Enhanced intestinal permeability and intestinal co-morbidities in heat strain: A review and case for autodigestion

Anthony A. Fung, Andy Zhou, Jennifer K. Vanos, Geert W. Schmid-Schönbein

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Enhanced intestinal permeability is a pervasive issue in modern medicine, with implications demonstrably associated with significant health consequences such as sepsis, multiorgan failure, and death. Key issues involve the trigger mechanisms that could compromise intestinal integrity and increase local permeability allowing the passage of larger, potentially dangerous molecules. Heat stress, whether exertional or environmental, may modulate intestinal permeability and begs interesting questions in the context of global climate change, increasing population vulnerabilities, and public health. Emerging evidence indicates that intestinal leakage of digestive enzymes and associated cell dysfunctions––a process referred to as autodigestion––may play a critical role in systemic physiological damage within the body. This increased permeability is exacerbated in the presence of elevated core temperatures. We employed Latent Dirichlet Allocation (LDA) topic modeling methods to analyze the relationship between heat stress and the nascent theory of autodigestion in a systematic, quantifiable, and unbiased manner. From a corpus of 11,233 scientific articles across four relevant scientific journals (Gut, Shock, Temperature, Gastroenterology), it was found that over 1,000 documents expressed a relationship between intestine, enhanced permeability, core temperature, and heat stress. The association has grown stronger in recent years, as heat stress and potential autodigestion are investigated in tandem, yet still by a limited number of specific research studies. Such findings justify the design of future studies to critically test novel interventions against digestive enzymes permeating the intestinal tract, especially the small intestine.

Original languageEnglish (US)
Pages (from-to)223-244
Number of pages22
Issue number3
StatePublished - 2021


  • Cytokines
  • autodigestion
  • endotoxins
  • extreme heat
  • heat mortality
  • multiorgan failure
  • systemic inflammatory response syndrome
  • thermoregulation

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)


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