Transcript
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Ben Bickman (1:52)
Welcome to the Metabolic Classroom Podcast. I'm Ben Bickman. Thanks for letting me be your guest professor for the next few minutes. Don't worry about any pop quizzes. I'm here to simply make the science of metabolism clear, practical and engaging. Welcome back to the Metabolic Classroom. I'm Ben Bickman, metabolic scientist and professor of Cell biology. Today's mini lecture steps into one of the most politically charged and I would say, scientifically misrepresented drugs of the past several years, Ivermectin. Now, I'm not here to wade into politics. We are here to do what we always do on the Metabolic Classroom, which is follow the peer reviewed science. When you set aside the noise and look at what research actually says, you find a molecule with a profound and underappreciated metabolic story, particularly when it comes to mitochondria, cancer, metabolism, inflammation and signaling pathways that we talk about regularly here on the Metabolic Classroom. So today we're going to cover where ivermectin came from, how it works classically, where it does, where it does its job, and what it does to the mitochondria in particular and in cancer cells specifically. And then we'll broaden out to explore the wider metabolic effects. I'll also address the so called horse dewormer narrative directly because that framing deserves a science based response. Let's get into it. The story of Ivermectin starts in a patch of soil in Japan in 1975 where a bacterium called Streptomyces avermitilis was isolated and cultured. What made this bacterium remarkable is that it produced a compound eventually named avermectin with extraordinarily effective antiparasitic properties. Avermectin was subsequently modified chemically into a more potent derivative, which we now call ivermectin. The discovery of this compound was so significant that it earned the 2015 Nobel Prize in Physiology or Medicine, the Nobel committee's first award for treatments of infectious diseases in over six decades. The Nobel assembly explicitly recognized ivermectin for its ability to radically lower the incidence of devastating parasitic diseases, including things like river blindness and one called lymphatic filariasis. Look it up. That's a crazy one. We need to appreciate that this is a Nobel Prize winning drug and the prize wasn't for its use in horses or livestock at all. It was for its transformative impact on human health. In fact, in a single year 2014, the World Health Organization, the WHO, reported that 139 million people were reached with Ivermectin through its elimination program for lymphatic filariasis alone. It is on the WHO's list of essential medicines and is FDA approved for human use. It's worth noting that access to human grade ivermectin has been expanding at the state level here within the United States as of in fact, Just recently, late 2025, at least five states, namely Tennessee, Arkansas, Idaho, Louisiana and Texas, have passed legislation allowing Ivermectin to be sold over the counter at pharmacies without a prescription. More states have legislation pending, actually. So it could in fact become even broader in its access. This means that for many Americans, obtaining this pharmaceutical grade ivermectin is becoming as straightforward as picking up some ibuprofen so when Ivermectin gets dismissed as just a horse dewormer, what we're really seeing, I think, is a rhetorical sleight of hand that strips away the drug's entire humanitarian history and Nobel Prize winning science to make it sound fringe and even dangerous. Yes, Ivermectin is also used in veterinary medicine, but so is metformin, which is used in horses and dogs. So is aspirin. The use of a drug in animals doesn't make it inappropriate or inherently toxic for use in humans. What matters is the pharmacology and the evidence. And on both counts, Ivermectin has a stellar track record. Of course, this is the metabolic classroom and we'll get to the metabolism. But before we do that, including the metabolism as it's relevant to its anti cancer role, let's briefly establish how I Ivermectin works as an anti parasitic. This context is important for understanding why it's relatively selective in how it affects different organisms. Ivermectin's classical mechanism of action involves binding to glutamate gated chloride channels found in invertebrate parasites. All right, now that's a lot. So when Ivermectin binds to these channels, it causes them to open up, it forces them open and to stay open. And in turn that will flood the parasite cells with chloride ions, which then paralyzes the parasite's nervous system and its muscular systems, which will lead it to die. The key reason this is relatively safe in mammals is that these specific glutamate gated chloride channels are essentially absent in our nervous system, which, and we have different receptor types. So it's not going to work on us. And that realm on top of that, mammals have a blood brain barrier which under normal conditions is going to prevent Ivermectin from accumulating in the brain anyway. The drug therefore has a favorable therapeutic window, meaning it can be effective against parasites at doses that don't significantly harm the human. Now that said, Ivermectin doesn't only interact with these parasite channels. As research has expanded over the past two decades, we've discovered that Ivermectin also interacts with several mammalian targets. And that's where the metabolic story opens up. All right, now let's talk about the mitochondria. What I want to do now is transition