{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T22:32:31Z","timestamp":1789425151015,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>The gut microbiota, as a vital micro-ecological system within the human body, plays a crucial role in regulating diverse physiological functions. Recent research has increasingly demonstrated its close association with the occurrence and progression of anemia. This review summarizes current understanding of how the gut microbiota influences iron metabolism, vitamin synthesis\u2014particularly vitamin B12\u2014and immune modulation, all of which are key factors in the pathogenesis of anemia. We explore the mechanisms by which dysbiosis of the gut microbiota contributes to anemia development, including disruptions in nutrient absorption and inflammatory responses. Furthermore, we analyze recent clinical studies that investigate the relationship between gut microbiota alterations and different anemia subtypes. By integrating the latest basic and clinical research findings, this review aims to provide a comprehensive overview of the gut microbiota\u2019s role in anemia and to highlight its potential as a novel therapeutic target. The insights offered here may guide future research and clinical interventions focused on microbiota modulation as an innovative strategy for anemia management.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1900845","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:32:44Z","timestamp":1784781164000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Gut microbiota in anemia: mechanistic insights into iron metabolism, vitamin synthesis, and immune regulation"],"prefix":"10.3389","volume":"17","author":[{"given":"Lanxin","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Geriatric Endocrinology, The Fifth People\u2019s Hospital of Jinan","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunsong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1039\/d5fo03139g","article-title":"The intricate microbial-gut-brain axis in Alzheimer's disease: a review of microbiota-targeted strategies","volume":"16","author":"Zhang","year":"2025","journal-title":"Food Funct"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.549678","article-title":"Gut microbiota signatures in gestational anemia","volume":"11","author":"Long","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajcnut.2025.09.035","article-title":"Maternal anemia during pregnancy and its association with the gut microbiota profile in pregnant and postpartum women, and their infants: a cohort study","volume":"122","author":"Mandell","year":"2025","journal-title":"Am J Clin Nutr"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s11427-024-2885-4","article-title":"Gut microbes-muscle axis in muscle function and meat quality","author":"He","year":"2025","journal-title":"Sci China Life Sci"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.919352","article-title":"Gut microbiota correlates with clinical responsiveness to erythropoietin in hemodialysis patients with anemia","volume":"12","author":"Zhu","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1681\/asn.2025g3cqvpv3","article-title":"Altered fecal microbial and metabolic profiles reveal potential mechanisms underlying anemia in patients with chronic renal failure","volume":"13","author":"Wang","year":"2025","journal-title":"Microbiol Spectr"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.dib.2024.110681","article-title":"Intestinal microbiota dataset revealed by high-throughput sequencing of 16S rRNA in children with anemia in southern Peru","volume":"55","author":"Zhu","year":"2024","journal-title":"Data Brief"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4292\/wjgpt.v16.i2.105375","article-title":"Exploring the gut microbiome's influence on cancer-associated anemia: mechanisms, clinical challenges, and innovative therapies","volume":"16","author":"Bangolo","year":"2025","journal-title":"World J Gastrointest Pharmacol Ther"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2023.100677","article-title":"Iron-deficiency anemia in CKD: a narrative review for the kidney care team","volume":"5","author":"Hain","year":"2023","journal-title":"Kidney Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-024-02447-3","article-title":"Alternative blood transfusion triggers: a narrative review","volume":"24","author":"Arynov","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"S2279","DOI":"10.4103\/jpbs.jpbs_213_24","article-title":"Diabetes and anaemia: a myth or reality","volume":"16","author":"Narang","year":"2024","journal-title":"J Pharm Bioallied Sci"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.734561","article-title":"Insight into the potential value of gut microbial signatures for prediction of gestational anemia","volume":"11","author":"Wei","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000041617","article-title":"Gut microbiota and risk of iron deficiency anemia: a two-sample Mendelian randomization study","volume":"104","author":"Lei","year":"2025","journal-title":"Med (Baltimore)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines13030677","article-title":"Causal relationships between iron deficiency anemia, gut microbiota, and metabolites: insights from Mendelian randomization and in vivo data","volume":"13","author":"Zhou","year":"2025","journal-title":"Biomedicines"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-022-00721-3","article-title":"The