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. 2022 Nov 1;12:1022603. doi: 10.3389/fcimb.2022.1022603

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Copyright © 2022 Liu, Li and Wei

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Level 1: patients with anastomotic leak (AL) are characterized by an altered gut microbiota. Level 2: the wound healing tissue is a desirable environment for collagenolytic strains. The extracellular matrix (ECM) on the anastomosis site, which includes collagen, fibrinogen, and laminin. Bacterial adhesin proteins are essential for the adhesion process. In addition, pathogen biofilm formation and a weakened colonization resistance from commensal bacteria together contribute to this process together. Level 3: following successful colonization, the pathogen can degrade mucin and inhibit epithelial cell repair. Most importantly, pathogens such as Enterococcus faecalis and Pseudomonas aeruginosa have been identified to express proteases and then activate matrix metalloproteinases (MMPs), which contribute to submucosal ECM breakdown and lead to AL.