To investigate the efficacy and mechanism of sulinic acid combined with bifidobacterium triplex live bacteria(bifico)in the treatment of familial adenomatous polyposis(FAP).

FAP patients admitted to Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2013 to January 1, 2022 were collected.These FAP patients confirmed by gastroenteroscopy and histopathology were divided into 3 groups by random number table method: sulinic acid group, bifico group and sulinic acid combined with bifico group.The sulinic acid group received sulinic acid 400 mg/d orally for 1 year.Bifico group received bifico 6 capsules/d for 1 year.The sulinic acid combined with bifico group received 400 mg/d of sulinic acid and 6 capsules/d of bifico for 1 year.Colonoscopy was performed once every 4 months to observe the general situation, pathological type, size and number of adenoma in each group.16sRNA high-throughput sequencing was used to analyze the changes of intestinal flora.Western blotting was used to detect the expression of apoptosis suppressor protein Bcl-2.

A total of 90 patients were enrolled, 30 in each group.Pathological types of adenomas in sulinic acid combined with bifico group at 4, 8 and 12 months after treatment were as follows: tubular adenomas accounted for 90.5%, 94.4% and 99.2% of the total biopsy adenomas, respectively.Tubulovillous adenomas accounted for 9.5%, 5.6% and 0.8%; 85.3%, 90.4%, 95.2% in the sulinic acid group and 80.5%, 85.3%, 90.2% in the bifico group, respectively.Compared with the bifico group and sulinic acid group, there was a statistically significant difference(P<0.05).According to 16sRNA sequencing, the proportion of firmicutes and actinomycetes increased in sulinic acid combined with bifico group, while the proportion of bacteroidetes decreased.Western blotting showed that the expression of Bcl-2 in the sulinic acid combined with bifico group was significantly higher than that in other groups(P<0.05).

Sulinic acid combined with bifico can effectively treat FAP, and its efficacy is better than that of sulinic acid and bifico alone.The possible mechanism may be related to the decrease of Bcl-2, the reduction of inhibition of apoptosis, the promotion of adenoma apoptosis, and the improvement of intestinal microflora.