Gut bacteria types may influence ITP progression in children: Study

Children and adolescents newly diagnosed with immune thrombocytopenia (ITP) show clear differences in gut microbiota — the community of bacteria and other microbes living in the gastrointestinal tract — compared with healthy peers, with specific bacteria types being closely linked to how the disease is likely to progress.

That’s according to a new study from Egypt, which found that higher levels of Eubacterium coprostanoligenes and Bifidobacterium were associated with an increased risk of the bleeding disorder developing into persistent ITP, a longer-lasting form of the disease. In contrast, higher levels of certain other bacterial populations were more commonly seen among children and adolescents who showed early remission.

“A clear difference in the mean log count of the microbiota types was obvious in [the] patient group compared to [the] control [group] in our study,” the researchers wrote.

These findings, and a “better understanding of ITP [disease mechanisms],” could lead to “newer treatment modalities,” the team noted.

“Altering diet using dietary yeast may assist in future management of ITP by inducing microbiota changes,” the researchers wrote.

The study, “Gut microbiota pattern in children and adolescents with newly diagnosed immune thrombocytopenia,” was published in the journal BMC Pediatrics.

Investigating the role of gut bacteria composition in ITP

ITP is an autoimmune condition in which the immune system mistakenly targets and destroys platelets, the cell fragments essential for blood clotting. This can lead to a low platelet count, or thrombocytopenia, which in turn can cause symptoms such as easy bruising, nosebleeds, and other bleeding problems.

The condition primarily affects children and, in most cases, resolves on its own within a few months. However, some cases progress into longer-lasting forms of the disease: Persistent ITP is defined as lasting from 3-12 months after diagnosis, and chronic ITP as extending beyond one year.

While the exact causes of ITP are not fully understood, alterations in gut microbiota composition are believed to play a role in influencing the immune responses that may contribute to disease development and/or progression.

However, “previous studies have been inconsistent with intestinal microbiota pattern in ITP,” the researchers wrote.

Now, a team in Cairo, led by scientists from Ain Shams University, sought to learn more.

One-quarter of children in study developed persistent ITP

To investigate the link between gut bacteria and ITP, the team conducted a prospective study involving 50 newly diagnosed children and adolescents, who ranged in age from 2 to 15. The participants were recruited from the university’s pediatric hematology oncology and bone marrow transplantation department between April and October 2023. All were enrolled before receiving any treatment. An additional 30 healthy children, matched for age and sex, were also included as controls.

Each participant was screened to exclude recent antibiotic use or other health conditions that could affect gut bacteria.

The patients had a median age of 6, and slightly more than half (58%) were girls. All had signs of skin bleeding, while 24% also had mucosal bleeding, and 8% showed signs of organ bleeding.

Stool samples were collected within the first week of diagnosis to analyze gut bacteria composition. The researchers then compared microbiota profiles between patients and healthy controls, as well as between ITP patients who showed different disease outcomes over a three-month follow-up.

By the end of the study period, 76% of patients had achieved early remission, while 24% developed persistent ITP. Children who progressed to persistent ITP were older than those who achieved early disease resolution (median age of 11.5 vs. 5 years).

Types of gut bacteria may be linked to disease severity

Distinct differences in gut microbiota were found between patients and controls, according to the researchers. Certain bacteria types, specifically Ruminococcaceae, Eubacterium coprostanoligenes, and Lachnospiraceae, were found only in children with ITP. Meanwhile, Bifidobacterium levels were significantly lower in patients compared with healthy children, but Phascolarctobacterium and Lactobacillus levels were significantly higher in patients.

Gut bacteria composition also appeared to correlate with disease progression. Children who achieved early remission had higher levels of Phascolarctobacterium, while those who developed persistent ITP showed increased levels of Bifidobacterium and Eubacterium coprostanoligenes. The researchers noted that the anti-inflammatory properties of Phascolarctobacterium could help explain its higher levels in children who achieved early remission.

Further statistical analysis confirmed that higher levels of Eubacterium coprostanoligenes and Bifidobacterium were associated with a greater risk of persistent disease.

Microbiota alteration seems to influence course of the [newly diagnosed ITP]. … These insights … thus [open] the door to explore microbiota-targeted therapy as [a] potential adjunct treatment for ITP in the future.

Additionally, those children who had organ bleeding showed significantly higher levels of Lactobacillus, Eubacterium coprostanoligenes, and Lachnospiraceae compared with those without organ involvement.

While no direct link between organ bleeding and specific gut bacteria has been reported in the literature, the researchers suggested that the observed association could be “related to the inflammatory process and the severity of the disease rather than bleeding itself.”

The team said additional research is needed.

“Microbiota alteration seems to influence course of the [newly diagnosed ITP],” the researchers wrote. “These insights advocate for further large-scale studies to confirm the associations observed between specific gut microbiota and ITP disease course, thus opening the door to explore microbiota-targeted therapy as [a] potential adjunct treatment for ITP in the future.”