Le paludisme demeure un problème de santé publique mondial qui risque de s'aggraver avec la résistance de Plasmodium falciparum aux thérapies combinées à base d'artémisinine (ACT), médicaments antipaludiques les plus récents et les plus efficaces. Mon travail avait pour but de proposer différents axes d'élimination du paludisme en Indonésie. Une première partie a consisté à rechercher de nouveaux médicaments antipaludiques à partir de données ethnobotaniques indonésiennes. Parmi les 25 extraits bruts réalisés à partir de plantes médicinales indonésiennes utilisées traditionnellement dans le traitement du paludisme, sept ont montré une activité antipaludique intéressante (CI50 <5 µg/mL) et certains d'entre eux se sont révélés également actifs sur 2 autres pathogènes Babesia divergens et Leishmania infantum. La deuxième partie de ce travail était axée sur les composés organométalliques synthétiques. Les études de relations structure-activité de ces complexes organométalliques d'or (I) -NHC ont permis de sélectionner un composé actif sur P. falciparum avec une CI50 de 320nM. La troisième partie du travail a été consacrée à l'étude de la résistance de P. falciparum à l'artémisinine et à ses dérivés. La corrélation entre le polymorphisme de PfK13 et la résistance à l'artémisinine a été clairement établie grâce à des études de génétique inverse avec des souches de laboratoire résistantes et sensibles et des isolats cliniques Cambodgiens. Cette résistance a été mise en évidence in vitro par un test de survie parasitaire appelé RSA(0-3h). Par les mêmes méthodes génétique et phénotypique, la cartographie de la distribution du polymorphisme de PfK13 en Indonésie a été réalisée dans la zone de Kupang sur des patients infectés par P. falciparum. Cependant au moment de la collecte des échantillons de sang, la prévalence de P. falciparum a montré une diminution spectaculaire empêchant la poursuite de l'étude clinique. Face au faible nombre de patients admissibles avec un paludisme à P. falciparum, aucun résultat concluant n'a pu être obtenu. En conclusion, les plantes médicinales indonésiennes et les composés synthétiques sont potentiellement intéressants comme point de départ chimique pour de nouveaux médicaments antipaludiques. En ce qui concerne la résistance à l'artémisinine, aucun échec thérapeutique ou parasitologique après traitement par ACT n'a été signalé, pour le moment, en Indonésie. Cependant, les zones de résistance de P. falciparum aux ACT dans le Sud-Est asiatique sont relativement proches et nécessitent, en Indonésie, un suivi des variations de la chimiosensibilité du paludisme à P. falciparum et du polymorphisme de PfK13, responsable de la résistance à l'artémisinine. / Malaria remains a global public health problem and worsening with the resistance of Plasmodium falciparum to Artemisinin-based Combination Therapies (ACTs), the latest and most effective antimalarial drugs. My project aimed to provide insight into malaria elimination in Indonesia. The first part was to look for new antimalarial drugs based on Indonesian ethnobotanical data. Among 25 crude extracts realized on Indonesian traditional medicinal plants, seven showed a good antimalarial activity (IC50 < 5µg/mL) and some of them were also active against Babesia divergens and Leishmania infantum. The second part of the study focused on chemosynthetic organometallic compounds. The structure- activity relationships study on organometallic gold(I)-NHC complexes led to a very active compound on P. falciparum with an IC50 of 320nM. The third part of this work was dedicated to the study of P. falciparum resistance to artemisinin and its derivatives. The correlation between PfK13 polymorphism and artemisinin resistance has been clearly established thanks to reverse genetic with resistant and sensitive laboratory strains and clinical isolates from Cambodia. This resistance was evidenced in vitro throughout a parasite survival assay called RSA(0-3h). By the same genotypic and phenotypic methods, mapping of PfK13 polymorphism distribution in Indonesia was performed in Kupang on P. falciparum malaria patients. However, at the time of P. falciparum blood samples collection, prevalence showed a dramatic decrease hindering the continuation of the clinical study. Facing to the very small number of eligible patients with a P. falciparum malaria, no conclusive results has been obtained. In conclusion, medicinal plants and synthetic compounds are potentially interesting as chemical starting point for new antimalarial drugs. Concerning artemisinin resistance, any treatment failure or delayed cure with ACTs has yet to be reported in Indonesia. However, because Indonesia is relatively close to the Southeast Asian areas of resistance, the possible occurrence of such cases in Indonesia must be anticipated by determining the variations of P. falciparum malaria chemo-sensitivity and by following PfK13 polymorphism, responsible for artemisinin resistance.

