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

Gut Microbes. 2022 Jan-Dec;14(1):2003176. doi: 10.1080/19490976.2021.2003176.

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.

Keywords: Type 2 diabetes; berberine; dyslipidemia; gut microbiome; postprandial lipidemia; probiotics.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Berberine / administration & dosage*
  • Cholesterol / blood
  • Cholesterol, LDL / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / microbiology
  • Double-Blind Method
  • Drug Therapy, Combination
  • Feces / microbiology
  • Female
  • Gastrointestinal Microbiome / drug effects
  • Humans
  • Hyperlipidemias / blood
  • Hyperlipidemias / drug therapy*
  • Hyperlipidemias / microbiology
  • Male
  • Middle Aged
  • Postprandial Period / drug effects
  • Probiotics / administration & dosage*

Substances

  • Cholesterol, LDL
  • Berberine
  • Cholesterol

Grants and funding

This study was funded by grants from the National Key R&D Program of China (2016YFC0901200); Fund of the Prevention and Control of Major Chronic Noncommunicable Diseases Research of China (2018YFC1313804); the Program for Shanghai Outstanding Medical Academic Leader (2019LJ07); the National Nature Science Foundation of China (91857205, 81870555); and the Fund of the Shenzhen Municipal Government of China (No. JCYJ20170817145809215).