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The promise of the gut microbiome as part of individualized treatment strategies
Open accessAbstract
Variability in disease presentation, progression and treatment response has been a central challenge in medicine. Although variability in host factors and genetics are important, it has become evident that the gut microbiome, with its vast genetic and metabolic diversity, must be considered in moving towards individualized treatment. In this Review, we discuss six broad disease groups: infectious disease, cancer, metabolic disease, cardiovascular disease, autoimmune or inflammatory disease, and allergic and atopic diseases. We highlight current knowledge on the gut microbiome in disease pathogenesis and prognosis, efficacy, and treatment-related adverse events and its promise for stratifying existing treatments and as a source of novel therapies. The Review is not meant to be comprehensive for each disease state but rather highlights the potential implications of the microbiome as a tool to individualize treatment strategies in clinical practice. Although early, the outlook is optimistic but challenges need to be overcome before clinical implementation, including improved understanding of underlying mechanisms, longitudinal studies with multiple data layers reflecting gut microbiome and host response, standardized approaches to testing and reporting, and validation in larger cohorts. Given progress in the microbiome field with concurrent basic and clinical studies, the microbiome will likely become an integral part of clinical care within the next decade.
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“Clinical outcomes vary widely because host genetics, baseline microbiota, diet, medications, and comorbidities modulate response and susceptibility, which explains the heterogeneous results across studies [15,114,115].”
From Current Concepts in Probiotic Safety and Efficacy (2026) · cites this paper as [115]
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TAGINE: fast taxonomy-based feature engineering for microbiome analysis
Baum, S., Meshulam, I., Algavi, Y. M., Peleg, O., & Borenstein, E. (2026) · Bioinformatics Advances · doi:10.1093/bioadv/vbag056
Personalized medicine in gastroenterology
Khan, H. R., Junaid, K., Muhammad, N., Tariq, A., Slahuddin, M., & Yasmeen, H. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-40483-2.00035-2
Joshi, R., Dwivedi, J., Singh, S., Paliwal, S., Sharma, S., Mishra, A., & Singh, S. (2026) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-026-02357-0
Luo, J., Feng, Y., Chen, J., Xu, N., Zhang, G., Ni, J., & Li, C. (2026) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2026.1799729
Günalan, E., Tartıcı, G., Aladağ, E., & Çonak, Ö. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101454
Gut Dysbiosis in Alzheimer’s Disease: Insights from the Microbiome
Kiran, N. S., Yashaswini, C., Chatterjee, A., & Prajapati, B. G. (2026) · Springer eBooks · doi:10.1007/978-981-95-7494-0_11
Robust Microbial Signature Discovery via Post-Selection Inference for Microbiome Compositions
Wang, W., Xu, X., Zhao, H., & Wang, T. (2026) · Journal of the American Statistical Association · doi:10.1080/01621459.2026.2671446
Wu, R., Teng, X., Cai, Y., Liu, Y., Zhang, W., Li, Z., & Fan, J. (2026) · Journal of Translational Medicine · doi:10.1186/s12967-026-08217-8
Huang, D., Gao, Y., Hao, K., Hu, C., Zhang, S., Gong, W., Qin, X., Du, G., Li, H., & Zhou, Y. (2026) · Journal of Pharmaceutical Analysis · doi:10.1016/j.jpha.2026.101674
Metadata
- Authors
- Schupack, D. A., Mars, R. A. T., Voelker, D. H., Abeykoon, J. P., & Kashyap, P. C.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Kashyap, Purna C.
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2021-08-27
- Volume
- 19
- Issue
- 1
- Pages
- 7-25
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- PMC
- PMC8712374
- OpenAlex
- W3195493570
- Cited by
- 217
- References
- 270
- Citations by year
- 2026: 50 · 2025: 60 · 2024: 47 · 2023: 37 · 2022: 20 · 2021: 3
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Nature Reviews Gastroenterology & Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114007)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Keywords
- gut microbiota, personalized treatment, precision medicine, microbiota-based therapy, treatment response variability, infectious diseases, cancer, metabolic disorders, cardiovascular disease, autoimmune disease, pathogenesis, treatment-related adverse events
- MeSH terms
- Gastrointestinal Microbiome, Gastrointestinal Diseases, Humans, Liver Diseases, Precision Medicine
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