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      Prioritization of Molecular Targets for Antimalarial Drug Discovery

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          Abstract

          There is a shift in antimalarial drug discovery from phenotypic screening toward target-based approaches, as more potential drug targets are being validated in Plasmodium species. Given the high attrition rate and high cost of drug discovery, it is important to select the targets most likely to deliver progressible drug candidates. In this paper, we describe the criteria that we consider important for selecting targets for antimalarial drug discovery. We describe the analysis of a number of drug targets in the Malaria Drug Accelerator (MalDA) pipeline, which has allowed us to prioritize targets that are ready to enter the drug discovery process. This selection process has also highlighted where additional data are required to inform target progression or deprioritization of other targets. Finally, we comment on how additional drug targets may be identified.

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          Most cited references58

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          Estimation of clinical trial success rates and related parameters

          SUMMARY Previous estimates of drug development success rates rely on relatively small samples from databases curated by the pharmaceutical industry and are subject to potential selection biases. Using a sample of 406 038 entries of clinical trial data for over 21 143 compounds from January 1, 2000 to October 31, 2015, we estimate aggregate clinical trial success rates and durations. We also compute disaggregated estimates across several trial features including disease type, clinical phase, industry or academic sponsor, biomarker presence, lead indication status, and time. In several cases, our results differ significantly in detail from widely cited statistics. For example, oncology has a 3.4% success rate in our sample vs. 5.1% in prior studies. However, after declining to 1.7% in 2012, this rate has improved to 2.5% and 8.3% in 2014 and 2015, respectively. In addition, trials that use biomarkers in patient-selection have higher overall success probabilities than trials without biomarkers.
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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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              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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                Author and article information

                Journal
                ACS Infect Dis
                ACS Infect Dis
                id
                aidcbc
                ACS Infectious Diseases
                American Chemical Society
                2373-8227
                15 September 2021
                08 October 2021
                : 7
                : 10
                : 2764-2776
                Affiliations
                []Wellcome Centre for Anti-Infectives Research, Division of Biological Chemistry and Drug Discovery, University of Dundee , Dundee, DD1 5EH, United Kingdom
                []Department of Pediatrics, School of Medicine, University of California, San Diego , La Jolla, California 92093, United States
                [§ ]Medicines for Malaria Venture , 1215 Geneva, Switzerland
                []TropIQ Health Sciences , 6534 AT, Nijmegen, The Netherlands
                []Global Health, GSK , 28760-Tres Cantos, Madrid, Spain
                [# ]Division of Infectious Diseases, Department of Medicine and Department of Molecular Microbiology, Washington University School of Medicine , St. Louis, Missouri 63110, United States
                []Wellcome Sanger Institute, Wellcome Genome Campus , Hinxton, CB10 1SA, United Kingdom
                []Infectious Disease and Microbiome Program, Broad Institute , Cambridge, Massachusetts 02142, United States
                []Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health , Boston, Massachusetts 02115, United States
                []Calibr, a Division of The Scripps Research Institute , 11119 North Torrey Pines Road, La Jolla, California 92037, United States
                []Department of Biological Engineering, Massachusetts Institute of Technology (MIT) , Cambridge Massachusetts 02139-4307, United States
                [% ]Department of Microbiology and Immunology, Columbia University Irving Medical Center , New York, New York 10032, United States
                [& ]Lgenia, Inc. , Fortville, Indiana 46040, United States
                [+ ]Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York, New York 10032, United States
                Author notes
                Author information
                https://orcid.org/0000-0001-9797-2612
                https://orcid.org/0000-0002-1854-2882
                https://orcid.org/0000-0003-3529-8399
                https://orcid.org/0000-0002-9560-7643
                https://orcid.org/0000-0002-5754-3407
                https://orcid.org/0000-0002-6250-8796
                https://orcid.org/0000-0001-8810-5605
                https://orcid.org/0000-0002-0959-1113
                https://orcid.org/0000-0002-4049-2113
                https://orcid.org/0000-0002-5238-1314
                Article
                10.1021/acsinfecdis.1c00322
                8608365
                34523908
                a4b8ac02-8970-4b64-8da9-933507f16308
                © 2021 The Authors. Published by American Chemical Society

                Permits the broadest form of re-use including for commercial purposes, provided that author attribution and integrity are maintained ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 15 June 2021
                Funding
                Funded by: Bill and Melinda Gates Foundation, doi 10.13039/100000865;
                Award ID: OPP1032548
                Funded by: Bill and Melinda Gates Foundation, doi 10.13039/100000865;
                Award ID: OPP1202973
                Funded by: Bill and Melinda Gates Foundation, doi 10.13039/100000865;
                Award ID: OPP1193840
                Funded by: Bill and Melinda Gates Foundation, doi 10.13039/100000865;
                Award ID: OPP1054480
                Categories
                Perspective
                Custom metadata
                id1c00322
                id1c00322

                malaria,plasmodium,drug discovery,molecular targets
                malaria, plasmodium, drug discovery, molecular targets

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