Bristol lock Delaney Burns will make her England debut as injuries and a retirement force changes to the Red Roses' pack for Sunday's Women's Six Nations match against Italy.
Vice-captain Zoe Aldcroft - usually a lock - will start at number eight for England for the first time following Sarah Hunter's retirement last weekend.
With Poppy Cleall injured, Cath O'Donnell comes into the second row.
Harlequins flanker Emily Robinson, 22, could make her debut off the bench.
England are bidding for a fifth successive Six Nations title and beat Scotland 58-7 last weekend, while Italy challenged World Cup semi-finalists France in a 22-12 loss.
The Red Roses' injury list includes 19 players, of which centre Amber Reed is one.
Reed's absence means Tatyana Heard and Lagi Tuima are at 12 and 13 respectively, while versatile back Sarah McKenna is brought on to the bench.
'Precarious' prop options
England's depth is most challenged at prop, where head coach Simon Middleton describes the situation as "precarious".
Detysha Harper sustained an Achilles tendon injury in Wednesday's training that will keep her out for the rest of the tournament.
Last week's debutant Mackenzie Carson starts again at loose-head, with the more experienced Sarah Bern at tight-head.
Liz Crake and Kelsey Clifford, who also made their debuts last week, are on the bench and Simi Pam has been brought into the wider training squad to replace Harper.
England's injured props include Hannah Botterman, Bryony Cleall and Maud Muir, while Shaunagh Brown has retired and Vickii Cornborough is missing the tournament for personal reasons.
It is hoped Botterman and Muir will return in time for the third-round match against Wales.
The Red Roses are also without key leaders as fly-half Zoe Harrison, centre Emily Scarratt and lock Abbie Ward will be absent for the Six Nations.
Flanker Marlie Packer has taken the captaincy following Hunter's retirement and head coach Simon Middleton said she "will want to stamp her own brand of leadership on the team".
"Delaney Burns has impressed us immensely," Middleton added.
"Her line-out and set-piece understanding is strong and she deserves her start.
"Giovanni Raineri and his staff will have their Italy team well prepared for this Six Nations, and that was clearly reflected in last weekend's strong opening performance."
England team to face Italy
England: Dow; Breach, Tuima, Heard, MacDonald; Aitchison, L Packer; Carson, Cokayne, Bern, O'Donnell, Burns, Kabeya, Packer (capt), Aldcroft.
Replacements: Davies, Crake, Clifford, Beckett, Robinson, Wyrwas, McKenna, Sing.
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