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Evidence-Based Complementary and Alternative Medicine
Volume 2018, Article ID 3412074, 9 pages
Review Article

Overcoming P-Glycoprotein-Mediated Multidrug Resistance in Colorectal Cancer: Potential Reversal Agents among Herbal Medicines

1Department of Clinical Oncology, Cheonan Korean Medicine Hospital of Daejeon University, 4, Notaesan-ro, Seobuk-gu, Cheonan-si, No. 31099, Republic of Korea
2Liver and Immunology Research Center, Dunsan Korean Medicine Hospital of Daejeon University, 75, Daedeok-daero 176beon-gil, Seo-gu, Daejeon-si, No. 35235, Republic of Korea
3Department of Internal Medicine, Graduated School of Korean Medicine, University of Daejeon, 62, Daehak-ro, Dong-gu, Daejeon-si, No. 34520, Republic of Korea

Correspondence should be addressed to Namhun Lee; rk.ujd@eelhn

Received 17 April 2018; Revised 24 July 2018; Accepted 2 August 2018; Published 12 August 2018

Academic Editor: María C. Carpinella

Copyright © 2018 Gayoung Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. Multidrug resistance (MDR) is the major reason for the failure of chemotherapy in colorectal cancer (CRC), and the primary determinant of MDR in CRC patients is active drug efflux owing to overexpression of P-glycoprotein (P-gp) in cancer tissues. Despite research efforts to overcome P-gp-mediated drug efflux, the high toxicity of P-gp inhibitors has been a major obstacle for the clinical use of these agents. The aim of this study was to review the literature for potential P-gp reversal agents among traditional herbal medicines, which offer the advantages of safety and potential synergetic effects in CRC chemotherapy. Methods. We searched ten databases including 3 English databases, 1 Chinese medical database, and 6 Korean medical databases up to July 2018 and included in vivo and in vitro studies evaluating the effects of herbal medicines as P-gp reversal agents in CRC. Results. A total of 28 potentially related studies were identified and 16 articles were included. Involving 3 studies about Salvia miltiorrhiza and 2 studies about Curcuma longa, finally we found 14 kinds of traditional herbal medicines—Salvia miltiorrhiza, Curcuma longa, Sinomenium acutum, Stephania tetrandra, Bufo gargarizans, Coptis japonica, Piper nigrum and Piper longum, Hedyotis diffusa, Schisandra chinensis, Glycyrrhiza glabra, Glycyrrhiza inflate, Daphne genkwa, Stemona tuberosa Lour, and Andrographis paniculata—as showing efficacy as P-gp inhibitors in anticancer drug-resistant CRC cells in vitro and in vivo. Conclusions. This brief account provides insight into the relationship between P-gp and CRC. Further studies on herbal medicines with demonstrated effects against P-gp overexpression will aid in improving the efficacy of chemotherapy in CRC.