Effect of plant sterols on intestinal health: a comprehensive review of biological activity in targeting cancer and inflammation pathways

The rising prevalence of chronic non-communicable diseases has driven interest in novel therapeutic adjuvant strategies, including dietary bioactive compounds like plant sterols (PS). This review evaluates the scientific evidence on the potential benefits of PS in intestinal diseases, particularly colorectal cancer (CRC) and inflammatory bowel disease (IBD). A systematic review, following PRISMA guidelines, analyzed 58 scientific articles. The findings, primarily from pre-clinical studies using cell lines and animal models, show that PS possess antiproliferative and anti-inflammatory properties. PS appear to selectively inhibit cancer cell proliferation without affecting healthy cells by modulating key processes such as apoptosis and cell cycle progression. Additionally, PS have been shown to influence the colonic microbiota and can be metabolized into antiproliferative metabolites, which are crucial to their cancer-inhibiting effects. Moreover, PS reduce intestinal inflammation by targeting pathways like NF-κB and MAPK, lowering inflammation and oxidative stress markers while improving intestinal barrier integrity. While PS show promising therapeutic adjuvant potential for CRC and IBD, further research is needed to assess their effects in food matrices, employing control foods without PS to establish a clear cause-effect relationship. Finally, clinical trials are essential to verify their efficacy in humans and explore their application in clinical practice.