肠道微生物群与药物相互作用的研究进展

Advances in gut microbiota-drug interactions

摘要:

药物的代谢是机体对药物处置过程的关键步骤，而肠道作为机体中重要的微生态系统，其在药物代谢方面的作用至关重要。肠道微生物群能够对各种药物等外源化合物进行生物转化、积累，并改变这些物质的活性和毒性，从而影响宿主机体对它们的反应。肠道微生物群与药物之间的相互作用相当复杂，亟待更多更加深入、全面的发掘和研究。近年来，随着人们对肠道微生物群代谢及其与药物互作关系，肠道菌-宿主共代谢认知的不断深化，越来越多的研究表明肠道微生物在药代动力学中扮演重要角色。本文通过调研、整理、归纳和总结国内外相关文献资料，对机体肠道微生物的分类、功能，几种常用药物对肠道微生物的影响以及肠道菌群对药物的代谢作用效果与几个主要的机制进行了梳理和综述，并讨论了微生物和药物之间的双向互作。有利于增进对微生物群影响药物疗效及其代谢途径和机制的了解，提高调控肠道微生物改善治疗的可能性，为指导临床合理用药、精准用药、个体化治疗、药物的评价和新药研发等提供科学参考。

Abstract:

Drug metabolism is a key step in the disposal of drugs, and the role of the gut as an important micro-ecosystem in the body is crucial in drug metabolism. The gut microbiota is capable of transforming and accumulating exogenous compounds (e.g., drugs) and modifying the activity and toxicity of these compounds, thereby influencing the host responses to the compounds. The interactions between gut microbiota and drugs are complex and need to be studied in detail. In recent years, the understanding of the metabolism of gut microbiota, gut microbiota-drug interactions, and the co-metabolism between gut microbiota and host are deepening, and increasing studies have shown that gut microorganisms play a crucial role in pharmacokinetics. By reviewing the relevant papers at home and abroad, we summarized the classification and functions of gut microorganisms, the effects of some commonly used drugs on gut microorganisms, and the metabolic effects and mechanisms of gut microbiota on drugs. In addition, we discussed the interactions between gut microbiota and drugs. The review helps to improve our understanding of the influences of gut microbiota on drug efficacy and the pathways and mechanisms of drug metabolism by gut microbiota, increase the possibility of modulating gut microbiota to improve treatment, and provide a reference for the rational and precise use of drugs, individualized treatment, and drug evaluation and development.