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Annu Rev Pharmacol Toxicol. 2018 Jan 6;58:253-270. doi: 10.1146/annurev-pharmtox-042017-031849. Epub 2017 Oct 2.

Impacts of the Human Gut Microbiome on Therapeutics.

Author information

1
Department of Computer Science and Engineering, University of California, San Diego, California 92093, USA; email: robknight@ucsd.edu.
2
Department of Pediatrics, University of California, San Diego, California 92093, USA.
3
Biomedical Sciences, University of California, San Diego, California 92093, USA.
4
Center for Microbiome Innovation, University of California, San Diego, California 92093, USA.
5
Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California 92093, USA.

Abstract

The human microbiome contains a vast source of genetic and biochemical variation, and its impacts on therapeutic responses are just beginning to be understood. This expanded understanding is especially important because the human microbiome differs far more among different people than does the human genome, and it is also dramatically easier to change. Here, we describe some of the major factors driving differences in the human microbiome among individuals and populations. We then describe some of the many ways in which gut microbes modify the action of specific chemotherapeutic agents, including nonsteroidal anti-inflammatory drugs and cardiac glycosides, and outline the potential of fecal microbiota transplant as a therapeutic. Intriguingly, microbes also alter how hosts respond to therapeutic agents through various pathways acting at distal sites. Finally, we discuss some of the computational and practical issues surrounding use of the microbiome to stratify individuals for drug response, and we envision a future where the microbiome will be modified to increase everyone's potential to benefit from therapy.

KEYWORDS:

metabolome; microbial ecology; microbiome; personalized medicine; precision medicine

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