Virginia Research Day 2025

Medical Student Research Clinical

04 Targeting Gut Dysbiosis in Dermatitis Herpetiformis Through the Therapeutic Potential of Microbiome Modulation in Autoimmune Blistering Disorders

Paige O’Brien Daly, BS, MA; Haily A. Fritts; Natalie Nguyen; Kelly M. Frasier, DO; Mahssa Rezaei, BS; Victoria Salathe, BS; Tyarah Trias, BS; Khai Harris, BS Corresponding author: pdaly@vt.vcom.edu

Idaho College of Osteopathic Medicine Des Moines University Northwell Health Burrell College of Osteopathic Medicine Edward Via College of Osteopathic Medicine University of Missouri California Health Sciences University Philadelphia College of Osteopathic Medicine Emerging evidence underscores the significant interplay between the gut microbiome and autoimmune skin diseases, with dermatitis herpetiformis (DH) serving as an illustrative model where gut-skin communication may play a crucial role in disease etiology. This comprehensive study investigates the novel hypothesis that gut dysbiosis— disruptions in the composition and function of the gut microbiota—may not only exacerbate the hallmark cutaneous manifestations of DH but also

drive the autoimmune processes through increased intestinal permeability (leaky gut) and molecular mimicry between gluten antigens and epidermal transglutaminase (eTG). By analyzing over 40 studies, we identified a consistent pattern of gut microbial disruption in DH patients, typified by a significant reduction in beneficial bacteria like Akkermansia muciniphila and an increase in pathogenic species like Escherichia coli . Furthermore, findings suggest that these microbial imbalances may enhance gluten

induced immune responses, leading to cross-reactive autoantibody production targeting eTG in the skin. Strategically modulating the gut microbiome through personalized probiotic and prebiotic regimens could offer a groundbreaking adjunctive therapy to the traditional gluten-free diet. This therapeutic strategy has the potential to attenuate the autoimmune cascade, improve gut barrier integrity, and reduce the frequency and severity of DH flares with the goal of transforming DH management.

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