Pathogenesis and treatments of gut microbiota in gut‑deprived acute respiratory distress syndrome

ZHANG Yuting; MU Sucheng

doi:10.14188/j.1671-8852.2024.0492

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Pathogenesis and treatments of gut microbiota in gut‑deprived acute respiratory distress syndrome

更新时间：2026-11-05

- Pathogenesis and treatments of gut microbiota in gut‑deprived acute respiratory distress syndrome
- Medical Journal of Wuhan University Vol. 46, Issue 2, Pages: 226-231(2025)
- 作者机构：
  
  复旦大学附属中山医院急诊科/复旦大学应急救援与急危重症研究所上海 200032
- 作者简介：
- 基金信息：
- DOI：10.14188/j.1671-8852.2024.0492
  CLC： R563
- Received：02 July 2024，
  
  Published：25 February 2025
- 稿件说明：
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张雨婷,穆素成.肠道菌群在肠源性急性呼吸窘迫综合征中的发病机制及其治疗应用进展[J].武汉大学学报（医学版）,2025,46(02):226-231.

ZHANG Yuting,MU Sucheng.Pathogenesis and treatments of gut microbiota in gut‑deprived acute respiratory distress syndrome[J].Medical Journal of Wuhan University,2025,46(02):226-231.
张雨婷,穆素成.肠道菌群在肠源性急性呼吸窘迫综合征中的发病机制及其治疗应用进展[J].武汉大学学报（医学版）,2025,46(02):226-231. DOI： 10.14188/j.1671-8852.2024.0492.

ZHANG Yuting,MU Sucheng.Pathogenesis and treatments of gut microbiota in gut‑deprived acute respiratory distress syndrome[J].Medical Journal of Wuhan University,2025,46(02):226-231. DOI： 10.14188/j.1671-8852.2024.0492.

摘要

急性呼吸窘迫综合征（ARDS）是一种以严重低氧血症为特征的呼吸系统疾病，是脓毒症最常见的并发症之一。以肠道功能障碍为始动因素如肠道损伤、肠道免疫功能紊乱、肠道菌群失调以及肠道代谢等引起的ARDS常被认为是肠源性ARDS，其常常表现为肠道完整性、通透性的改变，并影响肠道菌群的构成及其代谢物的生成。本综述旨在总结肠源性ARDS与肠道菌群的关联，阐述目前基于肠道功能改善ARDS的治疗措施，从而为肠源性ARDS治疗方案提供新的思路和方向。

Abstract

Acute respiratory distress syndrome (ARDS) is a respiratory disease characterized by severe hypoxemia and is regarded as one of the most common complications of sepsis. ARDS caused by intestinal dysfunction

such as intestinal injury

intestinal immune dysfunction

intestinal microbiota disorder

and intestinal metabolism

is often considered to be gut⁃derived ARDS. It is often manifested as changes in intestinal integrity and permeability and affects the composition of the gut microbiota as well as the production of metabolites. The purpose of this review is to summarize the relationship between gut⁃derived ARDS and gut microbiota

providing new ideas for the treatment of ARDS patients by altering their gut microbiota and its metabolites.

关键词

Keywords

references

Meyer N J , Gattinoni L , Calfee C S . Acute respiratory distress syndrome [J ] . Lancet , 2021 , 398 ( 10300 ): 622 ‑ 637 .

Abe T , Madotto F , Pham T , et al . Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries [J ] . Crit Care , 2018 , 22 ( 1 ): 195 .

Fernando S M , Ferreyro B L , Urner M , et al . Diagnosis and management of acute respiratory distress syndrome [J ] . CMAJ , 2021 , 193 ( 21 ): E761 ‑ e768 .

Mittal R , Coopersmith C M . Redefining the gut as the motor of critical illness [J ] . Trends Mol Med , 2014 , 20 ( 4 ): 214 ‑ 223 .

Angus D C , Seymour C W , Bibbins‑Domingo K . Caring for patients with acute respiratory distress syndrome: Summary of the 2023 ESICM practice guidelines [J ] . JAMA , 2023 , 330 ( 4 ): 368 ‑ 371 .

