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Ethanolic fraction of neem leaf (EFNL) is a botanical extract derived from the leaves of the neem tree (*Azadirachta indica*). Developed primarily by researchers at the Texas Tech University Health Sciences Center, EFNL is being investigated for its potential antineoplastic properties, particularly in the treatment of breast cancer, including estrogen receptor-positive (ER+) and triple-negative breast cancer (TNBC). EFNL exerts its anticancer effects by inducing the generation of reactive oxygen species (ROS), which subsequently inhibits the phosphorylation and activation of pro-survival signaling pathways, including Akt, mTOR, and NF-κB. Additionally, EFNL treatment has been shown to upregulate pro-apoptotic proteins such as p53, Bax, Bad, caspases, and PTEN, while downregulating anti-apoptotic proteins (Bcl-2), angiogenic factors (VEGF-A, angiopoietin), and cell cycle regulators (cyclin D1, CDK2, CDK4).
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