Berberine Shows Promise for Chemoprevention After Polypectomy

By Reuters Staff

January 22, 2020

NEW YORK (Reuters Health) - The natural supplement berberine significantly reduced the recurrence rate of colorectal adenoma and all polypoid lesions in a study conducted in China.

Berberine is an alkaloid herb that has been used for centuries in China for a variety of ailments including diarrhea and enteritis. Animal studies have suggested berberine has antitumor activity, with one study finding it could prevent tumorigenesis of colorectal cancer in mice by changing the structure of the microbiota.

Dr. Ying-Xuan Chen from Shanghai Institute of Digestive Disease and colleagues did a multicenter, randomized, double-blind, placebo-controlled trial of berberine (0.3 grams twice daily) for prevention of recurrent colorectal adenoma following adenomatous polypectomy.

During the two-year follow-up period, 155 of 429 (36%) people in the berberine group and 216 of 462 (47%) in the placebo group were found to have a recurrent adenoma or any polypoid lesions (unadjusted relative risk ratio for recurrence 0.77 for both). No colorectal cancers were found during follow-up.

No serious adverse events were reported. The most common adverse event was constipation, reported by 1% of patients in the berberine group.

The results suggest that berberine "could be an option for chemoprevention after polypectomy," the researchers said in The Lancet Gastroenterology & Hepatology.

The results are "exciting," write the authors of a Comment published with the study.

"This well-designed trial is the first evidence of a causal relationship for berberine and colorectal neoplasia in human beings, validating the significant body of experimental data and offering compelling proof-of-principle of the potential value of repurposing a natural product for chemoprevention," note Dr. Sohee Kwon and Dr. Andrew Chan from Massachusetts General Hospital and Harvard Medical School in Boston.

However, based on a number of study limitations, it's too early to recommend the use of berberine for colorectal cancer prevention, they caution.

"However, the promising results of Chen and colleagues warrant follow-up through additional, larger randomized trials, including in non-Asian populations. Studies that consider approaches using berberine and combined with other agents with established efficacy and complementary modes of action, such as aspirin, are also of keen interest. Ideally, these trials should be done with concurrent collection of biospecimens that can be leveraged to characterize the molecular mechanisms most relevant to berberine's effects in human beings. Taken together, such studies may open a new frontier for chemoprevention by charting an exciting new future for an agent with an ancient past," Drs. Kwon and Chan conclude.

The study was funded by the National Natural Science Foundation of China. The authors have declared no relevant conflicts of interest.

SOURCE: and Lancet Gastroenterology & Hepatology, online January 8, 2020.