role of iron in host-microbiota crosstalk and its effects on systemic glucose metabolism","volume":"18","author":"Mayneris-Perxachs","year":"2022","journal-title":"Nat Rev Endocrinol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1039\/d3fo04644c","article-title":"Iron deficiency anemia: a critical review on iron absorption, supplementation and its influence on gut microbiota","volume":"15","author":"Sun","year":"2024","journal-title":"Food Funct"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12071319","article-title":"Characteristics of gut microbiota and fecal metabolites in patients with colorectal cancer-associated iron deficiency anemia","volume":"12","author":"Zhang","year":"2024","journal-title":"Microorganisms"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1159\/000518655","article-title":"Neonatal hemoglobin levels in preterm infants are associated with early neurological functioning","volume":"118","author":"Kalteren","year":"2021","journal-title":"Neonatology"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2025.138465","article-title":"Pesticide exposure induces risks of gestational anemia by maternal gut microbiota: a prospective cohort study","volume":"494","author":"Dong","year":"2025","journal-title":"J Hazard Mater"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/toxins16110495","article-title":"Gut dysbiosis and its role in the anemia of chronic kidney disease","volume":"16","author":"Coll","year":"2024","journal-title":"Toxins (Basel)"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e18024","article-title":"Integration of gut microbiota and metabolomics for the hematopoiesis of Siwu paste on anemia rats","volume":"9","author":"Wan","year":"2023","journal-title":"Heliyon"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-023-02275-4","article-title":"The treatment of chronic anemia in heart failure: a global approach","volume":"113","author":"Bianchi","year":"2024","journal-title":"Clin Res Cardiol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3390\/ani12162063","article-title":"Regulation of a high-iron diet on lipid metabolism and gut microbiota in mice","volume":"12","author":"Xiong","year":"2022","journal-title":"Anim (Basel)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtemb.2022.127093","article-title":"Iron in infectious diseases friend or foe?: the role of gut microbiota","volume":"75","author":"Aksoyalp","year":"2023","journal-title":"J Trace Elem Med Biol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1186\/s12866-021-02320-0","article-title":"Oral iron supplementation after antibiotic exposure induces a deleterious recovery of the gut microbiota","volume":"21","author":"Cuisiniere","year":"2021","journal-title":"BMC Microbiol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01906-22","article-title":"Characterization of gut microbiota compositions along the intestinal tract in CD163\/pAPN double knockout piglets and their potential roles in iron absorption","volume":"11","author":"Zhang","year":"2023","journal-title":"Microbiol Spectr"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s12011-019-1658-1","article-title":"The effect of multispecies probiotic supplementation on iron status in rats","volume":"192","author":"Skrypnik","year":"2019","journal-title":"Biol Trace Elem Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1038\/s41392-024-01958-2","article-title":"Pyroptosis in health and disease: mechanisms, regulation and clinical perspective","volume":"9","author":"Liu","year":"2024","journal-title":"Signal Transduct Target Ther"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.985141","article-title":"Host and microbiota derived extracellular vesicles: crucial players in iron homeostasis","volume":"9","author":"Daou","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s11427-022-2302-5","article-title":"Gut microbiota bridges the iron homeostasis and host health","volume":"66","author":"Xiao","year":"2023","journal-title":"Sci China Life Sci"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1093\/femspd\/ftae005","article-title":"Interplay between gut microbiota and the master iron regulator, hepcidin, in the pathogenesis of liver fibrosis","volume":"82","author":"Ahmadi Badi","year":"2024","journal-title":"Pathog Dis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.freeradbiomed.2025.03.039","article-title":"Iron overload exacerbates metabolic dysfunction-associated steatohepatitis via the microbiota-gut-liver axis through lipopolysaccharide-mediated Akr1b8 activation","volume":"233","author":"Han","year":"2025","journal-title":"Free Radic Biol Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-92033-2_22","article-title":"Iron and the intestinal microbiome","volume":"1480","author":"Li","year":"2025","journal-title":"Adv Exp Med Biol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodres.2022.112031","article-title":"Effects of hemoglobin extracted from Tegillarca granosa on the gut microbiota in iron deficiency anemia mice","volume":"14","author":"Sun","year":"2023","journal-title":"Food Funct"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.932309","article-title":"Gut microbiota: linking nutrition and perinatal depression","volume":"12","author":"Song","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.20944\/preprints202408.0153.v1","article-title":"The