Thesis (M.Sc. Agriculture (Horticulture)) -- University of Limpopo, 2017 / Artemisia annua L. from the family Asteraceae is an annual medicinal plant and has been used to make herbal remedies in Asia for thousands of years. Artemisinin is a sesquiterpene lactone, isolated from aerial parts of Artemisia annua, with the highest concentrations being in flowers and leaves. In addition to potent anti-malarial activity, artemisinin possesses anti-cancer, anti-schistosomiatic, anti-hepatitis B, anti-HIV, anti-leishmanial and herbicidal activities. Low artemisinin production (0.01-2%) from A. annua is a major constraint in commercialisation of the drug for control of malaria. Worldwide, efforts have been underway to improve the concentration of artemisinin using conventional breeding, biochemical, physiological, molecular and hairy-root culture techniques, however all these methods are not economical. Cultural practices like spacing and pruning have limitation in improving artemisinin concentration and these may help in increasing the concentrations of artemisinin. Study was conducted at the experimental farm of the Agricultural Research Council – Vegetable and Ornamental Plants, Roodeplaat Pretoria. The objective of this study was to determine whether spacing, pruning and their interactions would have any effect on the concentrations of artemisinin, growth and yield of A. annua and whether drying methods would have an effect on the concentrations of artemisinin in A. annua. Since there was only one field trial, all sub-objectives were addressed at once (Chapter 3). Fresh seeds of A. annua were obtained from the ARC-VOP gene bank and sown in seedling trays in September 2014. Uniform eight-week-old seedlings were hardened-off, transplanted in November 2014 in 10 cm deep holes and then pruned ten weeks after transplanting. Treatments for Experiment 1, viz., 3 × 4 factorial experiment were laid out in a randomised complete block design, with four replications (n = 48). The two factors of the experiment were (a) spacing [0.5 × 1 m2 (standard: 0.50 m2), 0.5 × 0.7 m2 (small: 0.35 m2) 0.5 × 0.5 m2 (smaller: 0.25 m2) and 0.3 × 0.7 m2 (smallest: 0.21 m2)] and (b) pruning [no pruning (control), removing the apical bud and removing shoots three nodes from the bottom]. The plants were irrigated using overhead sprinklers system for two hours three times per week. Four readings for growth variables (plant height, stem diameter and chlorophyll content) were collected with one week interval. Plants were harvested after 180 days from planting, and leaves, stems and roots were separated weighed and oven dried at 40 ºC for 72 h. In Experiment 2 (drying methods), treatments, namely, 100% sun, 100% shade, 50% shade, freeze and oven drying were arranged in completely randomised design with four replicates (n = 20). The treatments were exposed for a week, to full sunlight, 50% shade-drying under a shade net that allows 50% light penetration, 100% shade under enclosed room at ambient (24-25 ºC) temperature, oven drying for 24 h at 40 ºC, and freeze-drying for three days. Freeze-drying had significant effect on artemisinin concentration of 1.941%. It was followed by oven (1.738%) and 100% shade drying (1.657%) and the lowest artemisinin concentration (1.412%) was obtained from 50% shade drying. The smaller spacing of 0.25 m2 in combination with apical bud removal had a significant effect on artemisinin concentration, producing artemisinin concentration of 0.193%. Spacing had a significant effect on stem diameter, fresh leaf mass and dry leaf mass but had no effect on plant height and chlorophyll content. Pruning had a significant effect on plant height and chlorophyll content and had no effect on stem diameter. The small spacing of 0.35 m2 had the highest fresh and dry leaf mass of 17.99 and 9.62 t/ha. The interaction of spacing and pruning had no significant effect on the growth and yield of A. annua. The results from this study suggested that cultural and processing practices may have direct effects in the concentration of artemisinin, growth and yield of A. annua. The results xiv provided some understanding on how agronomic and processing practices can be used to increase artemisinin content in A. annua and understand the interaction between different agronomic practices and thereby allowing the development of economic methods for A. annua post-harvest handling. Future work should focus on implementing various pruning techniques to trigger stress and indirectly secondary metabolites

