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Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19

Open access
Yeoh, Yun Kit, Zuo, Tao, Lui, Grace Chung-Yan, Zhang, Fen, Liu, Qin, Li, Amy YL, Chung, Arthur CK, Cheung, Chun Pan, Tso, Eugene YK, Fung, Kitty SC, Chan, Veronica, Ling, Lowell, Joynt, Gavin, Hui, David Shu-Cheong, Chow, Kai Ming, Ng, Susanna So Shan, Li, Timothy Chun-Man, Ng, Rita WY, Yip, Terry CF, Wong, Grace Lai-Hung, Chan, Francis KL, Wong, Chun Kwok, Chan, Paul KS, Ng, Siew C·2021·Gut

Abstract

Objective: Although COVID-19 is primarily a respiratory illness, there is mounting evidence suggesting that the GI tract is involved in this disease. We investigated whether the gut microbiome is linked to disease severity in patients with COVID-19, and whether perturbations in microbiome composition, if any, resolve with clearance of the SARS-CoV-2 virus. Methods: In this two-hospital cohort study, we obtained blood, stool and patient records from 100 patients with laboratory-confirmed SARS-CoV-2 infection. Serial stool samples were collected from 27 of the 100 patients up to 30 days after clearance of SARS-CoV-2. Gut microbiome compositions were characterised by shotgun sequencing total DNA extracted from stools. Concentrations of inflammatory cytokines and blood markers were measured from plasma. Results: Gut microbiome composition was significantly altered in patients with COVID-19 compared with non-COVID-19 individuals irrespective of whether patients had received medication (p<0.01). Several gut commensals with known immunomodulatory potential such as Faecalibacterium prausnitzii , Eubacterium rectale and bifidobacteria were underrepresented in patients and remained low in samples collected up to 30 days after disease resolution. Moreover, this perturbed composition exhibited stratification with disease severity concordant with elevated concentrations of inflammatory cytokines and blood markers such as C reactive protein, lactate dehydrogenase, aspartate aminotransferase and gamma-glutamyl transferase. Conclusion: Associations between gut microbiota composition, levels of cytokines and inflammatory markers in patients with COVID-19 suggest that the gut microbiome is involved in the magnitude of COVID-19 severity possibly via modulating host immune responses. Furthermore, the gut microbiota dysbiosis after disease resolution could contribute to persistent symptoms, highlighting a need to understand how gut microorganisms are involved in inflammation and COVID-19.

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Metadata

Authors
Yeoh, Y. K., Zuo, T., Lui, G. C.-Y., Zhang, F., Liu, Q., Li, A. Y., Chung, A. C., Cheung, C. P., Tso, E. Y., Fung, K. S., Chan, V., Ling, L., Joynt, G., Hui, D. S.-C., Chow, K. M., Ng, S. S. S., Li, T. C.-M., Ng, R. W., Yip, T. C., Wong, G. L.-H., Chan, F. K., Wong, C. K., Chan, P. K., & Ng, S. C.
Venue
Gut
Publisher
BMJ
Published
2021-01-11
Volume
70
Issue
4
Pages
698-706
ISSN
  • 0017-5749 (ISSN-L)
  • 1468-3288
OpenAlex
W3118579072
Cited by
1,317
References
43
FWCI
74.27
Type
journal article
Language
en
Open access
hybrid

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CoChat. (2026). Citation check: Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. https://app.cochat.ai/papers/10.1136/gutjnl-2020-323020
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Yeoh, Y. K., Zuo, T., Lui, G. C.-Y., Zhang, F., Liu, Q., Li, A. Y., Chung, A. C., Cheung, C. P., Tso, E. Y., Fung, K. S., Chan, V., Ling, L., Joynt, G., Hui, D. S.-C., Chow, K. M., Ng, S. S. S., Li, T. C.-M., Ng, R. W., Yip, T. C., . . . Ng, S. C. (2021). Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut. https://doi.org/10.1136/gutjnl-2020-323020

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