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World J Gastroenterol. Mar 21, 2023; 29(11): 1708-1720
Published online Mar 21, 2023. doi: 10.3748/wjg.v29.i11.1708
Gut microbiome therapeutic modulation to alleviate drug-induced hepatic damage in COVID-19 patients
Khansa Ahsan, Munir Ahmad Anwar, Nayla Munawar
Khansa Ahsan, Nayla Munawar, Department of Chemistry, United Arab Emirates University, Al Ain 15551, United Arab Emirates
Munir Ahmad Anwar, Industrial Biotechnology Division, National Institute for Biotechnology and Genetic Engineering College, Pakistan Institute of Engineering and Applied Sciences (NIBGE-C, PIEAS), Faisalabad 38000, Pakistan
Author contributions: Ahsan K performed data acquisition, the majority of the writing, and prepared the figures; Anwar MA wrote a section, reviewed, and edited; Munawar N conceptualized the manuscript, designed the outline and figures, wrote the abstract, and provided major input in writing and guidance in the investigation of data for the manuscript.
Supported by United Arab Emirates University UPAR 2022 Research Grant, No. 12S094.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Nayla Munawar, PhD, Assistant Professor, Department of Chemistry, College of Science, United Arab Emirates University (UAEU), Al Ain 15551, Abu Dhabi, United Arab Emirates.
Received: September 15, 2022
Peer-review started: September 15, 2022
First decision: November 15, 2022
Revised: January 6, 2023
Accepted: March 7, 2023
Article in press: March 7, 2023
Published online: March 21, 2023
Processing time: 182 Days and 20.1 Hours

Coronavirus disease 2019 (COVID-19) infection caused by the severe acute respiratory syndrome coronavirus 2 virus, its symptoms, treatment, and post-COVID-19 effects have been a major focus of research since 2020. In addition to respiratory symptoms, different clinical variants of the virus have been associated with dynamic symptoms and multiorgan diseases, including liver abnormalities. The release of cytokines by the activation of innate immune cells during viral infection and the high doses of drugs used for COVID-19 treatment are considered major drivers of liver injury in COVID-19 patients. The degree of hepatic inflammation in patients suffering from chronic liver disease and having COVID-19 could be severe and can be estimated through different liver chemistry abnormality markers. Gut microbiota influences liver chemistry through its metabolites. Gut dysbiosis during COVID-19 treatment can promote liver inflammation. Here, we highlighted the bidirectional association of liver physiology and gut microbiota (gut-liver axis) and its potential to manipulate drug-induced chemical abnormalities in the livers of COVID-19 patients.

Keywords: COVID-19, Gut-liver axis, Probiotics, Prebiotics, Cytokines, Gut microbiome

Core Tip: There are several reviews in the literature focused on the pathophysiology of liver damage during severe acute respiratory syndrome coronavirus 2 infection. However, we highlighted the potential role of gut microbiota in managing drug-induced liver damage during and after coronavirus disease 2019. We shed light on various metabolites produced by gut microorganisms that have a significant role in reducing liver damage in coronavirus disease 2019 with the use of different probiotics and prebiotics.