Accumulating evidence suggests that niclosamide targets multiple signaling pathways such as nuclear factor-kappaB (NF-kB), Wnt/β-catenin, and Notch, most of which are closely involved with cancer stem cell proliferation
The transcription factor NF-κB has been demonstrated to promote cancer growth, angiogenesis, escape from apoptosis, and tumorigenesis
NF-κB is sequestered in the cytosol of resting cells through binding the inhibitory subunit IκBα
Niclosamide blocked TNFα-induced IκBα phosphorylation, translocation of p65, and the expression of NF-κB-regulated genes
Niclosamide also inhibited the DNA binding of NF-κB to the promoter of its target genes
niclosamide has two independent effects: NF-kB activation and ROS elevation
The Wnt signaling pathway plays fundamental roles in directing tissue patterning in embryonic development, in maintaining tissue homeostasis in differentiated tissue, and in tumorigenesis
niclosamide is a potent inhibitor of the Wnt/β-catenin pathway
The Notch signaling pathway plays important roles in a variety of cellular processes such as proliferation, differentiation, apoptosis, cell fate decisions, and maintenance of stem cells
niclosamide potently suppresses the luciferase activity of a CBF-1-dependent reporter gene in both a dose-dependent and a time-dependent manners in K562 leukemia cells
niclosamide treatment abrogated the epidermal growth factor (EGF)-stimulated dimerization and nuclear translocation and transcriptional activity of Stat3, and induced cell growth inhibition and apoptosis in several types of cancer cells (e.g. Du145, Hela, A549) that exhibit relatively higher levels of Stat3 constitutive activation
niclosamide can rapidly increase autophagosome formation
niclosamide induced autophagy and inhibited mammalian target of rapamycin complex 1 (mTORC1)
Niclosamide has low toxicity in mammals (oral median lethal dose in rats >5000 mg/kg
Niclosamide is active against cancer cells such as AML and colorectal cancer cells, not only as a monotherapy but also as part of combination therapy, in which it has been found to be synergistic with frontline chemotherapeutic agents (e.g., oxaliplatin, cytarabine, etoposide, and daunorubicin)
Because niclosamide targets multiple signaling pathways (e.g., NF-κB, Wnt/β-catenin, and Notch), most of which are closely involved with cancer stem cells, it holds promise in eradicating cancer stem cells
Review article: common anti-parasitic medication, niclosamide, provides anti-proliferative effect in cancer stem cells (CSC), via inhibition of NF-kappaBeta, Wnt/B-catenin, Notch, ROS, mTORC1, and STAT2 pathways.
facilitates the dissemination of cancer cells to distant organs. In addition to facilitating metastasis, EMT is thought to generate cancer stem cells (CSCs), which are generally resistant to apoptosis and to standard chemotherapeutic drugs and radiotherapy
IL‐6, which enhances TGF‐β‐induced EMT changes in NSCLC
aside from TGF‐β and Snail, several other signalling pathways including Notch, Wnt, and integrin are known to activate EMT through transcriptional repression of E‐cadherin
increasing evidence that treatment with chemotherapy or chemoradiotherapy can induce EMT in NSCLC which in turn is thought to generate CSCs which are generally resistant to such treatments
cisplatin has been shown to increase the release of Interleukin‐6 (IL‐6) and expression of transforming growth factor beta (TGF‐β)
Ovarian cancer is the most lethal gynecologic malignancy and the fifth-most cause of overall cancer death of women in developed countries
An increasingly accepted cancer stem cell hypothesis regards tumors as caricatures of normal organs, possessing a hierarchy of cell types, at various stages of aberrant differentiation, descended from precursor tumor-initiating cells (TIC) cells that are highly resistant to conventional cytotoxics
Significant changes of gene expression in 2,928 genes were identified after niclosamide treatment for different time periods
uncoupling of mitochondrial oxidative phosphorylation is believed to be its anti-helminthic mechanism of action
we hypothesized that niclosamides antagonistic effects on OTICs could, in part, be due to its disruption of metabolism
