Showing posts with label Malaria Drug. Show all posts
Showing posts with label Malaria Drug. Show all posts

Saturday, October 24, 2015

Drugs in Clinical Pipeline: Artefenomel

Artefenomel  [4-(2-{4-[(1s,1''R,3''S,4s,5'r,5''S,7''S)-Dispiro[cyclohexane-1,3'-[1,2,4]trioxolane-5',2''-tricyclo[3.3.1.13,7]decan]-4-yl]phenoxy}ethyl)morpholine] is a synthetic peroxide antimalarial drug candidate designed to provide a single-dose oral cure in humans. The outstanding efficacy and prolonged blood concentrations of Artefenomel are the result of a design strategy that stabilizes the intrinsically unstable pharmacophoric peroxide bond, thereby reducing clearance yet maintaining the necessary Fe(II)-reactivity to elicit parasite death. In vitro, Artefenomel is fast-acting against all asexual erythrocytic Plasmodium falciparum stages with IC50 values comparable to those for the clinically used artemisinin derivatives. Unlike all other synthetic peroxides and semisynthetic artemisinin derivatives, Artefenomel completely cures Plasmodium berghei-infected mice with a single oral dose of 20 mg/kg and exhibits prophylactic activity superior to that of the benchmark chemoprophylactic agent, Mefloquine. Compared with other peroxide-containing antimalarial agents, such as the artemisinin derivatives and the first-generation ozonide OZ277, Artefenomel exhibits a substantial increase in the pharmacokinetic half-life and blood concentration versus time profile in three preclinical species. These exceptional antimalarial and pharmacokinetic properties led to its selection as a clinical drug development candidate. Artefenomel has successfully completed Phase I clinical trials, where it was shown to be safe at doses up to 1,600 mg and is currently undergoing Phase IIa trials in malaria patients [1].


References:
1. Charma, S. A.; et. al. Synthetic ozonide drug candidate OZ439 offers new hope for a single-dose cure of uncomplicated malaria. Proc Natl Acad Sci U S A 2011, 108(11), 4400-4405.

Wednesday, October 21, 2015

Drugs in Clinical Pipeline: Tafenoquine

Tafenoquine [N-[2,6-Dimethoxy-4-methyl-5-[3-(trifluoromethyl)phenoxy]quinolin-8-yl]pentane-1,4-diamine] is a Primaquine analogue. It is a member of the 8-aminoquinoline group of drugs that includes Primaquine and seldom used drug, Pamaquine. Tafenoquine is being manufactured by GlaxoSmithKline, where the drug is being investigated as a potential treatment for malaria, as well as for malaria prevention [1]. Tafenoquine is a long-acting analogue of primaquine. For non-immune travelers travelling to endemic areas for few weeks, Tafenoquine, has the potential to be the drug of choice. Besides, on leaving the endemic region, Tafenoquine need not be continued as it has an extended half-life and potential transmission blocking properties. Hence there are minimum chances of treatment failure due to non-compliance.

The distinct advantages of Tafenoquine are:

1. Proven activity against blood and liver stage parasites.

2. It has a long half life.

3. Better compliance.

4. Potential of being the drug of choice for travelers to endemic areas for short periods.

5. The drug can be stopped immediately upon leaving endemic area.

6. Chemoprophylactic properties against both P. falciparum and P. vivax.

7. The drug has a potential for radical cure of P. vivax.

8. Moreover, it has additional gametocidal and sporontocidal activity.

In December 2013, US Food and Drug Administration (US-FDA) granted "breakthrough therapy" designation for the investigational antimalarial drug Tafenoquine. Co-developers GlaxoSmithKline and the Medicines for Malaria Venture, have credited this to the ability of Tafenoquine to target Plasmodium vivax malaria, including a form that lies dormant in the liver and causes relapse of infection within weeks to months of the initial mosquito bite. An estimated 70 million to 390 million clinical cases of uncomplicated malaria caused by P. vivax occur annually with significant public health and economic consequences in South and East Asia, Latin America, and the horn of Africa. The drug, administered in a single dose, would be indicated for both malaria treatment and relapse prevention.


Common Name: Tafenoquine
Synonyms: SB-252263; SB252263; SB 252263; WR-238605; WR238605; WR 238605
IUPAC Name: N-[2,6-Dimethoxy-4-methyl-5-[3-(trifluoromethyl)phenoxy]quinolin-8-yl]pentane-1,4-diamine
CAS Number: 106635-80-7
Mechanism of Action: 
Indication: Anti-Malarial
Development Stage: Phase III
Company: GlaxoSmithKline/Medicines for Malaria Venture

References:
1. Prashar, L.; et. al. Tafenoquine: A New 8-Aminoquinoline. Medical Journal of Zambia 2009, 36(4), 187-190.

