PHARMACEUTICAL COMPOSITIONS OF A BILE ACID DERIVATIVE AND MICROBIOME AND USES THEREOF

1 . A pharmaceutical composition comprising a compound of formula I:

or a pharmaceutically acceptable salt or amino acid conjugate thereof, wherein:

R 1 is unsubstituted C 1 -C 6 alkyl;

R 2 is H or hydroxyl;

R 3 is H or hydroxyl;

R 4 , R 5 , R 6 , and R 7 are each independently H or hydroxyl;

R 8 is H or unsubstituted C 1 -C 6 alkyl;

X is C(O)OH, C(O)NH(CH 2 ) m SO 3 H, C(O)NH(CH 2 ) n CO 2 H, or OSO 3 H;

m is 1, 2, or 3; and

n is 1, 2, or 3,

and one or more gut microbiome species, and a pharmaceutically acceptable carrier.

2 - 17 . (canceled)

18 . The pharmaceutical composition of claim 1 , wherein the compound is of formula Ib-1 or Ib-2 or Ic:

or a pharmaceutically acceptable salt or amino acid conjugate thereof.

19 . (canceled)

20 . The pharmaceutical composition of claim 1 , wherein the compound is:

or a pharmaceutically acceptable salt or amino acid conjugate thereof.

21 . The pharmaceutical composition of claim 1 , wherein the compound is:

or a pharmaceutically acceptable salt or amino acid conjugate thereof.

22 . The pharmaceutical composition of claim 1 , wherein the compound is:

or a pharmaceutically acceptable salt or amino acid conjugate thereof.

23 . The pharmaceutical composition of claim 1 , wherein the compound is:

or a pharmaceutically acceptable salt or amino acid conjugate thereof.

24 . The pharmaceutical composition of claim 1 , wherein the one or more gut microbiome species is a member in a family selected from: Actinomycetaceae, Bogoriellaceae, Brevibacteriaceae, Cellulomonadaceae, Acholeplasmataceae, Acidithiobacillaceae, Alcanivoracaceae, Alteromonadaceae, Blattabacteriaceae, Cardiobacteriaceae, Chlamydiaceae, Chromatiaceae, Clostridiales Family XIII. Incertae Sedis, Cyclobacteriaceae, Dehalococcoidaceae, Desulfobacteraceae, Desulfobulbaceae, Ectothiorhodospiraceae, Elusimicrobiaceae, Entomoplasmataceae, Erythrobacteraceae, Gallionellaceae, Halanaerobiaceae, Jonesiaceae, Kofleriaceae, Leptospiraceae, Methanobacteriaceae, Methylococcaceae, Methylophilaceae, Myxococcaceae, Nitrosomonadaceae, Nitrospiraceae, Oceanospirillaceae, Oscillospiraceae, Piscirickettsiaceae, Propionibacteriaceae, Pseudoalteromonadaceae, Puniceicoccaceae, Rickettsiaceae, Rubrobacteraceae, Shewanellaceae, Spirochaetaceae, Spiroplasmataceae, Sutterellaceae, Syntrophomonadaceae, Thermaceae, Corynebacteriaceae, Dermabacteraceae, Dietziaceae, Geodermatophilaceae, Gordoniaceae, Intrasporangiaceae, Microbacteriaceae, Micrococcaceae, Micromonosporaceae, Mycobacteriaceae, Nocardiaceae, Promicromonosporaceae, Propionibacterineae, Streptomycetaceae, Micrococcineae, Bifidobacteriaceae, Coriobacteriaceae, Deinococcaceae, Halobacteroidaceae, Alicyclobacillaceae, Bacillaceae, Bacillales Incertae Sedis XI, Listeriaceae, Paenibacillaceae, Planococcaceae, Staphylococcaceae, Aerococcaceae, Carnobacteriaceae, Enterococcaceae, Lactobacillaceae, Leuconostocaceae, Streptococcaceae, Christensenellaceae, Clostridiaceae, Ruminococcaceae, Family XIII Incertae Sedis, Peptostreptococcaceae, Family XI Incertae Sedis, Lachnospiraceae, Eubacteriaceae, Erysipelotrichaceae, Erysipelotrichaceae XVI, Erysipelotrichaceae XVII, Erysipelotrichaceae XVIII, Acidiaminococcaceae, Peptococcaceae, Veillonellaceae, Bacteroidaceae, Porphyromonadaceae, Prevotellaceae, Rikenellaceae, Cytophagaceae, Flavobacteriaceae, Chitinophagaceae, Sphingobacteriaceae, Fusobacteriaceae, Leptotrichiaceae, Victivallaceae, Planctomycetaceae, Caulobacteraceae, Aurantimonadaceae, Bradyrhizobiaceae, Brucellaceae, Hyphomicrobiaceae, Methylobacteriaceae, Phyllobacteriaceae, Rhizobiaceae, Xanthobacteraceae, Rhodobacteraceae, Acetobacteraceae, Rhodospirillaceae, Sphingomonadaceae, Alcaligenaceae, Burkholderiaceae, Comamonadaceae, Oxalobacteraceae, Suterellaceae, Neisseriaceae, Rhodocyclaceae, Desulfovibrionaceae, Campylobacteraceae, Helicobacteraceae, Aeromonadaceae, Succinivibrionaceae, Enterobacteriaceae, Pasteurellaceae, Moraxellaceae, Pseudomonadaceae, Vibrionaceae, Sinobacteraceae, Xanthomonadaceae, Brachyspiraceae, Synergistaceae, Mycoplasmataceae, and Verrucomicrobiaceae.

