Pharmacomicrobiomics in Western Medicine and Traditional Chinese Medicine in Type 2 Diabetes

Abstract

Pharmacomicrobiomics refers to the interactions between foreign compounds and the gut microbiome resulting in heterogeneous efficacy, side effects, and toxicity of the compound concerned. Glucose lowering drugs reduce blood glucose by modulating insulin secretion and its actions as well as redistributing energy disposal. Apart from genetic, ecological, and lifestyle factors, maintaining an equilibrium of the whole gut microbiome has been shown to improve human health. Microbial fingerprinting using faecal samples indicated an ‘invisible phenotype’ due to different compositions of microbiota which might orchestrate the interactions between patients’ phenotypes and their responses to glucose-lowering drugs. In this article, we summarize the current evidence on differences in composition of gut microbiota between individuals with type 2 diabetes (T2D) and healthy individuals, the disruption of the balance of beneficial and pathogenic microbiota was shown in patients with T2D and how Western Medicine (WM) and Traditional Chinese Medicine (TCM) might re-shape the gut microbiota with benefits to the host immunity and metabolic health. We particularly highlighted the effects of both WM and TCM increase the relative abundance of health promoting bacteria, such as, Akkermansia muciniphila, Blautia, and Bifidobacterium adolescentis, and which have been implicated in type 2 diabetes (T2D). Several lines of evidence suggested that TCM might complement the efficacy of WM through alteration of microbiota which warrants further investigation in our pursuit of prevention and control of T2D.

Therapeutic mechanisms of mulberry leaves in type 2 diabetes based on metabolomics

“…Traditional Chinese medicine has rich experience in the treatment of T2D; the multicomponent and multitarget characteristics of Chinese medicine can target the complex pathogenesis of T2D and has unique advantages in the treatment of T2D. At the same time, the diverse chemical composition of Chinese medicine is a treasure trove for the exploration of hypoglycemic drugs and new drug development ( Dou et al, 2021 ; Chu et al, 2022 ).…”

“…Traditional Chinese medicine has rich experience in the treatment of T2D; the multicomponent and multitarget characteristics of Chinese medicine can target the complex pathogenesis of T2D and has unique advantages in the treatment of T2D. At the same time, the diverse chemical composition of Chinese medicine is a treasure trove for the exploration of hypoglycemic drugs and new drug development (Dou et al, 2021;Chu et al, 2022). MLs are the dry old leaves of Morus alba L., and are highly effective in the treatment of type 2 diabetes (Gryn et al, 2013;Wei et al, 2018), but their specific chemical composition and hypoglycemic mechanisms are not known.…”

The potential role of lactulose pharmacotherapy in the treatment and prevention of diabetes

“…In general, many studies confirm the ability of lactulose to stimulate the growth of the health-promoting bacteria Bifidobacteria ( 31 ) which influence the metabolism. Dysbiosis is normally a common feature of prediabetes and type 1 and type 2 diabetes ( 32 , 33 ). Dysbiosis refers to an imbalance between the types of microbiota present in a host gut which may contribute to a range of conditions and illnesses.…”

“…In a longer period of receiving 3 g of lactulose for 2 weeks with habitual diets, the relative abundance of Bifidobacterium increased significantly, and Clostridium perfringens and Bacteroidaceae decreased slightly when compared to the baseline. Apart from these, the most important modifications in the gut microbiota were found in one of the animal studies: an increase in the obesity- and diabetes-related bacteria strain Akkermansia and a decrease in the hyperglycemia-related bacteria strain Desulfovibrionaceae ( 33 ) after the lactulose intervention ( 36 ). Akkermansia was found to control the essential regulatory system of glucose and energy metabolism ( 37 , 38 ).…”

“…Considering the results of clinical studies published to date, the induction of SCFA-producing bacteria after the administration of lactulose was similar to the current glucose-lowering drug acarbose. In both animal and human studies, acarbose promoted the abundance of Bifidobacterium and inhibited the abundance of Bacteroides ( 33 ). On further investigation at the species level, Bacteroides plebeius , Bacteroides dorei/vulgatus , and Clostridium bolteae were observed after the administration of acarbose.…”