role of the gut microbiota in complications among hemodialysis patients","volume":"12","author":"Du","year":"2024","journal-title":"Microorganisms"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2024.108824","article-title":"The response of gut microbiota to arsenic metabolism is involved in arsenic-induced liver injury, which is influenced by the interaction between arsenic and methionine synthase","volume":"190","author":"Li","year":"2024","journal-title":"Environ Int"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.3390\/microorganisms10071330","article-title":"Prebiotics, probiotics, and postbiotics in the prevention and treatment of anemia","volume":"10","author":"Zakrzewska","year":"2022","journal-title":"Microorganisms"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev_202306_32822","article-title":"Risks and limits of bariatric surgery: old solutions and a new potential option","volume":"27","author":"Gambioli","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B40","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/jgh3.12843","article-title":"Management of Helicobacter pylori infection","volume":"7","author":"Aumpan","year":"2023","journal-title":"JGH Open"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.2147\/dmso.s387523","article-title":"Gut microbiota signature of obese adults across different classifications","volume":"15","author":"Hu","year":"2022","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1007\/s11010-024-05077-y","article-title":"Gut microbiota regulates gut homeostasis, mucosal immunity and influences immune-related diseases","volume":"480","author":"Ding","year":"2025","journal-title":"Mol Cell Biochem"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1243834","article-title":"Astragalus improves intestinal barrier function and immunity by acting on intestinal microbiota to treat T2DM: a research review","volume":"14","author":"Su","year":"2023","journal-title":"Front Immunol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2024.122612","article-title":"Gut microbiota as a key regulator of intestinal mucosal immunity","volume":"345","author":"Wang","year":"2024","journal-title":"Life Sci"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3390\/molecules26196076","article-title":"Probiotics regulate gut microbiota: an effective method to improve immunity","volume":"26","author":"Wang","year":"2021","journal-title":"Molecules"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.02441","article-title":"Potential role of gut microbiota in induction and regulation of innate immune memory","volume":"10","author":"Negi","year":"2019","journal-title":"Front Immunol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1093\/advances\/nmy084","article-title":"Glutamine metabolism in macrophages: a novel target for obesity\/type 2 diabetes","volume":"10","author":"Ren","year":"2019","journal-title":"Adv Nutr"},{"key":"B48","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1016\/j.rceng.2024.09.002","article-title":"Anemia of inflammation and iron metabolism in chronic diseases","volume":"224","author":"Conde D\u00edez","year":"2024","journal-title":"Rev Clin Esp (Barc)"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021013472","article-title":"The role of iron in chronic inflammatory diseases: from mechanisms to treatment options in anemia of inflammation","volume":"140","author":"Marques","year":"2022","journal-title":"Blood"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2026.116378","article-title":"Remodeling the gut ecosystem and its mechanism: natural products in the treatment of ulcerative colitis via regulating gut microbiota and metabolites","volume":"174","author":"Zhang","year":"2026","journal-title":"Int Immunopharmacol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1195441","article-title":"Fg-4592 relieves diabetic kidney disease severity by influencing metabolic profiles via gut microbiota reconstruction in both human and mouse models","volume":"14","author":"Jiang","year":"2023","journal-title":"Front Physiol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1038\/s12276-023-01088-9","article-title":"Unconventional immune cells in the gut mucosal barrier: regulation by symbiotic microbiota","volume":"55","author":"Yoo","year":"2023","journal-title":"Exp Mol Med"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.76316","article-title":"A cross-sectional study of the maternal health factors: the interplay between breastfeeding patterns, gut microbiota, anemia, and cardiovascular risk in lactating mothers","volume":"16","author":"Kant","year":"2024","journal-title":"Cureus"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1359644","article-title":"The increased tendency for anemia in traditional Chinese medicine deficient body constitution is associated with the gut microbiome","volume":"11","author":"Liang","year":"2024","journal-title":"Front Nutr"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1900845\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:32:54Z","timestamp":1784781174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1900845\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":54,"alternative-id":["10.3389\/fimmu.2026.1900845"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1900845","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1900845"}}