The human gut microbiota has now been associated with drug responses and efficacy, while chemical compounds present in these drugs can also impact the gut bacteria. However, drug-microbe interactions are still understudied in the clinical context, where polypharmacy and comorbidities co-occur. Here, we report relations between commonly used drugs and the gut microbiome. We performed metagenomics sequencing of faecal samples from a population cohort and two gastrointestinal disease cohorts. Differences between users and nonusers were analysed per cohort, followed by a meta-analysis. While 19 of 41 drugs are found to be associated with microbial features, when controlling for the use of multiple medications, proton-pump inhibitors, metformin, antibiotics and laxatives show the strongest associations with the microbiome. We here provide evidence for extensive changes in taxonomy, metabolic potential and resistome in relation to commonly used drugs. This paves the way for future studies and has implications for current microbiome studies by demonstrating the need to correct for multiple drug use.

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statistics from other independent studies 13,17,18 , we identify novel host-microbiota interactions. Furthermore, we explore the impact of potential confounding factors in modulating these genetic effects and identify potential diet-dependent host-microbiota interactions. We further assess the potential causal relationships between the gut microbiome and dietary habits, biomarkers and disease using Mendelian randomization (MR). Finally, we carry out a power analysis showing how microbiome studies, even at the current sample size, are underpowered to reveal the complex genetic architecture by which host genetics regulates the gut microbiome. ResultsGenome-wide associations with bacterial taxa and pathways. We investigated 5.5 million common (minor allele frequency (MAF) > 0.05) genetic variants on all autosomes and the X chromosome using linear mixed models 19 to test their association with 207 taxa and 205 bacterial pathways in 7,738 individuals from the DMP cohort (Methods and Supplementary Table 1) 19 . There was no evidence for test statistic inflation (median genomic lambda 1.002 (range, 0.75-1.03) for taxa and 1.004 (range, 0.87-1.04) for pathways). We identified 37 single nucleotide polymorphism (SNP)trait associations at 24 independent loci at a genome-wide P value threshold of 5 × 10 −8 (Fig. 1 and Supplementary Table 2). Genetic variants at two loci passed the more stringent study-wide threshold of 1.89 × 10 −10 that accounts for the number of independent tests performed (Methods).The strongest signal was seen for rs182549 located in an intron of MCM6, a perfect proxy of rs4988235 (r 2 = 1, 1000 Genomes Project European populations), one of the variants known to regulate the LCT gene and responsible for lactase persistence in adults (ClinVar accession RCV000008124). The T allele of rs182549, which confers lactase persistence through a dominant model of inheritance, was found to be associated with decreased abundances of the species Bifidobacterium adolescentis (P = 7.6 × 10 −14 ) and Bifidobacterium longum (P = 3.2 × 10 −08 ), as well as decreased abundances of higher-level taxa (Supplementary Table 2 (ref. 5 )). Associations at this locus were also seen for other taxa of the same genus but at lower levels of significance (Bifidobacterium catenulatum, P = 3.9 × 10 −5 ) and for species of the Collinsella genus (Extended Data Fig. 1). The genetic association at the LCT locus has been previously described, albeit only at the genus level, in Dutch, UK and US cohorts 6,8,14 , as well as in a recent large-scale meta-analysis 13 .The second locus that passed study-wide significance consisted of genetic variants near the ABO gene. ABO encodes the BGAT protein, a histo-blood group ABO system transferase. Associations found at this locus include species Bifidobacterium bifidum (rs8176645, p = 5.5 × 10 −15 ) and Collinsella aerofaciens (rs550057, P = 2.0 × 10 −8 , r 2 = 0.59 with rs8176645 in 1000 Genomes Project Europeans) and higher-order taxa (rs550057, genus Collinsella, P = 9.3 × 10 −11 ; family Coriobacteriac...

Several gastrointestinal diseases show a sex imbalance, although the underlying (patho)physiological mechanisms behind this are not well understood. The gut microbiome may be involved in this process, forming a complex interaction with host immune system, sex hormones, medication and other environmental factors. Here we performed sex-specific analyses of fecal microbiota composition in 1135 individuals from a population-based cohort. The overall gut microbiome composition of females and males was significantly different (p = 0.001), with females showing a greater microbial diversity (p = 0.009). After correcting for the effects of intrinsic factors, smoking, diet and medications, female hormonal factors such as the use of oral contraceptives and undergoing an ovariectomy were associated with microbial species and pathways. Females had a higher richness of antibiotic-resistance genes, with the most notable being resistance to the lincosamide nucleotidyltransferase (LNU) gene family. The higher abundance of resistance genes is consistent with the greater prescription of the Macrolide-Lincosamide-Streptogramin classes of antibiotics to females. Furthermore, we observed an increased resistance to aminoglycosides in females with self-reported irritable bowel syndrome. These results throw light upon the effects of common medications that are differentially prescribed between sexes and highlight the importance of sex-specific analysis when studying the gut microbiome and resistome.

The gut microbiome is an ecosystem that involves complex interactions. Currently, our knowledge about the role of the gut microbiome in health and disease relies mainly on differential microbial abundance, and little is known about the role of microbial interactions in the context of human disease. Here, we construct and compare microbial co-abundance networks using 2,379 metagenomes from four human cohorts: an inflammatory bowel disease (IBD) cohort, an obese cohort and two population-based cohorts. We find that the strengths of 38.6% of species co-abundances and 64.3% of pathway co-abundances vary significantly between cohorts, with 113 species and 1,050 pathway co-abundances showing IBD-specific effects and 281 pathway co-abundances showing obesity-specific effects. We can also replicate these IBD microbial co-abundances in longitudinal data from the IBD cohort of the integrative human microbiome (iHMP-IBD) project. Our study identifies several key species and pathways in IBD and obesity and provides evidence that altered microbial abundances in disease can influence their co-abundance relationship, which expands our current knowledge regarding microbial dysbiosis in disease.

The human gut harbors a complex ecosystem of microorganisms, including bacteria and viruses. With the rise of next-generation sequencing technologies, we have seen a quantum leap in the study of human-gut-inhabiting bacteria, yet the viruses that infect these bacteria, known as bacteriophages, remain underexplored. In this review, we focus on what is known about the role of bacteriophages in human health and the technical challenges involved in studying the gut virome, of which they are a major component. Lastly, we discuss what can be learned from studies of bacteriophages in other ecosystems.

The gut microbiome is associated with diverse diseases, but the universal signature of an (un)healthy microbiome remains elusive and there is a need to understand how genetics, exposome, lifestyle and diet shape the microbiome in health and disease. To fill this gap, we profiled bacterial composition, function, antibiotic resistance and virulence factors in the gut microbiomes of 8,208 Dutch individuals from a three-generational cohort comprising 2,756 families. We then correlated this to 241 host and environmental factors, including physical and mental health, medication use, diet, socioeconomic factors and childhood and current exposome. We identify that the microbiome is primarily shaped by environment and cohousing. Only ∼13% of taxa are heritable, which are enriched with highly prevalent and health-associated bacteria. By identifying 2,856 associations between microbiome and health, we find that seemingly unrelated diseases share a common signature that is independent of comorbidities. Furthermore, we identify 7,519 associations between microbiome features and diet, socioeconomics and early life and current exposome, of which numerous early-life and current factors are particularly linked to the microbiome. Overall, this study provides a comprehensive overview of gut microbiome and the underlying impact of heritability and exposures that will facilitate future development of microbiome-targeted therapies.