itraconazole / CYP51/14LDM Cancer Research Results

itraC, itraconazole: Click to Expand ⟱

Features:

Itraconazole — a synthetic, highly lipophilic triazole antifungal drug with substantial drug-repurposing interest in oncology. Standard abbreviations include ITZ and ITRA; Sporanox is a major brand name. Its approved pharmacologic function is inhibition of fungal lanosterol 14α-demethylase, disrupting ergosterol synthesis. Its anticancer activity is mechanistically distinct and appears to be multitargeted, involving direct inhibition of NPC1-dependent lysosomal cholesterol export, VDAC1-dependent metabolic signaling, mTOR suppression, inhibition of VEGFR2 maturation/angiogenesis, and inhibition of Hedgehog signaling through SMO. Itraconazole remains an approved antifungal rather than an approved anticancer drug.

Primary mechanisms (ranked):

↓ NPC1-mediated lysosomal cholesterol export, causing endolysosomal cholesterol accumulation and downstream disruption of growth and angiogenic signaling.
↓ Hedgehog signaling through inhibition of SMO trafficking/activation and downstream GLI signaling, particularly relevant to Hedgehog-dependent tumors such as basal cell carcinoma.
↓ Angiogenesis through impaired VEGFR2 glycosylation, trafficking and signaling, with reduced endothelial proliferation.
↓ mTORC1 signaling through complementary NPC1/cholesterol-trafficking and VDAC1/AMPK mechanisms.
↓ VDAC1-dependent mitochondrial metabolite transport, producing an increased AMP:ATP ratio, ↑ AMPK and ↓ mTOR signaling in endothelial models.
↓ P-glycoprotein/BCRP transporter activity and MDR-associated drug efflux, potentially contributing to chemosensitization; this is also a clinically important source of pharmacokinetic drug interactions.
↓ Glycolysis through the CEBPB–ENO1 axis in colorectal-cancer models, with decreases in glycolytic enzymes, glucose utilization, ECAR and tumor growth; this appears tumor- and model-dependent rather than a universal itraconazole mechanism.
↑ Autophagy and growth arrest in selected tumor models, frequently downstream of impaired cholesterol trafficking and AKT/mTOR signaling.
↑ Apoptosis and cell-cycle arrest in responsive tumor models as downstream phenotypes rather than primary direct molecular targets.

Bioavailability / PK relevance: Itraconazole has nonlinear, formulation-dependent pharmacokinetics and very low aqueous solubility. Conventional capsule absolute oral bioavailability is approximately 55%, is maximal immediately after a full meal, and decreases with reduced gastric acidity or acid-suppressive therapy. Capsule and oral-solution formulations are not pharmacokinetically interchangeable; systemic exposure is generally greater with oral solution at the same dose. After repeated capsule dosing, reported steady-state Cmax values are approximately 0.5, 1.1 and 2.0 µg/mL after 100 mg once daily, 200 mg once daily and 200 mg twice daily, respectively. Itraconazole is approximately 99.8% plasma-protein bound, extensively tissue distributed, metabolized predominantly through CYP3A4, and has an active hydroxy-itraconazole metabolite. Strong CYP3A4, P-glycoprotein and BCRP inhibition produces a major drug–drug interaction burden.

In-vitro vs systemic exposure relevance: Several experimentally important anticancer effects occur around the low-micromolar range, which overlaps total plasma concentrations achievable with high-dose clinical regimens, but free circulating itraconazole is far lower because protein binding approaches 99.8%. Tissue accumulation can exceed plasma concentrations, while exposure varies markedly among patients and formulations. Consequently, mechanistic plausibility is relatively strong for NPC1, VDAC1/mTOR and endothelial targets, but translation of individual in-vitro concentration-response findings should not be assumed without pharmacokinetic confirmation.

Clinical evidence status: Approved antifungal; oncology repurposing remains investigational. Human anticancer evidence includes phase II studies in basal cell carcinoma and prostate cancer, window-of-opportunity studies in NSCLC, and small combination studies in several malignancies. A recent randomized double-blind placebo-controlled study in 60 patients with advanced epithelial ovarian cancer reported improved response and progression-free outcomes when itraconazole was added to paclitaxel/carboplatin, but this remains a small single-institution study and does not establish an approved oncology indication. A recent perioperative phase II BCC study also showed a modest reduction in tumor diameter together with decreased CD105-associated angiogenesis. Important translational limitations include substantial interpatient PK variability, CYP3A4-mediated oncology drug interactions, a boxed warning concerning congestive heart failure/negative inotropy, and rare serious hepatotoxicity.

