1
|
Simwela NV, Guiguemde WA, Straimer J, Regnault C, Stokes BH, Tavernelli LE, Yokokawa F, Taft B, Diagana TT, Barrett MP, Waters AP. A conserved metabolic signature associated with response to fast-acting anti-malarial agents. Microbiol Spectr 2023; 11:e0397622. [PMID: 37800971 PMCID: PMC10714989 DOI: 10.1128/spectrum.03976-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/27/2023] [Indexed: 10/07/2023] Open
Abstract
IMPORTANCE In malaria drug discovery, understanding the mode of action of lead compounds is important as it helps in predicting the potential emergence of drug resistance in the field when these drugs are eventually deployed. In this study, we have employed metabolomics technologies to characterize the potential targets of anti-malarial drug candidates in the developmental pipeline at NITD. We show that NITD fast-acting leads belonging to spiroindolone and imidazothiadiazole class induce a common biochemical theme in drug-exposed malaria parasites which is similar to another fast-acting, clinically available drug, DHA. These biochemical features which are absent in a slower acting NITD lead (GNF17) point to hemoglobin digestion and inhibition of the pyrimidine pathway as potential action points for these drugs. These biochemical themes can be used to identify and inform on the mode of action of fast drug candidates of similar profiles in future drug discovery programs.
Collapse
Affiliation(s)
- Nelson V. Simwela
- Institute of Infection, Immunity and Inflammation, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, United Kingdom
| | | | - Judith Straimer
- Novartis Institute for Tropical Diseases, Emeryville, California, USA
| | - Clement Regnault
- Institute of Infection, Immunity and Inflammation, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, United Kingdom
| | - Barbara H. Stokes
- Institute of Infection, Immunity and Inflammation, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, United Kingdom
| | - Luis E. Tavernelli
- Institute of Infection, Immunity and Inflammation, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, United Kingdom
| | - Fumiaki Yokokawa
- Novartis Institute for Tropical Diseases, Emeryville, California, USA
| | - Benjamin Taft
- Novartis Institute for Tropical Diseases, Emeryville, California, USA
| | | | - Michael P. Barrett
- Institute of Infection, Immunity and Inflammation, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, United Kingdom
| | - Andrew P. Waters
- Institute of Infection, Immunity and Inflammation, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
2
|
Qiu D, Pei JV, Rosling JEO, Thathy V, Li D, Xue Y, Tanner JD, Penington JS, Aw YTV, Aw JYH, Xu G, Tripathi AK, Gnadig NF, Yeo T, Fairhurst KJ, Stokes BH, Murithi JM, Kümpornsin K, Hasemer H, Dennis ASM, Ridgway MC, Schmitt EK, Straimer J, Papenfuss AT, Lee MCS, Corry B, Sinnis P, Fidock DA, van Dooren GG, Kirk K, Lehane AM. A G358S mutation in the Plasmodium falciparum Na + pump PfATP4 confers clinically-relevant resistance to cipargamin. Nat Commun 2022; 13:5746. [PMID: 36180431 PMCID: PMC9525273 DOI: 10.1038/s41467-022-33403-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Diverse compounds target the Plasmodium falciparum Na+ pump PfATP4, with cipargamin and (+)-SJ733 the most clinically-advanced. In a recent clinical trial for cipargamin, recrudescent parasites emerged, with most having a G358S mutation in PfATP4. Here, we show that PfATP4G358S parasites can withstand micromolar concentrations of cipargamin and (+)-SJ733, while remaining susceptible to antimalarials that do not target PfATP4. The G358S mutation in PfATP4, and the equivalent mutation in Toxoplasma gondii ATP4, decrease the sensitivity of ATP4 to inhibition by cipargamin and (+)-SJ733, thereby protecting parasites from disruption of Na+ regulation. The G358S mutation reduces the affinity of PfATP4 for Na+ and is associated with an increase in the parasite’s resting cytosolic [Na+]. However, no defect in parasite growth or transmissibility is observed. Our findings suggest that PfATP4 inhibitors in clinical development should be tested against PfATP4G358S parasites, and that their combination with unrelated antimalarials may mitigate against resistance development. In a recent clinical trial for oral administration of cipargamin in individuals with malaria, there was an emergence of recrudescent parasites with a G358S mutation in PfATP4. In this work, the authors investigate the effect of this mutation on the function of the ATPase, on parasite growth and susceptibility to antimalarial drugs.
Collapse
Affiliation(s)
- Deyun Qiu
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Jinxin V Pei
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - James E O Rosling
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Vandana Thathy
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Dongdi Li
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Yi Xue
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - John D Tanner
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Jocelyn Sietsma Penington
- Bioinformatic Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
| | - Yi Tong Vincent Aw
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Jessica Yi Han Aw
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Guoyue Xu
- Department of Molecular Microbiology & Immunology and Johns Hopkins Malaria Institute, Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | - Abhai K Tripathi
- Department of Molecular Microbiology & Immunology and Johns Hopkins Malaria Institute, Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | - Nina F Gnadig
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Tomas Yeo
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Kate J Fairhurst
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Barbara H Stokes
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - James M Murithi
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | | | - Heath Hasemer
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Adelaide S M Dennis
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Melanie C Ridgway
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | | | - Judith Straimer
- Novartis Institute for Tropical Diseases, Emeryville, CA, 94608, USA
| | - Anthony T Papenfuss
- Bioinformatic Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Marcus C S Lee
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Ben Corry
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Photini Sinnis
- Department of Molecular Microbiology & Immunology and Johns Hopkins Malaria Institute, Johns Hopkins School of Public Health, Baltimore, MD, 21205, USA
| | - David A Fidock
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Center for Malaria Therapeutics and Antimicrobial Resistance, Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Giel G van Dooren
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Kiaran Kirk
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia
| | - Adele M Lehane
- Research School of Biology, Australian National University, Canberra, ACT, 2600, Australia.