Hot melt extrusion has attracted recent interest from the pharmaceutical industry and academia as an innovative drug delivery technology. This novel technique has been shown to be a viable and robust method for preparing different drug delivery systems including pellets, implants, tablets, capsules and granules. The aim of this research was to understand hot melt extrusion processing and explore its pharmaceutical applications. Two applications of hot melt extrusion (HME) have been investigated to improve the properties of poorly soluble thermolabile drugs; polymeric solid dispersions and solid state polymorphic transformation. HME is a solvent free, continuous and readily scalable technique which is increasingly being considered as a viable alternative to conventionally used batch techniques. However, the high temperature and shear forces imparted by the extrusion process can limit its applications with heat sensitive active pharmaceutical ingredients (APIs). Artemisinin was selected as a model drug which being thermolabile in nature and possesses processing challenges to processing HME. A low Tg amphiphillic copolymer, Soluplus® was selected as a matrix material. Drug-polymer compatibility was studied using rotational rheometry and thermal characterisation. The drug was found to be completely dissolved within the polymer, although some discolouration of the mixture was observed, indicating degradation of the API. The addition of a small percentage of citric acid to the formulation was found to prevent this degradation by increasing the pH. The dissolution profile of the formulation was approximately five times higher compared to that of the pure drug. The pharmacokinetic study was carried out using Albino rats to calculate bioavailability. The area under plasma concentration time curve (AUC0-24hr) and peak plasma concentration (Cmax) were four times higher for the prepared solid dispersion compared to that of pure artemisinin. Extruded solid dispersions were found to be amorphous in nature and maintained stability for 2 years. A second route to improving the solubility of poorly soluble APIs was also investigated. It was found that under carefully controlled conditions, high temperature extrusion (HTE) could be used to achieve polymorphic transformation with a number of APIs. This solvent-free continuous process was demonstrated with artemisinin, piracetam, carbamazepine and chlorpropamide. Artemisinin was used as a detailed case study of stability, solvent mediated transformation and mechanism of polymrophic transformation during extrusion, using computational modelling and model shear flows. At high temperature, phase transformation from orthorhombic to triclinic crystals was found to occur via the vapour phase. Under mechanical stress the crystalline structure was disrupted, leading to new surfaces being continuously formed and exposed to high temperatures; thus accelerating the transformation process. Polymorphic transformation during HTE was found to comprise three stages; i) preheating and conveying; ii) vapour phase transformation and size reduction and iii) continuous transformation and agglomeration. The triclinic form showed four times greater dissolution rate as compared to the orthorhombic form. The triclinic form showed two fold increase in bioavailability in Albino rats.

Resistance to antimalarial drugs continues to be a major obstacle in controlling and eradicating malaria. The identification of genetic markers of resistance is vital for disease management but they can be difficult to predict before resistance arises in the field. This thesis describes an alternative approach to gene identification, combining an in vivo experimental evolution model, Linkage Group Selection (LGS) and Solexa genome re-sequencing. Here this model was used to resolve the genetic basis of chloroquine and artemisinin resistance in the rodent malaria parasite Plasmodium chabaudi. AS-30CQ is a parasite with high resistance to chloroquine and resistance to artemisinin. It was crossed with the genetically different drug-sensitive strain AJ. The resulting progeny were selected with drugs and backcrossed to the sensitive parent. Both crosses were treated with increasing concentrations of chloroquine and artemisinin. The frequency of markers from the sensitive parasite were analysed in order to characterize the signatures of drug selection. Three loci involved progressively in chloroquine resistance were identified on chromosomes 11, 3 and 2. One main locus on chromosome 2 was identified with artemisinin selection. The Solexa platform was used to re-sequence the genomes of both AS-30CQ and its sensitive progenitor, AS-sens. The differences between the two genomes were integrated with the LGS data to identify: 1) a strong candidate for the main CQresistance determinant - a putative amino acid transporter on chromosome 11 (aat1) 2) two candidates for high level chloroquine resistance on chromosome 3. and 3) a mutation in ubp1 gene on chromosome 2 that is likely to contribute to the highest level of chloroquine resistance and be main determinant of the artemisinin resistance phenotype. In addition the last section of this thesis describes two otherwise isogenic clones showing low- and high levels of chloroquine resistance were grown competitively to evaluate the effect of these mutations on parasite fitness. The highly resistant strain demonstrated a loss of fitness in relation to its more sensitive progenitor and was outcompeted in untreated and low-treated infections.