Itraconazole Mechanistic Pathway Map

Rank	Pathway / Axis	Cancer Cells	Normal Cells	TSF	Primary Effect	Notes / Interpretation
1	NPC1 and lysosomal cholesterol trafficking	↓ NPC1 activity ↑ lysosomal cholesterol	↓ NPC1 activity ↑ lysosomal cholesterol	R/G	Disrupts cholesterol export and growth signaling	Direct itraconazole binding to NPC1 is structurally and functionally supported. This mechanism can contribute to ↓ mTOR signaling and altered membrane-associated signaling. It is not intrinsically cancer-selective.
2	Hedgehog SMO GLI signaling	↓ SMO ↓ GLI1 ↓ Hedgehog signaling	↓ (context-dependent)	R/G	Reduced Hedgehog-dependent proliferation	One of the strongest tumor-directed repurposing mechanisms. Most relevant where Hedgehog signaling is oncogenic, particularly basal cell carcinoma. Clinical pharmacodynamic suppression has been demonstrated.
3	VEGFR2 maturation and angiogenesis	↓ vascular support	↓ VEGFR2 glycosylation ↓ VEGFR2 trafficking ↓ endothelial proliferation	R/G	Anti-angiogenic activity	Itraconazole impairs VEGFR2 N-glycosylation and surface trafficking in endothelial cells. This is primarily an effect on tumor-supporting vasculature rather than direct killing of malignant cells.
4	VDAC1 AMPK mTOR axis	↑ AMPK ↓ mTOR (model-dependent)	↓ VDAC1 function ↑ AMP:ATP ↑ AMPK ↓ mTOR	P/R	Energetic stress and suppression of anabolic signaling	VDAC1 is a direct itraconazole target in endothelial models. AMPK activation can occur within minutes and precedes mTOR inhibition.
5	mTORC1 growth signaling	↓ (model-dependent)	↓ (endothelium)	R/G	Reduced protein synthesis, proliferation and angiogenic signaling	Mechanistically convergent downstream effect of both NPC1-mediated cholesterol sequestration and VDAC1-mediated AMPK activation.
6	P-glycoprotein and multidrug resistance	↓ P-gp activity ↓ drug efflux	↓ P-gp activity	P/R	Chemosensitization and altered drug disposition	Itraconazole inhibits P-glycoprotein and can increase intracellular exposure to P-gp substrates. Therapeutically interesting for resistant tumors but clinically hazardous because the same transporter and CYP3A4 inhibition can markedly alter concomitant anticancer-drug exposure.
7	CEBPB ENO1 glycolysis axis	↓ CEBPB ↓ ENO1 ↓ glycolysis ↓ ECAR	Not established	G	Reduced glycolytic metabolism and tumor growth	Demonstrated recently in colorectal-cancer models. ENO1, LDHA, PKM2 and GAPDH-related metabolic changes were reported, but this should currently be treated as tumor-specific rather than a universal itraconazole mechanism.
8	Autophagy and lysosomal stress	↑ autophagy (model-dependent)	↑ (stress-dependent)	G	Autophagic growth suppression or cell death	Frequently follows cholesterol-trafficking and AKT/mTOR disruption. Biological outcome varies by tumor type and can be cytostatic or cytotoxic.
9	Cell cycle and apoptosis	↑ arrest ↑ apoptosis (model-dependent)	↔ / ↑ (high exposure)	G	Reduced proliferation and programmed cell death	Downstream phenotype reported in multiple tumor systems rather than a single direct molecular target.
10	Clinical Translation Constraint	↓ usable therapeutic window	↓ tolerability margin	G	PK variability, DDIs and toxicity constrain oncology use	Capsule absorption depends strongly on food and gastric acidity; exposure is formulation-dependent and variable. Itraconazole and hydroxy-itraconazole are potent CYP3A4 inhibitors and itraconazole inhibits P-gp/BCRP. Major concerns include numerous anticancer-drug interactions, negative inotropy/CHF risk and rare serious hepatotoxicity.

TSF legend: P: 0–30 min R: 30 min–3 hr G: >3 hr

CYP51/14LDM, Lanosterol 14α-Demethylase: Click to Expand ⟱

Source:

Type:

CYP51A1 - Lanosterol 14α-Demethylase

Abbreviation: CYP51A1, CYP51, 14LDM, Lanosterol 14α-Demethylase

Type: Cytochrome P450 enzyme / cholesterol biosynthesis enzyme

Function: CYP51A1 catalyzes oxidative removal of the 14α-methyl group from lanosterol and related sterol intermediates during cholesterol biosynthesis. It is an evolutionarily conserved sterol-demethylating enzyme and is essential for normal sterol and membrane-lipid homeostasis.

Cancer: ↕ Context-dependent. CYP51A1 can support cholesterol and sterol synthesis in metabolically active tumor cells, but its expression and importance vary by cancer type, so no universal cancer-associated direction is appropriate.

Scientific Papers found: Click to Expand⟱

8015-

itraC,

Itraconazole, a commonly used antifungal that inhibits Hedgehog pathway activity and cancer growth

vitro+vivo,

BCC,

HH↓, Dose↝, CYP51/14LDM↓, Gli1↓,

Showing Research Papers: 1 to 1 of 1

* indicates research on normal cells as opposed to diseased cells
Total Research Paper Matches: 1

Pathway results for Effect on Cancer / Diseased Cells:

NA, unassigned(tgid=0) ⓘ

CYP51/14LDM↓, 1,

Proliferation, Differentiation & Cell State(tgid=12) ⓘ

Gli1↓, 1, HH↓, 1,

Drug Metabolism & Resistance(tgid=21) ⓘ

Dose↝, 1,
Total Targets: 4

Pathway results for Effect on Normal Cells:

Total Targets: 0

Scientific Paper Hit Count for: CYP51/14LDM, Lanosterol 14α-Demethylase

Query results interpretion may depend on "conditions" listed in the research papers.
Such Conditions may include : 
  -low or high Dose
  -format for product, such as nano of lipid formations
  -different cell line effects
  -synergies with other products 
  -if effect was for normal or cancerous cells

Filter Conditions: Pro/AntiFlg:%  IllCat:%  CanType:%  Cells:%  prod#:312  Target#:1748  State#:%  Dir#:%
  wNotes=0  sortOrder:rid,rpid