A shot in the arm for antimalarial drug discovery?

While heart disease, cancer and Alzheimer's continue to grab the headlines, malaria and tuberculosis continue to quietly do their deadly work behind the scenes. Diseases that disproportionately affect sub-Saharan Africa are not exactly priorities for drug companies. But they pose a tremendous unmet need. Especially malaria, which kills an unbelievable 800,000 people every year, has fought back against almost every traditional drug. The fight against the disease has boiled down to one class of drugs- the artemisinins. If the parasite develops resistance against these, nobody knows how fast and wide it will spread.

Since pharma companies often get bad press for neglecting....neglected diseases, this makes the duo of papers in this week's issue of Nature especially impressive. The papers talk about GSK collaborating with a host of academic laboratories to discover literally hundreds of hits against malaria through phenotypic screening. The sheer multidisciplinary effort put into this endeavor is laudable. Phenotypic screening is an effective method for drug discovery since it does not care about the target of a drug, at least in the beginning. It's a more top down approach that complements bottom-up rational drug design. The goal is to simply watch out for a particular kind of response, which could be anything from fluorescence to cell shrinkage. In this case it was 80% inhibition of growth of the parasite in the asexual stage in red blood cells. Target identification can come later.

The company screened its proprietary collection of about 2 million compounds. The compound library was chosen for diversity of scaffolds and novel chemotypes. The assay looked for 80% inhibition of the P. falciparum parasite, and came up with hundreds of diverse compounds. The scientists seemed to have taken due care to minimize false positives. They sought to eliminate promiscuous, lipophilic compounds from the list. They also screened their compounds against well known targets and processes that the malarial parasite exploits to subdue its host. One of these was particularly eye-opening for me; apparently, the insidious little weasel can hack up the amino acids from hemoglobin molecules in the host to assemble its own proteins. Now that's stealth for you. More interestingly, the group then screened the selected molecules against seven novel malarial targets and found encouraging inhibition profiles against these targets. Infectious disease are best treated when you can hit the causative agent in multiple places. Paucity of targets has especially been an issue for malaria and TB, and these chemotypes along with their suggested targets provide promising leads. As a final act, the first paper co-authored by Guiguemde et al. also demonstrates favorable pharmacokinetic properties for one of their hits.

Especially interesting is the report in the second paper authored by Gamo et al. where the authors follow a similar procedure but discover that the novel target list for the purported antimalarial candidates is enriched in kinases. They take due care to investigate that this enrichment is not a chance enrichment. Unlike the human genome which has about 500 kinases, the malarial genome has about 80. But finding kinases among the targets of these novel chemotypes has rich implications, since kinases have already been intensely investigated, the targets are well-understood and there are literally thousands of kinase inhibitors out there waiting to be tested. Testing kinase inhibitors against malaria would open up a whole new chapter for antimalarial drug discovery.

Finally, and this is the kicker most talked about, GSK has made the entire list of hits freely available to the public. This is a very laudable act. In an age where corporations are routinely derided for their emphasis on secrecy and profit-making, such a decision should drive home the good work that corporations can potentially do. It also underscores the tremendous opportunities for drug discovery against neglected diseases gained from academic-corporate collaboration. While it remains to be seen how many of these promising candidates become bona fide drugs, it provides many promising starting points for further efforts. Malaria is about as insidious a disease as you can have, lurking in the shadows and waiting to pounce on you. The more the hands that try to squeeze its neck, the better.

Guiguemde, W., Shelat, A., Bouck, D., Duffy, S., Crowther, G., Davis, P., Smithson, D., Connelly, M., Clark, J., Zhu, F., Jiménez-Díaz, M., Martinez, M., Wilson, E., Tripathi, A., Gut, J., Sharlow, E., Bathurst, I., Mazouni, F., Fowble, J., Forquer, I., McGinley, P., Castro, S., Angulo-Barturen, I., Ferrer, S., Rosenthal, P., DeRisi, J., Sullivan, D., Lazo, J., Roos, D., Riscoe, M., Phillips, M., Rathod, P., Van Voorhis, W., Avery, V., & Guy, R. (2010). Chemical genetics of Plasmodium falciparum Nature, 465 (7296), 311-315 DOI: 10.1038/nature09099

Gamo, F., Sanz, L., Vidal, J., de Cozar, C., Alvarez, E., Lavandera, J., Vanderwall, D., Green, D., Kumar, V., Hasan, S., Brown, J., Peishoff, C., Cardon, L., & Garcia-Bustos, J. (2010). Thousands of chemical starting points for antimalarial lead identification Nature, 465 (7296), 305-310 DOI: 10.1038/nature09107