The meddling microbes midst our medicines

Abstract

It is not surprising that the complex metabolic machinery of the gut microbiome has accidental, or directed, ability to alter our medicines and influence their efficacy. What is not known is the extent to which this has contributed to drug failures or contraindications, or to the derailment of clinical trials. Some studies are unraveling the mechanisms by which the microbiota alter specific drugs, such as digoxin, and contribute to variations in efficacies between patient populations. Microbiome profiling, therefore, may well become an inevitable arm of all clinical trials in the future.

Keywords: Eggerthella lenta; digoxin; medicines; microbiota.

Figure 1. Digoxin is reduced to the cardioinactive dihydrodigoxin by E. lenta strains harboring the cgr operon. Digoxin induces cgr expression, and normal gut microbiota potentiate this induction; dietary protein, and arginine, inhibit cgr expression and digoxin reduction.