Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
Department of Rheumatology, University Hospital of Zurich, University of Zurich, 8006 Zurich, Switzerland.
Genes (Basel). 2022 Dec 28;14(1):89. doi: 10.3390/genes14010089.
(1) Background: Gut microbiota (GM) is the set of microorganisms inhabiting the gastroenteric tract that seems to have a role in the pathogenesis of rheumatic diseases. Recently, many authors proved that GM may influence pharmacodynamics and pharmacokinetics of several drugs with complex interactions that are studied by the growing field of pharmacomicrobiomics. The aim of this review is to highlight current evidence on pharmacomicrobiomics applied to the main treatments of Rheumatoid Arthritis and Spondyloarthritis in order to maximize therapeutic success, in the framework of Personalized Medicine. (2) Methods: We performed a narrative review concerning pharmacomicrobiomics in inflammatory arthritides. We evaluated the influence of gut microbiota on treatment response of conventional Disease Modifying Anti-Rheumatic drugs (cDMARDs) (Methotrexate and Leflunomide) and biological Disease Modifying Anti-Rheumatic drugs (bDMARDs) (Tumor necrosis factor inhibitors, Interleukin-17 inhibitors, Interleukin 12/23 inhibitors, Abatacept, Janus Kinase inhibitors and Rituximab). (3) Results: We found a great amount of studies concerning Methotrexate and Tumor Necrosis Inhibitors (TNFi). Conversely, fewer data were available about Interleukin-17 inhibitors (IL-17i) and Interleukin 12/23 inhibitors (IL-12/23i), while none was identified for Janus Kinase Inhibitors (JAKi), Tocilizumab, Abatacept and Rituximab. We observed that microbiota and drugs are influenced in a mutual and reciprocal way. Indeed, microbiota seems to influence therapeutic response and efficacy, whereas in the other hand, drugs may restore healthy microbiota. (4) Conclusions: Future improvement in pharmacomicrobiomics could help to detect an effective biomarker able to guide treatment choice and optimize management of inflammatory arthritides.
(1) 背景：肠道微生物群（GM）是栖息在胃肠道中的微生物集合，似乎在风湿性疾病的发病机制中起作用。最近，许多作者证明 GM 可能会影响几种药物的药效学和药代动力学，这些药物具有复杂的相互作用，这是药理学微生物组学不断发展的研究领域。本综述的目的是强调在类风湿关节炎和强直性脊柱炎的主要治疗中应用药理学微生物组学的现有证据，以便在个性化医疗的框架内最大限度地提高治疗效果。
(2) 方法：我们进行了一项关于炎症性关节炎中药理学微生物组学的叙述性综述。我们评估了肠道微生物群对传统疾病修饰抗风湿药物（cDMARDs）（甲氨蝶呤和来氟米特）和生物疾病修饰抗风湿药物（bDMARDs）（肿瘤坏死因子抑制剂、白细胞介素-17 抑制剂、白细胞介素 12/23 抑制剂、阿巴西普、Janus 激酶抑制剂和利妥昔单抗）治疗反应的影响。
(3) 结果：我们发现了大量关于甲氨蝶呤和肿瘤坏死因子抑制剂（TNFi）的研究。相反，关于白细胞介素-17 抑制剂（IL-17i）和白细胞介素 12/23 抑制剂（IL-12/23i）的研究较少，而对于 Janus 激酶抑制剂（JAKi）、托珠单抗、阿巴西普和利妥昔单抗则没有研究。我们观察到，微生物群和药物是相互影响的。事实上，微生物群似乎会影响治疗反应和疗效，而另一方面，药物也可能恢复健康的微生物群。
(4) 结论：未来在药理学微生物组学方面的改进可能有助于发现有效的生物标志物，以指导治疗选择并优化炎症性关节炎的管理。
