A study by Duke researchers is offering compelling new evidence on how gut microbes shape children's resilience to COVID-19 — and potential new therapies for children with viral infections.
In the first large-scale pediatric study to examine interaction between the gut microbiome, immune response, and COVID-19 symptomatology — published July 16 in the Journal of Infectious Diseases and funded by the Duke Department of Medicine — co-investigators Drs. Jatin Roper and Neeraj Surana highlight gut microbiota as a potential modulator of COVID-19 severity, particularly through its effects on immune signaling molecules like interferons.
They found that children with symptomatic COVID-19 had significantly reduced gut microbiota diversity compared to asymptomatic children or kids with no infection at all.
Particularly notable is their discovery of reduced microbial pathways involved in tyrosine biosynthesis—an essential amino acid pathway—and decreased levels of interferon-alpha, a key antiviral defense molecule, suggesting a link between gut microbial metabolism and COVID-19 immune response outcomes.
Potential for New Microbiome-based Therapies
“Although most of us have forgotten, or are trying to forget, the COVID crisis, COVID-19 remains a major health concern, including for children,” said Dr. Roper, associate professor in the Division of Gastroenterology. “This research adds to a growing body of evidence showing that severe COVID-19 in both children and adults is associated with altered metabolic pathways in gut microbes. It will also lead to improved risk stratification and potentially new microbiome-based therapies for children with severe COVID-19 and other viral infections.”
“This work deepens our understanding of how the gut microbiome shapes immune responses in children—an area with potential implications for a wide range of pediatric illnesses,” said Dr. Surana, a pediatric infectious disease specialist. “Beyond COVID-19, this has relevance for understanding how gut microbes influence susceptibility to viral infections and how we might intervene.”
Children have largely been spared the most severe effects of COVID-19, but this resilience has not been well understood. A few pediatric COVID-19 studies have found alterations in the gut microbiome, but the studies were based on small numbers of patients and relied on taxonomic profiling.
The Duke study leveraged shotgun metagenomic sequencing to capture the composition and function of the microbial markers, and evaluated plasma cytokine levels, enabling a deeper analysis of microbiome–immune system interactions.
Future longitudinal studies are needed to determine whether microbiome-targeted interventions can modulate COVID-19 outcomes, the authors note.