Ranieri V M , Rubenfeld G D , Thompson B T , et al . Acute respiratory distress syndrome: The Berlin Definition [J ] . JAMA , 2012 , 307 ( 23 ): 2526 ‑ 2533 .

袁雪燕 , 刘玲 , 邱海波 . 2023急性呼吸窘迫综合征全球新标准: 进步与局限 [J ] . 中华医学杂志 , 2024 , 104 ( 15 ): 1216 ‑ 1220 .

Yuan X Y , Liu L , Qiu H B . New 2023 global definition of acute respiratory distress syndrome: Progress and limitation [J ] . Natl Med J China , 2024 , 104 ( 15 ): 1216 ‑ 1220 .

Matthay M A , Arabi Y , Arroliga A C , et al . A new global definition of acute respiratory distress syndrome [J ] . Am J Respir Crit Care Med , 2024 , 209 ( 1 ): 37 ‑ 47 .

Dickson R P . The microbiome and critical illness [J ] . Lancet Respir Med , 2016 , 4 ( 1 ): 59 ‑ 72 .

Gatt M , Reddy B S , MacFie J . Review article: Bacterial translocation in the critically ill: Evidence and methods of prevention [J ] . Aliment Pharmacol Ther , 2007 , 25 ( 7 ): 741 ‑ 757 .

Shankar‑Hari M , Phillips G S , Levy M L , et al . Developing a new definition and assessing new clinical criteria for septic shock: For the third international consensus definitions for sepsis and septic shock (sepsis‑3) [J ] . JAMA , 2016 , 315 ( 8 ): 775 ‑ 787 .

Klingensmith N J , Coopersmith C M . The gut as the motor of multiple organ dysfunction in critical illness [J ] . Crit Care Clin , 2016 , 32 ( 2 ): 203 ‑ 212 .

Ziaka M , Exadaktylos A . Exploring the lung‑gut direction of the gut‑lung axis in patients with ARDS [J ] . Crit Care , 2024 , 28 ( 1 ): 179 .

Dickson R P , Singer B H , Newstead M W , et al . Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome [J ] . Nat Microbiol , 2016 , 1 ( 10 ): 16113 .

He S Y , Lin F Y , Hu X Y , et al . Gut microbiome‑based therapeutics in critically ill adult patients‑a narrative review [J ] . Nutrients , 2023 , 15 ( 22 ): 4734 .

Mustansir Dawoodbhoy F , Patel B K , Patel K , et al . Gut microbiota dysbiosis as a target for improved post‑surgical outcomes and improved patient care: A review of current literature [J ] . Shock , 2021 , 55 ( 4 ): 441 ‑ 454 .

Kontopoulou K , Iosifidis E , Antoniadou E , et al . The clinical significance of carbapenem‑resistant Klebsiella pneumoniae rectal colonization in critically ill patients: From colonization to bloodstream infection [J ] . J Med Microbiol , 2019 , 68 ( 3 ): 326 ‑ 335 .

Wang H , Liu J S , Peng S H , et al . Gut‑lung crosstalk in pulmonary involvement with inflammatory bowel diseases [J ] . World J Gastroenterol , 2013 , 19 ( 40 ): 6794 ‑ 6804 .

Zhang D W , Lu J L , Dong B Y , et al . Gut microbiota and its metabolic products in acute respiratory distress syndrome [J ] . Front Immunol , 2024 , 15 : 1330021 .

Li M H , Zhang R F , Li J , et al . The role of C‑type lectin receptor signaling in the intestinal microbiota‑inflammation‑cancer axis [J ] . Front Immunol , 2022 , 13 : 894445 .

Spiljar M , Merkler D , Trajkovski M . The immune system bridges the gut microbiota with systemic energy homeostasis: Focus on TLRs, mucosal barrier, and SCFAs [J ] . Front Immunol , 2017 , 8 : 1353 .

