Rosmarinic acid as a chemosensitizer in colorectal cancer: Targeting nuclear factor-kappa B pathway to overcome chemoresistance.

Abstract

Colorectal cancer (CRC) is the third most common malignancy. However, the efficacy of current treatment strategies remains limited. In recent years, monomeric compounds from traditional Chinese medicine have received extensive attention in cancer therapy. Rosmarinic acid (RA), a natural phenolic acid, has multiple biological activities and exhibits anti-oncogenic effects in several cancers. Liu et al previously uncovered that RA could serve as a dual-action therapeutic agent in CRC. By suppressing nuclear factor-kappa B signaling via direct inhibition of inhibitory kappa B kinase beta, RA not only impedes tumor progression but also synergizes with first-line chemotherapeutics (5-fluorouracil/oxaliplatin) to reverse drug resistance. The authors demonstrate RA's capacity to downregulate nuclear factor-kappa B-driven oncogenes and enhance chemotherapeutic cytotoxicity in vitro through integrative approaches, including molecular docking, luciferase assays, and functional validation. While these findings position RA as a cost-effective adjuvant in precision oncology, critical clinical translational gaps remain, including optimizing RA's in vivo bioavailability, validating systemic safety in combinatorial regimens, and elucidating its immunomodulatory effects within the tumor microenvironment. This underscores the urgency of bridging phytochemistry and clinical oncology, advocating for biomarker-driven animal studies and phase I trials to translate RA's potential into actionable CRC therapies. By addressing these hurdles, RA could emerge as a paradigm-shifting agent, harmonizing natural product efficacy with modern therapeutic precision.