Page 63 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology TCM regulates gut microbiota in pediatric MP pneumonia

while Enterobacteriaceae decreased following intervention regulate the immune system, reduce adverse reactions, and
with Ginseng Ling Baijusan, which mitigated antibiotic- provide anti-inflammatory and antiviral effects through a
associated adverse reactions. multi-target and multi-component mechanism of action,
considering the child as a whole. In conclusion, the
Pneumolysin, one of the major virulence factors
of Streptococcus pneumoniae, enhances bacterial combined treatment of MPP in children using TCM and
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Western medicines is both effective and safe, warranting
colonization and drug resistance, helping S. pneumoniae extensive attention and in-depth research in both academic
evade immune clearance by suppressing the host immune and clinical settings.
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response. Studies have shown that pneumolysin can
activate inflammatory signaling pathways in intestinal During our review, we identified RCTs of TCM based
epithelial cells (e.g., NOD-like receptor family pyrin on intestinal microbiota modulation for the treatment
domain containing 3 [NLRP3]) inflammasome, leading of children with MPP, starting with changes in intestinal
to the release of pro-inflammatory factors (e.g., IL-1β, and microbiota modulation by TCM. We conducted a meta-
IL-18) and triggering intestinal inflammation. Moreover, analysis of the 11 included studies using Stata 12.0 software.
pneumolysin can increase intestinal permeability and The results revealed that the overall clinical effectiveness
disrupt barrier function by disrupting tight junction rate of combining Western medicine and TCM for
proteins (e.g., zona occluden-1 and occludin) in intestinal treating MPP in children was higher compared to Western
epithelial cells, thereby promoting the infection and spread medicine alone. The analysis indicated that the treatment
of pneumonia. In contrast, a study by Guo et al. found with TCM increased the number of probiotics, such as
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that Ma Xing Shi Gan Tang not only affects the oligomeric Bifidobacteria and Lactobacilli, and reduced the count
state of pneumolysin, reducing its activity and protecting of pathogenic bacteria like Enterobacteriaceae, thereby
the intestinal barrier but also promotes the production of improving the inflammatory response. Concurrently,
beneficial intestinal bacteria and SCFAs, thereby alleviating immune function showed improvements, with increased
pneumonia exacerbated by immune dysregulation. 75,76 levels of cluster of differentiation (CD)4⁺ and the CD4⁺/
Experimental results showed that Ma Xing Shi Gan Tang CD8⁺ ratio in children, as well as increased levels of
significantly attenuated lung pathological damage and secretory immunoglobulin A in saliva and feces. In terms of
reduced mortality in mice infected with S. pneumoniae. inflammation, the level of TNF-α significantly decreased.
Rhodopsin inhibits the NLRP3 inflammasome-mediated The study’s results demonstrated that TCM treatment for
neutrophil recruitment and lysis signaling pathways, MPP offers significant advantages in enhancing clinical
thereby ameliorating lipopolysaccharide-induced lung effectiveness and modulating the systemic immune
injury. Thus, herbal interventions can treat pulmonary response by regulating intestinal microbiota and restoring
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systemic diseases by modulating relevant inflammatory homeostasis in children. In the authors’ view, TCM can
factors, mucosal immunity, protein expression, and mitigate the inflammatory response in children, ameliorate
maintaining the homeostatic balance of the pulmonary immune imbalances, enhance immune capabilities, and
and intestinal microbiota. repair lung and intestinal mucosal barrier damage by
modulating the intestinal microbiota, thereby achieving
In exploring effective treatment options for MPP in the goal of treating MPP.
children, the combination of TCM and Western medicine
therapies has demonstrated unique advantages. Clinical 4.3. Limitations and shortcomings
practice has shown that the use of pediatric elimination This study has several limitations: (i) some of the included
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of accumulation and relieving cough oral solution, studies had small sample sizes, and specific blinding
combined with doxycycline, can significantly shorten implementation protocols were not reported, potentially
the duration of symptoms such as fever, cough, and lung affecting the stability and authenticity of the results;
rales, while effectively reducing levels of inflammatory (ii) several studies did not mention adverse reactions or
markers such as TNF-α and C-reactive protein, compared safety evaluations, which limits the completeness and
to the doxycycline-only treatment group. Furthermore, the comprehensiveness of this study; (iii) the trial group
combination of Xuanbai Chengqi Tang and azithromycin involved Chinese medicine therapy, and due to the limited
effectively regulates immune imbalances in children with coverage of such studies in foreign journals, the included
MPP and alleviates acute-phase symptoms. In clinical literature was all in Chinese, with China as the primary
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settings, antibiotics directly inhibit or kill M. pneumoniae, study area, which may introduce potential bias; (iv) most
demonstrating rapid onset of action and significant of the literature did not address the children’s follow-up
pathogen inhibition and anti-inflammatory effects. status, and the absence of long-term follow-up data makes
The combined use of TCM and Western medicines can the trial’s long-term effectiveness unclear, rendering

Volume 9 Issue 2 (2025) 55 doi: 10.36922/ejmo.8602