A Gut Feeling


Intestinal bacteria may determine whether statins lower cholesterol.

Statins can be effective at lowering cholesterol, but they have a perplexing tendency to work for some people and not others. The answer to the question of varying effectiveness may be in the gut.

A research team has identified three bile acids produced by gut bacteria that were evident in people who responded well to a common cholesterol- lowering drug called simvastatin. The finding demonstrates how gut bacteria can cause inherent differences in the way people digest, metabolize, and benefit from substances such as drugs.

"This is personalized medicine—the effects of drugs and how we respond," says Rima Kaddurah-Daouk, an associate professor in Duke's Department of Psychiatry and lead author on the study. "We found that the benefit of statins could be partly related to the type of bacteria that lives in our guts. The reason we respond differently is not only our genetic makeup, but also our gut microbiome."

A blood test that screens for the specific bile acids identified in the study could provide a way for doctors to determine who would respond to simvastatin. The finding could also point to new strategies to manipulate the gut microbiome using probiotics to spur different gut bacteria, which could then give the drugs a boost.

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