| |
Collapse
|
3
|
Taft BR, Yokokawa F, Kirrane T, Mata AC, Huang R, Blaquiere N, Waldron G, Zou B, Simon O, Vankadara S, Chan WL, Ding M, Sim S, Straimer J, Guiguemde A, Lakshminarayana SB, Jain JP, Bodenreider C, Thompson C, Lanshoeft C, Shu W, Fang E, Qumber J, Chan K, Pei L, Chen YL, Schulz H, Lim J, Abas SN, Ang X, Liu Y, Angulo-Barturen I, Jiménez-Díaz MB, Gamo FJ, Crespo-Fernandez B, Rosenthal PJ, Cooper RA, Tumwebaze P, Aguiar ACC, Campo B, Campbell S, Wagner J, Diagana TT, Sarko C. Discovery and Preclinical Pharmacology of INE963, a Potent and Fast-Acting Blood-Stage Antimalarial with a High Barrier to Resistance and Potential for Single-Dose Cures in Uncomplicated Malaria. J Med Chem 2022; 65:3798-3813. [PMID: 35229610 PMCID: PMC9278664 DOI: 10.1021/acs.jmedchem.1c01995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
![]()
A series of 5-aryl-2-amino-imidazothiadiazole (ITD) derivatives
were identified by a phenotype-based high-throughput screening using
a blood stage Plasmodium falciparum (Pf) growth inhibition assay. A lead optimization program focused on
improving antiplasmodium potency, selectivity against human kinases,
and absorption, distribution, metabolism, excretion, and toxicity
properties and extended pharmacological profiles culminated in the
identification of INE963 (1), which demonstrates
potent cellular activity against Pf 3D7 (EC50 = 0.006 μM) and achieves “artemisinin-like”
kill kinetics in vitro with a parasite clearance
time of <24 h. A single dose of 30 mg/kg is fully curative in the Pf-humanized severe combined immunodeficient mouse model. INE963 (1) also exhibits a high barrier to resistance
in drug selection studies and a long half-life (T1/2) across species. These properties suggest the significant
potential for INE963 (1) to provide a curative
therapy for uncomplicated malaria with short dosing regimens. For
these reasons, INE963 (1) was progressed
through GLP toxicology studies and is now undergoing Ph1 clinical
trials.
Collapse
Affiliation(s)
- Benjamin R Taft
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Fumiaki Yokokawa
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Tom Kirrane
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Anne-Catherine Mata
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Richard Huang
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Nicole Blaquiere
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Grace Waldron
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Bin Zou
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Oliver Simon
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Subramanyam Vankadara
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Wai Ling Chan
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Mei Ding
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Sandra Sim
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Judith Straimer
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Armand Guiguemde
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Suresh B Lakshminarayana
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Jay Prakash Jain
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Christophe Bodenreider
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Christopher Thompson
- Novartis Institutes for Biomedical Research, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Christian Lanshoeft
- Novartis Institutes for Biomedical Research, Fabrikstrasse 14, Basel CH-4056, Switzerland
| | - Wei Shu
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Eric Fang
- Chemical Biology and Therapeutics, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| | - Jafri Qumber
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Katherine Chan
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Luying Pei
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Yen-Liang Chen
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Hanna Schulz
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Jessie Lim
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Siti Nurdiana Abas
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Xiaoman Ang
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Yugang Liu
- Technical Research and Development, Global Drug Development, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, New Jersey 07936, United States
| | - Iñigo Angulo-Barturen
- The Art of Discovery, Astondo Bidea, BIC Bizkaia building, no. 612 Derio 48160 Bizkaia, Basque Country, Spain
| | - María Belén Jiménez-Díaz
- The Art of Discovery, Astondo Bidea, BIC Bizkaia building, no. 612 Derio 48160 Bizkaia, Basque Country, Spain
| | - Francisco Javier Gamo
- Tres Cantos Medicines Development Campus, GlaxoSmithKline, Severo Ochoa 2, Tres Cantos, Madrid 28760, Spain
| | - Benigno Crespo-Fernandez
- Tres Cantos Medicines Development Campus, GlaxoSmithKline, Severo Ochoa 2, Tres Cantos, Madrid 28760, Spain
| | - Philip J Rosenthal
- Department of Medicine, University of California, 533 Parnassus Avenue, San Francisco, California 94143, Unites States
| | - Roland A Cooper
- Department of Natural Sciences and Mathematics, Dominican University of California, San Rafael, California 94901, United States
| | - Patrick Tumwebaze
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, P.O. Box 7475 Kampala, Uganda
| | | | - Brice Campo
- Medicines for Malaria Venture, 20 Route de Pre-Bois, 1215 Geneva 15, Switzerland
| | - Simon Campbell
- Medicines for Malaria Venture, 20 Route de Pre-Bois, 1215 Geneva 15, Switzerland
| | - Jürgen Wagner
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, no. 05-01, Chromos, Singapore 138670, Singapore
| | - Thierry T Diagana
- Novartis Institute for Tropical Diseases, 5959 Horton Street, Emeryville, California 94608, United States
| | - Christopher Sarko
- Global Discovery Chemistry, Novartis Institutes for Biomedical Research, 5959 Horton Street, Emeryville, California 94608, United States
| |
Collapse
|
4
|
Schmitt EK, Ndayisaba G, Yeka A, Asante KP, Grobusch MP, Karita E, Mugerwa H, Asiimwe S, Oduro A, Fofana B, Doumbia S, Su G, Csermak Renner K, Venishetty VK, Sayyed S, Straimer J, Demin I, Barsainya S, Boulton C, Gandhi P. Efficacy of cipargamin (KAE609) in a randomized, Phase II dose-escalation study in adults in sub-Saharan Africa with uncomplicated Plasmodium falciparum malaria. Clin Infect Dis 2021; 74:1831-1839. [PMID: 34410358 PMCID: PMC9155642 DOI: 10.1093/cid/ciab716] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Cipargamin (KAE609) is a potent antimalarial in a phase II trial. Here we report efficacy, pharmacokinetics, and resistance marker analysis across a range of cipargamin doses. These were secondary endpoints from a study primarily conducted to assess the hepatic safety of cipargamin (hepatic safety data are reported elsewhere). Methods This phase II, multicenter, randomized, open-label, dose-escalation trial was conducted in sub-Saharan Africa in adults with uncomplicated Plasmodium falciparum malaria. Cipargamin monotherapy was given as single doses up to 150 mg or up to 50 mg once daily for 3 days, with artemether-lumefantrine as control. Key efficacy endpoints were parasite clearance time (PCT), and polymerase chain reaction (PCR)–corrected and uncorrected adequate clinical and parasitological response (ACPR) at 14 and 28 days. Pharmacokinetics and molecular markers of drug resistance were also assessed. Results All single or multiple cipargamin doses ≥50 mg were associated with rapid parasite clearance, with median PCT of 8 hours versus 24 hours for artemether-lumefantrine. PCR-corrected ACPR at 14 and 28 days was >75% and 65%, respectively, for each cipargamin dose. A treatment-emerging mutation in the Pfatp4 gene, G358S, was detected in 65% of treatment failures. Pharmacokinetic parameters were consistent with previous data, and approximately dose proportional. Conclusions Cipargamin, at single doses of 50 to 150 mg, was associated with very rapid parasite clearance, PCR-corrected ACPR at 28 days of >65% in adults with uncomplicated P. falciparum malaria, and recrudescent parasites frequently harbored a treatment-emerging mutation. Cipargamin will be further developed with a suitable combination partner. Clinical Trials Registration ClinicalTrials.gov (NCT03334747).
