Insights on exploring the therapeutic potential and structural modification of Tetrandrine

Tetrandrine (Tet), a bisbenzylisoquinoline alkaloid from Stephania tetrandra, is noted for its diverse pharmacological effects but faces limitations in clinical use due to toxicity, poor solubility, and low bioavailability. Researchers are working to address these issues by developing Tet derivatives with greater therapeutic potential through structural modification. Generally, key modifications include: 1) introducing an aromatic heterocycle or a hydrophobic alkyne unit at the C-5 position can enhance its antitumor activity; 2) adding an amide, sulfonamide, or electron-withdrawing group at the C-14 position can enhance its antitumor activity; 3) changing its structure to a quaternary ammonium salt can alter its solubility and greatly boost its antibacterial activity; 4) structural modification of the C-12-methoxybenzyl motif can enhance its metabolic stability and thus change the activity of the analogs; 5) Tet structural simplification may result in the identification of anticancer lead compounds with novel mechanisms of action. This review systematically summarizes these modification strategies and evaluates the biological activities of Tet derivatives, aiming to guide further optimization and facilitate the discovery of lead analogs with improved efficacy. The future direction and possibility of Tet structural optimization are also considered.