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Review
. 2020 Feb 18;52(2):241-255.
doi: 10.1016/j.immuni.2020.01.007.

The Role of Lung and Gut Microbiota in the Pathology of Asthma

Weronika Barcik  1 , Rozlyn C T Boutin  1 , Milena Sokolowska  2 , B Brett Finlay  3
Affiliations
Review

The Role of Lung and Gut Microbiota in the Pathology of Asthma

Weronika Barcik et al. Immunity. .

Abstract

Asthma is a common chronic respiratory disease affecting more than 300 million people worldwide. Clinical features of asthma and its immunological and molecular etiology vary significantly among patients. An understanding of the complexities of asthma has evolved to the point where precision medicine approaches, including microbiome analysis, are being increasingly recognized as an important part of disease management. Lung and gut microbiota play several important roles in the development, regulation, and maintenance of healthy immune responses. Dysbiosis and subsequent dysregulation of microbiota-related immunological processes affect the onset of the disease, its clinical characteristics, and responses to treatment. Bacteria and viruses are the most extensively studied microorganisms relating to asthma pathogenesis, but other microbes, including fungi and even archaea, can potently influence airway inflammation. This review focuses on recently discovered connections between lung and gut microbiota, including bacteria, fungi, viruses, and archaea, and their influence on asthma.

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Conflict of interest statement

Declaration of Interests The authors declare no competing interests.

Figures

Figure 1
Figure 1
Schematic Representation of Asthma Phenotypes and Endotypes with Differences in Microbiota between Endotypes and Simplified Cellular Mechanisms Involved in Asthma and Its Correlation with Microbiota (A) Schematic representation of asthma phenotypes and endotypes with differences in microbiota between endotypes. Endotypes classify asthma based on pathophysiological mechanisms, whereas phenotype refers to the clinical and morphological description of disease. The two best-described asthma endotypes are the type 2 endotype, which includes mostly Th2 cell responses, and the non-type 2 endotype. However, endotypes can co-exist and/or include other mixed processes. Type 2 asthma is usually observed in the clinic as early-onset allergic asthma, late-onset eosinophilic asthma, or exercise-induced asthma. Non-type 2 asthma mechanisms are observed usually in neutrophilic, obesity-related, and paucigranulocytic phenotypes. (B) Simplified cellular mechanisms involved in asthma and its correlation with microbiota. Th2-cell-driven inflammation engages Th 2 cells, type 2 innate lymphoid cells, T follicular helper cells, type 2 B cells, eosinophils, and mast cells and results in increased amounts of IL-4, IL-5, IL-9, IL-13, prostaglandin D2, and CCR8 in sputum, BAL, serum, and bronchial biopsies. Non-type 2 asthma is characterized by infiltration of Th1 and Th17 cells, neutrophils, and the presence of type I interferons, NLRP3 inflammasome, and IL-1β and IL-17 cytokines.
Figure 2
Figure 2
Gut-Lung Axis in Lung Inflammation Context A connection between lungs and gut has been repeatedly demonstrated in both human and mouse studies. Many studies show that the microbiota is an important factor responsible for the interactions between these two sites. The interaction can be bidirectional; the gut microbiome can influence immune responses in lungs and lung stimulation can result in gut responses.
Figure 3
Figure 3
Bacteria, Fungi, Viruses, and Archaea in the Lungs and Gut that Dysbiosis Has the Influence on Asthma Development and Maintenance
See this image and copyright information in PMC

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