Le paludisme est la plus importante infection parasitaire dans le monde, menaçant environ 40% de la population humaine. Dans les dernières années c'est devenu un problème de santé publique majeur en raison de l'augmentation des parasites résistants aux traitements actuels. Certains complexes NHC-or(I) présentent des activités antipaludiques, et sont une alternative très prometteuse dans le traitement du paludisme en raison de leur potentiel inhibiteur de la thiorédoxine réductase (TrxR) qui joue un rôle majeur dans la chaîne respiratoire mitochondriale (une des deux voies actives à l'état de quiescence des parasites résistants). Dans ce travail de thèse, un panel de complexes médicament-NHC-or(I) a été synthétisé et caractérisé. Le premier groupe de molécules concerne une famille de complexes cationiques bis-NHC-or(I) et de complexes neutres mono-NHC-or(I) fonctionnalisés avec substituents aliphatiques ou aromatiques. Le groupe comprend trois séries. Les trois séries ont été testées contre la souche sensible de F32-TEM de P. falciparum présentant des activités élevées, avec des valeurs d'IC50 de l'orde du nM. Le deuxième groupe concerne une série de complexes cationiques bis-NHC-or(I) fonctionnalisés avec des substituants aliphatiques ou aromatiques comprenant un groupement triclosan relié par un connecteur aliphatique. Le triclosan inhibe la voie de synthèse des acides gras, qui reste également active chez les parasites résistants. Ces complexes ont été testés contre P. falciparum, montrant des activités élevées avec des valeurs IC50 dans la gamme du nM. Les ligands de cette série et leurs complexes respectifs ont également été testés contre L. infantum, l'un des parasites provoquant la leishmaniose, et se sont révélés très efficaces sous les formes amastigote et promastigote, avec des valeurs d'IC50 dans le bas µM. / Malaria is the most important parasitic infection in people, threatening around 40% of the human population. In the last years it has become a bigger public health concern because of the augmentation of malaria parasites resistant to artemisinin and its derivatives. Some NHC-gold(I) complexes show antimalarial activities, being a very promising alternative in malaria treatment because of their potential to inhibit thioredoxin reductase (TrxR) that plays a major role in mitochondrial respiratory chain (one of the two pathways that remains active in the quiescent state of the resistant parasites). In this work of thesis a panel of drug-NHC-gold(I) complexes including artemisinin and triclosan moieties has been synthesized and characterized with the objective of developing hybrid molecules with a dual mode of action able to overcome plasmodium resistance to artemisinin and its derivatives. The first group of molecules concerns a family of aliphatic or aromatic-functionalized cationic bis-NHC-gold(I) and neutral mono-NHC-gold(I) complexes with an artemisinin moiety connected through an aliphatic linker. The group includes three series depending on the length of the aliphatic linker (C3, C4, and C5). The three series have been tested against the sensible F32-TEM strain of P. falciparum showing high activities with IC50 values in the nM range. The second group concerns a series of aliphatic or aromatic-functionalized bis-NHC-gold(I) complexes with an triclosan moiety connected through an aliphatic linker. Triclosan inhibits the fatty acid synthesis pathway, which also remains active in the quiescent state on resistant parasites. These complexes were tested against P. falciparum showing, high activities with IC50 values in the nM range. The ligands of this series and their respective complexes have been also tested against one of the leishmaniosis causing parasites, L. infantum, being very effective in both, amastigote and promastigote forms, with IC50 values in the low µM range.

In order to reduce malaria prevalence worldwide, a better understanding of parasite transmission and the effect of drug resistance is needed. The effect of drug resistance on malaria transmission has been examined for some drugs, but not for mitochondrial inhibitors such as atovaquone and the current basis of malaria therapy, artemisinin. Therefore, the goal of this study was to produce gametocytes, the life cycle stage that transmits from mosquito to human, in several different drug resistant patient isolates as well as to determine the effect of drug resistance on gametocyte development and transmission. Previous studies have shown that the mutation that confers resistance to atovaquone, a common antimalarial, occurs de novo after treatment and transmission of this resistance is not seen in the field. Therefore, to determine whether or not the resistance mutation can be transmitted, mosquito-feeding experiments were conducted using atovaquone resistant parasites and resulting oocyst DNA was analyzed. In addition to these atovaquone studies, artemisinin resistant gametocytes were also grown in vitro and drug pressure was added to determine if resistance mechanisms affect gametocyte development. This study is the first examine gametocyte development in these resistant strains and the first to report that transmission of the atovaquone resistant mutation may be possible. However, data is currently inconclusive on the effect of artemisinin resistance on gametocyte development.

