Intestinal permeability changes with bacterial translocation as key events modulating systemic host immune response to SARS-CoV-2: A working hypothesis

Vincenzo Cardinale, Gabriele Capurso, Gianluca Ianiro, Antonio Gasbarrini, Paolo Giorgio Arcidiacono, Domenico Alvaro

Risultato della ricerca: Contributo in rivistaArticolo in rivista


The microbiota-gut-liver-lung axis plays a bidirectional role in the pathophysiology of a number of infectious diseases. During the course of severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and 2 (SARS-CoV-2) infection, this pathway is unbalanced due to intestinal involvement and systemic inflammatory response. Moreover, there is convincing preliminary evidence linking microbiota-gut-liver axis perturbations, proinflammatory status, and endothelial damage in noncommunicable preventable diseases with coronavirus disease 2019 (Covid-19) severity. Intestinal damage due to SARS-CoV-2 infection, systemic inflammation-induced dysfunction, and IL-6-mediated diffuse vascular damage may increase intestinal permeability and precipitate bacterial translocation. The systemic release of damage- and pathogen-associated molecular patterns (e.g. lipopolysaccharides) and consequent immune-activation may in turn auto-fuel vicious cycles of systemic inflammation and tissue damage. Thus, intestinal bacterial translocation may play an additive/synergistic role in the cytokine release syndrome in Covid-19. This review provides evidence on gut-liver axis involvement in Covid-19 as well as insights into the hypothesis that intestinal endotheliitis and permeability changes with bacterial translocation are key pathophysiologic events modulating systemic inflammatory response. Moreover, it presents an overview of readily applicable measures for the modulation of the gut-liver axis and microbiota in clinical practice.
Lingua originaleEnglish
pagine (da-a)1383-1389
Numero di pagine7
RivistaDigestive and Liver Disease
Stato di pubblicazionePubblicato - 2020


  • Alarmins
  • Angiotensin-Converting Enzyme 2
  • Bacterial Translocation
  • COVID-19
  • Cytokine Release Syndrome
  • Cytokine release syndrome
  • Disease Progression
  • Gastrointestinal Microbiome
  • Gut-liver axis
  • Humans
  • Immunity
  • Inflammation
  • Interleukin-6
  • Intestinal Mucosa
  • Lipopolysaccharides
  • Liver
  • Lung
  • Microbiota
  • Microbiota modulation
  • Pathogen-Associated Molecular Pattern Molecules
  • Permeability
  • SARS-CoV-2
  • SARS-CoV-2 host response
  • Serine Endopeptidases


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