IDDF2022-ABS-0221 The roles of GUT microbiota in hand, foot and mouth disease

Background

The recent upsurge of hand, foot and mouth disease (HFMD) cases poses a significant threat to the paediatric and neonatal populations in the Asia-Pacific region. Coxsackievirus type A and Enterovirus 71 are the primary causative pathogens for HFMD, an infectious disease characterised by clinical manifestations of fever, oral ulcers and erythema on hands, feet and mouth, rare severe neurological complications and cardiopulmonary dysfunction. Recently, several studies highlighted the significant role of intestinal microorganisms in the replication and pathogenesis of enteric viruses. Despite that, the intricate interactions between intestinal bacteria and enteric viruses remain to be explored. Therefore, this study explores the role of the gut microbiome in HFMD and potential gut microbiota modulation therapy for HFMD.

Methods

Three databases (OVID Medline, PubMed, Web of Science) were used to perform systematic literature searches using 'HFMD' OR 'coxsackievirus' OR 'enterovirus' AND 'gut microbiome' OR 'intestinal microbiota' as the MeSH terms. Studies reported on the roles of gut microbiota in HFMD in relation to its severity, pathogenesis and therapy were included. Meanwhile, studies without the gut microbiome investigations were excluded, along with reviews and conference proceedings.

Results

Eleven out of the 1365 studies were included for qualitative analysis. Six studies involved human subjects, while the remaining were preclinical studies. Dysbiosis has been evidenced in patients with HFMD, showing reduced bacterial diversity, changes in the abundance of butyrate-producing (Bifidobacteria, Faecalibacterium, Ruminococcus and Roseburia) and inflammation-inducing (Prevotella, Streptococcus, Escherichia and Enterococcus) gut microbiota. Significant effort has also been evidenced in evaluating the antiviral activities of probiotics (Lactobacillus rhamnosus, L. reuteri) and their metabolites against Coxsackievirus and Enteroviruses. To date, only cohort studies are available that report the combinations of probiotics and prebiotics confer protective effects against gut dysbiosis (IDDF2022-ABS-0221 Figure 1).

Conclusions

In summary, there is an altered gut microbiota composition in patients with HFMD. Furthermore, the severity of HFMD has also been proposed to be attributed to the enrichment of specific gut microbiota and the gut-derived translocating bacterial surface components that drive inflammation and viral proliferation. Lastly, this study calls for larger clinical trials to validate synbiotics supplementation as a promising approach to protect against HFMD.