Revolution 9: How the microbiome is evolving our understanding of drug disposition

The human microbiome, a complex community of bacteria, fungi, protozoa, and viruses, doesn't just passively coexist with the drugs we take; it actively participates in a bidirectional relationship that can impact drug efficacy and toxicity. From immunosuppressants in transplant patients to medicines in other fields of medicine, it is becoming apparent that the microbiome has been a missing piece in our understanding of drug variability, and that it can uniquely impact drug interactions. As this field rapidly evolves, it promises new strategies for personalising medicine through microbiome biomarkers and targeted manipulation of our microbial communities.

In this episode, we'll hear about:

• The bidirectional nature of drug-microbiome interactions: how drugs alter microbial composition and how microbes chemically modify drugs or influence their disposition

• Mycophenolate and tacrolimus as case studies that demonstrate how the microbiota influences drug disposition in transplant patients

• The clinical consequences of microbiome-drug interactions, from gastrointestinal toxicity to unexpected variability in dose requirements

• The challenges and limitations researchers face, and why regulatory frameworks need to evolve to incorporate microbiome considerations in drug development.

About our guests:

Laure Elens is a Professor of Pharmacokinetics at UCLouvain's Faculty of Pharmacy and Biomedical Sciences, and leads the PMGK research lab.

Roland Lawson is an Associate Professor of Pharmacology at the University of Limoges and leads the microbiome group of the INSERM research unit, Pharmacology & Transplantation.

Eight Drugs a Week is supported by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). The personal views of the hosts and guests do not necessarily reflect the position of the Association.