endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2025-6-3-06endofocus-181Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWМодификация микробиома кишечника на фоне применения метформина и других сахароснижающих препаратовModification of the gut microbiome in response to metformin and other antidiabetic drugshttps://orcid.org/0000-0002-3656-0312ЛобановаК. Г.LobanovaK. G.

Лобанова Кристина Геннадьевна – к.м.н., ассистент кафедры эндокринологии ИКМ 

г. Москва

Kristina G. Lobanova – C. Sci. (Med.), assistant at the Department of Endocrinology, Institute of Clinical Medicine

Moscow

miss.sapog@mail.ruhttps://orcid.org/0000-0002-6826-5924ТепловаА. С.TeplovaA. S.

Теплова Анна Сергеевна – ассистент кафедры эндокринологии ИКМ

г. Москва

Anna S. Teplova – Assistant of the Department of Endocrinology of the Medical Faculty Pirogov

Moscow

anna_kochina_@mail.ruhttps://orcid.org/0000-0002-8684-6095ТитоваВ. B.TitovaV. V.

Титова Виктория Викторовна – ассистент кафедры эндокринологии ИКМ

г. Москва

Victoria  V.  Titova  –  assistant  of  the  department  of  endocrinology  medical  faculty

Moscow

 

meteora-vica@mail.ruФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России (Пироговский университет)Pirogov Russian National Research Medical University202513112025638695Copyright © Лобанова К.Г., Теплова А.С., Титова В.B., 20252025Лобанова К.Г., Теплова А.С., Титова В.B.Lobanova K.G., Teplova A.S., Titova V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/181

В настоящее время отмечается стремительный рост изучения взаимосвязи кишечной микробиоты (КМ) с фармакокинетикой и фармакодинамикой лекарственных средств, в том числе сахароснижающих препаратов (ССП). В обзоре описываются возможные механизмы, посредством которых КМ может влиять на эффективность и безопасность различных ССП, описываются бактерии кишечника, влияющие на их фармакокинетику. Несмотря на то что данные о взаимосвязи КМ с эффективностью и развитием побочных эффектов ССП резко ограничены, на примере метформина установлено, что присутствие в КМ высокого количества продуцентов короткоцепочечных жирных кислот (КЦЖК) и родов бактерий, ассоциированных с метаболизмом желчных кислот (ЖК), ассоциировано с высокой эффективностью препарата и развитием побочных эффектов. Это обусловлено тем, что КЦЖК и первичные ЖК являются триггерами секреции глюкагоноподобного пептида-1, который, с одной стороны, способствует улучшению показателей гликемии через инкретиновый эффект и регуляцию работы механизма «кишечник – мозг – периферия», а с другой определяет развитие дискомфорта со стороны желудочно-кишечного тракта. Приведенные в статье данные позволяют предположить, что развитие побочных эффектов метформина на фоне высоких концентраций КЦЖК и первичных ЖК в просвете кишечника является некой «платой» за более выраженный гипогликемический эффект метформина. Тем не менее выявленная авторами закономерность требует последующих научных доказательств.

Currently, there is a rapid increase in the study of the relationship of the gut microbiota (GM) with the pharmacokinetics and pharmacodynamics of drugs, including hypoglycemic ones. The review describes possible mechanisms by which GM can influence the efficacy and safety of various hypoglycemic drugs (HDs). Moreover, intestinal bacteria affecting the pharmacokinetics of HDs are described. Despite the fact that data on the relationship of GM with the effectiveness and development of side effects of HDs are sharply limited, using the example of metformin, it was determined that the presence in GM of a high number of Short-chain fatty acids (SCFAs) producers and genera associated with bile acid metabolism is associated with high drug efficacy and the development of side effects. The fact is that SCFAs and primary bile acids are triggers for the secretion of glucagon-like peptide-1, which, on the one hand, contributes to the improvement of glycemic indices through the incretin effect and the operation of the “intestine – brain – perif” mechanism.

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The authors declare that there are no conflicts of interest present.