## 8 Other Uses of Ciclopirox Olamine  
Beyond its well-established use in the treatment of fungal infections, ciclopirox olamine is currently being investigated for its therapeutic potential in other areas of medicine. Its iron-chelating properties and its capacity to modulate the activity of certain enzymes and signaling pathways render it a promising candidate for the treatment of various diseases. One such potential application is in cancer treatment, including acute myelogenous leukemia, breast cancer, rhabdomyosarcoma, and colon carcinoma [1]. Ciclopirox olamine can inhibit the growth of cancer tumors by affecting key cellular processes such as DNA replication, the cell cycle, and apoptosis [45]. Preclinical studies have confirmed its anticancer activity in animal models, and phase I clinical trials are currently underway to evaluate its efficacy and safety in patients with advanced blood cancers [9]. Chronic hepatitis B virus (HBV) infection is a major cause of hepatocellular carcinoma (HCC). Ciclopirox shows promising potential for HBV treatment by inhibiting replication through the disruption of normal viral capsid assembly, reducing HBV's ability to form virions. It binds to three of the six sites in the hydrophobic pocket of the HBV core protein, inducing conformational changes that enhance its penetration and efficacy. Ciclopirox has a synergistic effect with tenofovir (TDF) and entecavir (ETV), targeting multiple HBV life cycle stages, including HBV polymerase and capsid assembly. Preclinical studies suggest it could serve as an adjunctive therapy with limited side effects and no interference with HBV transcription. Further clinical studies are needed to evaluate its safety and efficacy in HBV treatment [46]. Ciclopirox, in addition to its previously reported therapeutic potential, effectively inhibited SARS-CoV-2 replication in vitro and in vivo. It exerts its antiviral effect by inducing abnormal nucleocapsid proteins (NP) condensates, which are degraded via the autophaglysoomal pathway. SARS-CoV-2 encodes four structural proteins, spike (S), envelope (E), membrane (M), and nucleocapsid (NP). NP is highly expressed in infected cells, conserved across strains, and implicated in inflammatory responses and \"long COVID\". Reducing NP expression can impair viral replication and limit inflammation. The studies suggest that ciclopirox targets NP to disrupt SARS-CoV-2 replication and also alleviates lung pathology in infected mice by suppressing inflammation [47]. In the field of immunology, ciclopirox olamine may offer novel approaches in the management of Acquired Immunodeficiency Syndrome (AIDS). It has been found to inhibit HIV replication by affecting the translation initiation factor eIF5A, which is essential for viral replication [48]. Importantly, this drug also blocks viral gene expression through a unique mechanism, affecting the 5\({}^{\prime}\) untranslated regions of HIV, potentially enabling it to combat HIV drug resistance. Additionally, its antiviral properties have been demonstrated against human papillomavirus (HPV) and other viral infections, and it also plays a role in preventing cyst formation in polycystic kidney disease [1]. Furthermore, ciclopirox olamine may have a beneficial effect on the treatment of type I diabetes. By inhibiting the enzyme deoxyhypusine hydroxylase (DOHH), which plays a role in the pathogenesis of the disease, ciclopirox olamine could be a useful therapeutic agent. Additionally, its ability to promote angiogenesis may be utilized in the treatment of diabetic complications, such as diabetic foot [10]. Ciclopirox exerts therapeutic effects by interacting with uroporphyrinogen III synthase, an enzyme whose deficiency is the underlying cause of congenital erythropoietin (CEP). It binds to an allosteric site located away from the enzyme's active site, enabling its stabilization without disrupting its catalytic function.