Nutraceuticals in colorectal cancer: A mechanistic approach.

Colorectal cancer (CRC) is one of the most diagnosed cancers in the world. Even though screening, surgery and oncology have greatly advanced, CRC is still one of the leading causes of cancer deaths, with 700,000 annual mortalities in both men and women. Environmental and lifestyle factors brought up by industrialization, such as an altered diet, lack of physical activity, increase in alcohol consumption, and circadian disruption, have greatly affected the burden of CRC. These factors increase the CRC risk, at least partly, by pathologically altering the colonic environment, including composition of the gut microbiota, referred to as dysbiosis. Colonic dysbiosis can promote pro-carcinogenic immune signaling cascades, leading to pro-tumorigenic inflammation, carcinogen production, and altered cellular responses in susceptible host resulting to development and/or progression of CRC. Nutraceuticals such as prebiotic molecules and probiotic bacterial species can help maintain intestinal microbial homeostasis and thus mitigate this pathological processes. Therefore, prebiotics and probiotics can hinder the effects of dysbiosis by encouraging anti-carcinogenic, anti-inflammatory immunity, the maintenance of the intestinal epithelial barrier, pro-apoptotic mechanisms, and carcinogen inactivation. In addition to its implications in preventing CRC, because of the mechanisms affected, nutraceuticals are being discovered as potential adjuncts to immune checkpoint inhibitors in the treatment of CRC. In this review, we provide an overview of the potential implications of prebiotics and probiotics in the prevention and treatment of CRC.