From gut microbiota dysbiosis to immune dysregulation: pathogenic mechanisms and emerging therapeutic perspectives in pediatric asthma.

Pediatric asthma is a chronic inflammatory airway disease with high heterogeneity. Its onset and progression are closely related to environmental exposures in early life and impaired immune regulation. Gut microbiota dysbiosis not only alters the production of metabolites such as short-chain fatty acids, 12,13-diHOME, and succinate, but also drives airway inflammation through multiple immunoregulatory mechanisms. Gut microbial dysbiosis can affect the production of metabolites, such as short-chain fatty acids, and promote airway inflammation through complex immune regulatory mechanisms. In addition, multi-axis interactions, including the gut-brain-lung and gut-bone-lung axis, may influence inflammatory phenotypes and disease heterogeneity in pediatric asthma. This review summarizes the characteristics of gut microbiota dysbiosis in pediatric asthma and focuses on the core mechanisms by which the gut-lung axis contributes to asthma pathogenesis, including metabolite-mediated regulation, disruption of immune homeostasis, mucosal barrier dysfunction, and multi-axis crosstalk. It also summarizes potential intervention approaches targeting the gut microbiota. Elucidating the gut microbiota-immune-multi-organ regulatory network may provide a theoretical basis for the early identification and precision intervention of pediatric asthma.