{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:58:39Z","timestamp":1760576319264,"version":"build-2065373602"},"reference-count":25,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Human and animal studies have supported the existence of the gut-lung axis, where gastrointestinal commensals and their products can modulate lung immune function. The role of a balanced, healthy gut microbiota and its restoration may impact the microbiota in the lung. Yet the robustness of this evidence varies considerably, with many studies having considerable limitations. Intestinal microbiota diversity is decreased in pulmonary TB patients, and changes in the intestinal microbiota after Mycobacterium tuberculosis infection have been reported, underscoring the bidirectionality of the lung-gut axis. These changes may be associated with the progression of TB, influencing the microbiota and immunity homeostasis in those receiving anti-TB treatment. The crosstalk between the gut and the lung is increasingly recognized as a key modulator in the development, progression, and treatment outcomes of tuberculosis (TB). A protective role of the intestinal microbiota against lung infections through its role in macrophage activation makes it a promising approach as anti-TB adjunct therapy. This mini review synthesizes current understanding of gut-lung interactions in TB pathogenesis, appraising strengths and limitations of the literature, clarifying areas of consensus versus speculation, highlighting where findings remain preliminary, summarizing the impact of anti-TB treatment on microbial communities, and discussing future directions for microbiota-informed interventions to improve patient outcomes.<\/jats:p>","DOI":"10.1093\/femsle\/fnaf106","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T14:47:23Z","timestamp":1759502843000},"source":"Crossref","is-referenced-by-count":0,"title":["Advances in our understanding of the lung-gut axis in tuberculosis"],"prefix":"10.1093","volume":"372","author":[{"given":"Skyler","family":"Colwell","sequence":"first","affiliation":[{"name":"Dr. Kiran C. Patel College of Allopathic Medicine. Nova Southeastern University , Fort Lauderdale, FL 33328 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4359-5951","authenticated-orcid":false,"given":"Jorge","family":"Cervantes","sequence":"additional","affiliation":[{"name":"Dr. Kiran C. Patel College of Allopathic Medicine. Nova Southeastern University , Fort Lauderdale, FL 33328 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"2025101514185078300_bib1","doi-asserted-by":"publisher","first-page":"1237998","DOI":"10.3389\/fmicb.2023.1237998","article-title":"The microbiome and the gut-lung axis in tuberculosis: interplay in the course of disease and treatment","volume":"14","author":"Alvarado-Pena","year":"2023","journal-title":"Front Microbiol"},{"key":"2025101514185078300_bib2","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1016\/j.vaccine.2015.02.041","article-title":"Helicobacter hepaticus infection in BALB\/c mice abolishes subunit-vaccine-induced protection against M. tuberculosis","volume":"33","author":"Arnold","year":"2015","journal-title":"Vaccine"},{"key":"2025101514185078300_bib3","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.micpath.2019.03.041","article-title":"The lung microbiome, vitamin D, and the tuberculous granuloma: a balance triangle","volume":"131","author":"Balcells","year":"2019","journal-title":"Microb Pathog"},{"key":"2025101514185078300_bib4","doi-asserted-by":"crossref","first-page":"267","DOI":"10.3390\/antibiotics13030267","article-title":"Helicobacter pylori in inflammatory bowel diseases: active protagonist or innocent bystander?","volume":"13","author":"Bretto","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"2025101514185078300_bib5","doi-asserted-by":"publisher","first-page":"e0061521","DOI":"10.1128\/spectrum.00615-21","article-title":"Gut mycobiota dysbiosis in pulmonary tuberculosis patients undergoing anti-tuberculosis treatment","volume":"9","author":"Cao","year":"2021","journal-title":"Microbiol Spectr"},{"key":"2025101514185078300_bib6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/femspd\/ftx097","article-title":"The gut-lung axis in tuberculosis","volume":"75","author":"Cervantes","year":"2017","journal-title":"Pathog Dis"},{"key":"2025101514185078300_bib7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3389\/fcimb.2020.00009","article-title":"The gut-lung axis in health and Respiratory diseases: a place for inter-organ and inter-Kingdom crosstalks","volume":"10","author":"Enaud","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"key":"2025101514185078300_bib8","doi-asserted-by":"publisher","first-page":"1209932","DOI":"10.3389\/fmicb.2023.1209932","article-title":"Impact of the gut-lung axis on tuberculosis susceptibility and progression","volume":"14","author":"Enjeti","year":"2023","journal-title":"Front Microbiol"},{"key":"2025101514185078300_bib9","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.tube.2018.02.006","article-title":"Meta-analysis of the lung microbiota in pulmonary tuberculosis","volume":"109","author":"Hong","year":"2018","journal-title":"Tuberculosis"},{"key":"2025101514185078300_bib10","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.jinf.2018.08.006","article-title":"Gut microbiota associated with pulmonary tuberculosis and dysbiosis caused by anti-tuberculosis drugs","volume":"78","author":"Hu","year":"2019","journal-title":"J Infect"},{"key":"2025101514185078300_bib11","doi-asserted-by":"publisher","first-page":"126","DOI":"10.3390\/pathogens8030126","article-title":"Alteration