Efficacy of Probiotics and Postbiotics in Treating Dengue Fever - A Potential Strategy to Reduce Antibody-dependent...

Dengue virus (DENV), a member of the flavivirus family, is transmitted by the Aedes mosquito, with an incubation period of typically four to ten days, and causes a clinical spectrum of Dengue virus infection (DVI), ranging from classic dengue fever (DF) to sever illness, with symptoms such as vascular leakage, hemorrhage, organ dysfunction, and dysregulated inflammatory responses mediated by cytokines such as interleukin 6 (IL-6). However, Concerns about the absence of effective antiviral treatments or the efficacy and safety limitations of existing vaccines have led to considering novel treatment ways. Probiotics and postbiotics modulate mucosal and systemic immunity in a variety of ways, including mechanisms such as interaction with intestinal epithelial cells and dendritic cells (DCs), increased antigen (Ag) presentation, modulation of the toll-like receptor (TLR) signaling pathway, upregulation of regulatory pathways, and stimulation of antiviral cellular responses, including increased interferon-gamma (IFN-γ) production and cluster of differentiation 4⁺ (CD4⁺) and CD8⁺ T cell activity. According to the immunological properties, probiotics and postbiotics have been hypothesized to influence host responses related to DENV infection. Furthermore, probiotics have been proposed as a potential approach to modulate immune responses following dengue infection or vaccination; however, their role in alleviating antibody-dependent enhancement (ADE) is not yet clearly established. They may rather contribute as adjunctive immunomodulators or potential vaccine adjuvants, rather than as independent therapeutic agents. This review article shows a conceptual and perspective potential of probiotics and postbiotics through which they may integrate mechanistic insights and preclinical or clinical evidence, rather than implying immediate therapeutic applicability. This review includes mechanistic data and existing preclinical and clinical evidence, identifies key gaps in strain selection, dosing, molecular correlates of protection, and safety assessment, and suggests higher-priority research avenues, including adequately powered randomized controlled trials that measure clinical endpoints, immunological markers, and potential interactions with DENV vaccines and antibody-dependent risk enhancement.