Fragmented knowledge

Think of the well-known instruction not to drink alcohol in combination with antibiotics or pain relievers. "Ethanol is a well-studied toxin that can alter the effect of the active agent," says Warth. Bisphenol A (BPA) is another popular environmental toxin that practically everybody has accumulated in his or her body, although mostly in very low concentrations not considered to be critical for human health. BPA, a crucial component in the plastics production, has shown to interact with various anti-cancer therapeutics, which can result in drug resistance and reduced effectiveness.

Genistein, a phytoestrogen derived from soybeans and a prominent active agent in hormone drugs for menopausal symptoms, can also affect various drugs, in particular hormone-relevant chemotherapeutics against breast cancer, the researchers explain in their article. These interactions can have negative as well as positive effects.

"Among the tens of thousands to hundreds of thousands of molecules that humans are exposed to, countless could interact with therapeutics, especially under certain conditions or in critical phases of life such as pregnancy or adolescence," PhD student Manuel Pristner explains.

Exposome & health effects

"Today's high-resolution mass spectrometry enables us to measure a very large number of molecules in parallel. This way, we can systematically investigate the network of relationships between the so-called exposome, i.e. all measurable exposures, and certain active agents," says Warth. Furthermore, improved bio-informatic algorithms enable the researchers to analyse the generated big data sets.

To date, researchers have been specifically looking for the effect of a certain molecule on a specific receptor. "With the new technologies at hand, we can expand the approach and not only use a fishing rod, but a fishing net to implement a comprehensive screening strategy, which might lead to discoveries that we would not have been able to make based on rational hypothesis," say the chemists.

Personalised medicin

There are different reasons why certain active agents work well in one person and less or not at all in another, depending on an individual genome, the presence of certain receptors, the activity of enzymes or simply chemical reactivity.

An improved understanding of exposome-drug interactions could enable physicians to prescribe drugs and drug doses on an individual basis, increasing their effectiveness and minimising or even avoiding side effects. Individualised medication for a patient through a standardised pre-screening of his or her exposome "are still future dreams," according to Warth, "but the systematic approach could be ground-breaking and also benefit the early stages of drug development."

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Materials provided by University of Vienna. Note: Content may be edited for style and length.

Journal Reference:

1. Manuel Pristner, Benedikt Warth. Drug–Exposome Interactions: The Next Frontier in Precision Medicine. Trends in Pharmacological Sciences, 2020; 41 (12): 994 DOI: 10.1016/j.tips.2020.09.012