Effective case management of malaria is hampered by the spread of parasite resistance to nonartemisinin antimalarials. To counteract the impact of drug resistance, the World Health Organization (WHO) has endorsed artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated Plasmodium falciparum malaria. Currently recommended ACTs are artemether-lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate plus sulfadoxine-pyrimethamine and dihydroartemisinin-piperaquine. This study sought to review evidence of the efficacy and safety of different non-artemisinin antimalarials in combination with artesunate, artemether or dihydroartemisinin for the treatment of uncomplicated P. falciparum malaria in non-pregnant adults and children. The search for randomized controlled trials (RCTs) was conducted in the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE and in ClinicalTrials.gov in January 2009. The eligibility and the methodological quality of trials were assessed and data were extracted, using standard forms. Data were captured and analyzed in Review Manager Software, versions 4.2 and 5.0. The outcomes assessed were: treatment failure, fever and parasite clearance time, calculating the relative risk (RR) and a weighted mean difference (WMD) with a 95% confidence interval and p-values, indicating statistical significance at 0.05. Thirty-seven trials with 6862 participants were included. Artesunate combined with amodiaquine had a statistically significant lower risk of treatment failure compared to the combination of artesunate with sulfadoxine-pyrimethamine (RR=0.57, 95% CI [0.33, 0.97], p=0.04, seven trials, N=1341). In addition, treatment with artesunate plus mefloquine was significantly associated with a lower risk of treatment failure compared to artesunate plus azithromycin (RR=0.04, 95% CI [0.00, 0.64], p=0.02, one trial, N=54). There was no significant difference when either mefloquine or atovaquone-proguanil were combination partners with artesunate (RR=2.6, 95% CI [0.93; 7.24], p=0.07, one trial, N=1066). When artesunate was combined with chloroquine, primaquine or azithromycin and compared with artesunate monotherapy, there was no statistically significant difference in the risk of unadjusted treatment failure. Each of these comparisons had one trial each. Artesunate plus chloroquine was quicker at clearing fever compared to artesunate plus sulfadoxinepyrimethamine (WMD= -7.20, 95% CI [-12.53, -1.87], one trial, N=132). Few trials adequately reported adverse events. There was no significant difference observed in the risk of adverse events between artesunate plus amodiaquine compared with artesunate monotherapy, however, adverse events were significantly less in artesunate plus amodiaquine compared to artesunate plus methylene-blue. Artesunate plus amodiaquine on the other hand had significantly more adverse events reported compared to artesunate plus sulfadoxine-pyrimethamine. The findings of this study support the implementation of artemisinin-based combination therapy for the treatment of uncomplicated malaria. Most crucially, this review found a greater advantage of combining amodiaquine with artesunate compared to sulfadoxine-pyrimethamine. The efficacy of artesunate plus mefloquine was superior to that of artesunate plus azithromycin. Furthermore, the combination of artemisinins with chloroquine, primaquine and azithromycin has shown very low efficacy and these combination therapies should not be recommended. The reporting of efficacy was not standardized as many trials did not differentiate between re-infections and recrudescences. Adverse events were also not adequately reported. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Introduction - Malaria is a major global health problem, with more than 500 million reported cases and at least 1 million deaths each year. The main problem with malaria control is the emerging drug resistance. Plasmodium falciparum (P. falciparum) developed widespread resistance to antimalarial drugs such as chloroquine (CQ) and mefloquine, but not to the artemisinins. The World Health Organization (WHO) recommended artemisinin combination therapy (ACT) for the treatment of uncomplicated malaria in all chloroquine resistance areas. However, P. falciparum has recently started to display resistance to these ACTs, highlighting the need for new chemotherapeutic approaches for the treatment of P. falciparum infections. Aims - The aims of this study were: (i) to design and synthesise a new