211.1 Unraveling interindividual differences and functional consequences of gut microbial metabolism of immunosuppressants

Burkhard Toenshoff, Germany

Vice Chairman
Department of Pediatrics I
University Children's Hospital Heidelberg

Biography

Burkhard Tönshoff, MD, PhD, is Professor of Pediatrics and Pediatric Nephrology at the University Children’s Hospital Heidelberg, Germany; Vice Chairman of the Department of Pediatrics I; Medical Director of the Pediatric Kidney Transplantation Program. His current research focuses on various aspects of kidney transplantation including studies of the pharmacokinetics, efficacy and safety of novel immunosuppressive drugs in pediatric kidney transplant recipients, optimization of immunosuppressive therapy through therapeutic drug monitoring and immunomonitoring, prevention of infectious and other complications after kidney transplantation, biomarker-guided minimization of immunosuppressive therapy, the impact of donor-specific HLA and non-HLA antibodies on graft histology and function, and the role of the gut microbiome in immunosuppressive drug metabolism and transplant outcome. In the year 2009 he founded the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN; www.certain-registry.eu) as a multicenter research network and platform based on a novel, web-based registry; CERTAIN is the official transplant registry of the European Society for Paediatric Nephrology (ESPN). Awards and nominations: Member of the Eurotransplant Kidney Advisory Committee. Scientific Steering Committee of the Transplant Cohort of the German Center for Infectious Diseases. Chairman of the Kidney Transplant Working Group of the European Society for Paediatric Nephrology (ESPN) and of the German Society for Paediatric Nephrology (GPN). Council member of the International Pediatric Transplant Association (IPTA); 2015 - 2017 President of IPTA. Since 2018 Editor-in-Chief of the journal “Pediatric Transplantation”, the official journal of IPTA.

Abstract

Unraveling interindividual differences and functional consequences of gut microbial metabolism of immunosuppressants

Maral Baghai Arassi1,2, Burkhard Tönshoff1, Nicolai Karcher2, Eleonora Mastrorilli2, Matthias Gross2, Amber Brauer-Nikonow2, Raymund Hackett3, David Czock4, Georg Zeller1,3.

1Medical Faculty, Department of Pediatrics I, Heidelberg University, Heidelberg, Germany; 2Molecular Systems Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany; 3Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, Germany; 4Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany

A major challenge in kidney transplantation (KT) is the large interpatient variability in the pharmacokinetics of immunosuppressive drugs. Here, we explored the role of the gut microbiome in interindividual variation in immunosuppressive drug metabolism. Analysis of 38 fecal communities, including 10 from KT recipients, and 45 bacterial species against 25 drugs, revealed significant interindividual and drug-specific differences in metabolism. Notably, 15 of 16 immunosuppressants tested were metabolized by at least one microbial community, and we found specific bacterial species, such as Bacteroides uniformis, to be potent metabolizers. We identified 18 different metabolites for 16 drugs, including two previously undescribed metabolites for sirolimus and everolimus. Our study reveals the functional impact of microbial metabolism on key immunosuppressants, including inactivation of tacrolimus, activation and potential increase in toxicity of mycophenolate mofetil (MMF), and shows that the microbial metabolite of methylprednisolone exhibits a 2.6-fold increase in epithelial permeability compared to the parent drug. Through a gain-of-function genetic screen we identified the B. uniformis enzyme BACUNI_RS05305 to be responsible for MMF activation. Using machine learning to model microbial community drug metabolism, abundance features of prevalent species predicted the biotransformation of some drugs well, while for others, a priori experimental information on bacterial genes and enzyme protein structures led to improved predictions. Our research highlights the potential of gut microbiome features to explain interindividual variability in  immunosuppressive therapies and sets the stage for clinical trials to identify microbiome-encoded signatures predictive of drug metabolism in KT patients.

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