Collapse
Affiliation(s)
| | | | - Adoke Yeka
- Infectious Diseases Research Collaboration, Busia, Uganda
| | | | - Martin P Grobusch
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,University of Tübingen, Tübingen, Germany
| | | | | | - Stephen Asiimwe
- Kabwohe Clinical Research Center and Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Guoqin Su
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | - Judith Straimer
- Novartis Institutes for BioMedical Research, Emeryville, California, USA
| | | | | | | | | |
Collapse
|
5
|
Stokes BH, Dhingra SK, Rubiano K, Mok S, Straimer J, Gnädig NF, Deni I, Schindler KA, Bath JR, Ward KE, Striepen J, Yeo T, Ross LS, Legrand E, Ariey F, Cunningham CH, Souleymane IM, Gansané A, Nzoumbou-Boko R, Ndayikunda C, Kabanywanyi AM, Uwimana A, Smith SJ, Kolley O, Ndounga M, Warsame M, Leang R, Nosten F, Anderson TJ, Rosenthal PJ, Ménard D, Fidock DA. Plasmodium falciparum K13 mutations in Africa and Asia impact artemisinin resistance and parasite fitness. eLife 2021; 10:66277. [PMID: 34279219 PMCID: PMC8321553 DOI: 10.7554/elife.66277] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/17/2021] [Indexed: 12/22/2022] Open
Abstract
The emergence of mutant K13-mediated artemisinin (ART) resistance in Plasmodium falciparum malaria parasites has led to widespread treatment failures across Southeast Asia. In Africa, K13-propeller genotyping confirms the emergence of the R561H mutation in Rwanda and highlights the continuing dominance of wild-type K13 elsewhere. Using gene editing, we show that R561H, along with C580Y and M579I, confer elevated in vitro ART resistance in some African strains, contrasting with minimal changes in ART susceptibility in others. C580Y and M579I cause substantial fitness costs, which may slow their dissemination in high-transmission settings, in contrast with R561H that in African 3D7 parasites is fitness neutral. In Cambodia, K13 genotyping highlights the increasing spatio-temporal dominance of C580Y. Editing multiple K13 mutations into a panel of Southeast Asian strains reveals that only the R561H variant yields ART resistance comparable to C580Y. In Asian Dd2 parasites C580Y shows no fitness cost, in contrast with most other K13 mutations tested, including R561H. Editing of point mutations in ferredoxin or mdr2, earlier associated with resistance, has no impact on ART susceptibility or parasite fitness. These data underline the complex interplay between K13 mutations, parasite survival, growth and genetic background in contributing to the spread of ART resistance.
Collapse
Affiliation(s)
- Barbara H Stokes
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Satish K Dhingra
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Kelly Rubiano
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Sachel Mok
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Judith Straimer
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Nina F Gnädig
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Ioanna Deni
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Kyra A Schindler
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Jade R Bath
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Kurt E Ward
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States.,Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Josefine Striepen
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Tomas Yeo
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Leila S Ross
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, United States
| | - Eric Legrand
- Malaria Genetics and Resistance Unit, Institut Pasteur, INSERM U1201, CNRS ERL9195, Paris, France
| | - Frédéric Ariey
- Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Clark H Cunningham
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Issa M Souleymane
- Programme National de Lutte Contre le Paludisme au Tchad, Ndjamena, Chad
| | - Adama Gansané
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Romaric Nzoumbou-Boko
- Laboratoire de Parasitologie, Institut Pasteur de Bangui, Bangui, Central African Republic
| | | | | | - Aline Uwimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Samuel J Smith
- National Malaria Control Program, Freetown, Sierra Leone
| | | | - Mathieu Ndounga
- Programme National de Lutte Contre le Paludisme, Brazzaville, Democratic Republic of the Congo
| | - Marian Warsame
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Rithea Leang
- National Center for Parasitology, Entomology & Malaria Control, Phnom Penh, Cambodia
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Philip J Rosenthal
- Department of Medicine, University of California, San Francisco, San Francisco, United States
| | - Didier Ménard
- Malaria Genetics and Resistance Unit, Institut Pasteur, INSERM U1201, CNRS ERL9195, Paris, France
| | - David A Fidock
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, United States
| |
Collapse
|
6
|
Straimer J, Gandhi P, Renner KC, Schmitt EK. High prevalence of P. falciparum K13 mutations in Rwanda is associated with slow parasite clearance after treatment with artemether-lumefantrine. J Infect Dis 2021; 225:1411-1414. [PMID: 34216470 PMCID: PMC9016418 DOI: 10.1093/infdis/jiab352] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
In Southeast Asia, mutations in the Plasmodium falciparum K13 gene have led to delayed parasite clearance and treatment failures in patients with malaria receiving artemisinin combination therapies. Until recently, relevant K13 mutations had been mostly absent from Africa. Between 2018 and 2019, a phase 2 clinical study with 186 patients was conducted in Mali, Gabon, Ghana, Uganda, and Rwanda. Patients with malaria were randomized and treated with artemether-lumefantrine or cipargamin. Here we report an allele frequency of 22% for R561H in Rwanda and associated delayed parasite clearance. Notwithstanding, efficacy of artemether-lumefantrine remained high in Rwanda, with a 94.4% polymerase chain reaction–corrected cure rate.
Collapse
Affiliation(s)
- Judith Straimer
- Novartis Institutes for Biomedical Research, Emeryville, California, 94608, USA
| | | | | | | |
Collapse
|
7
|
Gnädig NF, Stokes BH, Edwards RL, Kalantarov GF, Heimsch KC, Kuderjavy M, Crane A, Lee MCS, Straimer J, Becker K, Trakht IN, Odom John AR, Mok S, Fidock DA. Insights into the intracellular localization, protein associations and artemisinin resistance properties of Plasmodium falciparum K13. PLoS Pathog 2020; 16:e1008482. [PMID: 32310999 PMCID: PMC7192513 DOI: 10.1371/journal.ppat.1008482] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/30/2020] [Accepted: 03/17/2020] [Indexed: 12/23/2022] Open
Abstract
The emergence of artemisinin (ART) resistance in Plasmodium falciparum intra-erythrocytic parasites has led to increasing treatment failure rates with first-line ART-based combination therapies in Southeast Asia. Decreased parasite susceptibility is caused by K13 mutations, which are associated clinically with delayed parasite clearance in patients and in vitro with an enhanced ability of ring-stage parasites to survive brief exposure to the active ART metabolite dihydroartemisinin. Herein, we describe a panel of K13-specific monoclonal antibodies and gene-edited parasite lines co-expressing epitope-tagged versions of K13 in trans. By applying an analytical quantitative imaging pipeline, we localize K13 to the parasite endoplasmic reticulum, Rab-positive vesicles, and sites adjacent to cytostomes. These latter structures form at the parasite plasma membrane and traffic hemoglobin to the digestive vacuole wherein artemisinin-activating heme moieties are released. We also provide evidence of K13 partially localizing near the parasite mitochondria upon treatment with dihydroartemisinin. Immunoprecipitation data generated with K13-specific monoclonal antibodies identify multiple putative K13-associated proteins, including endoplasmic reticulum-resident molecules, mitochondrial proteins, and Rab GTPases, in both K13 mutant and wild-type isogenic lines. We also find that mutant K13-mediated resistance is reversed upon co-expression of wild-type or mutant K13. These data help define the biological properties of K13 and its role in mediating P. falciparum resistance to ART treatment.