25 . The pharmaceutical composition of claim 24 , wherein the one or more gut microbiome species is gram positive.

26 . The pharmaceutical composition of claim 25 , wherein the one or more gut microbiome species is selected from Bifidobacterium breve, Bifidobacterium longum, Lactobacillus casei, Lactobacillus paracasei, Pediococcus pentosaceus, Lactococcus lactis, Streptococcus parasanguinis, Streptococcus salivarius, Streptococcus thermophilus, Ruminococcus bromii, Ruminococcus torques, Anaerotruncus unclassified, Subdoligranulum unclassified, Clostridium difficile, Blautia ( Ruminococcus ) obeum, Dorea longicatena, Eubacterium ramulus, Ruminococcus gnavus , Ruminococcus torques, Lachnospiracea bacterium 5_1_63FAA, Lachnospiraceae bacterium 3_1_57FAA_CT1, and Lachnospiraceae bacterium 8_1_57FAA, Coprobacillus unclassified, Clostridium spiroforme, Clostridium symbiosum, Veillonella parvula , and Veillonella unclassified.

27 . The pharmaceutical composition of claim 24 , wherein the one or more gut microbiome species is gram negative.

28 . The pharmaceutical composition of claim 27 , wherein the one or more gut microbiome species is selected from Bacteroides ovatus, Bacteroides plebeius, Bacteroides uniformis , Bacteroidales ph8 , Odoribacter splanchnicus, Paraprevotella clara, Paraprevotella unclassified, Alistipes putredinis, Alistipes shahii, Escherichia coli , and Akkermansia muciniphila.

29 . The pharmaceutical composition of claim 1 , wherein the one or more gut microbiome species is sensitive to growth inhibition by an endogenous bile acid.

30 . The pharmaceutical composition of claim 1 , wherein the one or more gut microbiome species is a human gut microbiome species.

31 . The pharmaceutical composition of claim 1 , wherein the compound or a pharmaceutically acceptable amino acid conjugate or salt thereof is present in the amount of 5-25 mg in the pharmaceutical composition.

32 . The pharmaceutical composition of claim 1 , wherein the pharmaceutical composition comprises the one or more gut microbiome species in the amount of 100-10 12 colony forming unit.

33 . The pharmaceutical composition of claim 1 , wherein the compound or a pharmaceutically acceptable amino acid conjugate or salt thereof is formulated for oral, parenteral, or topical administration.

34 . The pharmaceutical composition of claim 33 , wherein the compound or a pharmaceutically acceptable amino acid conjugate or salt thereof is formulated for oral administration.

35 . The pharmaceutical composition of claim 1 , wherein the one or more gut microbiome species is formulated for oral administration.

36 . A method of treating or preventing an FXR mediated disease or condition or a disease or condition in which an abnormal composition of the gut microbiome is involved, comprising administering to a subject in need thereof a pharmaceutical composition of claim 1 .

37 - 39 . (canceled)

40 . A method of enhancing the efficacy of an FXR ligand in treating or preventing a disease or condition, comprising administering to a subject in need thereof one or more gut microbiome species.

41 - 43 . (canceled)