The interaction of gut microbiome and drugs

Drugs have a significant impact on the gut microbiome, but the opposite is also true, gut microbiome has an impact on how the drug fulfills its mission.

The onehealth paradigm is once again highlighted as a potential game-changer for treatment efficacy and toxicity elaboration. 

Antibiotics influence the gut microbiome as their function is to impact bacteria, but other drugs can also take a role in bacterial equilibrium in the gut microbiome

It is now well known that lifestyle (alimentation and environment), has a massive impact on the bacterial diversity of our microbiota. Indeed, an individual microbiome composition is widely different for urban people than for rural people. A new concept is rising around the effect of our microbiome composition on drug efficacy. 

Especially about the gut microbiome. Our daily routine of medication takes a primordial role in the composition of our gut microbiome. It has been shown that gut microbes contribute to drug efficacy and safety by enzymatically transforming drug structure and altering drug bioavailability, bioactivity, or toxicity. 

Levodopa, an oral treatment of Parkinson disease, is an interesting example of the microbial impact on drug efficacy.  Levodopa needs to be absorbed by the small intestine so it can enter the bloodstream and reach the brain to be converted into therapeutically active dopamine. 

Recent studies have shown that Enterococcus faecalis and Lactobacillus species appear to be able to metabolize Levodopa in the gut thanks to tyrosine decarboxylases activity. Levodopa is then not brought to its activity location: the brain.  Bacterial L-dopa metabolism, therefore, impacts the bioavailability of Levodopa and thus the efficacy of the drug. 

A concept to take noticed in the elaboration of a TPP, depending of the route of administration a drug efficacy can be affected by the gut microbiome 

More information 👉 https://pubmed.ncbi.nlm.nih.gov/32409589