Innovative malaria prodrug targets liver, enhances efficacy while reducing toxicity, preclinical studies show

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Innovative malaria prodrug targets liver, enhances efficacy while reducing toxicity, preclinical studies show
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Tafenoquine, a prodrug that could fulfill the criteria for a mass eradication campaign.

By Dr. Liji Thomas, MDApr 23 2024Reviewed by Lily Ramsey, LLM With malaria still posing a constant and often deadly threat to billions worldwide, new therapies are urgently required to combat the infection. This is made more difficult by the multiple stages of the parasite’s lifecycle.

While P. falciparum is the most lethal parasite, P. vivax causes the most cases because it has the largest habitat. About 3,300 million people are thus at risk of P. vivax infection globally. They live in the American continents, India, South-East Asia, and the Western Pacific regions. The problem with tafenoquine Tafenoquine is an oral medication taken as a single dose, contrasting with the 14-day regimen required for primaquine. However, it is not suitable for people with glucose-6-phosphate dehydrogenase deficiency, a common enzyme defect, or for those whose G6PD status is unknown.

To address these challenges, research into prodrugs has been conducted to potentially broaden the therapeutic margin, even slightly. Prior studies suggest that these modifications may make tafenoquine safe for use in individuals with G6PD deficiency. The prodrug is designed to remain stable in the bloodstream but is broken down by cathepsin enzymes within the body. Given the absence of non-8-aminoquinoline options for radical cures and the practicality of SC administration in mass eradication efforts, this development could represent a significant advancement.

What did the study show? By modifying the blood-stable linker in the prodrug, the researchers increased the stability of the prodrug fourfold on SC administration.Surprisingly, it targeted the liver, with hepatocyte exposure significantly higher than oral TQ. Simultaneously, it exhibited selectivity, with a significantly lower maximum concentration in the plasma.

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