P-glycoprotein (P-gp) is a drug transporter that effluxes chemotherapeutic drugs and is implicated in the development of resistance of cancer cells to chemotherapeutic drugs. To date, no drug has been approved to inhibit P-gp and restore chemotherapy efficacy. Moreover, majority of the reported inhibitors have high molecular weight and complex structures, making it difficult to understand the basic structural requirement for P-gp inhibition. In this study, two structurally simple, low molecular weight piperine analogs Pip1 and Pip2 were designed and found to better interact with P-gp than piperinein silico. A one step, acid-amine coupling reaction between piperic acid and 6,7-dimethoxytetrahydroisoquinoline or 2-(3,4-dimethoxyphenyl)ethylamine afforded Pip1 and Pip2, respectively.In vitrotesting in drug resistant P-gp overexpressing KB (cervical) and SW480 (colon) cancer cells showed that both analogs, when co-administered with vincristine, colchicine or paclitaxel were able to reverse the resistance. Moreover, accumulation of P-gp substrate (rhodamine 123) in the resistant cells, a result of alteration of the P-gp efflux, was also observed. These investigations suggest that the natural product analog – Pip1 ((2E,4E)-5-(benzo[d][1,3]dioxol-5-yl)-1-(6,7-dimethoxy-3,4-dihydroisoquinolin-2(1 H)-yl)penta-2,4-dien-1-one) – is superior to piperine and could inhibit P-gp function. Further studies are required to explore the full potential of Pip1 in treating drug resistant cancer.

A major impediment for cancer chemotherapy is the development of multidrug-resistance (MDR). Continuous use of chemotherapeutic drugs during cancer therapy induces the expression of PGlycoprotein (P-gp, MDR1), an ATP dependant transporter, which in turn reduces the intracellular accumulation of chemotherapeutic drugs leading to MDR. Extensive research over the years has identified several potential P-gp inhibitors, both synthetic as well as natural origin, to overcome the MDR during cancer chemotherapy. In this review, we discuss the cellular pathways involved and transcription factors regulating the expression of P-gp. A number of phytochemicals are reported to inhibit P-gp activity and MDR1 expression; the structure-activity relationship (SAR) among the phytochemicals for P-gp inhibition and the effect of these phytochemicals on cellular signaling pathways regulating P-gp expression are discussed in detail. Moreover, structural biology and mutagenesis studies on P-gp along with docking studies throw light on the structural requirements for P-gp inhibition. Insight provided in the review about the phytochemicals molecular mechanism and SAR could catalyze the design of potent P-gp inhibitors in the future and could help to overcome MDR in cancer chemotherapy.

Natural products, especially foods and extracts from plant origin have been successful in treating various disorders in traditional medicine. Piperine, a versatile bioactive compound is found in almost 2000 varieties of piper species from piper genus. The plants containing piperine, particularly, Piper nigrum (black pepper) and Piper longum (long pepper), are widely used in the traditional as well as alternative therapies for both human and domestic illnesses. Effect of piperine on gastrointestinal system, drug metabolizing enzymes, P-glycoprotein and alteration of bioavailability of other drugs are the major area of research. Particularly, bio-enhancing properties of piperine is of clinical importance, as co-administration with drugs for the treatment of human immunodeficiency virus (HIV) infections, pancreatitis, tuberculosis, hyperlipidemia, bronchial asthma and epileptic disorders, resulted in enhanced bioavailability of these drugs. Also investigations are being carried out to elucidate the underlying mechanism of action for the anti-fertility and anti-cancer effects of piperine. Comprehensive data regarding the in silico, safety, pre-clinical pharmacology, clinical studies of piperine and its derivatives are compiled in this review, to act as a guide for future drug development.