The presence of particular microbes or enzymes could explain why some treatments are ineffective for some people.
Researchers now have evidence that healthy people metabolise certain drugs in different ways, depending on their microbial make-up.
Computational biologist Leah Guthrie, from the Albert Einstein College of Medicine in New York City, and colleagues, collected faecal samples from 20 healthy people.
They treated the samples with irinotecan, and measured the compounds produced by bacteria in the samples as they interacted with the drug.
Analysing the proteins produced in the faecal samples, they found that those from people with high bacterial metabolisms contained strains that made more β-glucuronidases. These people also had increased levels of proteins that transport sugar into cells.
This suggests that they would be more likely to absorb the toxic compound and develop gastrointestinal problems, they claim.
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