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Review
. 2025 Jun 10:13:e19535.
doi: 10.7717/peerj.19535. eCollection 2025.

Advances in drug resistance and resistance mechanisms of four colorectal cancer-associated gut microbiota

Yu Gan  1 , Hao Yang  2 , Maijian Wang  3 , Jida Li  1   4
Affiliations
Review

Advances in drug resistance and resistance mechanisms of four colorectal cancer-associated gut microbiota

Yu Gan et al. PeerJ. .

Abstract

Colorectal cancer (CRC) is a common malignant tumor in the gastrointestinal tract with inconspicuous early symptoms, high morbidity and mortality, and poor prognosis. Gut microbiota are present in the human intestinal system and have certain functions, which include the integrity of the epithelial barrier and the enhancement of protective immune responses. The etiology of CRC is numerous and complex, including poor lifestyle and dietary habits, and instability of the gut microbiota, which is considered to be one of the major factors in the development of CRC, includes mainly Bacteroides fragilis, Fusobacterium nucleatum, Escherichia coli, and Enterococcus faecalis. Enrichment of these bacteria in CRC tumor tissues may increase other pro-inflammatory opportunistic pathogens and decrease butyrate-producing bacteria, leading to an imbalance in intestinal homeostasis (dysbiosis) and ultimately tumor formation. Antibiotic-induced changes in the gut microbiota affect tissue utilization and redox homeostasis of macronutrients and micronutrients. However, the long-term use and abuse of antibiotics has made the problem of drug resistance a difficult problem that currently plagues the regulation of gut microbiota, as well as a complicated issue in the prevention and treatment of CRC. In this review, we elucidated the drug resistance of four CRC-associated gut microbiota, namely Bacteroides fragilis, Fusobacterium nucleatum, Escherichia coli, and Enterococcus faecalis, and discussed the common and different aspects of the resistance mechanisms of the four gut microbiota, with the aim of providing a basis for the prevention and control of CRC.

Keywords: Bacteroides fragilis; Colorectal cancer; Drug resistance mechanism; Enterococcus faecalis; Enterotoxin-producing Escherichia coli; Fusobacterium nucleatum.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Changes in global colorectal cancer incidence and deaths, 2017–2022.
Figure 2
Figure 2. Literature reports of gut microbiota associated with colorectal cancer in the last decade.
Figure 3
Figure 3. Nim-mediated metronidazole resistance.
Figure 4
Figure 4. Mechanisms of horizontal gene transfer-mediated drug resistance.
Figure 5
Figure 5. Mechanism of E. coli AcrAB-TolC-mediated efflux.
See this image and copyright information in PMC

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