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Gupta AK, Eliasen AM, Andahazy W, Zhou F, Henson K, Chi V, Woods AK, Joseph SB, Kuhen KL, Wisler J, Ramachandruni H, Duffy J, Burrows JN, Vadas E, Slade A, Schultz PG, McNamara CW, Chatterjee AK. A Prodrug Strategy to Reposition Atovaquone as a Long-Acting Injectable for Malaria Chemoprotection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.08.579395. [PMID: 38979188 PMCID: PMC11230151 DOI: 10.1101/2024.02.08.579395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Recent malaria drug discovery approaches have been extensively focused on the development of oral, smallmolecule inhibitors for disease treatment whereas parenteral routes of administration have been avoided due to limitations in deploying a shelf-stable injectable even though it could be dosed less frequently. However, an updated target candidate profile from Medicines for Malaria Venture (MMV) and stakeholders have advocated for long-acting injectable chemopreventive agents as an important interventive tool to improve malaria prevention. Here, we present strategies for the development of a long-acting, intramuscular, injectable atovaquone prophylactic therapy. We have generated three prodrug approaches that are contrasted by their differential physiochemical properties and pharmacokinetic profiles: mCBK068, a docosahexaenoic acid ester of atovaquone formulated in sesame oil, mCKX352, a heptanoic acid ester of atovaquone formulated as a solution in sesame oil, and mCBE161, an acetic acid ester of atovaquone formulated as an aqueous suspension. As a result, from a single 20 mg/kg intramuscular injection, mCKX352 and mCBE161 maintain blood plasma exposure of atovaquone above the minimal efficacious concentration for >70 days and >30 days, respectively, in cynomolgus monkeys. The differences in plasma exposure are reflective of the prodrug strategy, which imparts altered chemical properties that ultimately influence aqueous solubility and depot release kinetics. On the strength of the pharmacokinetic and safety profiles, mCBE161 is being advanced as a first-in-class clinical candidate for first-in-human trials.
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Pertinez H, Kaushik A, Curley P, Arshad U, El-Khateeb E, Li SY, Tasneen R, Sharp J, Kijak E, Herriott J, Neary M, Noë M, Flexner C, Nuermberger E, Owen A, Ammerman NC. Hyaluronidase impacts exposures of long-acting injectable paliperidone palmitate in rodent models. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.03.583160. [PMID: 38496644 PMCID: PMC10942359 DOI: 10.1101/2024.03.03.583160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
A significant challenge in the development of long-acting injectable drug formulations, especially for anti-infective agents, is delivering an efficacious dose within a tolerable injection volume. Co-administration of the extracellular matrix-degrading enzyme hyaluronidase can increase maximum tolerable injection volumes but is untested for this benefit with long-acting injectable formulations. One concern is that hyaluronidase could potentially alter the tissue response surrounding an injection depot, a response known to be important for drug release kinetics of long-acting injectable formulations. The objective of this pilot study was to evaluate the impact of co-administration of hyaluronidase on the drug release kinetics, pharmacokinetic profiles, and injection site histopathology of the long-acting injectable paliperidone palmitate for up to four weeks following intramuscular injection in mouse and rat models. In both species, co-administration of hyaluronidase increased paliperidone plasma exposures the first week after injection but did not negate the overall long-acting release nature of the formulation. Hyaluronidase-associated modification of the injection site depot was observed in mice but not in rats. These findings suggest that further investigation of hyaluronidase with long-acting injectable agents is warranted.
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Affiliation(s)
- Henry Pertinez
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Amit Kaushik
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Paul Curley
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Usman Arshad
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Eman El-Khateeb
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Si-Yang Li
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Rokeya Tasneen
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Joanne Sharp
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Edyta Kijak
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Joanne Herriott
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Megan Neary
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Michaël Noë
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands
| | - Charles Flexner
- Departments of Medicine and Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Andrew Owen
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Nicole C. Ammerman
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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Scarsi KK, Sayles H, Kapungu K, Sifuna P, Ippolito MM, Furl R, Anderson MJ, Ofimboudem JD, Chongwe G, Hutter J, Rannard SP, Owen A, Swindells S. Preferences of Patients and Providers in High-Burden Malaria Settings for Long-Acting Malaria Chemoprevention. Am J Trop Med Hyg 2023; 109:752-760. [PMID: 37604474 PMCID: PMC10551098 DOI: 10.4269/ajtmh.23-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/29/2023] [Indexed: 08/23/2023] Open
Abstract
Antimalarial medications are recommended for chemoprevention as part of malaria control programs to decrease the morbidity and mortality related to more than 200 million infections each year. We sought to evaluate patient and provider acceptability of malaria chemoprevention in a long-acting formulation. We administered questionnaires to patients and providers in malaria endemic districts in Kenya and Zambia. Questions explored preferences and concerns around long-acting antimalarial formulations compared with oral formulations. We recruited 202 patient respondents (Kenya, n = 102; Zambia, n = 100) and 215 provider respondents (Kenya, n = 105; Zambia, n = 110). Long-acting injection was preferred to oral pills, whereas oral pills were preferred to implant or transdermal administration by patient respondents. Of 202 patient respondents, 80% indicated that they 'definitely would try' malaria chemoprevention offered by injection instead of oral pills. Of parents or guardians, 84% of 113 responded that they 'definitely would' have their child age < 12 years and 90% of 88 'definitely would' have their child ≥12 years receive an injection for malaria prevention. Provider respondents indicated that they would be more likely to prescribe a long-acting injectable product compared with an oral product for malaria chemoprevention in adults (70%), adolescents ages 12 years and older (67%), and children <12 years (81%). Potential for prolonged adverse effects with long-acting products was the highest concern for patient respondents, while higher medication-related cost was cited as the most concerning barrier to implementation by providers. Overall, these findings indicate enthusiasm for the development of long-acting injectable antimalarials to provide individual delivery method options across age groups.
