Narrative review on gut microbiota modulation in Henoch-Schonlein purpura pathogenesis

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Frontiers in Medicine Published May 22, 2026 Medically reviewed May 22, 2026 Study authors: Shuo Sun, Haiyan Lang, Sitong Cheng, Ruhua Ren, Wenjing Yao, Yucao Ma, Dalai Nashun, Yuhong Wang, Qi… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider that gut microbiota modulation in HSP is an investigational approach with unclear clinical benefit.

This is a narrative review that synthesizes current evidence on the role of gut microbiota dysbiosis in the pathogenesis of Henoch-Schonlein purpura (HSP), also known as immunoglobulin A vasculitis. The scope includes potential therapeutic strategies to modulate the gut microbiota, such as probiotics, prebiotics, traditional Chinese medicine, fecal microbiota transplantation, and targeted-release formulations.

The authors argue that gut microbiota dysbiosis may contribute to HSP pathogenesis, but they do not report pooled effect sizes or specific quantitative findings from primary studies. The review qualitatively discusses the rationale for microbiota modulation as a therapeutic approach.

Key limitations noted by the authors include that the pathogenesis of HSP remains unclear and that evidence for microbiota-based interventions is preliminary. The review does not report a study population, sample size, intervention details, comparator groups, or adverse events.

Practice relevance is not reported, and the authors do not make specific clinical recommendations. The synthesis is cautious, emphasizing the need for further research to establish causality and clinical efficacy.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

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.