ABSTRACT
It has been very recently suggested that individuals with chronic gut inflammation are highly susceptible to COVID-19. They constitute the serious cases of COVID-19, in which inflammatory cytokine storm is observed. On the contrary, the healthy gut microbiota is linked with low chronic gut and systemic inflammation. This raises the idea that maintenance of the healthy gut microbiota and prevention of gut microbial dysbiosis in COVID-19 patients might avoid the increased cytokine storm, which in turn might reduce the mortality rate. It has been shown that the modulation of the gut microbiota is an effective strategy to strengthen immunity and might be a possible treatment for individuals with viral infections. Currently, there is no clinical data considering the impact of the modulation of the gut microbiota on the treatment of COVID-19. We hypothesize that targeting the gut microbiota might be a novel therapeutic approach or at least a supportive therapy. In the present review article, we described the interaction between SARS-CoV-2 and gut microbiota dysbiosis through two possible mechanisms, including aberrant immune activation and aberrant mammalian target of rapamycin (mTOR) activation. Further, the disruption of the gastrointestinal reninangiotensin system (GI RAS), dysregulation of the coagulation and fibrinolytic systems, and the activity of human serine proteases in COVID-19 pathogenesis were addressed. We also provided possible strategies to restore all the discussed aspects via gut microbiota modulation.