Collapse
Affiliation(s)
- Nina F. Gnädig
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Barbara H. Stokes
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Rachel L. Edwards
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Gavreel F. Kalantarov
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Kim C. Heimsch
- Biochemistry and Molecular Biology, Interdisciplinary Research Center, Justus Liebig University, Giessen, Germany
| | | | - Audrey Crane
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Marcus C. S. Lee
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Judith Straimer
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Katja Becker
- Biochemistry and Molecular Biology, Interdisciplinary Research Center, Justus Liebig University, Giessen, Germany
| | - Ilya N. Trakht
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Audrey R. Odom John
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States of America
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Sachel Mok
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - David A. Fidock
- Department of Microbiology & Immunology, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| |
Collapse
|
8
|
McLean KJ, Straimer J, Hopp CS, Vega-Rodriguez J, Small-Saunders JL, Kanatani S, Tripathi A, Mlambo G, Dumoulin PC, Harris CT, Tong X, Shears MJ, Ankarklev J, Kafsack BFC, Fidock DA, Sinnis P. Generation of Transmission-Competent Human Malaria Parasites with Chromosomally-Integrated Fluorescent Reporters. Sci Rep 2019; 9:13131. [PMID: 31511546 PMCID: PMC6739413 DOI: 10.1038/s41598-019-49348-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/15/2019] [Indexed: 01/01/2023] Open
Abstract
Malaria parasites have a complex life cycle that includes specialized stages for transmission between their mosquito and human hosts. These stages are an understudied part of the lifecycle yet targeting them is an essential component of the effort to shrink the malaria map. The human parasite Plasmodium falciparum is responsible for the majority of deaths due to malaria. Our goal was to generate transgenic P. falciparum lines that could complete the lifecycle and produce fluorescent transmission stages for more in-depth and high-throughput studies. Using zinc-finger nuclease technology to engineer an integration site, we generated three transgenic P. falciparum lines in which tdtomato or gfp were stably integrated into the genome. Expression was driven by either stage-specific peg4 and csp promoters or the constitutive ef1a promoter. Phenotypic characterization of these lines demonstrates that they complete the life cycle with high infection rates and give rise to fluorescent mosquito stages. The transmission stages are sufficiently bright for intra-vital imaging, flow cytometry and scalable screening of chemical inhibitors and inhibitory antibodies.
Collapse
Affiliation(s)
- Kyle Jarrod McLean
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Judith Straimer
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Novartis Institutes for Biomedical Research, Novartis Institute for Tropical Diseases, Emeryville, CA, 94608, USA
| | - Christine S Hopp
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Joel Vega-Rodriguez
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Jennifer L Small-Saunders
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Sachie Kanatani
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Abhai Tripathi
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Godfree Mlambo
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Peter C Dumoulin
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA
| | - Chantal T Harris
- Department of Microbiology and Immunology, Weill Cornell School of Medicine, New York, NY, 10065, USA
| | - Xinran Tong
- Department of Microbiology and Immunology, Weill Cornell School of Medicine, New York, NY, 10065, USA
| | - Melanie J Shears
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, WA, 98109, USA
| | - Johan Ankarklev
- Department of Microbiology and Immunology, Weill Cornell School of Medicine, New York, NY, 10065, USA
- Department of Molecular Biosciences, The Wenner Gren Institute, Stockholm University, SE-106 91, Stockholm, Sweden
| | - Björn F C Kafsack
- Department of Microbiology and Immunology, Weill Cornell School of Medicine, New York, NY, 10065, USA
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.
| | - Photini Sinnis
- Department of Molecular Microbiology and Immunology, and Johns Hopkins Malaria Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| |
Collapse
|
9
|
Dembele L, Ang X, Chavchich M, Bonamy GMC, Selva JJ, Lim MYX, Bodenreider C, Yeung BKS, Nosten F, Russell BM, Edstein MD, Straimer J, Fidock DA, Diagana TT, Bifani P. The Plasmodium PI(4)K inhibitor KDU691 selectively inhibits dihydroartemisinin-pretreated Plasmodium falciparum ring-stage parasites. Sci Rep 2017; 7:2325. [PMID: 28539634 PMCID: PMC5443816 DOI: 10.1038/s41598-017-02440-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/11/2017] [Indexed: 11/23/2022] Open
Abstract
Malaria control and elimination are threatened by the emergence and spread of resistance to artemisinin-based combination therapies (ACTs). Experimental evidence suggests that when an artemisinin (ART)-sensitive (K13 wild-type) Plasmodium falciparum strain is exposed to ART derivatives such as dihydroartemisinin (DHA), a small population of the early ring-stage parasites can survive drug treatment by entering cell cycle arrest or dormancy. After drug removal, these parasites can resume growth. Dormancy has been hypothesized to be an adaptive physiological mechanism that has been linked to recrudescence of parasites after monotherapy with ART and, possibly contributes to ART resistance. Here, we evaluate the in vitro drug sensitivity profile of normally-developing P. falciparum ring stages and DHA-pretreated dormant rings (DP-rings) using a panel of antimalarial drugs, including the Plasmodium phosphatidylinositol-4-OH kinase (PI4K)-specific inhibitor KDU691. We report that while KDU691 shows no activity against rings, it is highly inhibitory against DP-rings; a drug effect opposite to that of ART. Moreover, we provide evidence that KDU691 also kills DP-rings of P. falciparum ART-resistant strains expressing mutant K13.
