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      MalDA, Accelerating Malaria Drug Discovery

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          Abstract

          The Malaria Drug Accelerator (MalDA) is a consortium of 15 leading scientific laboratories. The aim of MalDA is to improve and accelerate the early antimalarial drug discovery process by identifying new, essential, druggable targets. In addition, it seeks to produce early lead inhibitors that may be advanced into drug candidates suitable for preclinical development and subsequent clinical testing in humans. By sharing resources, including expertise, knowledge, materials, and reagents, the consortium strives to eliminate the structural barriers often encountered in the drug discovery process. Here we discuss the mission of the consortium and its scientific achievements, including the identification of new chemically and biologically validated targets, as well as future scientific directions.

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          High-level semi-synthetic production of the potent antimalarial artemisinin.

          In 2010 there were more than 200 million cases of malaria, and at least 655,000 deaths. The World Health Organization has recommended artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria caused by the parasite Plasmodium falciparum. Artemisinin is a sesquiterpene endoperoxide with potent antimalarial properties, produced by the plant Artemisia annua. However, the supply of plant-derived artemisinin is unstable, resulting in shortages and price fluctuations, complicating production planning by ACT manufacturers. A stable source of affordable artemisinin is required. Here we use synthetic biology to develop strains of Saccharomyces cerevisiae (baker's yeast) for high-yielding biological production of artemisinic acid, a precursor of artemisinin. Previous attempts to produce commercially relevant concentrations of artemisinic acid were unsuccessful, allowing production of only 1.6 grams per litre of artemisinic acid. Here we demonstrate the complete biosynthetic pathway, including the discovery of a plant dehydrogenase and a second cytochrome that provide an efficient biosynthetic route to artemisinic acid, with fermentation titres of 25 grams per litre of artemisinic acid. Furthermore, we have developed a practical, efficient and scalable chemical process for the conversion of artemisinic acid to artemisinin using a chemical source of singlet oxygen, thus avoiding the need for specialized photochemical equipment. The strains and processes described here form the basis of a viable industrial process for the production of semi-synthetic artemisinin to stabilize the supply of artemisinin for derivatization into active pharmaceutical ingredients (for example, artesunate) for incorporation into ACTs. Because all intellectual property rights have been provided free of charge, this technology has the potential to increase provision of first-line antimalarial treatments to the developing world at a reduced average annual price.
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            Spiroindolones, a potent compound class for the treatment of malaria.

            Recent reports of increased tolerance to artemisinin derivatives--the most recently adopted class of antimalarials--have prompted a need for new treatments. The spirotetrahydro-beta-carbolines, or spiroindolones, are potent drugs that kill the blood stages of Plasmodium falciparum and Plasmodium vivax clinical isolates at low nanomolar concentration. Spiroindolones rapidly inhibit protein synthesis in P. falciparum, an effect that is ablated in parasites bearing nonsynonymous mutations in the gene encoding the P-type cation-transporter ATPase4 (PfATP4). The optimized spiroindolone NITD609 shows pharmacokinetic properties compatible with once-daily oral dosing and has single-dose efficacy in a rodent malaria model.
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              Uncovering the essential genes of the human malaria parasitePlasmodium falciparumby saturation mutagenesis

