Class of 2013 Abstract / Specific Aims: To determine if melanoma cells are more vulnerable to Amodiaquine (AQ) or Lumefantrine (LF)-based artemisinin combination therapy compared to artemisinin monotherapy. Methods: Tested anti-malarials in vitro for anti-melanoma activity, which contained 100,000 of the A375 human metastatic melanoma cells that were repeatedly treated independently three times. Main Results: Dihydroartemisinin (DHA) monotherapy induced significant cell death in melanoma cells. However, artemisinin combination therapy (ACT) did not enhance DHA-induced cell death. AQ protected against DHA-induced cell death causing morphological changes detected by electron microscopy. As for LF, it did not affect DHA-induced cell death. Conclusion: The results demonstrated that ACT does not display enhanced anti-melanoma activity compared to artemisinin monotherapy. It suggests that AQ may have anti-oxidant properties, but would need to be explored further in the context of anti-oxidant cyto-protection.

The malaria parasite Plasmodium falciparum is responsible for about 500,000 deaths a year and is evolving resistance to the front-line treatment of artemisinin-based combination therapy. Resistance is currently confined to South East Asia, however millions of lives will be at risk if resistance spreads to Africa. Understanding the mechanism of resistance to artemisinins would aid containment strategies to prevent the spread of artemisinin resistance. There is also an urgent need to accelerate drug discovery since drug resistance has already been documented to all existing antimalarials. Here, I report on our efforts to understand the function of the gene k13, the gene with the strongest association with artemisinin resistance, and the potential genetic mechanisms associated with resistance to atovaquone, another widely used antimalarial. To precisely study the transcriptome characteristics of an isogenic k13 dysregulation mutant and wild type strain, I developed a new computational algorithm called Dephasing Identifier (DI) that is capable of identifying the genes dysregulated in cell cycle shifts. DI is designed to solve the problem of pinpointing important patterns in complex genomics data with temporal sequences that cannot be resolved by standard pair-wise comparison methods, by using an innovative method that leverages external reference data for systematic comparisons. In the k13 study, I demonstrated that the algorithm identifies co- regulated gene sets that have consistent annotated functions. The DI algorithm successfully identified aberrantly early DNA replication as the driving process of transcriptome changes in the mutant. To understand genome-wide changes that occurred in a set of atovaquone resistance stains, I analyzed whole genome sequencing data previously generated for a P. falciparum strain that underwent in vitro atovaquone selection to create atovaquone resistant strains. I systematically analyzed the genomes of these strains to search for significant genetic changes associated with atovaquone resistance; and used stringent criteria to identify genes involved in regulating transcription and protein modifications as acquiring non- synonymous mutations. Additionally, copy number variations in plasmepsin genes, a family known to be involved in resistance, were found in the resistant strains. In summary, genomics and transcriptomics technologies can be used to rapidly identify resistance mechanisms allowing for faster adjustment of current containment strategies. Future research on the critical targets identified in this study can aid new drug discovery efforts and novel control strategies.

Malaria, a disease caused by parasites of the Plasmodium genus, infects over 220 million people annually, resulting in over 400,000 deaths. Most of these deaths occur in Africa in children < 5 years of age. Artemisia annua L., an ancient Chinese medicinal herb, is known for its foremost phytochemical constituent, artemisinin (AN). Semisynthetic derivatives of AN form the primary component of artemisinin combination therapies (ACTs), the frontline treatment for malaria worldwide. However, ACTs have several drawbacks including cost and availability. Thus, cheaper, more readily available antimalarials are needed. Recent clinical data suggested dried leaves of A. annua (DLA) administered orally as a tea infusion may be as efficacious as ACTs despite a significantly lower AN dose delivered. In mice, AN plasma concentration was improved when administered as DLA compared to pure AN. I therefore hypothesized that phytochemicals within DLA enhanced the oral bioavailability of AN. To investigate this hypothesis, here I examined the effects of DLA on the underlying mechanisms that govern oral bioavailability. Using an in vitro human digestion model, I showed that AN solubility was greater when delivered as DLA, largely due to essential oil in the plant. Furthermore, AN intestinal permeability was enhanced in a Caco-2 cell model of the intestinal epithelium. Extracts, teas, and phytochemicals produced by Artemisia also inhibited the activity of CYP2B6 and CYP3A4, the enzymes responsible for first-pass AN metabolism in the liver. Additionally, AN tissue distribution was improved when delivered as DLA and AN accumulation in tissues was higher in female vs. male rats. Finally, I showed that DLA was a more efficacious anti-inflammatory than pure AN in rats, potentially due to enhanced AN bioavailability. Taken together, these results shed light on the mechanisms behind enhanced oral bioavailability afforded by DLA and demonstrate the potential for DLA to be used as a therapeutic for malaria and other diseases.