Collapse
Affiliation(s)
- L Dembele
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - X Ang
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - M Chavchich
- Department of Drug Evaluation, Australian Army Malaria Institute, Brisbane, QLD, 4051, Australia
| | - G M C Bonamy
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - J J Selva
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - M Yi-Xiu Lim
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - C Bodenreider
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - B K S Yeung
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - F Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - B M Russell
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - M D Edstein
- Department of Drug Evaluation, Australian Army Malaria Institute, Brisbane, QLD, 4051, Australia
| | - J Straimer
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - D A Fidock
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - T T Diagana
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore
| | - P Bifani
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, #05-01 Chromos, 138670, Singapore, Singapore. .,Department of Microbiology and Immunology Program, Yong Loo Lin School of Medicine, Life Sciences Institute, National University of Singapore, 119077, Singapore, Singapore.
| |
Collapse
|
10
|
Le Bihan A, de Kanter R, Angulo-Barturen I, Binkert C, Boss C, Brun R, Brunner R, Buchmann S, Burrows J, Dechering KJ, Delves M, Ewerling S, Ferrer S, Fischli C, Gamo–Benito FJ, Gnädig NF, Heidmann B, Jiménez-Díaz MB, Leroy D, Martínez MS, Meyer S, Moehrle JJ, Ng CL, Noviyanti R, Ruecker A, Sanz LM, Sauerwein RW, Scheurer C, Schleiferboeck S, Sinden R, Snyder C, Straimer J, Wirjanata G, Marfurt J, Price RN, Weller T, Fischli W, Fidock DA, Clozel M, Wittlin S. Characterization of Novel Antimalarial Compound ACT-451840: Preclinical Assessment of Activity and Dose-Efficacy Modeling. PLoS Med 2016; 13:e1002138. [PMID: 27701420 PMCID: PMC5049785 DOI: 10.1371/journal.pmed.1002138] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Artemisinin resistance observed in Southeast Asia threatens the continued use of artemisinin-based combination therapy in endemic countries. Additionally, the diversity of chemical mode of action in the global portfolio of marketed antimalarials is extremely limited. Addressing the urgent need for the development of new antimalarials, a chemical class of potent antimalarial compounds with a novel mode of action was recently identified. Herein, the preclinical characterization of one of these compounds, ACT-451840, conducted in partnership with academic and industrial groups is presented. METHOD AND FINDINGS The properties of ACT-451840 are described, including its spectrum of activities against multiple life cycle stages of the human malaria parasite Plasmodium falciparum (asexual and sexual) and Plasmodium vivax (asexual) as well as oral in vivo efficacies in two murine malaria models that permit infection with the human and the rodent parasites P. falciparum and Plasmodium berghei, respectively. In vitro, ACT-451840 showed a 50% inhibition concentration of 0.4 nM (standard deviation [SD]: ± 0.0 nM) against the drug-sensitive P. falciparum NF54 strain. The 90% effective doses in the in vivo efficacy models were 3.7 mg/kg against P. falciparum (95% confidence interval: 3.3-4.9 mg/kg) and 13 mg/kg against P. berghei (95% confidence interval: 11-16 mg/kg). ACT-451840 potently prevented male gamete formation from the gametocyte stage with a 50% inhibition concentration of 5.89 nM (SD: ± 1.80 nM) and dose-dependently blocked oocyst development in the mosquito with a 50% inhibitory concentration of 30 nM (range: 23-39). The compound's preclinical safety profile is presented and is in line with the published results of the first-in-man study in healthy male participants, in whom ACT-451840 was well tolerated. Pharmacokinetic/pharmacodynamic (PK/PD) modeling was applied using efficacy in the murine models (defined either as antimalarial activity or as survival) in relation to area under the concentration versus time curve (AUC), maximum observed plasma concentration (Cmax), and time above a threshold concentration. The determination of the dose-efficacy relationship of ACT-451840 under curative conditions in rodent malaria models allowed prediction of the human efficacious exposure. CONCLUSION The dual activity of ACT-451840 against asexual and sexual stages of P. falciparum and the activity on P. vivax have the potential to meet the specific profile of a target compound that could replace the fast-acting artemisinin component and harbor additional gametocytocidal activity and, thereby, transmission-blocking properties. The fast parasite reduction ratio (PRR) and gametocytocidal effect of ACT-451840 were recently also confirmed in a clinical proof-of-concept (POC) study.
Collapse
Affiliation(s)
| | | | - Iñigo Angulo-Barturen
- GlaxoSmithKline, TresCantos Medicines Development Campus, Diseases of the Developing World, Tres Cantos, Madrid, Spain
| | | | | | - Reto Brun
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ralf Brunner
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Michael Delves
- Department of Life Sciences, Imperial College London, SW7 2AZ, London, United Kingdom
| | | | - Santiago Ferrer
- GlaxoSmithKline, TresCantos Medicines Development Campus, Diseases of the Developing World, Tres Cantos, Madrid, Spain
| | - Christoph Fischli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Francisco Javier Gamo–Benito
- GlaxoSmithKline, TresCantos Medicines Development Campus, Diseases of the Developing World, Tres Cantos, Madrid, Spain
| | - Nina F. Gnädig
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
| | | | - María Belén Jiménez-Díaz
- GlaxoSmithKline, TresCantos Medicines Development Campus, Diseases of the Developing World, Tres Cantos, Madrid, Spain
| | - Didier Leroy
- Medicines for Malaria Venture, Geneva, Switzerland
| | - Maria Santos Martínez
- GlaxoSmithKline, TresCantos Medicines Development Campus, Diseases of the Developing World, Tres Cantos, Madrid, Spain
| | - Solange Meyer
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Caroline L. Ng
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
| | | | - Andrea Ruecker
- Department of Life Sciences, Imperial College London, SW7 2AZ, London, United Kingdom
| | - Laura María Sanz
- GlaxoSmithKline, TresCantos Medicines Development Campus, Diseases of the Developing World, Tres Cantos, Madrid, Spain
| | | | - Christian Scheurer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sarah Schleiferboeck
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert Sinden
- Department of Life Sciences, Imperial College London, SW7 2AZ, London, United Kingdom
| | | | - Judith Straimer
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
| | - Grennady Wirjanata
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Thomas Weller
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - David A. Fidock
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | | | - Sergio Wittlin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| |
Collapse
|
11
|
Ménard D, Khim N, Beghain J, Adegnika AA, Shafiul-Alam M, Amodu O, Rahim-Awab G, Barnadas C, Berry A, Boum Y, Bustos MD, Cao J, Chen JH, Collet L, Cui L, Thakur GD, Dieye A, Djallé D, Dorkenoo MA, Eboumbou-Moukoko CE, Espino FECJ, Fandeur T, Ferreira-da-Cruz MF, Fola AA, Fuehrer HP, Hassan AM, Herrera S, Hongvanthong B, Houzé S, Ibrahim ML, Jahirul-Karim M, Jiang L, Kano S, Ali-Khan W, Khanthavong M, Kremsner PG, Lacerda M, Leang R, Leelawong M, Li M, Lin K, Mazarati JB, Ménard S, Morlais I, Muhindo-Mavoko H, Musset L, Na-Bangchang K, Nambozi M, Niaré K, Noedl H, Ouédraogo JB, Pillai DR, Pradines B, Quang-Phuc B, Ramharter M, Randrianarivelojosia M, Sattabongkot J, Sheikh-Omar A, Silué KD, Sirima SB, Sutherland C, Syafruddin D, Tahar R, Tang LH, Touré OA, Tshibangu-wa-Tshibangu P, Vigan-Womas I, Warsame M, Wini L, Zakeri S, Kim S, Eam R, Berne L, Khean C, Chy S, Ken M, Loch K, Canier L, Duru V, Legrand E, Barale JC, Stokes B, Straimer J, Witkowski B, Fidock DA, Rogier C, Ringwald P, Ariey F, Mercereau-Puijalon O. A Worldwide Map of Plasmodium falciparum K13-Propeller Polymorphisms. N Engl J Med 2016; 374:2453-64. [PMID: 27332904 PMCID: PMC4955562 DOI: 10.1056/nejmoa1513137] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent gains in reducing the global burden of