Arnaud Pontin (Image : AI / Gay Globe)
Montelukast, an asthma medication discovered over 25 years ago in the laboratories of Merck Frosst in Kirkland, near Montreal, is now attracting growing interest in research on certain drug-resistant cancers and HIV.
Montelukast is primarily used to treat asthma and respiratory allergies. Marketed under the brand name Singulair, it works by blocking the action of leukotrienes, inflammatory substances produced by the body that contribute to airway narrowing, inflammation, and mucus production.
Prescribed since the late 1990s, montelukast is commonly used to prevent asthma symptoms, reduce episodes of wheezing, and relieve both seasonal and persistent allergic rhinitis. It is usually taken once daily in tablet form.
Interest in montelukast in cancer research is based on a relatively recent discovery: some cancer cells appear to exploit the same inflammatory pathways involved in asthma in order to survive, proliferate, and resist treatment.
By blocking leukotrienes, inflammatory molecules involved in asthma, montelukast may also interfere with biological pathways that certain cancers use to grow. Several studies suggest that tumors can produce or exploit these same substances. By inhibiting this pathway, the drug could potentially make cancer cells more vulnerable or slow their growth.
One of the most promising areas of research involves so-called “persistent” or “dormant” cancer cells, which can survive chemotherapy and trigger relapse years later. Researchers have observed that montelukast may help target some of these highly resistant cells.
Experimental studies have also suggested potential effects against several cancer types, including lung cancer, colorectal cancer, breast cancer, certain blood cancers, and pancreatic cancer. Proposed mechanisms include reducing inflammation, slowing cancer cell proliferation, inducing programmed cell death, and limiting metastatic spread.
One of the main advantages of montelukast is that it is already a well-known medication, used in clinical practice for more than 25 years. Its safety profile is well established, which could accelerate potential repurposing in oncology if clinical trials confirm early laboratory findings.
Could montelukast play a role in HIV research?
Although primarily used for asthma and allergies, montelukast is not part of standard HIV therapy. However, in recent years, it has attracted interest from researchers exploring its potential effects on inflammation and HIV-related complications.
One early line of investigation involves immune reconstitution inflammatory syndrome (IRIS), a complication that can occur in some people living with HIV after starting antiretroviral therapy. In a small case series published in 2006, researchers reported significant clinical improvement in three patients with severe inflammation that did not respond to conventional treatments. Although preliminary, these findings opened the door to further exploration of montelukast’s anti-inflammatory potential in this context.
Other studies have focused on leukotrienes, inflammatory molecules targeted by montelukast. Laboratory research suggests these compounds may play a role in HIV replication and in inflammatory processes affecting the central nervous system. Some experiments even indicate they could influence early stages of infection in certain immune cells, although these findings still require confirmation in humans.
Researchers have also examined possible interactions between montelukast and certain antiretroviral drugs. A pharmacological study found that the drug could alter intracellular transport of saquinavir, an older HIV medication. This led to the hypothesis that montelukast might one day be used as an adjunct therapy to improve intracellular drug retention, although this remains purely experimental.
More recently, attention has turned to the potential neuroprotective effects of montelukast. In experimental models, the drug reduced certain neuronal damages caused by HIV-related proteins. These findings suggest a possible role in limiting neurological complications associated with HIV, even though montelukast does not directly target the virus.
At present, there is no solid clinical evidence that montelukast is an effective treatment for HIV. Research remains exploratory and limited. However, its effects on inflammation, neurological pathways, and drug interactions continue to attract scientific interest.
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