of gut microbiota in inflammatory bowel disease (IBD): cause or consequence? IBD treatment targeting the gut microbiome","volume":"8","author":"Khan","year":"2019","journal-title":"Pathogens"},{"key":"2025101514185078300_bib12","doi-asserted-by":"publisher","first-page":"116291","DOI":"10.1016\/j.diagmicrobio.2024.116291","article-title":"The characteristics of the gut microbiota in patients with pulmonary tuberculosis: a systematic review","volume":"109","author":"Li","year":"2024","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2025101514185078300_bib13","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1038\/mi.2016.140","article-title":"Colonization with Helicobacter is concomitant with modified gut microbiota and drastic failure of the immune control of Mycobacterium tuberculosis","volume":"10","author":"Majlessi","year":"2017","journal-title":"Mucosal Immunol"},{"key":"2025101514185078300_bib14","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01018-19","article-title":"Correlation between disease severity and the intestinal microbiome in Mycobacterium tuberculosis-infected Rhesus macaques","volume":"10","author":"Namasivayam","year":"2019","journal-title":"mBio"},{"key":"2025101514185078300_bib15","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s40168-017-0286-2","article-title":"Longitudinal profiling reveals a persistent intestinal dysbiosis triggered by conventional anti-tuberculosis therapy","volume":"5","author":"Namasivayam","year":"2017","journal-title":"Microbiome"},{"key":"2025101514185078300_bib16","article-title":"Gut microbiota dysbiosis observed in tuberculosis patients resolves partially with anti-tuberculosis therapy","author":"Sahu","year":"2023","journal-title":"MedRxiv"},{"key":"2025101514185078300_bib17","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.chom.2017.03.003","article-title":"Anaerobic bacterial fermentation products increase tuberculosis risk in antiretroviral-drug-treated HIV patients","volume":"21","author":"Segal","year":"2017","journal-title":"Cell Host Microbe"},{"key":"2025101514185078300_bib18","doi-asserted-by":"publisher","first-page":"112108","DOI":"10.1016\/j.biopha.2021.112108","article-title":"The role of microbiota in respiratory health and diseases, particularly in tuberculosis","volume":"143","author":"Shah","year":"2021","journal-title":"Biomed Pharmacother"},{"key":"2025101514185078300_bib19","doi-asserted-by":"publisher","first-page":"1469562","DOI":"10.3389\/fmicb.2024.1469562","article-title":"Editorial: gut-lung axis: tuberculosis and drug resistance","volume":"15","author":"Tarashi","year":"2024","journal-title":"Front Microbiol"},{"key":"2025101514185078300_bib20","first-page":"22","article-title":"Principles of infectious diseases: transmission, diagnosis, prevention, and control","volume-title":"International Encyclopedia of Public Health","author":"van\u00a0Seventer","year":"2016","edition":"2nd"},{"key":"2025101514185078300_bib21","doi-asserted-by":"publisher","first-page":"53","DOI":"10.3389\/fmicb.2020.00053","article-title":"Long-term effects of multi-drug-resistant tuberculosis treatment on gut microbiota and its health consequences","volume":"11","author":"Wang","year":"2020","journal-title":"Front Microbiol"},{"key":"2025101514185078300_bib22","doi-asserted-by":"publisher","first-page":"10767","DOI":"10.1038\/s41598-017-10346-6","article-title":"Antibiotic treatment for tuberculosis induces a profound dysbiosis of the microbiome that persists long after therapy is completed","volume":"7","author":"Wipperman","year":"2017","journal-title":"Sci Rep"},{"key":"2025101514185078300_bib23","doi-asserted-by":"publisher","first-page":"2029997","DOI":"10.1080\/19490976.2022.2029997","article-title":"The gut microbiota mediates protective immunity against tuberculosis via modulation of lncRNA","volume":"14","author":"Yang","year":"2022","journal-title":"Gut Microbes"},{"key":"2025101514185078300_bib24","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s13099-025-00718-z","article-title":"The gut-lung axis and microbiome dysbiosis in non-tuberculous mycobacterial infections: immune mechanisms, clinical implications, and therapeutic frontiers","volume":"17","author":"Zhu","year":"2025","journal-title":"Gut Pathog"},{"key":"2025101514185078300_bib25","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1080\/14787210.2023.2283036","article-title":"The gut and lung microbiota in pulmonary tuberculosis: susceptibility, function, and new insights into treatment","volume":"21","author":"Zhuo","year":"2023","journal-title":"Expert Rev Anti Infect Ther"}],"container-title":["FEMS Microbiology Letters"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/femsle\/advance-article-pdf\/doi\/10.1093\/femsle\/fnaf106\/64484999\/fnaf106.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/femsle\/article-pdf\/doi\/10.1093\/femsle\/fnaf106\/64484999\/fnaf106.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/femsle\/article-pdf\/doi\/10.1093\/femsle\/fnaf106\/64484999\/fnaf106.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T18:19:00Z","timestamp":1760552340000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/femsle\/article\/doi\/10.1093\/femsle\/fnaf106\/8272666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":25,"URL":"https:\/\/doi.org\/10.1093\/femsle\/fnaf106","relation":{},"ISSN":["1574-6968"],"issn-type":[{"type":"electronic","value":"1574-6968"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2025]]},"article-number":"fnaf106"}}