Intra- and interindividual variation in drug responses is one major reason for the failure of drug therapy, drug toxicity, and even the death of patients. Precision medicine, or personalized medicine, is a field of medicine that customizes an individual's medical diagnosis and treatment based on his/her genes, microbiomes, environments, etc. Over the past decade, a large number of studies have demonstrated that gut microbiota can modify the efficacy and toxicity of drugs, and the extent of the modification varies greatly from person to person because of the variability of the gut microbiota. Personalized manipulation of gut microbiota is an important approach to rectify the abnormal drug response. In this review, we aim to improve drug efficacy and reduce drug toxicity by combining precision medicine and gut microbiota. After describing the interactions between gut microbiota and xenobiotics, we discuss (1) the effects of gut microbiota on drug efficacy and toxicity and the corresponding mechanisms, (2) the variability of gut microbiota, which leads to variation in drug responses, (3) the biomarkers used for the patient stratification and treatment decisions before the use of drugs, and (4) the methods used for the personalized manipulation of gut microbiota to improve drug outcomes. Overall, we hope to improve the drug response by incorporating the knowledge of gut microbiota into clinical practice.

中文翻译：

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针对肠道微生物群的精准医疗：关注药物的功效和毒性


药物反应的个体内和个体间差异是药物治疗失败、药物毒性甚至患者死亡的主要原因之一。精准医学，或称个性化医学，是根据个体的基因、微生物组、环境等定制医疗诊断和治疗的医学领域。过去十年来，大量研究表明肠道菌群可以改变个体的健康状况。由于肠道微生物群的差异，药物的功效和毒性以及修饰的程度因人而异。肠道菌群的个性化调控是纠正异常药物反应的重要方法。在这篇综述中，我们的目标是通过结合精准医疗和肠道微生物群来提高药物疗效并降低药物毒性。在描述了肠道微生物群与外源性物质之间的相互作用后，我们讨论了（1）肠道微生物群对药物功效和毒性的影响及其相应机制，（2）肠道微生物群的变异性导致药物反应的变化，（3）在使用药物之前用于患者分层和治疗决策的生物标志物，以及（4）用于个性化操纵肠道微生物群以改善药物结果的方法。总的来说，我们希望通过将肠道微生物群的知识融入临床实践来改善药物反应。