Kyo M , Nishioka K , Nakaya T , et al . Unique patterns of lower respiratory tract microbiota are associated with inflammation and hospital mortality in acute respiratory distress syndrome [J ] . Respir Res , 2019 , 20 ( 1 ): 246 .

Dickson R P , Schultz M J , van der Poll T , et al . Lung microbiota predict clinical outcomes in critically ill patients [J ] . Am J Respir Crit Care Med , 2020 , 201 ( 5 ): 555 ‑ 563 .

Villablanca E J , Selin K , Hedin C R H . Mechanisms of mucosal healing: Treating inflammatory bowel disease without immunosuppression? [J ] . Nat Rev Gastroenterol Hepatol , 2022 , 19 ( 8 ): 493 ‑ 507 .

Lorentz C A , Liang Z , Meng M , et al . Myosin light chain kinase knockout improves gut barrier function and confers a survival advantage in polymicrobial sepsis [J ] . Mol Med , 2017 , 23 : 155 ‑ 165 .

Uzzan M , Corcos O , Martin J C , et al . Why is SARS‑CoV‑2 infection more severe in obese men? The gut lymphatics ‑ Lung axis hypothesis [J ] . Med Hypotheses , 2020 , 144 : 110023 .

Ma Y G , Yang X Y , Chatterjee V , et al . The gut‑lung axis in systemic inflammation. Role of mesenteric lymph as a conduit [J ] . Am J Respir Cell Mol Biol , 2021 , 64 ( 1 ): 19 ‑ 28 .

Fan Y , Pedersen O . Gut microbiota in human metabolic health and disease [J ] . Nat Rev Microbiol , 2021 , 19 ( 1 ): 55 ‑ 71 .

Gao J , Chen H F , Xu L Y , et al . Effects of intestinal microorganisms on influenza‑infected mice with antibiotic‑induced intestinal dysbiosis, through the TLR7 signaling pathway [J ] . Front Biosci (Landmark Ed) , 2023 , 28 ( 3 ): 43 .

Wang J F , Shi C Y , Ying H Z . Cephalosporins‑induced intestinal dysbiosis exacerbated pulmonary endothelial barrier disruption in Streptococcus pneumoniae ‑infected mice [J ] . Front Cell Infect Microbiol , 2022 , 12 : 997368 .

Ding Y P , Feng Q J , Chen J S , et al . TLR4 /NF‑κB signaling pathway gene single nucleotide polymorphisms alt er gene expression levels and affect ARDS occurrence and prognosis outcomes [J ] . Medicine , 2019 , 98 ( 26 ): e16029 .

Zhang D , Xu C J , Zhang J T , et al . Plasma TNFRSF11B as a new predictive inflammatory marker of sepsis‑ARDS with endothelial dysfunction [J ] . J Proteome Res , 2023 , 22 ( 11 ): 3640 ‑ 3651 .

Sanwal R , Mintsopoulos V , Ditmans M , et al . Ultrasound‑guided transfection of claudin‑5 improves lung endothelial barrier function in lung injury without impairing innate immunity [J ] . Am J Physiol Lung Cell Mol Physiol , 2023 , 325 ( 2 ): L135 ‑ L142 .

Mu S C , Xiang H , Wang Y Z , et al . The pathogens of secondary infection in septic patients share a similar genotype to those that predominate in the gut [J ] . Crit Care , 2022 , 26 ( 1 ): 68 .

Haak B W , Levi M , Wiersinga W J . Microbiota‑targeted therapies on the intensive care unit [J ] . Curr Opin Crit Care , 2017 , 23 ( 2 ): 167 ‑ 174 .

Long X Y , Mu S C , Zhang J , et al . Global signatures of the microbiome and metabolome during hospitalization of septic patients [J ] . Shock , 2023 , 59 ( 5 ): 716 ‑ 724 .

Wang J J , Zhu N N , Su X M , et al . Gut‑microbiota‑derived metabolites maintain gut and systemic immune homeostasis [J ] . Cells , 2023 , 12 ( 5 ): 793 .

