23-hydroxybetulinic acid is one of the bioactive components responsible for its anticancer activity.In vitro: 23-hydroxybetulinic acid also shows different proliferation inhibitory activity against B16, HeLa, and HUVEC, with the IC50 value of 78.5, 80, and 94.8 uM, respectively. 23-hydroxybetulinic acid can promote cell cycle arrest at S phase and induce apoptosis via intrinsic pathway. 23-hydroxybetulinic acid disrupts mitochondrial membrane potential significantly (p<0.01) and selectively downregulates the levels of Bcl-2, survivin and upregulates Bax, cytochrome C, cleaved caspase-9 23-hydroxybetulinic acid can induce apoptosis in K562 cells. [1] 23-hydroxybetulinic acid enhances sensitivity of doxorubicin (DOX, ADR) on MCF-7/ADR cell lines, indicating its potential to be developed as a novel MDR modulator.[2] 23-HBA significantly improve the sensitivity of the tumor to doxorubicin. [3]

[1]. Liu M et al. Cytotoxicity of the compounds isolated from Pulsatilla chinensis saponins and apoptosis induced by 23-hydroxybetulinic acid. Pharm Biol. 2015 Jan;53(1):1-9. [2]. Zhang DM et al. BBA, a derivative of 23-hydroxybetulinic acid, potently reverses ABCB1-mediated drug resistance in vitro and in vivo. Mol Pharm. 2012 Nov 5;9(11):3147-59. [3]. Zheng Y et al. 23-Hydroxybetulinic acid from Pulsatilla chinensis (Bunge) Regel synergizes the antitumor activities of doxorubicin in vitro and in vivo. J Ethnopharmacol. 2010 Apr 21;128(3):615-22.