Gut microbiota in COVID-19: key microbial changes, potential mechanisms and clinical applications

Fen Zhang, Raphaela I. Lau, Qin Liu, Qi Su, Francis K. L. Chan, Siew C. Ng*

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

73 Citations (Scopus)


The gastrointestinal tract is involved in coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The gut microbiota has important roles in viral entry receptor angiotensin-converting enzyme 2 (ACE2) expression, immune homeostasis, and crosstalk between the gut and lungs, the ‘gut–lung axis’. Emerging preclinical and clinical studies indicate that the gut microbiota might contribute to COVID-19 pathogenesis and disease outcomes; SARS-CoV-2 infection was associated with altered intestinal microbiota and correlated with inflammatory and immune responses. Here, we discuss the cutting-edge evidence on the interactions between SARS-CoV-2 infection and the gut microbiota, key microbial changes in relation to COVID-19 severity and host immune dysregulations with the possible underlying mechanisms, and the conceivable consequences of the pandemic on the human microbiome and post-pandemic health. Finally, potential modulatory strategies of the gut microbiota are discussed. These insights could shed light on the development of microbiota-based interventions for COVID-19.

Original languageEnglish
Pages (from-to)323-337
Number of pages15
JournalNature Reviews Gastroenterology and Hepatology
Issue number5
Early online dateOct 2022
Publication statusPublished - May 2023

Scopus Subject Areas

  • Hepatology
  • Gastroenterology


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