Belvoncikova P , Maronek M , Gardlik R . Gut dysbiosis and fecal microbiota transplantation in autoimmune diseases [J ] . Int J Mol Sci , 2022 , 23 ( 18 ): 10729 .

Tan J K , Macia L , MacKay C R . Dietary fiber and SCFAs in the regulation of mucosal immunity [J ] . J Allergy Clin Immunol , 2023 , 151 ( 2 ): 361 ‑ 370 .

Sultan M , Wilson K , Abdulla O A , et al . Endocannabinoid anandamide attenuates acute respiratory distress syndrome through modulation of microbiome in the gut‑lung axis [J ] . Cells , 2021 , 10 ( 12 ): 3305 .

Deitch E A . Gut lymph and lymphatics: A source of factors leading to organ injury and dysfunction [J ] . Ann N Y Acad Sci , 2010 , 1207 ( Suppl 1 ): E103 ‑ E111 .

Liang L P , Liu L , Zhou W Y , et al . Gut microbiota‑derived butyrate regulates gut mucus barrier repair by activating the macrophage/WNT/ERK signaling pathway [J ] . Clin Sci (Lond) , 2022 , 136 ( 4 ): 291 ‑ 307 .

Alghetaa H , Mohammed A , Zhou J H , et al . Resveratrol‑mediated attenuation of superantigen‑driven acute respiratory distress syndrome is mediated by microbiota in the lungs and gut [J ] . Pharmacol Res , 2021 , 167 : 105548 .

Yin J H , Zhou C , Yang K Q , et al . Mutual regulation between butyrate and hypoxia‑inducible factor‑1α in epithelial cell promotes expression of tight junction proteins [J ] . Cell Biol Int , 2020 , 44 ( 6 ): 1405 ‑ 1414 .

Ayres J S , Trinidad N J , Vance R E . Lethal inflammasome activation by a multidrug‑resistant pathobiont upon antibiotic disruption of the microbiota [J ] . Nat Med , 2012 , 18 : 799 ‑ 806 .

Mohammed A , Alghetaa H K , Zhou J H , et al . Protective effects of Δ(9)‑tetrahydrocannabinol against enterotoxin‑induced acute respiratory distress syndrome are mediated by modulation of microbiota [J ] . Br J Pharmacol , 2020 , 177 ( 22 ): 5078 ‑ 5095 .

Zhang Y D , Zhang L B , Mao L J , et al . Intestinal microbiota‑derived propionic acid protects against zinc oxide nanoparticle‑induced lung injury [J ] . Am J Respir Cell Mol Biol , 2022 , 67 ( 6 ): 680 ‑ 694 .

Pontes‑Arruda A , Demichele S , Seth A , et al . The use of an inflammation‑modulating diet in patients with acute lung injury or acute respiratory distress syndrome: A meta‑analysis of outcome data [J ] . JPEN J Parenter Enteral Nutr , 2008 , 32 ( 6 ): 596 ‑ 605 .

De Luca D , Alonso A , Autilio C . Bile acid‑induced lung injury: Update of reverse translational biology [J ] . Am J Physiol Lung Cell Mol Physiol , 2022 , 323 ( 1 ): L93 ‑ L106 .

Plantinga N L , de Smet A M G A , Oostdijk E A N , et al . Selective digestive and oropharyngeal decontamination in medical and surgical ICU patients: Individual patient data meta‑analysis [J ] . Clin Microbiol Infect , 2018 , 24 ( 5 ): 505 ‑ 513 .

Myburgh J A , Seppelt I M , Goodman F , et al . Effect of selective decontamination of the digestive tract on hospital mortality in critically ill patients receiving mechanical ventilation: A randomized clinical trial [J ] . JAMA , 2022 , 328 ( 19 ): 1911 ‑ 1921 .

Carvalho T . First oral fecal microbiota transplant therapy approved [J ] . Nat Med , 2023 , 29 ( 7 ): 1581 ‑ 1582 .

Han S , Shannahan S , Pellish R . Fecal microbiota transplant: Treatment options for Clostridium difficile infection in the intensive care unit [J ] . J Intensive Care Med , 2016 , 31 ( 9 ): 577 ‑ 586 .

