A long-duration dihydroorotate dehydrogenase inhibitor (DSM265) for prevention and treatment of malaria

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Phillips, Margaret A
Lotharius, Julie
Marsh, Kennan
White, John
Dayan, Anthony
White, Karen L
Njoroge, Jacqueline W
El Mazouni, Farah
Lao, Yanbin
Kokkonda, Sreekanth
Tomchick, Diana R
Deng, Xiaoyi
Laird, Trevor
Bhatia, Sangeeta N
March, Sandra
Ng, Caroline L
Fidock, David A
Wittlin, Sergio
Lafuente-Monasterio, Maria
Gamo Benito, Francisco Javier
Sanz Alonso, Laura Maria
Santos Martinez, Maria
Belen Jimenez-Diaz, Maria
Ferrer Bazaga, Santiago
Angulo-Barturen, Inigo
Haselden, John N
Louttit, James
Cui, Yi
Sridhar, Arun
Zeeman, Anna-Marie
Kocken, Clemens
Sauerwein, Robert
Dechering, Koen
Avery, Vicky M
Duffy, Sandra
Delves, Michael
Sinden, Robert
Ruecker, Andrea
Wickham, Kristina S
Rochford, Rosemary
Gahagen, Janet
Iyer, Lalitha
Riccio, Ed
Mirsalis, Jon
Bathhurst, Ian
Rueckle, Thomas
Ding, Xavier
Campo, Brice
Leroy, Didier
Rogers, M John
Rathod, Pradipsinh K
Burrows, Jeremy N
Charman, Susan A
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2015
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Abstract

Malaria is one of the most significant causes of childhood mortality, but disease control efforts are threatened by resistance of the Plasmodium parasite to current therapies. Continued progress in combating malaria requires development of new, easy to administer drug combinations with broad-ranging activity against all manifestations of the disease. DSM265, a triazolopyrimidine-based inhibitor of the pyrimidine biosynthetic enzyme dihydroorotate dehydrogenase (DHODH), is the first DHODH inhibitor to reach clinical development for treatment of malaria. We describe studies profiling the biological activity, pharmacological and pharmacokinetic properties, and safety of DSM265, which supported its advancement to human trials. DSM265 is highly selective toward DHODH of the malaria parasite Plasmodium, efficacious against both blood and liver stages of P. falciparum, and active against drug-resistant parasite isolates. Favorable pharmacokinetic properties of DSM265 are predicted to provide therapeutic concentrations for more than 8 days after a single oral dose in the range of 200 to 400 mg. DSM265 was well tolerated in repeat-dose and cardiovascular safety studies in mice and dogs, was not mutagenic, and was inactive against panels of human enzymes/receptors. The excellent safety profile, blood- and liver-stage activity, and predicted long half-life in humans position DSM265 as a new potential drug combination partner for either single-dose treatment or once-weekly chemoprevention. DSM265 has advantages over current treatment options that are dosed daily or are inactive against the parasite liver stage.

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Science Translational Medicine

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7

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296

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Medicinal and biomolecular chemistry not elsewhere classified

Biological sciences

Biomedical and clinical sciences

Medical biotechnology

Biomedical engineering

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