-CoV-2 faecal viral activity in association with gut microbiota composition in patients with COVID-19. Gut. 2020;70:276–84.
• Man WH, de Steenhuijsen Piters WAA, Bogaert D. The microbiota of the respiratory tract: gatekeeper to respiratory health. Nat Rev Microbiol. 2017;15:259–70.
• Fan J, Li X, Gao Y, et al. The lung tissue microbiota features of 20 deceased patients with COVID-19. J Infect. 2020;81:e64–7.
• Konturek PC, Harsch IA, Neurath MF, Zopf Y. COVID-19 - more than respiratory disease: a gastroenterologist’s perspective. J Physiol Pharmacol. 2020;71(2):179–89.
• He LH, Ren LF, Li JF, Wu YN, Li X, Zhang L. Intestinal flora as a potential strategy to fight SARS-CoV-2 infection. Front Microbiol. 2020;11:1388.
• Kurian SJ, Unnikrishnan MK, Miraj SS, et al. Probiotics in prevention and treatment of COVID-19: current perspective and future prospects. Arc Med Res. 2021;52(6):582-594.
• Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version), for the Zhongnan Hospital of Wuhan University Novel Coronavirus Management and Research Team, Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM), Mil. Med. Res. 2020;7(1):4.
• He Y. Translation: diagnosis and treatment protocol for novel Coronavirus pneumonia (Trial Version 7), National Health Commission, National Administration of Traditional Chinese Medicine. Infectious Microbes & Diseases, 2020.
• Zeng J, Wang CT, Zhang FS, et al. Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial. Intensive Care Med. 2016;42(6):1018–1028.
• Su M, Jia Y, Li Y. Probiotics for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Respir Care. 2020;65:673–685.
• Xu K, Cai H, Shen Y. Management of corona virus disease-19 (COVID-19): the Zhejiang experience. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49:147–157.
• d’Ettorre G, Ceccarelli G, Marazzato M, et al. Challenges in the management of SARS-CoV2 infection: The role of oral bacteriotherapy as complementary therapeutic strategy to avoid the progression of COVID-19. Front Med. 2020;7:389.
• https://clinicaltrials.gov/ct2/results?cond=Corona+Virus+Infection&term=probiotics&cntry=&state=&city=&dist= Erişim tarihi: 01.11.2021.
• Liang W, Feng Z, Rao S. Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus. Gut. 2020;69:1141–1143
• Feng Z, Wang Y, Qi W. The small intestine, an underestimated site of SARS-CoV-2 infection: from red queen effect to probiotics. Preprints.org 2020.
• Pradhan B, Guha D, Naik AK. Probiotics L. acidophilus and B. clausii modulate gut microbiota in Th1- and Th2- biased mice to ameliorate Salmonella typhimurium-induced diarrhea. Probiotics Antimicrob Proteins. 2019;11:887–904.
• Mak JWY, Chan FKL, Ng SC. Probiotics and COVID-19: one size does not fit all. Lancet Gastroenterol Hepatol. 2020;5:644–645.