Thursday, May 21, 2015

Gra17 And Gra23 Proteins As New Target For Anti-Malaria Drugs

Gra17 And Gra23 Proteins As New Target For Anti-Malaria Drugs

In a paper published in Cell Host and Microbe, the researchers describe how they identified novel drug targets while studying the way in which the parasites Toxoplasma gondii (which causes toxoplasmosis), and Plasmodium, (which causes malaria), access vital nutrients from their host cells.

Pathogens that cause malaria and tuberculosis spend a large portion of their life inside specially built compartments within their host cells. These compartments, termed as “parasitophorous vacuoles,” separate the host cytoplasm and the parasite by a membrane, and thereby protect the parasites from the host cell’s defenses. These "vacuoles" appeared to be designed in such a manner that its membrane acts as a barrier between the parasite and the host cell. This makes it more difficult for the parasite to release proteins involved in the transformation of the host cell beyond the membrane in order to spread the disease, and for the pathogen to gain access to vital nutrients.

Previous research has shown that the vacuoles are selectively permeable to small molecules, allowing certain nutrients to pass through pores in the membrane. But until now, no one has been able to determine the molecular makeup of these pores, and how they are formed.

Researchers used the most basic knowledge of survival to solve this riddle. A parasite by definition will hunt for certain key nutrients from their host. So it will evolve some mechanism to overcome these “vacuoles” membrane issues to gain access to these nutrients. The researchers discovered two proteins namely GRA17 and GRA23, secreted by the parasite Toxoplasma, which are responsible for forming these pores in the vacuole.  Though it was found by an accident (as all good researches have been ), while investigating how the parasites are able to release their own proteins out into the host cell beyond the vacuole membrane after invasion. Similar research into how the related Plasmodium pathogen performs this trick had identified a so-called “protein export complex” that transports encoded proteins from the parasite into its host red blood cell, which transforms these red blood cells in a way that is vital to the spread of malaria.

Moreover, researchers identified proteins secreted by Toxoplasma that appeared to be homologues, or of shared ancestry to, this protein export complex in Plasmodium.

In the next step, researchers planned experiments to find out what these proteins do to help the parasite survive. When researchers stopped these proteins from functioning, they found it made no difference to the export of proteins from the parasite beyond the vacuole. This meant that these proteins are involved in something more important that protein export, which might be small molecule transfer (as in survival important). So, in step two researchers added dyes to the host cell, and again knocked out the two proteins, the researchers found that it prevented the dyes flowing into the vacuole. More significantly though, when the researchers expressed a Plasmodium export complex gene in the modified Toxoplasma, they found that the dyes were able to flow into the vacuole once again, suggesting that this small-molecule transport function had been restored.

The authors summed up their works in these important statements:

1. Crucially, since these proteins are only found in the parasite phylum Apicomplexa, to which both Toxoplasma and Plasmodium belong, they could be used as a drug target against the diseases.

2. This is a really strong potential drug target for restricting the access of these parasites to a set of nutrients.

3. In addition to malaria, the technique could also be used to target the parasite Eimeria, which affects cattle and poultry, among other animals, and therefore has a huge economic cost.


Article Citation: Gold, D. A.; et. al. The Toxoplasma Dense Granule Proteins GRA17 and GRA23 Mediate the Movement of Small Molecules between the Host and the Parasitophorous Vacuole. Cell Host Microbe 2015, 17(5), 642-652.

Friday, April 17, 2015

SAYE: An Antimalarial Phytomedicine from Burkina Faso

SAYE: An Antimalarial Phytomedicine from Burkina Faso

Burkina Faso (formerly called the Republic of Upper Volta) is a landlocked country in West Africa around 274,200 square kilometres (105,900 sq mi) in size. It is surrounded by six countries: Mali to the north; Niger to the east; Benin to the southeast; Togo and Ghana to the south; and Ivory Coast to the southwest. Its capital is Ouagadougou.

Like many other African countries, Burkina Faso faces malaria as one of the biggest human killer disease. The humane laws in Burkina Faso officially recognizes traditional medicine as part of the health system (Loi No 23/94/ADP). The national policy on traditional medicine aims to integrate traditional medical practices and medicinal products derived from the traditional pharmacopoeia into the national health care system in order to improve access to medicines for the whole population.


SAYE sounds like CHAI, thats North-Indian word for TEA

Using this life-promoting law, Dr. Zéphirin Dakuyo promotes/sells mixture named SAYE, which literally means “jaundice” in the local Dioula language. SAYE is manufactured by mixing the three dried and coarsely chopped ingredients in the proportions given in Table. It is sold in a box of 175 g of the chopped, dried plant parts. Patients are instructed to mix 3 tablespoons of the dried plant material in two glasses of water, boil the mixture for 5 minutes, filter it, and drink it. Adults should drink one large glass three times a day, and children age 7 years and older are advised to drink half a glass three times a day for 5 days.