series of antimalarial hybrid drugs, consisting of dihydroartemisinin (DHA) and aminoquinoline moieties bound covalently through different, very distinctive linkers; (ii) to determine the in vitro antiplasmodial activity and cytotoxicity of the synthesised series; (iii) to ascertain whether the in vitro antiplasmodial activity of the promising compounds would be carried over in vivo against Plasmodium vinckei (P. vinckei); and, (iv) to obtain an indication of the pharmacokinetic properties of this class of antimalarial drugs by performing snapshot pharmacokinetic analysis. Methods - DHA was coupled via an aminoethylether bond to various aminoquinolines to give hybrids and hybrid-dimers. CQ-susceptible (D10 and 3D7) and CQ-resistant (Dd2) strains of P. falciparum were used to determine the in vitro antiplasmodial activity. In vitro cytotoxicity was assessed using a mammalian cell-line (Chinese Hamster Ovarian, CHO). The antiproliferative activity of the hybrid-dimers was tested against three cell lines; renal adenocarcinoma (TK-10), breast adenocarcinoma (MCF-7) and melanoma (UACC-62). P. vinckei-infected mice were treated with the hybrid drugs for four days at a dosage of 0.8 mg/kg, 2.5 mg/kg, 7.5 mg/kg or 15 mg/kg intraperitoneally (ip) or orally (po), with 2.7 mg/kg, 8.3 mg/kg, 25 mg/kg or 50 mg/kg, in order to determine their antimalarial activity. A snapshot oral and intravenous (IV) pharmacokinetic study was performed. Results - All compounds were obtained as the 10-β-isomers and were isolated as the oxalate salts. Low nanomolar in vitro antiplasmodial activities were displayed by several compounds in this series, with IC50 values ranging from 5.15 to 29.5 nM, in comparison with the values of 2.09–5.11 nM and 21.54–157.90 nM for each of DHA and CQ respectively. All compounds displayed good selectivity towards P. falciparum in vitro (selectivity index (SI) ≥ 20). Two of the hybrids, featuring non-methylated and methylated two-carbon diaminoalkyl linkers, exerted potent in vivo antimalarial activities, with ED50 values of 1.1 and 1.4 mg/kg by ip route and 12 and 16 mg/kg po, respectively. Long-term monitoring of parasitaemia showed a complete cure of mice (without recrudescence) at 15 mg/kg ip and at 50 mg/kg po for these two hybrids, whereas artesunate was able to provide a complete cure only at 30 mg/kg ip and 80 mg/kg po. Conclusions - These compounds may provide a lead into a new class of antimalarial drugs so badly needed for treatment of resistant strains. Despite shorter half-lives and moderate oral bioavailability in comparison with DHA, two of the compounds of this series were able to cure malaria in mice at very low dosages, implicating extremely active metabolites. The optimum linker length for antimalarial activity was found to be a diaminoalkyl linker consisting of two carbon atoms, either unmethylated or bearing a single methyl group. / Thesis (PhD (Pharmaceutical Chemistry))--North-West University, Potchefstroom Campus, 2013

Introduction - Malaria is a major global health problem, with more than 500 million reported cases and at least 1 million deaths each year. The main problem with malaria control is the emerging drug resistance. Plasmodium falciparum (P. falciparum) developed widespread resistance to antimalarial drugs such as chloroquine (CQ) and mefloquine, but not to the artemisinins. The World Health Organization (WHO) recommended artemisinin combination therapy (ACT) for the treatment of uncomplicated malaria in all chloroquine resistance areas. However, P. falciparum has recently started to display resistance to these ACTs, highlighting the need for new chemotherapeutic approaches for the treatment of P. falciparum infections. Aims - The aims of this study were: (i) to design and synthesise a new series of antimalarial hybrid drugs, consisting of dihydroartemisinin (DHA) and aminoquinoline moieties bound covalently through different, very distinctive linkers; (ii) to determine the in vitro antiplasmodial activity and cytotoxicity of the synthesised series; (iii) to ascertain whether the in vitro antiplasmodial activity of the promising compounds would be carried over in vivo against Plasmodium vinckei (P. vinckei); and, (iv) to obtain an indication of the pharmacokinetic properties of this class of antimalarial drugs by performing snapshot pharmacokinetic analysis. Methods - DHA was coupled via an aminoethylether bond to various aminoquinolines to give hybrids and hybrid-dimers. CQ-susceptible (D10 