Review
SARS-CoV-2 and immune-microbiome interactions: Lessons from respiratory viral infections

https://doi.org/10.1016/j.ijid.2021.02.071Get rights and content
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Highlights

  • The current outbreak of SARS-CoV-2 causes a severe respiratory illness called coronavirus disease 2019 (COVID-19).

  • Exacerbation in the disease severity of COVID-19, and associated complications, have been associated with hypertension, diabetes, cardiovascular disease, cancer, and lung disease.

  • A body of evidence, relating to the microbiome-immune system axis, has emphasized the pulmonary and gut microbiome as possible modulators for altering the pathogenesis of COVID-19.

  • We performed a comprehensive literature review of COVID-19 and the microbiome to highlight relationships between the severity of COVID-19 disease and changes in the microbiome and immunity.

Abstract

By the beginning of 2020, infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had rapidly evolved into an emergent worldwide pandemic, an outbreak whose unprecedented consequences highlighted many existing flaws within public healthcare systems across the world. While coronavirus disease 2019 (COVID-19) is bestowed with a broad spectrum of clinical manifestations, involving the vital organs, the respiratory system transpires as the main route of entry for SARS-CoV-2, with the lungs being its primary target. Of those infected, up to 20% require hospitalization on account of severity, while the majority of patients are either asymptomatic or exhibit mild symptoms. Exacerbation in the disease severity and complications of COVID-19 infection have been associated with multiple comorbidities, including hypertension, diabetes mellitus, cardiovascular disorders, cancer, and chronic lung disease. Interestingly, a recent body of evidence indicated the pulmonary and gut microbiomes as potential modulators for altering the course of COVID-19, potentially via the microbiome-immune system axis. While the relative concordance between microbes and immunity has yet to be fully elucidated with regards to COVID-19, we present an overview of our current understanding of COVID-19-microbiome-immune cross talk and discuss the potential contributions of microbiome-related immunity to SARS-CoV-2 pathogenesis and COVID-19 disease progression.

Keywords

SARS-CoV-2
COVID-19
Respiratory tract microbiome
Gut microbiome
Immunity

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Both authors contributed equally.