title: The influence of gut microbiota on drug metabolism and toxicity.
abstract: BACKGROUND
  Gut microbiota plays critical roles in drug metabolism. The variation of gut microbiota contributes to the interindividual differences toward drug therapy including drug-induced toxicity and efficacy. Accordingly, the investigation and elucidation of gut microbial impacts on drug metabolism and toxicity will not only facilitate the way of personalized medicine, but also improve rational drug design.
  
  
  METHODS
  This review provides an overview of the microbiota-host co-metabolism on drug metabolism and summarizes 30 clinical drugs that are co-metabolized by host and gut microbiota. Moreover, this review is specifically focused on elucidating the gut microbial modulation of some clinical drugs, in which the gut microbial influences on drug metabolism, drug-induced toxicity and efficacy are discussed.
  
  
  CONCLUSIONS
  The gut microbial contribution to drug metabolism and toxicity is increasingly recognized, but remains largely unexplored due to the extremely complex relationship between gut microbiota and host. The mechanistic elucidation of gut microbiota in drug metabolism is critical before any practical progress in drug design or personalized medicine could be made by modulating human gut microbiota. Analytical technique innovation is urgently required to strengthen our capability in recognizing microbial functions, including metagenomics, metabolomics and the integration of multidisciplinary knowledge.
authors.affiliation: a Center for Chinese Medical Therapy and Systems Biology , Shanghai University of Traditional Chinese Medicine , Shanghai 201203 , China.
authors.forename: Houkai
authors.initials: H
authors.lastname: Li
authors.affiliation: a Center for Chinese Medical Therapy and Systems Biology , Shanghai University of Traditional Chinese Medicine , Shanghai 201203 , China.
authors.forename: Jiaojiao
authors.initials: J
authors.lastname: He
authors.affiliation: a Center for Chinese Medical Therapy and Systems Biology , Shanghai University of Traditional Chinese Medicine , Shanghai 201203 , China.|b Cancer Epidemiology Program , University of Hawaii Cancer Center , Honolulu , HI 96813 , USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Jia
mesh_terms: D000818:Animals; D015195:Drug Design; D064420:Drug-Related Side Effects and Adverse Reactions / Q000378:metabolism* / Q000382:microbiology; D000069196:Gastrointestinal Microbiome; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D055432:Metabolomics / Q000379:methods; D056186:Metagenomics / Q000379:methods; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000378:metabolism*
chemical_list: D004364:Pharmaceutical Preparations
keywords: drug metabolism; efficacy; gut microbiota; toxicity