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Review

Enteric Infections, Dysbiosis, and Metabolic Dysfunction: The Role of Diarrheagenic Pathogens in Insulin Resistance

by
Martin Zermeño-Ruiz
1,2,
Filiberto Gutierrez-Gutierrez
2,
Elsa Janneth Anaya-Ambriz
1,3,
Emiliano Peña-Durán
4,
Jesús Jonathan García-Galindo
5,6,
Alfredo Huerta-Huerta
7,
Araceli Lizbeth Quiñonez-Gallardo
7 and
Daniel Osmar Suárez-Rico
5,6,7,*
1
Doctorado en Microbiología Médica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Mexico
2
Departamento de Farmacobiología, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Blvd. Marcelino García Barragán #1421, Guadalajara 44430, Mexico
3
Departamento de Ciencias de la Salud, Centro Universitario de los Valles, Universidad de Guadalajara, Ameca 46708, Mexico
4
Licenciatura en Médico Cirujano y Partero, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Mexico
5
Departamento de Fisiología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Calle Sierra Mojada 950, Independencia Oriente, Guadalajara 44340, Mexico
6
Institute of Experimental and Clinical Terapeutics (INTEC), Health Science University Center, Universidad de Guadalajara, Guadalajara 44340, Mexico
7
Hospital Medica de la Ciudad, Santa Catalina, Calle. Pablo Valdez 719, La Perla, Guadalajara 44360, Mexico
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2026, 27(3), 1610; https://doi.org/10.3390/ijms27031610
Submission received: 12 December 2025 / Revised: 11 January 2026 / Accepted: 31 January 2026 / Published: 6 February 2026
(This article belongs to the Special Issue Microbiome-Immunity Crosstalk and Its Role in Health and Disease)
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Abstract

Type 2 diabetes and insulin resistance are increasingly recognized as conditions influenced not only by genetic and lifestyle factors but also by infectious and microbial exposures. Diarrheagenic pathogens, including enterotoxigenic, enteroaggregative, and enterohemorrhagic Escherichia coli, as well as other enteric microorganisms, disrupt the gut microbiota and compromise intestinal barrier integrity. These alterations promote dysbiosis, increased intestinal permeability, and systemic exposure to lipopolysaccharides and other microbial products, leading to metabolic endotoxemia and chronic low-grade inflammation. In parallel, pathogen-induced modulation of host immune responses contributes to adipose tissue inflammation, mitochondrial dysfunction, and impaired insulin signaling. This review summarizes current evidence linking diarrheagenic pathogens to insulin resistance, with emphasis on the microbiota–immune–metabolism axis. Understanding these interactions highlights novel perspectives on the pathogenesis of insulin resistance and suggests that targeted modulation of the gut microbiota or reduction in pathogen-driven inflammation may represent therapeutic opportunities to improve metabolic outcomes.
Keywords: insulin resistance; diarrheagenic pathogens; gut microbiota; intestinal barrier dysfunction; short-chain fatty acids (SCFAs); chronic low-grade inflammation; Escherichia coli; Salmonella enterica; Clostridioides difficile; norovirus; rotavirus; Giardia lamblia insulin resistance; diarrheagenic pathogens; gut microbiota; intestinal barrier dysfunction; short-chain fatty acids (SCFAs); chronic low-grade inflammation; Escherichia coli; Salmonella enterica; Clostridioides difficile; norovirus; rotavirus; Giardia lamblia

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MDPI and ACS Style

Zermeño-Ruiz, M.; Gutierrez-Gutierrez, F.; Anaya-Ambriz, E.J.; Peña-Durán, E.; García-Galindo, J.J.; Huerta-Huerta, A.; Quiñonez-Gallardo, A.L.; Suárez-Rico, D.O. Enteric Infections, Dysbiosis, and Metabolic Dysfunction: The Role of Diarrheagenic Pathogens in Insulin Resistance. Int. J. Mol. Sci. 2026, 27, 1610. https://doi.org/10.3390/ijms27031610

AMA Style

Zermeño-Ruiz M, Gutierrez-Gutierrez F, Anaya-Ambriz EJ, Peña-Durán E, García-Galindo JJ, Huerta-Huerta A, Quiñonez-Gallardo AL, Suárez-Rico DO. Enteric Infections, Dysbiosis, and Metabolic Dysfunction: The Role of Diarrheagenic Pathogens in Insulin Resistance. International Journal of Molecular Sciences. 2026; 27(3):1610. https://doi.org/10.3390/ijms27031610

Chicago/Turabian Style

Zermeño-Ruiz, Martin, Filiberto Gutierrez-Gutierrez, Elsa Janneth Anaya-Ambriz, Emiliano Peña-Durán, Jesús Jonathan García-Galindo, Alfredo Huerta-Huerta, Araceli Lizbeth Quiñonez-Gallardo, and Daniel Osmar Suárez-Rico. 2026. "Enteric Infections, Dysbiosis, and Metabolic Dysfunction: The Role of Diarrheagenic Pathogens in Insulin Resistance" International Journal of Molecular Sciences 27, no. 3: 1610. https://doi.org/10.3390/ijms27031610

APA Style

Zermeño-Ruiz, M., Gutierrez-Gutierrez, F., Anaya-Ambriz, E. J., Peña-Durán, E., García-Galindo, J. J., Huerta-Huerta, A., Quiñonez-Gallardo, A. L., & Suárez-Rico, D. O. (2026). Enteric Infections, Dysbiosis, and Metabolic Dysfunction: The Role of Diarrheagenic Pathogens in Insulin Resistance. International Journal of Molecular Sciences, 27(3), 1610. https://doi.org/10.3390/ijms27031610

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