Component Amount per box (g) Amount per batch (kg)
C. planchonii Hook. f. ex Planch. (Bixaceae) rhizome 115 230
Cassia alata L. (Caesalpiniaceae) leaves 25 50
Phyllanthus amarus Schumach. (Euphorbiaceae) whole plant 35 70

Dr. Zéphirin Dakuyo was the first pharmacist to be posted in Banfora Hospital in Southwest Burkina Faso, in 1983. At the time, chloroquine was the first-line treatment for malaria, but it has since been abandoned because of high levels of drug resistance. He soon received feedback from patients that they did not like chloroquine but preferred to treat themselves with herbal medicines, in particular the roots of N'Dribala (Cochlospermum planchonii). However, they did not have time to collect this medicinal plant themselves, so Dr. Dakuyo, with support from the hospital staff, started to harvest and package it for the patients. The medicine was sold at the hospital to patients with malaria and was also provided to community health workers to supply to patients.

Dr. Dakuyo received feedback from patients that SAYE was even more effective than N'Dribala for treating malaria, and patients started buying it for this condition. In 1986, Dr. Dakuyo also developed capsules of powdered SAYE because he found that many patients did not have time to boil the herbs every day.

In 1993, Dr. Dakuyo left the hospital to start his own pharmacy; he also set up a small factory for producing the herbal medicine. As demand increased and he began producing other herbal products, the size of the factory gradually increased. In 2001 it was registered as a company, Phytofla. In 2005, SAYE and N'Dribala both received an official license from the Ministry of Health for the treatment of uncomplicated malaria. Annual sales now stand at 60,000 boxes of SAYE and 25,000 boxes of N'Dribala. Although Artemisinin-based Combination Therapies (ACTs) are widely available in Burkina Faso, they are expensive and are believed to have some adverse effects. Therefore, many adult patients still prefer to use SAYE, sometimes in combination with a modern medicine and sometimes alone.

Article citation: Dakuyo, Z.; et. al. SAYE: The Story of an Antimalarial Phytomedicine from Burkina Faso. The Journal of Alternative and Complementary Medicine 2015, 21(4), 187-195.

Herbal medicine is Ayurveda

Friday, April 3, 2015

Novel Antimalarial Scaffolds From Astrazeneca

The widespread emergence and dissemination of Plasmodium falciparum (Pf) strains resistant to conventional antimalarial drugs has intensified the efforts to discover and develop novel, structurally diverse drugs against multidrug-resistant Plasmodium strains. This situation is further aggravated by the emergence of Pf strains resistant to artemisinin derivatives in various part of Asia [1].

Scaffolds disclosed:
1. Triaminopyrimidine [1]
2. Aminoazabenzimidazoles [2]
3. N-Aryl-2-Aminobenzimidazoles [3]

Triaminopyrimidine

Authors report the discovery and optimization of novel antimalarial compounds, the triaminopyrimidines (TAPs), which emerged from a phenotypic screen against the blood stages of Pf. The clinical candidate (named as compound 12) is efficacious in a mouse model of Pf malaria with an ED99  less than 30-mgkg-1 in vivo safety margins in guinea pigs and rats. With a predicted half-life of 36 h in humans, a single dose of 260 mg might be sufficient to maintain therapeutic blood concentration for 4-5 days.

Compound 12, IUPAC name: (R)-N2-(4-cyclopropyl-5-fluoro-6-methylpyridin-2-yl)-N4-(1, 5-dimethyl-1H-pyrazol-3-yl)-5-(3, 4-dimethylpiperazin-1-yl)pyrimidine-2,4-diamine

Procedure:
(A) Pyridine, microwave, 150 °C, 45 min. 
(B) (i) POCl3, reflux, 6 h 
(ii) sodium carbonate, di-tert-butyl dicarbonate, room temperature, 16 h. 
(C) N,N-Diisopropylethylamine (DIPEA), ethanol, microwave, 110 °C, 1 h. 
(D) (i) Potassium tert-butoxide, 2,2'-bis(diphenylphosphino)-1,1'-binaphthyl (BINAP), pd2(dba)3, toluene, reflux, 12 h. 
(E) HCl (4 N) in dioxane, 15-30 min. 
(F) Compound 9, DIPEA, dichloromethane, formaldehyde (HCHO), sodium cyanoborohydride, 15 min.



References:
1. Sambandamurthy, V. K.; et. al. Triaminopyrimidine is a fast-killing and long-acting antimalarial clinical candidate. Nat Commun 2015, 6, Article number: 6715 doi:10.1038/ncomms7715
2. Hameed, P. S.; et. al. Aminoazabenzimidazoles, a novel class of orally active antimalarial agents. J Med Chem 2014, 57(13), 5702-5713.
3. Ramachandran, S.; et. al. N-aryl-2-aminobenzimidazoles: novel, efficacious, antimalarial lead compounds. J Med Chem 2014, 57(15), 6642-6652.