Dimeric Artesunate Glycerophosphocholine Conjugate Nano-Assemblies as Slow-Release Antimalarials to Overcome Kelch 13 Mutant Artemisinin Resistance

Current best practice for the treatment of malaria relies on short half-life artemisinins that are failing against emerging Kelch 13 mutant parasite strains. Here, we introduce a liposome-like self-assembly of a dimeric artesunate glycerophosphocholine conjugate (dAPC-S) as an amphiphilic prodrug for the short-lived antimalarial drug, dihydroartemisinin (DHA), with enhanced killing of Kelch 13 mutant artemisinin-resistant parasites. Cryo-electron microscopy (cryoEM) images and the dynamic light scattering (DLS) technique show that dAPC-S typically exhibits a multilamellar liposomal structure with a size distribution similar to that of the liposomes generated using thin-film dispersion (dAPC-L). Liquid chromatography-mass spectrometry (LCMS) was used to monitor the release of DHA. Sustainable release of DHA from dAPC-S and dAPC-L assemblies increased the effective dose and thus efficacy against Kelch 13 mutant artemisinin-resistant parasites in an in vitro assay. To better understand the enhanced killing effect, we investigated processes for deactivation of both the assemblies and DHA, including the roles of serum components and trace levels of iron. Analysis of parasite proteostasis pathways revealed that dAPC assemblies exert their activity via the same mechanism as DHA. We conclude that this easily prepared multilamellar liposome-like dAPC-S with long-acting efficacy shows potential for the treatment of severe and artemisinin-resistant malaria.

An ultrasensitive chemiluminescent biosensor for tracing glutathione in human serum using BSA@AuNCs as a peroxidase-mimetic nanozyme on a luminol/artesunate system

In this work, a nanosensor chemiluminescent (CL) probe for sensing glutathione (GSH) was developed, for the first time, based on its inhibition of the intrinsic peroxidase-mimetic effect of BSA@AuNCs. The endoperoxide linkage of artesunate could be hydrolyzed by BSA@AuNCs resulting in the release of reactive oxygen species (ROS), and the consequent generation of strong CL emission. By virtue of the strong covalent interactions of -S⋯Au-, GSH could greatly suppress the peroxidase-mimetic effect of BSA@AuNCs, leading to a drastic CL quenching. The CL quenching efficiency increased proportionally to the logarithm of GSH concentration through the linearity range of 50.0-5000.0 nM with a limit of detection of 5.2 nM. This CL-based strategy for GSH tracing demonstrated the advantages of ultrasensitivity, high selectivity and simplicity. This strategy was successfully utilized to measure GSH levels in human serum with reasonable recovery results of 98.71%, 103.18%, and 101.68%, suggesting that this turn-off CL sensor is a promising candidate for GSH in biological and clinical samples.

Artesunate-luminol chemiluminescence system for the detection of hemin

Fabricating simple, accurate and user-friendly diagnostic device for "point of care testing" (POCT) applications is one of the most challenging objectives in the analytical field. Hemin detection is important for drugs monitoring, diagnosis, and forensic latent bloodstain imaging. Herein is developed, luminol chemiluminescence biosensor for hemin detection using artesunate as coreactant. A possible mechanism to account for the chemiluminescence reaction is discussed. Hemin was detected using both photomultiplier tube (PMT) and smartphone as detector. The detection limit for hemin using smartphone as detector is 20 nM, enabling the visual detection of hemin in blood sample with a dilution factor of blood up to 120,000. While PMT detector is used, the system is able to detect hemin down to 0.22 nM. In addition to high sensitivity, this sensing system exhibit high selectivity. It can successfully distinguish bloodstain from other stains while applying the system for point of care testing using smart phone as detector. Moreover, the system can detect artesunate with a linear range from 0.1 nM to 1.0 μM with a limit of detection of 0.078 nM.