Li Q R , Wang C Y , Tang C , et al . Successful treatment of severe sepsis and diarrhea after vagotomy utilizing fecal microbiota transplantation: A case report [J ] . Crit Care , 2015 , 19 ( 1 ): 37 .

Leo S , Lazarevic V , Girard M , et al . Metagenomic characterization of gut microbiota of carriers of extended‑spectrum beta‑lactamase or carbapenemase‑producing Enterobacteriaceae following treatment with oral antibiotics and fecal microbiota transplantation: Results from a multicenter randomized trial [J ] . Microorganisms , 2020 , 8 ( 6 ): 941 .

Littmann E R , Lee J J , Denny J E , et al . Host immunity modulates the efficacy of microbiota transplantation for treatment of Clostridioides difficile infection [J ] . Nat Commun , 2021 , 12 ( 1 ): 755 .

Hua F , Cui E H , Lv L , et al . Fecal microbiota transplantation from HUC‑MSC‑treated mice alleviates acute lung injury in mice through anti‑inflammation and gut microbiota modulation [J ] . Front Microbiol , 2023 , 14 : 1243102 .

Liu M Q , Ma J X , Xu J Y , et al . Fecal microbiota transplantation alleviates intestinal inflammatory diarrhea caused by oxidative stress and pyroptosis via reducing gut microbiota‑derived lipopolysaccharides [J ] . Int J Biol Macromol , 2024 , 261 ( Pt 1 ): 129696 .

Sapra L , Saini C , Das S , et al . Lactobacillus rhamnosus (LR) ameliorates pulmonary and extrapulmonary acute respiratory distress syndrome (ARDS) via targeting neutrophils [J ] . Clin Immunol , 2024 , 258 : 109872 .

Reizine F , Lesouhaitier M , Gregoire M , et al . SARS‑CoV‑2‑induced ARDS associates with MDSC expansion, lymphocyte dysfunction, and arginine shortage [J ] . J Clin Immunol , 2021 , 41 ( 3 ): 515 ‑ 525 .

Zhou X , Liao Y X . Gut‑lung crosstalk in sepsis‑induced acute lung injury [J ] . Front Microbiol , 2021 , 12 : 779620 .

Zhao S , Feng P Y , Meng W B , et al . Modulated gut microbiota for potential COVID‑19 prevention and treatment [J ] . Front Med , 2022 , 9 : 811176 .

舒琳 , 姚林利 , 周青山 . 肠道菌群在急性呼吸窘迫综合征中的作用 [J ] . 武汉大学学报(医学版) , 2023 , 44 ( 11 ): 1330 ‑ 1334 .

Shu L , Yao L L , Zhou Q S . The role of intestinal flora in acute respiratory distress syndrome [J ] . Med J Wuhan Univ , 2023 , 44 ( 11 ): 1330 ‑ 1334 .

Chen Y , Xiao S M , Gong Z P , et al . Wuji Wan formula ameliorates diarrhea and disordered colonic motility in post‑inflammation irritable bowel syndrome rats by modulating the gut microbiota [J ] . Front Microbiol , 2017 , 8 : 2307 .

Mei X R , Zhang X Y , Wang Z G , et al . Insulin sensitivity‑enhancing activity of phlorizin is associated with lipopolysaccharide decrease and gut microbiota changes in obese and type 2 diabetes (db/db) mice [J ] . J Agric Food Chem , 2016 , 64 ( 40 ): 7502 ‑ 7511 .

Mu S C , Zhang J , Du S L , et al . Gut microbiota modulation and anti‑inflammatory properties of Xuanbai Chengqi decoction in septic rats [J ] . J Ethnopharmacol , 2021 , 267 : 113534 .

Hu T T , Zhu Y , Zhu J , et al . Wine‑processed radix scutellariae alleviates ARDS by regulating tryptophan metabolism through gut microbiota [J ] . Front Pharmacol , 2022 , 13 : 1104280 .

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