Global environmental change and the gut–kidney–brain axis: a review and framework of vulnerability and resilience
Year: 2026
Type: article
Abstract: Climate-health research often examines organ systems in isolation, which limits our understanding of how environmental stressors shape multiorgan disease patterns. We propose an integrative framework that explores how perturbations in the gut-kidney-brain axis might contribute to differential climate and environmental vulnerability. Climatic and environmental stressors might influence intestinal and blood-brain barrier integrity alongside established haemodynamic, toxicological, endocrine, and neurovascular pathways. Experimental and mechanistic evidence indicates that some environmental exposures can alter epithelial tight junction function and promote translocation of microbial products. Such translocation can drive systemic inflammation, altered metabolic signalling, and neural dysfunction implicated in chronic kidney disease progression and neurological impairment. In the proposed framework, barrier integrity is positioned as a biologically plausible interface within a multipathway model linking the gut, kidney, and brain. The framework highlights how climate and environmental exposures interact with pre-existing physiological and social vulnerabilities, adaptive capacity, and cumulative exposure burden to shape susceptibility to adverse health outcomes across the life course. Because current evidence relies heavily on experimental models and associative data, these mechanisms require validation under real-world, multifactorial climatic and environmental conditions. We also identify crucial research priorities, including prospective studies in climate-exposed populations, biomarker validation of barrier integrity, and targeted interventions to help preserve gut-kidney-brain axis function alongside exposure-reducing efforts. If empirical evidence supports this framework, the suggested systems-based approach could inform prevention, surveillance, and equity-centred resilience strategies.
Source: The Lancet Planetary Health
Authors: Shazia Adalat, Konstantinos Giannakou, Benjamin Valderrama, Juan Guillermo Cárdenas-Aguilera, Giorgos K Sakkas, Jonathan Overeem, Gaye Hafez, Dearbhla Kelly, Jelena Vulevic, Guohua He, Silvia M Mihăilă, Alessandra Tammaro, Burcin Ikiz, John F Cryan, Shazia Adalat, Caroline Anderson, Juan Guillermo Cárdenas-Aguilera, John F Cryan, Konstantinos Giannakou, Gaye Hafez, Guohua He, Burcin Ikiz, Dearbhla Kelly, Jing Li, Silvia M Mihăilă, Jonathan Overeem, Giorgos K Sakkas, Christophe Sarran, Alessandra Tammaro, Ariane van Koppen, Benjamin Valderrama, Jelena Vulevic, Altynay Balmukhanova, Ogochukwu Chinedum Okoye, Sophie Liabeuf
Institutions: King's College London, Guy's and St Thomas' NHS Foundation Trust, Evelina London Children's Healthcare, European University Cyprus, University College Cork, APC Microbiome Institute, Pontificia Universidad Javeriana, University of Thessaly, University of Nicosia, Amsterdam University Medical Centers, University of Amsterdam, Université Paris-Saclay, Centre de recherche en Epidémiologie et Santé des Populations, Altınbaş University, Brigham and Women's Hospital, University of Oxford, The First Affiliated Hospital, Sun Yat-sen University, Utrecht University, Leiden University Medical Center, Columbia University, Stanford University
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $6,680
Funder: University of Thessaly
OpenAlex ID: W7154385272