| 1 |
HK-II–VDAC mitochondrial coupling |
HK-II mitochondrial binding ↓; VDAC association ↓; glycolytic coupling ↓ |
Less characterized; proposed selectivity relates partly to greater mitochondrial HK-II dependence in cancer |
P-R |
ATP production ↓; metabolic vulnerability ↑ |
Best-defined direct molecular mechanism. MeJa binds hexokinase and promotes detachment of mitochondria-associated hexokinase from VDAC. |
| 2 |
Mitochondrial membrane integrity |
Mitochondrial membrane potential ↓; cytochrome c release ↑; mitochondrial dysfunction ↑ |
Generally less affected in tested mammalian normal-cell models, but universal tumor selectivity is not established |
P-R |
Intrinsic apoptosis ↑; ATP depletion ↑ |
Closely coupled to HK-II–VDAC disruption and represents a central cytotoxic mechanism. |
| 3 |
ROS oxidative stress |
ROS ↑; H2O2 ↑ (model-dependent) |
Variable and incompletely characterized |
P-R |
Oxidative stress ↑; apoptosis and autophagic cell death ↑ |
ROS scavenging can markedly suppress MeJa-induced apoptosis and autophagy in NSCLC models, supporting a causal role. |
| 4 |
DDIT3–TNFRSF10B–caspase death signaling |
DDIT3 ↑; TNFRSF10B ↑; CFLAR ↓; caspase activity ↑ |
Insufficient comparative evidence |
R-G |
Extrinsic apoptosis ↑ |
Well demonstrated in NSCLC; strongly ROS-dependent but not necessarily universal across tumor types. |
| 5 |
BCL-2 family and caspase apoptosis |
BAX/BCL-XS ↑; caspase-3 ↑; mitochondrial apoptosis ↑ |
Usually less cytotoxic in comparative cell studies |
R-G |
Apoptosis ↑ |
Intrinsic and extrinsic death pathways can operate simultaneously and are partly tumor-model dependent. |
| 6 |
Glycolysis and cellular ATP |
Glycolytic flux ↓; ATP ↓ |
Less pronounced where mitochondrial HK-II dependence is lower |
P-R |
Bioenergetic collapse ↑ |
Metabolic mechanism is especially relevant to highly glycolytic tumors and provides rationale for combination with 2-deoxyglucose and related metabolic inhibitors. |
| 7 |
Autophagy |
Autophagy ↑ |
Insufficient comparative evidence |
R-G |
Pro-death autophagy ↑ (context-dependent) |
In NSCLC models, pharmacologic/autophagic studies indicate that the response contributes to rather than protects against MeJa cytotoxicity. |
| 8 |
Cell-cycle and proliferation control |
Cell-cycle arrest ↑; PCNA ↓; proliferation ↓ |
Generally smaller response in comparative studies |
G |
Growth inhibition ↑ |
G0/G1, S or other arrest patterns have been reported depending on tumor type and experimental conditions. |
| 9 |
Survivin and XIAP anti-apoptotic signaling |
Survivin ↓; XIAP ↓ |
Insufficient evidence |
G |
Apoptotic threshold ↓ |
Reported particularly in neuroblastoma and combination studies; may contribute to TRAIL and other treatment sensitization. |
| 10 |
Migration and invasion |
Migration ↓; invasion ↓; MMP14 ↓ |
Not established |
G |
Metastatic phenotype ↓ |
Observed at sub-cytotoxic concentrations in gastric cancer and melanoma models. |
| 11 |
Sp1–MMP14–VEGF angiogenic signaling |
Sp1 ↓; MMP14 ↓; VEGF ↓; angiogenic activity ↓ |
Direct endothelial effects become cytotoxic at high concentrations |
G |
Angiogenesis ↓ (dose-dependent) |
Interpret cautiously: low micromolar concentrations produced complex angiogenic responses in endothelial models, whereas higher millimolar concentrations were toxic. |
| 12 |
Chemosensitization |
Cisplatin, TRAIL and metabolic-inhibitor cytotoxicity ↑ (model-dependent) |
Limited comparative combination data |
G |
Combination efficacy ↑ |
Preclinical evidence includes cisplatin, TRAIL, 2-deoxyglucose and other cytotoxic agents; no validated clinical combination regimen exists. |
| 13 |
Radiosensitization |
X-ray cytotoxicity ↑; required radiation dose ↓ (model-dependent) |
Insufficient comparative evidence |
G |
Radiation sensitivity ↑ |
Demonstrated in cervical cancer cell lines with X-rays and, less consistently, alpha-particle irradiation. |
| 14 |
Clinical Translation Constraint |
Effective direct cytotoxic concentrations frequently 0.5–3 mM |
Human therapeutic window unknown |
G |
Clinical translatability ↓ |
Hydrophobicity, formulation, lack of human anticancer PK and predominance of millimolar in-vitro activity are major limitations. Human systemic efficacy has not been established. |