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Peer review Peer review information Nature Communications thanks the anonymous reviewers for their contribution to the peer review of this work

Phylum-level analyses indicate predominant Firmicutes with relative Bacteroidetes reduction in some studies (264, 265), while others report increased Actinobacteria , Verrucomicrobia , or pro-inflammatory Proteobacteria , alongside potential reduction of beneficial Bacteroidetes and Actinobacteria ( 262, 266)

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Furthermore, the urothelium also shows reduced cell growth and heightened cell permeability (Kiuchi et al., 2009)

Apart from viral infections [82], multiple factors can cause degradation of the GL, including major surgery, ischemia/reperfusion, hypoxia/reoxygenation, mechanical ventilation [3, 48, 69], sodium overload [64, 80], ox-LDLs [5, 40, 86], sepsis, haemorrhagic shock, excessive shear stress, hypervolemia [48, 49], hyperglycaemia [68, 80], inflammatory cytokines such as tumour necrosis factor (TNF ) [5, 85], interleukin (IL)-1 , IL-6, and IL-10 [48, 57, 58], matrix metalloproteinases (MMPs) [64, 65, 87], and reactive oxygen/nitrogen species [6]