Monoclonal Antibodies That Recognize the Alkylation Signature of Antimalarial Ozonides OZ277 (Arterolane) and OZ439 (Artefenomel)

The singular structure of artemisinin, with its embedded 1,2,4-trioxane heterocycle, has inspired the discovery of numerous semisynthetic artemisinin and structurally diverse synthetic peroxide antimalarials, including ozonides OZ277 (arterolane) and OZ439 (artefenomel). Despite the critical importance of artemisinin combination therapies (ACTs), the precise mode of action of peroxidic antimalarials is not fully understood. However, it has long been proposed that the peroxide bond in artemisinin and other antimalarial peroxides undergoes reductive activation by ferrous heme released during hemoglobin digestion to produce carbon-centered radicals that alkylate heme and parasite proteins. To probe the mode of action of OZ277 and OZ439, this paper now describes initial studies with monoclonal antibodies that recognize the alkylation signature (sum of heme and protein alkylation) of these synthetic peroxides. Immunofluorescence experiments conducted with ozonide-treated parasite cultures showed that ozonide alkylation is restricted to the parasite, as no signal was found in the erythrocyte or its membrane. In Western blot experiments with ozonide-treated Plasmodium falciparum malaria parasites, distinct protein bands were observed. Significantly, no protein bands were detected in parallel Western blot experiments performed with lysates from ozonide-treated Babesia divergens, parasites that also proliferate inside erythrocytes but, in contrast to P. falciparum, do not catabolize hemoglobin. However, subsequent immunoprecipitation experiments with these antibodies failed to identify the P. falciparum proteins alkylated by OZ277 and OZ439. To the best of the authors’ knowledge, this shows for the first time that antimalarial ozonides, such as the artemisinins, alkylate proteins in P. falciparum.

Iron and heme metabolism in Plasmodium falciparum and the mechanism of action of artemisinins

During the asexual blood stage of its lifecycle, the malaria parasite Plasmodium falciparum grows and multiplies in the hemoglobin-rich environment of the human erythrocyte. Although the parasite has evolved unique strategies to survive in this environment, its interaction with iron represents an Achilles' heel that is exploited by many antimalarial drugs. Recent work has shed new light on how the parasite deals with hemoglobin breakdown products and on the role of iron as a mediator of the action of the antimalarial drug, artemisinin.

Comparative antimalarial activities and ADME profiles of ozonides (1,2,4-trioxolanes) OZ277, OZ439, and their 1,2-dioxolane, 1,2,4-trioxane, and 1,2,4,5-tetraoxane isosteres

To ascertain the structure-activity relationship of the core 1,2,4-trioxolane substructure of dispiro ozonides OZ277 and OZ439, we compared the antimalarial activities and ADME profiles of the 1,2-dioxolane, 1,2,4-trioxane, and 1,2,4,5-tetraoxane isosteres. Consistent with previous data, both dioxolanes had very weak antimalarial properties. For the OZ277 series, the trioxane isostere had the best ADME profile, but its overall antimalarial efficacy was not superior to that of the trioxolane or tetraoxane isosteres. For the OZ439 series, there was a good correlation between the antimalarial efficacy and ADME profiles in the rank order trioxolane > trioxane > tetraoxane. As we have previously observed for OZ439 versus OZ277, the OZ439 series peroxides had superior exposure and efficacy in mice compared to the corresponding OZ277 series peroxides.

In vitro interaction of artemisinin derivatives or the fully synthetic peroxidic anti-malarial OZ277 with thapsigargin in Plasmodium falciparum strains

Background

Semi-synthetic artemisinin derivatives are powerful peroxidic drugs in artemisinin-based combination therapy (ACT) recommended as first-line treatment of Plasmodium falciparum malaria in disease-endemic countries. Studies by Eckstein-Ludwig and co-workers showed both thapsigargin and artemisinin specifically inhibit the sarcoplasmic reticulum Ca²⁺−ATPase of Plasmodium falciparum (PfATP6). In the present study the type of interaction between thapsigargin and artemisinin derivatives as well as the ozonide OZ277 (RBx11160 or arterolane) was evaluated in parasite cultures. The latter compound is an adamantane-based peroxide and the first fully synthetic clinical candidate recently registered in India by Ranbaxy Laboratories Ltd. for anti-malarial combination therapy.

Methods

Drug interaction studies were performed using a previously described fixed ratio method and anti-malarial activity measured using the [³H] hypoxanthine incorporation assay.

Results

The sum 50% and 90% fractional inhibitory concentration (∑FIC_{50, 90}) of the interaction of thapsigargin with OZ277, artemether or artesunate, against NF54 and K1 strains of P. falciparum ranged from 0.9 to 1.4.

Conclusion

The interaction of thapsigargin with OZ277, artesunate or artemether was additive, data consistent with previous observations indicating that activity of anti-malarial peroxides does not derive from reversible interactions with parasite targets.