malaria are threatened by the emergence of Plasmodium falciparum resistance to artemisinins. The discovery that mutations in portions of a P. falciparum gene encoding kelch (K13)-propeller domains are the major determinant of resistance has provided opportunities for monitoring such resistance on a global scale. METHODS We analyzed the K13-propeller sequence polymorphism in 14,037 samples collected in 59 countries in which malaria is endemic. Most of the samples (84.5%) were obtained from patients who were treated at sentinel sites used for nationwide surveillance of antimalarial resistance. We evaluated the emergence and dissemination of mutations by haplotyping neighboring loci. RESULTS We identified 108 nonsynonymous K13 mutations, which showed marked geographic disparity in their frequency and distribution. In Asia, 36.5% of the K13 mutations were distributed within two areas--one in Cambodia, Vietnam, and Laos and the other in western Thailand, Myanmar, and China--with no overlap. In Africa, we observed a broad array of rare nonsynonymous mutations that were not associated with delayed parasite clearance. The gene-edited Dd2 transgenic line with the A578S mutation, which expresses the most frequently observed African allele, was found to be susceptible to artemisinin in vitro on a ring-stage survival assay. CONCLUSIONS No evidence of artemisinin resistance was found outside Southeast Asia and China, where resistance-associated K13 mutations were confined. The common African A578S allele was not associated with clinical or in vitro resistance to artemisinin, and many African mutations appear to be neutral. (Funded by Institut Pasteur Paris and others.).
Collapse
Affiliation(s)
- Didier Ménard
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Nimol Khim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Johann Beghain
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Ayola A Adegnika
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mohammad Shafiul-Alam
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Olukemi Amodu
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Ghulam Rahim-Awab
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Céline Barnadas
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Antoine Berry
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Yap Boum
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Maria D Bustos
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jun Cao
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jun-Hu Chen
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Louis Collet
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Liwang Cui
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Garib-Das Thakur
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Alioune Dieye
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Djibrine Djallé
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Monique A Dorkenoo
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | | | - Thierry Fandeur
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Abebe A Fola
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Hans-Peter Fuehrer
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Abdillahi M Hassan
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Socrates Herrera
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Bouasy Hongvanthong
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sandrine Houzé
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Maman L Ibrahim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mohammad Jahirul-Karim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lubin Jiang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Shigeyuki Kano
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Wasif Ali-Khan
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Maniphone Khanthavong
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Peter G Kremsner
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Marcus Lacerda
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Rithea Leang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mindy Leelawong
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mei Li
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Khin Lin
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jean-Baptiste Mazarati
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sandie Ménard
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Isabelle Morlais
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Lise Musset
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Kesara Na-Bangchang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Michael Nambozi
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Karamoko Niaré
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Harald Noedl
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jean-Bosco Ouédraogo
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Dylan R Pillai
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Bruno Pradines
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Bui Quang-Phuc
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Michael Ramharter
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Jetsumon Sattabongkot
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Abdiqani Sheikh-Omar
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Kigbafori D Silué
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sodiomon B Sirima
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Colin Sutherland
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Din Syafruddin
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Rachida Tahar
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lin-Hua Tang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Offianan A Touré
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Inès Vigan-Womas
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Marian Warsame
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lyndes Wini
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sedigheh Zakeri
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Saorin Kim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Rotha Eam
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Laura Berne
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Chanra Khean
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sophy Chy
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Malen Ken
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Kaknika Loch
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lydie Canier
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Valentine Duru
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Eric Legrand
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jean-Christophe Barale
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Barbara Stokes
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Judith Straimer
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Benoit Witkowski
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - David A Fidock
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Christophe Rogier
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Pascal Ringwald
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Frederic Ariey
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | |
Collapse
|
12
|
Tilley L, Straimer J, Gnädig NF, Ralph SA, Fidock DA. Artemisinin Action and Resistance in Plasmodium falciparum. Trends Parasitol 2016; 32:682-696. [PMID: 27289273 DOI: 10.1016/j.pt.2016.05.010] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 12/16/2022]
Abstract
The worldwide use of artemisinin-based combination therapies (ACTs) has contributed in recent years to a substantial reduction in deaths resulting from Plasmodium falciparum malaria. Resistance to artemisinins, however, has emerged in Southeast Asia. Clinically, resistance is defined as a slower rate of parasite clearance in patients treated with an artemisinin derivative or an ACT. These slow clearance rates associate with enhanced survival rates of ring-stage parasites briefly exposed in vitro to dihydroartemisinin. We describe recent progress made in defining the molecular basis of artemisinin resistance, which has identified a primary role for the P. falciparum K13 protein. Using K13 mutations as molecular markers, epidemiological studies are now tracking the emergence and spread of artemisinin resistance. Mechanistic studies suggest potential ways to overcome resistance.
