Fluorouracil (5-FU) is a fluoropyrimidine and uracil analogue commonly used in the treatment of colorectal cancer. 5-FU exerts cytotoxicity by inhibiting nucleotide synthesis and by misincoorporating into RNA and DNA, leading to cancer cell damage and death1. Despite the widespread use of this drug, new approaches are needed to boost efficacy and decrease toxicity. Furthermore, 5-FU treatment outcome is variable between patients and cannot be completely explained by genetic factors, suggesting that environmental factors could contribute to its efficacy. The gut microbiota is defined as the collective community of microbes that reside a host gastrointestinal tract, and have recently been linked to other elements of host fitness, such as immunity2 and metabolism3. However, not much is known about the interplay between drug, gut microbes and the host. To unravel the mechanism by which the microbiota is affecting the metabolism of 5-FU, we used the nematode C. elegans as a host model and microbe E. coli as a gut microbe model. Via high-throughput screens and metabolomic approaches we found that microbes can affect drug conversion and efficacy in the host. We discovered this effect to be influenced by bacterial metabolism and synthesis of ribonucleotides and vitamins B9 and B6. Additionally, we find deoxynucleotide pools imbalances in bacteria increased autophagy and cell death on host cells upon 5-FU treatment. Interestingly, this effect was found to be dependent and regulated by the host gene nucleoside diphosphate kinase
ndk-1. In summary, our data suggests bacteria can contribute to drug efficacy on host metabolism through two distinct but complementary processes4. These findings emphasize the importance of the gut microbiome in the co-metabolism of host-targeted drugs. Moreover, this study reveals the potential therapeutic power of manipulating gut microbial communities to help treat disease and improve treatment outcomes. References: 1. Longley, D.B., et al. Nat. Rev. Cancer (2003) 2. Nicholson, J.K., et al. Science (2012) 3. Cabreiro, F., et al. Cell (2013) 4. Scott, A.T., Quintaneiro, L. M., et al. Cell (in press)