Our results showed that genes participating in protein complexes of oxidative phosphorylation were downregulated
niclosamide treatment resulted in a more than 20% increase in reactive oxygen species (ROS) in cultured OTICs
niclosamide, which has proved to be safe and effective for the past 2 decades against numerous parasites, inhibited OTIC growth both in vitro and in vivo
niclosamide represses metabolic enzymes responsible for bioenergetics, biosynthesis, and redox regulation specifically in OTICs, presumably leading to mitochondrial intrinsic apoptosis pathways, loss of tumor stemness, and growth inhibition
Niclosamide is believed to inhibit mitochondrial oxidative phosphorylation
Niclosamide was reported to inactivate NF-κB, causing mitochondrial damage and the generation of ROS, leading to apoptosis of leukemic stem cells
niclosamide were identified in a screen for mTOR-signaling inhibitors
mTOR was reported to maintain stemness properties of HSCs by inhibiting mitochondrial biogenesis and ROS levels (39), implying that mTOR inhibitors (such as niclosamide) may interfere with mitochondria and various metabolic pathways in TICs via disruption of antioxidant responses
We observed Wnt hyperactivity in OTICs, in agreement with previous hypotheses of Wnt inhibitor effectiveness as an ovarian cancer therapy
niclosamide has now been independently identified in screens for Wnt inhibitors
downregulation of the Wnt/β-catenin target oncogenes survivin and c-Myc
ovarian carcinogenesis, the cell-to-cell signaling pathway Notch (8), were also suppressed by niclosamide (data not shown). These results agree with another recent niclosamide study in leukemia (49), and it has been widely hypothesized that disruption of Notch signaling may represent a highly effective therapy for ovarian and other solid tumors, via its essentiality to maintaining TIC stemness
Niclosamide, common anti-parasitic medication, inhibits cellular metabolism and increases ROS; both of which provide powerful anti-proliferative, anti-cancer treatment mechanism in TICs. Powerful target therapy for cancer stem cells. Also shown to inhibit Wnt stimulated oncogenes survivin and c-Myc, disrupts Notch signaling, inactivates NF-kappaBeta, and inhibits mTOR-signaling. This has been found in in vitro and in vivo studies.
To date nearly half of known human tumors show a dysregulation of the WNT signaling pathway
It should be also noted that the WNT pathway is not exclusively employed during development or overactivated in cancer. In adults many healthy tissues rely on it for renewal and homeostasis maintenance, most notably the intestine, haematopoietic system, hair, bones and skin. Therefore one might expect adverse reactions in all these organ systems, which has indeed been observed for many WNT-targeting compounds upon attempts to push them into the clinics
The intestine seems to be the most vulnerable in this regard
Ivermectin inhibits proliferation of human colon cancer and lung cancer cells both in vitro and in vivo
The anti-proliferative action, affecting both the bulk tumor cells and CSCs, was linked in this study to inhibition of WNT signaling
the anti-WNT IC50 of ivermectin is 5–10 times (~1–2 µM vs. 10 µM) lower than that of its toxic effect against chloride channels
oral bioavailability of the drug, as for other antiparasitic drugs discussed in this section, is very low
Toxicity studies in vivo have also demonstrated a wide therapeutic index for ivermectin
Its anti-proliferative activity has been demonstrated in a wide array of cancer cell lines representative of WNT-dependent cancers: non-small lung carcinoma [96], multiple myeloma [97], hepatoma [98], adrenocortical carcinoma [99], ovarian cancer [100] and glioblastoma
Niclosamide inhibits the canonical WNT pathway
In addition to inhibiting the canonical WNT pathway, niclosamide may mediate its anticancer activities through several other signaling pathways such as NOTCH [107], MTOR [108], NF-κB [97] and STAT3 [96]
review article highlights older medications that have anti-Wnt pathway effects in cancer. Roughly, 50% of cancer involve upregulated Wnt pathway activity. Other drugs of note: metformin