Collapse
Affiliation(s)
- Leann Tilley
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Australia.
| | - Judith Straimer
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nina F Gnädig
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Stuart A Ralph
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Australia
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| |
Collapse
|
13
|
Petersen I, Gabryszewski SJ, Johnston GL, Dhingra SK, Ecker A, Lewis RE, de Almeida MJ, Straimer J, Henrich PP, Palatulan E, Johnson DJ, Coburn-Flynn O, Sanchez C, Lehane AM, Lanzer M, Fidock DA. Balancing drug resistance and growth rates via compensatory mutations in the Plasmodium falciparum chloroquine resistance transporter. Mol Microbiol 2015; 97:381-95. [PMID: 25898991 DOI: 10.1111/mmi.13035] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/28/2022]
Abstract
The widespread use of chloroquine to treat Plasmodium falciparum infections has resulted in the selection and dissemination of variant haplotypes of the primary resistance determinant PfCRT. These haplotypes have encountered drug pressure and within-host competition with wild-type drug-sensitive parasites. To examine these selective forces in vitro, we genetically engineered P. falciparum to express geographically diverse PfCRT haplotypes. Variant alleles from the Philippines (PH1 and PH2, which differ solely by the C72S mutation) both conferred a moderate gain of chloroquine resistance and a reduction in growth rates in vitro. Of the two, PH2 showed higher IC50 values, contrasting with reduced growth. Furthermore, a highly mutated pfcrt allele from Cambodia (Cam734) conferred moderate chloroquine resistance and enhanced growth rates, when tested against wild-type pfcrt in co-culture competition assays. These three alleles mediated cross-resistance to amodiaquine, an antimalarial drug widely used in Africa. Each allele, along with the globally prevalent Dd2 and 7G8 alleles, rendered parasites more susceptible to lumefantrine, the partner drug used in the leading first-line artemisinin-based combination therapy. These data reveal ongoing region-specific evolution of PfCRT that impacts drug susceptibility and relative fitness in settings of mixed infections, and raise important considerations about optimal agents to treat chloroquine-resistant malaria.
Collapse
Affiliation(s)
- Ines Petersen
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA.,Hygiene Institut, Abteilung Parasitologie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Germany
| | - Stanislaw J Gabryszewski
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Geoffrey L Johnston
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA.,School of International and Public Affairs, Columbia University, New York, NY, 10027, USA
| | - Satish K Dhingra
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA.,Department of Biological Sciences, Binghamton University, Binghamton, NY, 13902, USA
| | - Andrea Ecker
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Rebecca E Lewis
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | | | - Judith Straimer
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Philipp P Henrich
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Eugene Palatulan
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - David J Johnson
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Olivia Coburn-Flynn
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Cecilia Sanchez
- Hygiene Institut, Abteilung Parasitologie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Germany
| | - Adele M Lehane
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michael Lanzer
- Hygiene Institut, Abteilung Parasitologie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Germany
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, 10032, USA.,Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| |
Collapse
|
14
|
Dogovski C, Xie SC, Burgio G, Bridgford J, Mok S, McCaw JM, Chotivanich K, Kenny S, Gnädig N, Straimer J, Bozdech Z, Fidock DA, Simpson JA, Dondorp AM, Foote S, Klonis N, Tilley L. Targeting the cell stress response of Plasmodium falciparum to overcome artemisinin resistance. PLoS Biol 2015; 13:e1002132. [PMID: 25901609 PMCID: PMC4406523 DOI: 10.1371/journal.pbio.1002132] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 11/30/2022] Open
Abstract
Successful control of falciparum malaria depends greatly on treatment with artemisinin combination therapies. Thus, reports that resistance to artemisinins (ARTs) has emerged, and that the prevalence of this resistance is increasing, are alarming. ART resistance has recently been linked to mutations in the K13 propeller protein. We undertook a detailed kinetic analysis of the drug responses of K13 wild-type and mutant isolates of Plasmodium falciparum sourced from a region in Cambodia (Pailin). We demonstrate that ART treatment induces growth retardation and an accumulation of ubiquitinated proteins, indicative of a cellular stress response that engages the ubiquitin/proteasome system. We show that resistant parasites exhibit lower levels of ubiquitinated proteins and delayed onset of cell death, indicating an enhanced cell stress response. We found that the stress response can be targeted by inhibiting the proteasome. Accordingly, clinically used proteasome inhibitors strongly synergize ART activity against both sensitive and resistant parasites, including isogenic lines expressing mutant or wild-type K13. Synergy is also observed against Plasmodium berghei in vivo. We developed a detailed model of parasite responses that enables us to infer, for the first time, in vivo parasite clearance profiles from in vitro assessments of ART sensitivity. We provide evidence that the clinical marker of resistance (delayed parasite clearance) is an indirect measure of drug efficacy because of the persistence of unviable parasites with unchanged morphology in the circulation, and we suggest alternative approaches for the direct measurement of viability. Our model predicts that extending current three-day ART treatment courses to four days, or splitting the doses, will efficiently clear resistant parasite infections. This work provides a rationale for improving the detection of ART resistance in the field and for treatment strategies that can be employed in areas with ART resistance. Resistance to artemisinin antimalarial drugs is jeopardizing malaria control. This study shows that proteasome-mediated stress responses can be targeted to overcome artemisinin resistance and suggests alternate therapeutic regimens and monitoring strategies. Resistance to artemisinin antimalarials, some of the most effective antimalarial drugs, has emerged in Southeast Asia, jeopardizing malaria control. We have undertaken a detailed study of artemisinin-sensitive and-resistant strains of Plasmodium falciparum, the parasite responsible for malaria, taken directly from the field in a region where resistance is developing. We compared these strains to lab strains engineered with either mutant or wild-type resistance alleles. We demonstrate that in sensitive P. falciparum, artemisinin induces growth retardation and accumulation of ubiquitinated proteins, indicating that the drugs activate the cellular stress response. Resistant parasites, on the other hand, exhibit reduced protein ubiquitination and delayed onset of cell death following drug exposure. We show that proteasome inhibitors strongly synergize artemisinin activity, offering a means of overcoming artemisinin resistance. We have developed a detailed model of parasite responses and have modelled in vivo clearance profiles. Our data indicate that extending artemisinin treatment from the standard three-day treatment to a four-day treatment will clear resistant parasites, thus preserving the use of this critical therapy in areas experiencing artemisinin resistance.
Collapse
Affiliation(s)
- Con Dogovski
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stanley C Xie
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gaetan Burgio
- John Curtin School of Medical Research, the Australian National University, Canberra, Australian Capital Territory, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Jess Bridgford
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sachel Mok
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - James M McCaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Royal Childrens Hospital, Victoria, Australia
| | | | - Shannon Kenny
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nina Gnädig
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
| | - Judith Straimer
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America
| | - Zbynek Bozdech
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York, United States of America; Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Arjen M Dondorp
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - Simon Foote
- John Curtin School of Medical Research, the Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nectarios Klonis
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leann Tilley
- Department of Biochemistry and Molecular Biology and ARC Centre of Excellence for Coherent X-ray Science, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Straimer J, Gnädig NF, Witkowski B, Amaratunga C, Duru V, Ramadani AP, Dacheux M, Khim N, Zhang L, Lam S, Gregory PD, Urnov FD, Mercereau-Puijalon O, Benoit-Vical F, Fairhurst RM, Ménard D, Fidock DA. Drug resistance. K13-propeller mutations confer artemisinin resistance in Plasmodium falciparum clinical isolates. Science 2014; 347:428-31. [PMID: 25502314 DOI: 10.1126/science.1260867] [Citation(s) in RCA: 490] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The emergence of artemisinin resistance in Southeast Asia imperils efforts to reduce the global malaria burden. We genetically modified the Plasmodium falciparum K13 locus using zinc-finger nucleases and measured ring-stage survival rates after drug exposure in vitro; these rates correlate with parasite clearance half-lives in artemisinin-treated patients. With isolates from Cambodia, where resistance first emerged, survival rates decreased from 13 to 49% to 0.3 to 2.4% after the removal of K13 mutations. Conversely, survival rates in wild-type parasites increased from ≤0.6% to 2 to 29% after the insertion of K13 mutations. These mutations conferred elevated resistance to recent Cambodian isolates compared with that of reference lines, suggesting a contemporary contribution of additional genetic factors. Our data provide a conclusive rationale for worldwide K13-propeller sequencing to identify and eliminate artemisinin-resistant parasites.
