COVID-19 Patogenezinde Diyetin Bağırsak-Akciğer Ekseni Üzerine Potansiyel Etkileri

Dünya çapında milyonlarca insan SARS-CoV-2 virüsünün neden olduğu ve COVID-19 olarak bilinen yeni koranavirüs hastalığından etkilenmiş durumdadır. COVID-19 enfeksiyonu, asemptomatik bir enfeksiyon olarak ortaya çıkabildiği gibi öksürük, titreme, ateş, yorgunluk ve nefes darlığı şeklinde belirtilerle karakterize bir solunum yolu hastalığı olarak da görülebilmektedir. Çoklu organ yetmezliği olan ağır hastalarda, şiddetli akut inflamasyon ve sitokin fırtınası olarak adlandırılan aşırı sitokin salınımı söz konusudur. Virüs ile enfekte bazı kişilerde diyare ve gastrointestinal sistemde tutulum görülmesi bağırsak mikrobiyotasını ve bağırsak-akciğer eksenini akla getirmektedir. COVID-19’un kötü klinik sonuçları yaşlılık ve komorbidite varlığı gibi spesifik risk faktörleri ile ilişkili olması ve aynı zamanda bu risk faktörlerinin de sağlıksız mikrobiyota ile ilişkili olması bu ihtimali kuvvetlendirmektedir. Bağırsak-akciğer ekseninin COVID-19 için çift yönlü hareket ettiği düşünülmektedir. Mikrobiyota kaynaklı endotoksinler ve metabolitler, akciğerleri dolaşım aracılığı ile etkileyebilmekte ve akciğerde inflamasyon oluştuğunda bu durum ise bağırsak mikrobiyotasını etkileyebilmektedir. Bununla birlikte bağırsak mikrobiyotası ile immün sistem arasındaki denge halinde bozulma meydana geldiğinde inflamatuar süreçler başlamaktadır. Diyet, bağırsak mikrobiyotasının şekillenmesinde önemli bir rol oynamaktadır ve bağırsak-akciğer ekseni boyunca etki eden farklı diyet faktörleri gündeme gelmiştir. Bunlardan kısa zincirli yağ asitlerinin, bağırsak-akciğer ekseni boyunca anti-inflamatuar ve immün yanıtı düzenleyici etkisi olduğu düşünülmektedir. Polifenoller, vitamin ve mineraller gibi besin bileşenlerinin bağırsak mikrobiyotası üzerinde immün yanıtı düzenleyici önemli etkileri bulunabilmektedir. Probiyotikler, prebiyotikler ve diyet lifi gibi diyet takviyeleri ile birlikte kişiselleştirilmiş, bütüncül bir diyet, COVID-19'dan etkilenen hastalarda iyileşmeyi hızlandırmak ve klinik sonuçları geliştirmek için umut vadeden bir yaklaşım olabilir. Bu derlemenin amacı, bağırsak-akciğer ekseni ve mikrobiyota ilişkili diyet faktörleri ve COVID-19 üzerine potansiyel etkilerinin açıklanmasıdır.

Anahtar Kelimeler:

COVID-19, Mikrobiyota, Diyet, Bağırsak-akciğer ekseni

Potential Effects of Diet on the Gut-Lung Axis in the Pathogenesis of COVID-19

Millions of people around the world are affected by the novel coranavirus disease known as COVID-19, caused by the SARS-CoV-2 virus. COVID-19 infection can be observed as an asymptomatic infection, or a respiratory disease characterized by symptoms such as cough, fever, fatigue and shortness of breath. Severe acute inflammation and cytokine release can be detected in patients with multiple organ failure. Diarrhea and gastrointestinal involvement in some people infected with the virus suggest the role of gut microbiota and the gut-lung axis. The bad clinical consequences of COVID-19 are associated with specific risk factors such as old age and the presence of comorbidity, and at the same time, these risk factors are also associated with unhealthy microbiota. The gut-lung axis is thought to be bidirectional for COVID-19. Microbiota-derived endotoxins and metabolites can affect the lungs through circulation, and when inflammation occurs in the lungs, this can affect the intestinal microbiota. When the balance between the intestinal microbiota and the immune system is disrupted, inflammatory processes begin. Diet plays an important role in shaping the gut microbiota, and different dietary factors that act along the gut-lung axis have come into question. Short-chain fatty acids are thought to have anti-inflammatory and immune regulatory effects along the gut-lung axis. Components such as polyphenols can have important effects on the intestinal microbiota thus, regulating the immune response. A personalized diet combined with dietary supplements such as probiotics, prebiotics and dietary fiber could be a promising approach to accelerate recovery and improve clinical outcomes in patients affected by COVID-19. The aim of this review is to describe the gut-lung axis and microbiota-related dietary factors and their potential effects on COVID-19.

Keywords:

COVID-19, Microbiota, Diet, Gut-lung axis,

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