Role of Gut Microbiota in Drug Metabolism and Therapeutic Efficacy

Abstract

The gut microbiota, comprising trillions of microorganisms inhabiting the gastrointestinal tract, plays a pivotal role in human health and disease. Emerging evidence suggests a profound influence of gut microbiota on drug metabolism and therapeutic efficacy, thereby impacting individual responses to pharmacotherapy. This review explores the intricate interplay between gut microbiota composition, drug metabolism, and therapeutic outcomes. The gut microbiota's metabolic activities encompass the biotransformation of various drugs, leading to altered pharmacokinetics and dynamics. Microbial enzymes, primarily of bacterial origin, can metabolize 
xenobiotics, including drugs, into metabolites with modified bioactivity, potentially influencing drug efficacy, toxicity, and adverse reactions. Moreover, gut microbiota-mediated metabolism can contribute to interindividual variability in drug responses, complicating clinical management. Furthermore, the gut microbiota influences drug absorption, distribution, metabolism, and excretion through interactions with host epithelial cells, immune cells, and the gut barrier