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Peer-reviewedCC BY 4.0Nutrients

Berberine as a Mitochondrial Metabolic Reprogrammer in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Adaptive Energetic Stress, Quality Control, and Translational Limitations

  • Hossein Rafiei1
  • Kosar Omidian2
  • Miguel Tolentino1
  • Ali Jafari3
  • Hossein Bahari4
  • Mousa Khalafi5
5 affiliations
  1. 1Department of Nutrition and Dietetics, Saint Louis University, Saint Louis, MO 63104, USA
  2. 2College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
  3. 3Student Research Committee, Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran 1467864763, Iran
  4. 4Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9919191778, Iran
  5. 5Department of Sport Sciences, Faculty of Humanities, University of Kashan, Kashan 8731753153, Iran
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Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to mitochondrial dysfunction, including altered oxidative phosphorylation, disrupted fatty-acid oxidation, redox imbalance, abnormal mitochondrial dynamics, and impaired quality control. Berberine (BBR), a plant-derived isoquinoline alkaloid used as a nutraceutical, has been described both as a partial inhibitor of respiratory-chain complex I and as an intervention that improves mitochondrial function. This narrative review critically synthesizes evidence from hepatoma cells, primary hepatocytes, animal models, and human studies to reconcile these divergent effects. The preclinical literature supports a proposed, context-dependent model in which BBR imposes an energetic constraint during nutrient overload while activating AMP-activated protein kinase- and sirtuin-linked pathways that remodel substrate handling, respiration, redox balance, mitochondrial architecture, and autophagy. The strongest mechanistic evidence supports complex I-associated respiratory remodeling, SIRT3-mediated deacetylation of long-chain acyl-CoA dehydrogenase, SIRT1-mediated stabilization of carnitine palmitoyltransferase 1A, and SIRT1-dependent autophagy. Evidence for consistent mitochondrial biogenesis, selective mitophagy, mitochondria–endoplasmic reticulum contact-site remodeling, mitochondrial DNA danger signaling, and ferroptosis regulation in MASLD remains limited. Human evidence is mixed: a recent placebo-controlled trial found no significant reduction in liver fat with pure BBR, and no included trial directly measured hepatic mitochondrial function or established a mitochondria-mediated clinical effect. Therefore, BBR is best viewed as a context-dependent modulator of hepatic mitochondrial metabolism rather than a uniform mitochondrial enhancer. Pure BBR should not be conflated with whole barberry fruit, uncharacterized botanical preparations, or berberine ursodeoxycholate (HTD1801). Translation requires characterized formulations, exposure-matched models, and direct mitochondria-focused endpoints.

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Cite

BibTeXRIS
BibTeX
@article{rafiei2026berberine,
  title = {{Berberine as a Mitochondrial Metabolic Reprogrammer in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Adaptive Energetic Stress, Quality Control, and Translational Limitations}},
  author = {Hossein Rafiei and Kosar Omidian and Miguel Tolentino and Ali Jafari and Hossein Bahari and Mousa Khalafi},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18203366},
  url = {https://www.mdpi.com/2072-6643/18/20/3366},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Berberine as a Mitochondrial Metabolic Reprogrammer in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Adaptive Energetic Stress, Quality Control, and Translational Limitations
AU  - Hossein Rafiei
AU  - Kosar Omidian
AU  - Miguel Tolentino
AU  - Ali Jafari
AU  - Hossein Bahari
AU  - Mousa Khalafi
PY  - 2026
DA  - 2026/10/14
JO  - Nutrients
DO  - 10.3390/nu18203366
UR  - https://www.mdpi.com/2072-6643/18/20/3366
AB  - Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to mitochondrial dysfunction, including altered oxidative phosphorylation, disrupted fatty-acid oxidation, redox imbalance, abnormal mitochondrial dynamics, and impaired quality control. Berberine (BBR), a plant-derived isoquinoline alkaloid used as a nutraceutical, has been described both as a partial inhibitor of respiratory-chain complex I and as an intervention that improves mitochondrial function. This narrative review critically synthesizes evidence from hepatoma cells, primary hepatocytes, animal models, and human studies to reconcile these divergent effects. The preclinical literature supports a proposed, context-dependent model in which BBR imposes an energetic constraint during nutrient overload while activating AMP-activated protein kinase- and sirtuin-linked pathways that remodel substrate handling, respiration, redox balance, mitochondrial architecture, and autophagy. The strongest mechanistic evidence supports complex I-associated respiratory remodeling, SIRT3-mediated deacetylation of long-chain acyl-CoA dehydrogenase, SIRT1-mediated stabilization of carnitine palmitoyltransferase 1A, and SIRT1-dependent autophagy. Evidence for consistent mitochondrial biogenesis, selective mitophagy, mitochondria–endoplasmic reticulum contact-site remodeling, mitochondrial DNA danger signaling, and ferroptosis regulation in MASLD remains limited. Human evidence is mixed: a recent placebo-controlled trial found no significant reduction in liver fat with pure BBR, and no included trial directly measured hepatic mitochondrial function or established a mitochondria-mediated clinical effect. Therefore, BBR is best viewed as a context-dependent modulator of hepatic mitochondrial metabolism rather than a uniform mitochondrial enhancer. Pure BBR should not be conflated with whole barberry fruit, uncharacterized botanical preparations, or berberine ursodeoxycholate (HTD1801). Translation requires characterized formulations, exposure-matched models, and direct mitochondria-focused endpoints.
SN  - 2072-6643
ER  -