              Severe malaria is caused by the apicomplexan parasite Plasmodium falciparum. Despite decades of research the unique biology of these parasites has made it challenging to establish high throughput genetic approaches for identification of therapeutic targets. Using transposon mutagenesis of P. falciparum in an approach that exploited its AT-rich genome we generated >38,000 mutants, saturating the genome and defining fitness costs for 95% of genes. Of 5,399 genes we found ~3,000 genes are essential for optimal growth of asexual blood-stages in vitro . Our study defines ∼1000 essential genes, including genes associated with drug resistance, vaccine candidates, and conserved proteins of unknown function. We validated this approach by testing proteasome pathways for individual mutants associated with artemisinin sensitivity. Transposon mutagenesis of Plasmodium falciparum was used to generate >38,000 mutants, saturating the genome and defining fitness costs for 95% of genes. We functionally define the relative fitness cost of disruption for 5,399 genes, and find that ~3,000 genes, ~62% of the genome, are essential for optimal asexual blood-stage in vitro growth. Our study defines ∼1000 essential genes, including genes associated with drug resistance, leading vaccine candidates, and hundreds of Plasmodium- conserved proteins of unknown function that are now potential therapeutic intervention targets. We experimentally validated the essentiality of proteasome pathways with drug studies of individual mutants associated with artemisinin sensitivity. This study defines high-priority targets and pathways and points the way for the future of P. falciparum high throughput genetics. Saturation-scale mutagenesis of Plasmodium falciparum reveals a core set of genes essential for asexual blood-stage growth in vitro . INTRODUCTION: Malaria remains a devastating global parasitic disease, with the majority of malaria deaths caused by the highly virulent Plasmodium falciparum . The extreme AT-bias of the P. falciparum genome has hampered genetic studies through targeted approaches such as homologous recombination or CRISPR-Cas9, and only a few hundred P. falciparum mutants have been experimentally generated in the past decades. In this study, we have used high throughput piggyBac transposon insertional mutagenesis and Quantitative Insertion Site Sequencing (QIseq) to reach saturation-level mutagenesis of this parasite. RATIONALE: Our study exploits the AT-richness of P. falciparum genome, which provides numerous piggyBac transposon insertion targets within both gene coding and non-coding flanking sequences, to generate over 38,000 P. falciparum mutants. At this level of mutagenesis, we could distinguish essential genes as non-mutable and dispensable genes as mutable. Subsequently, we identified 3,357 genes essential for in vitro asexual blood-stage growth. RESULTS: We calculated Mutagenesis Index Scores (MIS) and Mutagenesis Fitness Scores (MFS) to functionally define the relative fitness cost of disruption for 5,399 genes. A competitive growth phenotype screen confirmed that MIS and MFS were predictive of the fitness cost for in vitro asexual growth. Genes predicted to be essential included genes implicated in drug resistance, such as the “ K13 ” Kelch propeller, mdr and dhfr-ts , as well as targets considered to be high-value for drugs development such as pkg , and cdpk5 . The screen revealed essential genes that are specific to human Plasmodium parasites but absent from rodent-infective species, such as lipid metabolic genes that may be crucial to transmission commitment in human infections. MIS and MFS profiling provides a clear ranking of the relative essentiality of gene ontology (GO) functions in P. falciparum . GO pathways associated with translation, RNA metabolism, and cell cycle control are more essential, whereas genes associated with protein phosphorylation, virulence factors, and transcription are more likely to be dispensable. Finally, we confirm that the proteasome-degradation pathway is a high-value druggable target based on its high ratio of essential:dispensable genes, and by functionally confirming its link to the mode of action of artemisinin, the current front-line antimalarial. CONCLUSION: Saturation-scale mutagenesis allows prioritization of intervention targets in the genome of the most important cause of malaria. The identification of the essential genome, consisting of over 3000 genes, will be valuable for antimalarial therapeutic research.
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                Author and article information

                Journal
                100966034
                21990
                Trends Parasitol
                Trends Parasitol
                Trends in parasitology
                1471-4922
                1471-5007
                22 June 2021
                26 February 2021
                June 2021
                07 July 2021
                : 37
                : 6
                : 493-507
                Affiliations
                [1 ]Department of Pediatrics, School of Medicine, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
                [2 ]Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO 63130, USA
                [3 ]Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO 63130, USA
                [4 ]Bioinformatics and Systems Biology Graduate Program, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
                [5 ]Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
                [6 ]Infectious Disease and Microbiome Program, Broad Institute, Cambridge, MA 02142, USA
                [7 ]Wellcome Center for Anti-Infectives Research, Division of Biological Chemistry and Drug Discovery, University of Dundee, Dundee DD1 5EH, UK
                [8 ]Medicines for Malaria Venture, 1215 Geneva 15, Switzerland
                [9 ]Structural Genomics Consortium, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
                [10 ]Department of Biological Engineering, Massachusetts Institute of Technology (MIT), Building 56-341, 77 Massachusetts Avenue, Cambridge MA 02139-4307, USA
                [11 ]Drug Discovery and Development Centre (H3D), University of Cape Town, Rondebosch 7701, South Africa
                [12 ]South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
                [13 ]TropIQ Health Sciences, 6534 AT, Nijmegen, The Netherlands
                [14 ]Department of Biochemistry and Molecular Biology and Department of Chemistry, Huck Center for Malaria Research, The Pennsylvania State University, University Park, PA 16082, USA
                [15 ]Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
                [16 ]Global Health Drug Discovery Institute, Zhongguancun Dongsheng International Science Park, 1 North Yongtaizhuang Road, Beijing 100192, China
                [17 ]Calibr, a division of The Scripps Research Institute, La Jolla, CA 92037, USA
                [18 ]Tres Cantos Medicines Development Campus, Diseases of the Developing World, GlaxoSmithKline, Tres Cantos, 28760, Madrid, Spain
                [19 ]Department of Microbiology and Immunology and Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
                [20 ]The complete author list is provided in the Acknowledgments
                Author notes
                [* ]Correspondence: ewinzeler@ 123456health.ucsd.edu (E.A. Winzeler).
                Article
                NIHMS1712584
                10.1016/j.pt.2021.01.009
                8261838
                33648890
                a637f55b-006b-428a-90f8-f88e9de2c0ee

                This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/).

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                Parasitology
                Parasitology

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