Microbiome-driven precision medicine: advancing drug development with pharmacomicrobiomics.

Abstract

Pharmacomicrobiomics investigates the complicated relationship between the gut microbiome and medications. Microbial communities can influence the metabolism and efficacy of many medications in two primary ways: directly and indirectly. Direct mechanisms typically entail the induction of biochemical alterations and multiple transformations directly on the drug, whereas indirect mechanisms encompass modifications in host metabolism, alterations in the gut microbial community, the synthesis of various metabolites, and interactions with the host immune system, which indirectly influence the drug's metabolism, absorption, and efficacy. For instance, microbial communities play an important part in activating prodrugs like sulfasalazine, improving the outcomes of immunotherapy, and minimising toxicity through specific interventions. Nonetheless, barriers can also emerge from the microbial breakdown of medications, reducing their therapeutic efficacy, along with adverse reactions mediated by microbiota. Innovations like probiotics, faecal microbiota transplantation, and microbiota profiling have shown promise in enhancing these interactions. Utilising the distinct microbiota composition of individuals, pharmacomicrobiomics offers a route to personalised, precise, and safer therapies, signalling an important evolution in drug development and clinical practice. This study aims to provide a comprehensive overview of microbiome-drug interactions.