and 3D7) and CQ-resistant (Dd2) strains of P. falciparum were used to determine the in vitro antiplasmodial activity. In vitro cytotoxicity was assessed using a mammalian cell-line (Chinese Hamster Ovarian, CHO). The antiproliferative activity of the hybrid-dimers was tested against three cell lines; renal adenocarcinoma (TK-10), breast adenocarcinoma (MCF-7) and melanoma (UACC-62). P. vinckei-infected mice were treated with the hybrid drugs for four days at a dosage of 0.8 mg/kg, 2.5 mg/kg, 7.5 mg/kg or 15 mg/kg intraperitoneally (ip) or orally (po), with 2.7 mg/kg, 8.3 mg/kg, 25 mg/kg or 50 mg/kg, in order to determine their antimalarial activity. A snapshot oral and intravenous (IV) pharmacokinetic study was performed. Results - All compounds were obtained as the 10-β-isomers and were isolated as the oxalate salts. Low nanomolar in vitro antiplasmodial activities were displayed by several compounds in this series, with IC50 values ranging from 5.15 to 29.5 nM, in comparison with the values of 2.09–5.11 nM and 21.54–157.90 nM for each of DHA and CQ respectively. All compounds displayed good selectivity towards P. falciparum in vitro (selectivity index (SI) ≥ 20). Two of the hybrids, featuring non-methylated and methylated two-carbon diaminoalkyl linkers, exerted potent in vivo antimalarial activities, with ED50 values of 1.1 and 1.4 mg/kg by ip route and 12 and 16 mg/kg po, respectively. Long-term monitoring of parasitaemia showed a complete cure of mice (without recrudescence) at 15 mg/kg ip and at 50 mg/kg po for these two hybrids, whereas artesunate was able to provide a complete cure only at 30 mg/kg ip and 80 mg/kg po. Conclusions - These compounds may provide a lead into a new class of antimalarial drugs so badly needed for treatment of resistant strains. Despite shorter half-lives and moderate oral bioavailability in comparison with DHA, two of the compounds of this series were able to cure malaria in mice at very low dosages, implicating extremely active metabolites. The optimum linker length for antimalarial activity was found to be a diaminoalkyl linker consisting of two carbon atoms, either unmethylated or bearing a single methyl group. / Thesis (PhD (Pharmaceutical Chemistry))--North-West University, Potchefstroom Campus, 2013

Artemisinin-resistant Plasmodium falciparum parasites have been reported in the Greater Mekong Subregion since 2007. Artemisinin combination therapy (ACT) is the mainstay of antimalarial treatment and is responsible for decreases in malaria-related morbidity and mortality over the past fifteen years. The slowed parasite clearance rates following ACT indicates resistance to artemisinin derivatives. This resistance places increasing selective pressure for variants or traits that confer resistance to the partner drug used in combination and has led to the rapid failure of several partner drugs. While a single nucleotide polymorphism (SNP) in kelch13 has been shown to mediate some resistance phenotypes, the complete mechanism of artemisinin resistance is poorly understood. The known mechanisms of resistance hint at a connection to autophagy, an intracellular pathway that cells use to degrade waste molecules or organelles in response to stress and starvation, which is poorly characterized in Plasmodium. In this doctoral thesis project, I investigated the role of an autophagy-like mechanism in P. falciparum in the mechanism of artemisinin resistance. I found a SNP in autophagy-related gene 18 (atg18) that was associated with clinical delayed parasite clearance half-life following ACT. This gene encodes PfAtg18, a protein that I characterized as being similar to mammalian/yeast homologues in terms of structure, binding abilities, and ability to form puncta in response to stress. In order to investigate the contribution of the mutation in this protein, I edited the atg18 gene using CRISPR/Cas9 and screened the mutant and parent parasites against a drug library of over 6000 unique compounds. I discovered that while the SNP did not change the mutant parasite's susceptibility to any of the antimalarial compounds using a 72-hour drug pulse, it did alter the susceptibility to 227 other compounds. Further, I found that the SNP offers parasites a fitness advantage by allowing them to grow better in nutrient-limited settings. Finally, I determined that neither this atg18 SNP nor several polymorphisms in kelch13 modulate a dormancy phenotype that appears to be involved in the artemisinin-resistance mechanism.