Gut microbiota in Henoch-Schönlein purpura: from pathogenesis to therapeutic strategies

Henoch–Schönlein purpura (HSP), also known as immunoglobulin A vasculitis, is a common systemic vasculitis in children. Although its pathogenesis remains unclear, recent studies suggest that the gut microbiota may play a significant role in its initiation and progression. In patients with HSP, gut microbiota dysbiosis and associated metabolic alterations are linked to impaired intestinal barrier integrity, activation of the innate immune system, and dysregulation of adaptive immune cell subsets; this includes imbalances in the T helper 17 (Th17)/regulatory T (Treg) and follicular helper T (Tfh)/follicular regulatory T (Tfr) axes. These changes may ultimately trigger immunoglobulin A immune complex deposition and dysregulation of the complement system, potentially establishing a positive feedback loop that drives immune-mediated inflammatory injury. Modulation of the gut microbiota has been shown to restore intestinal barrier function and immune homeostasis; this indicates its potential as a therapeutic target. This review summarizes recent research on gut microbiota alterations in patients with HSP, and evaluates its role in the pathogenesis of the condition. It also discusses promising therapeutic strategies, including probiotics and prebiotics, traditional Chinese medicine and its active components, fecal microbiota transplantation, and targeted-release formulations. This review aims to identify potential microbial biomarkers and therapeutic targets for improving the clinical management of HSP.