Collapse
Affiliation(s)
- Judith Straimer
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nina F Gnädig
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Benoit Witkowski
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Chanaki Amaratunga
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Valentine Duru
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Arba Pramundita Ramadani
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Chimie de Coordination UPR8241, Toulouse, France. Université de Toulouse, UPS, Institut National Polytechnique de Toulouse, Toulouse, France
| | - Mélanie Dacheux
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nimol Khim
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Lei Zhang
- Sangamo BioSciences, Richmond, CA, USA
| | | | | | | | | | - Françoise Benoit-Vical
- Centre National de la Recherche Scientifique (CNRS), Laboratoire de Chimie de Coordination UPR8241, Toulouse, France. Université de Toulouse, UPS, Institut National Polytechnique de Toulouse, Toulouse, France
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Didier Ménard
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY, USA. Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| |
Collapse
|
16
|
Moraes Barros RR, Straimer J, Sa JM, Salzman RE, Melendez-Muniz VA, Mu J, Fidock DA, Wellems TE. Editing the Plasmodium vivax genome, using zinc-finger nucleases. J Infect Dis 2014; 211:125-9. [PMID: 25081932 DOI: 10.1093/infdis/jiu423] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Plasmodium vivax is a major cause of malaria morbidity worldwide yet has remained genetically intractable. To stably modify this organism, we used zinc-finger nucleases (ZFNs), which take advantage of homology-directed DNA repair mechanisms at the site of nuclease action. Using ZFNs specific to the gene encoding P. vivax dihydrofolate reductase (pvdhfr), we transfected blood specimens from Saimiri boliviensis monkeys infected with the pyrimethamine (Pyr)-susceptible Chesson strain with a ZFN plasmid carrying a Pyr-resistant mutant pvdhfr sequence. We obtained Pyr-resistant parasites in vivo that carried mutant pvdhfr and additional silent mutations designed to confirm editing. These results herald the era of stable P. vivax genetic modifications.
Collapse
Affiliation(s)
- Roberto R Moraes Barros
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Juliana M Sa
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Rebecca E Salzman
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Viviana A Melendez-Muniz
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jianbing Mu
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David A Fidock
- Department of Microbiology and Immunology Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Thomas E Wellems
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
17
|
Straimer J, Lee MCS, Lee AH, Zeitler B, Williams AE, Pearl JR, Zhang L, Rebar EJ, Gregory PD, Llinás M, Urnov FD, Fidock DA. Site-specific genome editing in Plasmodium falciparum using engineered zinc-finger nucleases. Nat Methods 2012; 9:993-8. [PMID: 22922501 DOI: 10.1038/nmeth.2143] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/27/2012] [Indexed: 01/21/2023]
Abstract
Malaria afflicts over 200 million people worldwide, and its most lethal etiologic agent, Plasmodium falciparum, is evolving to resist even the latest-generation therapeutics. Efficient tools for genome-directed investigations of P. falciparum-induced pathogenesis, including drug-resistance mechanisms, are clearly required. Here we report rapid and targeted genetic engineering of this parasite using zinc-finger nucleases (ZFNs) that produce a double-strand break in a user-defined locus and trigger homology-directed repair. Targeting an integrated egfp locus, we obtained gene-deletion parasites with unprecedented speed (2 weeks), both with and without direct selection. ZFNs engineered against the parasite gene pfcrt, responsible for escape under chloroquine treatment, rapidly produced parasites that carried either an allelic replacement or a panel of specified point mutations. This method will enable a diverse array of genome-editing approaches to interrogate this human pathogen.
Collapse
Affiliation(s)
- Judith Straimer
- Department of Microbiology & Immunology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Sasi P, Abdulrahaman A, Mwai L, Muriithi S, Straimer J, Schieck E, Rippert A, Bashraheil M, Salim A, Peshu J, Awuondo K, Lowe B, Pirmohamed M, Winstanley P, Ward S, Nzila A, Borrmann S. In vivo and in vitro efficacy of amodiaquine against Plasmodium falciparum in an area of continued use of 4-aminoquinolines in East Africa. J Infect Dis 2009; 199:1575-82. [PMID: 19405863 DOI: 10.1086/598862] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In light of reports of increasing resistance of parasites to amodiaquine in African countries in which Plasmodium falciparum is endemic as well as the paucity of recent in vitro sensitivity data, we assessed the in vivo and in vitro sensitivity to amodiaquine of P. falciparum isolates from 128 pediatric outpatients (0.5-10 years old) in Pingilikani, Kilifi District, Kenya, who were treated with amodiaquine (10 mg/kg/day for 3 days). The polymerase chain reaction-corrected parasitological cure rate on day 28 (by Kaplan-Meier analysis) was 82% (95% confidence interval [CI], 74%-88%). Twenty-six percent (17/66) of tested pretreatment P. falciparum field isolates had 50% in vitro growth inhibition at concentrations of N-desethyl-amodiaquine (DEAQ)-the major biologically active metabolite of amodiaquine-above the proposed resistance threshold of 60 nmol/L, but baseline median DEAQ 50% inhibitory concentration values were not associated with subsequent risk of asexual parasite recrudescence (29 nmol/L [95% CI, 23-170 nmol/L] and 34 nmol/L [95% CI, 30-46 nmol/L] for patients with and those without recrudescences, respectively). The median absolute neutrophil count dropped by 1.3 X 10(3) cells/microL (95% CI, -1.7 X 10(3) to -0.7 X 10(3) cells/microL) between days 0 and 28. The high prevalence of in vitro and in vivo resistance precludes the use of amodiaquine on its own as second-line treatment. These findings also suggest that the value of amodiaquine combinations as first- or second-line treatment in areas with similar patterns of 4-aminoquinoline resistance should be reassessed.
Collapse
Affiliation(s)
- Philip Sasi
- Kenya Medical Research Institute, Center for Geographic Medicine Research-Coast, Kilifi, Kenya
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|