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Affiliation(s)
- Kimberly K. Scarsi
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Harlan Sayles
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kelvin Kapungu
- Department of Public Health and Epidemiology, Tropical Diseases Research Centre, Ndola, Zambia
| | - Peter Sifuna
- Kombewa Clinical Research Center, Kenya Medical Research Institute (KEMRI)/U.S. Army Medical Research Directorate–Africa (USAMRD-A), Kisumu, Kenya
| | - Matthew M. Ippolito
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Malaria Research Institute, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Renae Furl
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew J. Anderson
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Jack Hutter
- Kombewa Clinical Research Center, Kenya Medical Research Institute (KEMRI)/U.S. Army Medical Research Directorate–Africa (USAMRD-A), Kisumu, Kenya
| | - Steven P. Rannard
- Department of Chemistry, Centre of Excellence in Long-Acting Therapeutics (CELT), University of Liverpool, Liverpool, United Kingdom
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Susan Swindells
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Xu M, Hu YX, Lu SN, Idris MA, Zhou SD, Yang J, Feng XN, Huang YM, Xu X, Chen Y, Wang DQ. Seasonal malaria chemoprevention in Africa and China's upgraded role as a contributor: a scoping review. Infect Dis Poverty 2023; 12:63. [PMID: 37403183 DOI: 10.1186/s40249-023-01115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Children under five are the vulnerable population most at risk of being infected with Plasmodium parasites, especially in the Sahel region. Seasonal malaria chemoprevention (SMC) recommended by World Health Organization (WHO), has proven to be a highly effective intervention to prevent malaria. Given more deaths reported during the COVID-19 pandemic than in previous years due to the disruptions to essential medical services, it is, therefore, necessary to seek a more coordinated and integrated approach to increasing the pace, coverage and resilience of SMC. Towards this end, fully leverage the resources of major players in the global fight against malaria, such as China could accelerate the SMC process in Africa. METHODS We searched PubMed, MEDLINE, Web of Science, and Embase for research articles and the Institutional Repository for Information Sharing of WHO for reports on SMC. We used gap analysis to investigate the challenges and gaps of SMC since COVID-19. Through the above methods to explore China's prospective contribution to SMC. RESULTS A total of 68 research articles and reports were found. Through gap analysis, we found that despite the delays in the SMC campaign, 11.8 million children received SMC in 2020. However, there remained some challenges: (1) a shortage of fully covered monthly courses; (2) lack of adherence to the second and third doses of amodiaquine; (3) four courses of SMC are not sufficient to cover the entire malaria transmission season in areas where the peak transmission lasts longer; (4) additional interventions are needed to consolidate SMC efforts. China was certified malaria-free by WHO in 2021, and its experience and expertise in malaria elimination can be shared with high-burden countries. With the potential to join the multilateral cooperation in SMC, including the supply of quality-assured health commodities, know-how transfer and experience sharing, China is expected to contribute to the ongoing scale-up of SMC. CONCLUSIONS A combination of necessary preventive and curative activities may prove beneficial both for targeted populations and for health system strengthening in the long run. More actions are entailed to promote the partnership and China can be one of the main contributors with various roles.
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Affiliation(s)
- Ming Xu
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yun-Xuan Hu
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Shen-Ning Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, China
| | | | - Shu-Duo Zhou
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jian Yang
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xiang-Ning Feng
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yang-Mu Huang
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xian Xu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Ying Chen
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
| | - Duo-Quan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, China.
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Miglianico M, Bolscher JM, Vos MW, Koolen KJM, de Bruijni M, Rajagopal DS, Chen E, Kiczun M, Gray D, Campo B, Sauerwein RW, Dechering KJ. Assessment of the drugability of initial malaria infection through miniaturized sporozoite assays and high-throughput screening. Commun Biol 2023; 6:216. [PMID: 36823266 PMCID: PMC9950425 DOI: 10.1038/s42003-023-04599-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
The sporozoite stages of malaria parasites are the primary cause of infection of the vertebrate host and are targeted by (experimental) vaccines. Yet, little is known about their susceptibility to chemical intervention. Phenotypic high-throughput screens have not been feasible due to a lack of in vitro systems. Here we tested 78 marketed and experimental antimalarial compounds in miniaturized assays addressing sporozoite viability, gliding motility, hepatocyte traversal, and intrahepatocytic schizogony. None potently interfered with sporozoite viability or motility but ten compounds acted at the level of schizogony with IC50s < 100 nM. To identify compounds directly targeting sporozoites, we screened 81,000 compounds from the Global Health Diversity and reFRAME libraries in a sporozoite viability assay using a parasite expressing a luciferase reporter driven by the circumsporozoite promoter. The ionophore gramicidin emerged as the single hit from this screening campaign. Its effect on sporozoite viability translated into reduced gliding motility and an inability of sporozoites to invade human primary hepatocytes and develop into hepatic schizonts. While providing proof of concept for a small molecule sporontocidal mode of action, our combined data indicate that liver schizogony is more accessible to chemical intervention by (candidate) antimalarials.
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Affiliation(s)
| | | | | | | | | | | | - Emily Chen
- Calibr, a division of The Scripps Research Institute, La Jolla, California, United States of America
| | - Michael Kiczun
- Drug Discovery Unit, University of Dundee, Dundee, United Kingdom
| | - David Gray
- Drug Discovery Unit, University of Dundee, Dundee, United Kingdom
| | - Brice Campo
- Medicines for Malaria Venture, Geneva, Switzerland
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