Unlocking the Healing Power of Berberine: A Promising Aid for Multiple Sclerosis

Multiple sclerosis (MS) is a debilitating autoimmune disorder characterized by inflammatory demyelination and progressive neurodegeneration within the central nervous system (CNS). Despite advances in disease-modifying therapies (DMTs), current treatments primarily mitigate relapses and slow disease progression but fall short in comprehensively addressing cumulative disability or neurodegeneration. Berberine (BBR), a naturally occurring isoquinoline alkaloid, has emerged as a promising therapeutic candidate due to its potent immunomodulatory, anti-inflammatory, and neuroprotective properties. In this narrative review, we synthesize the molecular mechanisms underpinning BBR's effects on MS pathology and evaluate preclinical evidence from MS-relevant animal models. Studies in experimental autoimmune encephalomyelitis (EAE) —the primary MS model—and the cuprizone (CPZ) -induced demyelination model demonstrate that BBR (typically 5–300mg/kg in preclinical protocols) reduces pro-inflammatory cytokines, modulates immune responses, and promotes remyelination—processes critical for counteracting MS-associated neurodegeneration. BBR modulates key signaling pathways, including JAK/STAT and SPHK1/S1P, which are pivotal in attenuating immune-mediated damage and preserving blood-brain barrier (BBB) integrity. Despite its therapeutic potential, challenges such as poor bioavailability and suboptimal pharmacokinetics have spurred investigations into advanced delivery systems. Nanoformulations, particularly BBR-loaded iron oxide nanoparticles (BBR-IONP), have shown superior efficacy in preclinical models by enhancing CNS delivery and improving remyelination outcomes. By highlighting BBR's multifaceted bioactivities, this review underscores its promise as a complementary or alternative approach to address unmet needs in MS management, while acknowledging the critical need for clinical trials to validate these preclinical findings.