into that, that sort of section or chapter of this mini lecture looking at mitochondrial function and how it relates to disease. Cancer cells often rely on altered mitochondrial function for biosynthesis and Rapid proliferation. So in other words, helping it grow really quickly and, and proliferate or multiply. And so if you disrupt that already changed mitochondrial function, it can be lethal to the cancer cell. This is where ivermectin enters the picture in a very interesting way that needs some attention. Multiple peer reviewed studies have demonstrated that ivermectin can inhibit mitochondrial complex 1, which is the first and largest enzyme complex in what we call the electron transport system. Complex 1 is the entry point for electrons coming from what we call reducing equivalence, A molecule called adh. In fact, for a little more information on adh, look back at my previous metabolic classroom on nad. But complex one takes in the NADH and introduces it into this respiratory chain or the electron transport system. And we need this to happen for the mitochondria to produce nutrients, ATP, that main molecule that the cell will use to purchase some kind of work. A neuron fires because of ATP. A muscle can contract and relax because of ATP and every other effect in the body. So given the important location and role of complex I, when complex I is inhibited, the electron transport chain stalls research. In glioblastoma cancer cells, one of the most aggressive and treatment resistant brain cancers, it's shown that ivermectin produces a dose dependent reduction in both basal oxygen consumption and maximal capacity. These are standard measures of mitochondrial respiration. In fact, indeed standard measures that we use in my own lab. These same studies have documented decreased mitochondrial membrane potential that refers to the electrochemical gradient across that inner mitochondrial membrane. So we have to have this, this not a chaos, but a tension that, that creates the, what we call the membrane potential. We must have that in order to create ATP. And in turn, in addition to disrupting that membrane potential, it increase, we also have an increase in reactive oxygen species and, and mitochondrial superoxide, that's that main oxidative stress mole. This combination represents a state of profound dysfunction of the mitochondria. Again, that's helpful because we're trying to kill these cancer cells. And cancer cells, because of their very high metabolic demand, are disproportionately sensitive to this kind of mitochondrial disruption compared to a normal slow growing cell. Studies comparing leukemia cells to normal bone marrow cells compared to, and that matters because these leukocytes that are affected in leukemia come from the bone marrow. And also looking at renal or kidney cancer cells to normal kidney cells, they found that cancerous cells were substantially more sensitive to ivermectin's effects. This selectivity is exactly what you want in a potential anti cancer agent. When complex one is inhibited, ATP levels fall and the cells experience an energy crisis. This in turn activates ampk, AMP activated protein kinase. Again AMPK is the acronym and AMPK functions as a sort of cellular energy sensor. When the amp, which is a metabolite, when you break down ATP, because you've used it for some kind of work, when you break down ATP, you get amp as the product. So you can look at the ratio of amp, the sign of ATP breakdown to, and compare that to ATP. When that ratio rises, meaning you're breaking down more ATP than you're rebuilding, AMPK is activated. And then when AMPK is activated, it in turn suppresses mtor, another one we've talked about previously on the Metabolic Classroom. That is MTOR is a very important driver of cancer cell growth and multiplication or proliferation. So in ivermectin hits the mitochondria, it sets off a cascade and it looks a little something like this complex one slows down, ATP drops, AMPK is activated and then MTOR is suppressed and the cancer cells are pushed toward growth arrest where they stop growing and eventually they'll die. That is the, I would say very coherent and even a well described molecular story. There's one more dimension worth understanding here when it comes to cancer. When the mitochondrial membrane potential collapses, which happens following complex 1 inhibition, it triggers intrinsic apoptosis, meaning programmed cell death initiated from within the cell. So this is when a cell dies, but not because there's some external stimulus telling it to die, but within its own substance, the cell gets the signal. It's time for me to die. In cervical cancer, esophageal carcinoma, leukemia, glioblastoma and glioblastoma models, studies have documented this exact sequence. The collapse of the membrane potential, an increase in reactive oxygen species and then a shift into the pro apoptotic signaling. So the cell is ultimately now getting more death signal in these cancer cells then survival signal. This mitochondria initiated apoptosis has now been documented across multiple cancer types in multiple peer reviewed publications. Now as compelling as the mitochondria story is, and as loathe as I am to step away from the mitochondria, it is in fact just one thread in a larger tapestry. Here two additional mechanisms are worth mentioning. First, ivermectin inhibits a kinase or an enzyme called Pacific1PAK1, which is overactivated in the vast majority of human cancers. Ivermectin promotes the degradation of Pack 1, essentially tagging it for destruction by the cell's own protein recycling machinery, if you will.
