| Rank |
Pathway / Axis |
Cancer Cells |
Normal Cells |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
Lipid peroxidation / membrane protection |
↓ (context-dependent) |
↓ |
P |
Antioxidant “chain-breaker” in membranes |
Core pharmacology; can protect normal tissue but may also protect tumor cells from oxidative stress therapies (model-dependent). |
| 2 |
ROS tone |
↓ (context-/dose-dependent) |
↓ |
P→R |
↓ oxidative stress signaling |
Often secondary to lipid radical scavenging; can blunt ROS-mediated cytotoxicity from chemo/radiation in some settings (context-dependent). |
| 3 |
Ferroptosis axis (iron/lipid-ROS death) |
↓ (anti-ferroptotic bias) |
↓ |
P→R |
Suppresses lipid-ROS propagation |
Mechanistically coherent: VitE tends to oppose ferroptotic lipid peroxidation; may be undesirable where ferroptosis is leveraged therapeutically. |
| 4 |
NRF2 antioxidant program |
↑ (context-dependent) |
↑ |
G |
Adaptive antioxidant response |
NRF2 can be tissue-protective in normal cells yet pro-survival / resistance-promoting in some tumors (context-dependent). |
| 5 |
NF-κB / inflammatory signaling |
↓ (model-dependent) |
↓ (often) |
R→G |
Anti-inflammatory bias |
Redox-linked; magnitude varies by isoform (αT vs γT vs tocotrienols) and stimulus. |
| 6 |
Apoptosis / mitochondrial stress |
↑ (tocotrienols & high concentration only) |
↔ / ↓ (protective) |
R→G |
Pro-apoptotic signaling (select models) |
Tocotrienols are more often reported pro-apoptotic vs αT; frequently requires supra-physiologic exposure (model-dependent). |
| 7 |
Ca²⁺ handling (ER/mitochondrial stress coupling) |
↔ (model-dependent) |
↔ |
R |
Stress-modulating cross-talk |
Not a universal “signature axis” for VitE, but can matter when ER stress/mitochondrial dysfunction is the readout. |
| 8 |
Clinical Translation Constraint |
— |
— |
— |
Prevention/adjunct limitations |
Isoform + dose matter; high-dose αT (400 IU/d) increased prostate cancer risk in SELECT; in-vitro dosing often exceeds realistic systemic exposure. |
| Rank |
Pathway / Axis |
Cells (AD-relevant; mostly “normal” neurons/glia under stress) |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
Lipid peroxidation / membrane oxidative injury |
↓ |
P |
Neuroprotective antioxidant (membrane) |
Mechanistic fit to oxidative-stress hypothesis; strongest “core” axis for VitE in CNS stress contexts. |
| 2 |
ROS tone |
↓ |
P→R |
↓ oxidative stress signaling |
Often downstream of lipid radical scavenging; may reduce oxidative damage markers (model-dependent). |
| 3 |
Neuroinflammation (NF-κB-linked) |
↓ (model-dependent) |
R→G |
Anti-inflammatory bias |
Magnitude depends on model and background diet/status. |
| 4 |
Clinical evidence constraint |
— |
— |
Mixed RCT outcomes by stage |
MCI: 2000 IU/d VitE did not significantly delay progression to AD in a 3-year trial; mild–moderate AD: 2000 IU/d αT slowed functional decline vs placebo in TEAM-AD; earlier ADCS trial also reported slowed progression signals (stage-dependent). |