Combined berberine and probiotic treatment as an effective regimen for improving postprandial hyperlipidemia in type 2 diabetes patients: a double blinded placebo controlled randomized study

Abstract

Non-fasting lipidemia (nFL), mainly contributed by postprandial lipidemia (PL), has recently been recognized as an important cardiovascular disease (CVD) risk as fasting lipidemia (FL). PL serves as a common feature of dyslipidemia in Type 2 Diabetes (T2D), albeit effective therapies targeting on PL were limited. In this study, we aimed to evaluate whether the therapy combining probiotics (Prob) and berberine (BBR), a proven antidiabetic and hypolipidemic regimen via altering gut microbiome, could effectively reduce PL in T2D and to explore the underlying mechanism. Blood PL (120 min after taking 100 g standard carbohydrate meal) was examined in 365 participants with T2D from the Probiotics and BBR on the Efficacy and Change of Gut Microbiota in Patients with Newly Diagnosed Type 2 Diabetes (PREMOTE study), a random, placebo-controlled, and multicenter clinical trial. Prob+BBR was superior to BBR or Prob alone in improving postprandial total cholesterol (pTC) and low-density lipoprotein cholesterol (pLDLc) levels with decrement of multiple species of postprandial lipidomic metabolites after 3 months follow-up. This effect was linked to the changes of fecal Bifidobacterium breve level responding to BBR alone or Prob+BBR treatment. Four fadD genes encoding long-chain acyl-CoA synthetase were identified in the genome of this B. breve strain, and transcriptionally activated by BBR. In vitro BBR treatment further decreased the concentration of FFA in the culture medium of B. breve compared to vehicle. Thus, the activation of fadD by BBR could enhance FFA import and mobilization in B. breve and diliminish the intraluminal lipids for absorption to mediate the effect of Prob+BBR on PL. Our study confirmed that BBR and Prob ( B. breve ) could exert a synergistic hypolipidemic effect on PL, acting as a gut lipid sink to achieve better lipidemia and CVD risk control in T2D.

Effects of Berberine Plus Inulin on Diabetes Care in Patients With Latent Autoimmune Diabetes in Adults: Protocol for a Randomized Controlled Trial

“…The hypoglycemic effect of this traditional Chinese medicine may be partly attributed to one of its main components, BBR. Clinical studies have demonstrated that BBR not only exerts a hypoglycemic effect by regulating the structure and function of the human gut microbiota, but also improves fasting and postprandial lipidemia in T2D patients to achieve better cardiovascular risk control ( 30 , 31 ). Animal experiments have also shown that BBR has important potential in the treatment of diabetes-related complications such as diabetic nephropathy ( 32 , 33 ), diabetic retinopathy ( 34 , 35 ), diabetic cardiomyopathy ( 36 ), diabetic encephalopathy ( 37 ) and diabetic neuropathy ( 38 ) by inhibiting inflammation and oxidative stress, anti-endothelial injury, regulating glucose and lipid metabolism, inhibiting microvascular proliferation and regulating autophagy.…”

Traditional Chinese medicine in thyroid-associated orbitopathy

“…Berberine, an isoquinoline alkaloid extracted from the Chinese herb Coptidis rhizoma (Huanglian), demonstrated multiple biological functions, including anti-inflammatory and anti-bacterial effects, alleviation of liver fibrosis, inhibition of carcinogenesis, cardiometabolic protection, as well as neuroprotection [89][90][91][92].…”

Alterações da microbiota intestinal em portadores de Diabetes mellitus tipo 2, impactos conhecidos e perspectivas futuras

“…Além disso, 02 (dois) estudos com Berberina foram avaliados na presente revisão (Wang et al 2021 Foi analisado 01 (um) artigo que avaliou a eficácia das fibras dietéticas no manejo da sintomatologia da DM2 (ZHAO et al 2018), que demonstrou que houve redução significativa de hemoglobina glicada, glicose em jejum e HOMA-IR. O impacto do exercício físico na microbiota foi avaliado em 01 (um) artigo (Motiani et al 2019) mostrando aumento de Butirato, redução de hemoglobina glicada e glicose em jejum, não sendo avaliado índice HOMA nesse estudo.…”