Indiana University-Purdue University Indianapolis (IUPUI) / Artemisinin resistance was first observed in Southeast Asia (SEA) and could pose a threat to malaria treatment all over the world. Recently mutations in the propeller region of Pfkelch13 gene have been used as a genetic marker for resistance observed in SEA. We investigated the presence of mutations in the Pfkelch gene in children in Kampala, Uganda with severe malaria (SM) treated with intravenous quinine, or with asymptomatic P.falciparum infection (AP) treated with artemether-lumefantrine. We sequenced the Pfkelch gene (2178bp) in 157 children with SM and 49 children with AP infection. In children with SM and AP we identified 106 (60.8%) and 27 (55.1%) parasites with mutations upstream of the Pfkelch13 propeller region. The two most prevalent mutations were 142NN (26.1% in SM, 33% in AP) and K189T (16.5% in SM, 12.2% in AP). In SM, only a single infection had a mutation in the propeller region (A578S), while in AP, mutations in the propeller region included A578S (n=1) and S522C (n=1). In children with SM, parasites with 142NN insertion compared to 3D7 Pfkelch13 parasites had lower parasite density (p=0.02) and lower parasite biomass (p=0.03). Children with SM who either had 142NN or K189T mutation cleared parasites after quinine treatment faster than those with the 3D7 Pfkelch13 genotype (P<0.001 for both mutations compared to 3D7). In this cohort mutations, upstream of the Pfkelch13 propeller region were common. Future studies will assess the presence of Pfcrt and Pfmdr mutations in this cohort, and how these relate to the Pfkelch13 mutations and to parasite clearance.

Yes / Ancient Chinese herbal texts as far back as the 4th Century Zhou hou bei ji fang describe methods for the use of Qing Hao (Artemisia annua) for the treatment of intermittent fevers. Today, the A. annua constituent artemisinin is an important antimalarial drug and the herb itself is being grown and used locally for malaria treatment although this practice is controversial. Here we show that the ancient Chinese methods that involved either soaking, (followed by wringing) or pounding, (followed by squeezing) the fresh herb are more effective in producing artemisinin-rich extracts than the usual current method of preparing herbal teas from the dried herb. The concentrations of artemisinin in the extracts was up to 20-fold higher than that in a herbal tea prepared from the dried herb, but the amount of total artemisinin extracted by the Chinese methods was much less than that removed in the herbal tea. While both extracts exhibited potent in vitro activities against Plasmodium falciparum, only the pounded juice contained sufficient artemisinin to suppress parasitaemia in P. berghei infected mice. The implications of these results are discussed in the context of malaria treatment using A. annua infusions.

No / This communication reports a novel solvent free method to generate and stabilise the triclinic form of artemisinin. We show that the stability of the triclinic form obtained by high temperature extrusion is greater than that of material made using a solvent based technique.

Artemisinin-based Combination Therapies (ACTs) are currently the frontline treatment against Plasmodium falciparum malaria, but parasite resistance to artemisinin (ART) and its derivatives, core components of ACTs, is spreading in the Mekong countries. In this study, we report the synthesis of several novel artemisinin derivatives and evaluate their in vitro and in silico capacity to counteract Plasmodium falciparum artemisinin resistance. Furthermore, recognizing that the malaria parasite devotes considerable resources to minimizing the oxidative stress that it creates during its rapid consumption of hemoglobin and the release of heme, we sought to explore whether further augmentation of this oxidative toxicity might constitute an important addition to artemisinins. The present report demonstrates, in vitro, that FM-AZ, a newly synthesized artemisinin derivative, has a lower IC50 than artemisinin in P. falciparum and a rapid action in killing the parasites. The docking studies for important parasite protein targets, PfATP6 and PfHDP, complemented the in vitro results, explaining the superior IC50 values of FM-AZ in comparison with ART obtained for the ART-resistant strain. However, cross-resistance between FM-AZ and artemisinins was evidenced in vitro

Malaria endemic areas not only pose a public health threat, but affects 3.3 billion people worldwide. In 2011, estimated malaria related deaths amounted to 660 000 out of 219 million reported cases, with 81% of these and 91% of malaria related mortality occurred in the African region. Those most affected were pregnant women, children under the age of five and immunocompromised individuals. Malaria is the fifth deadliest disease worldwide and accounts for the second highest death rate in Africa, following HIV/Aids. To combat this parasitic infection of antiquity, the ideal malaria pharmacotherapy would be a cost effective and easily obtainable monotherapy. The malaria parasite, however, has an intrinsic ability to develop drug resistance through various mechanisms. Widespread resistance towards antimalarial drugs has rendered traditionally used drugs therapeutically ineffective, hence accentuating the efficacy of the artemisinins as first line treatment option for uncomplicated Plasmodium falciparum (P. falciparum). A devastating reality of the challenging battle against malaria is the confirmed prolonged parasitic clearance times of the artemisinins, despite adequate drug exposure, which emphasises the urgent need for identifying and developing new, effective and safe therapies. During this study, 9-aminoacridines and artemisinin-acridine hybrids were successfully synthesised through nucleophillic substitution and their chemical structures confirmed by means of nuclear magnetic resonance spectroscopy (NMR), high resolution mass spectroscopy (HRMS) and infrared spectroscopy (IR). The hybrid compounds were synthesised through microwave assisted radiation, by covalently linking the artemisinin- and amino-functionalised acridine pharmacophores by means of a liable aminoethyl ether chain. The target compounds were screened in vitro for antimalarial activity against both the chloroquine sensitive (NF54) and chloroquine resistant (Dd2) strains of P. falciparum. Their cytotoxicities were assessed against various mammalian cells of different origins, viz. the Chinese hamster ovarian cells (CHO) from animal origin, and from human origin, hepatocellular- (HepG2), neuroblastoma- (SH-SY5Y) and cervical cancer (HeLa) cells. The synthesised hybrids exhibited antimalarial activity against both Plasmodium strains. Compound 7, featuring an ethylenediamine moiety in the linker, was the most active hybrid, with 50% inhibitory concentration (IC50) values of 2.6 nM and 35.3 nM against the NF54 and Dd2 strains, respectively. It had gametocytocidal activity against the NF54 strain, comparable to dihydroartemisinin (DHA) and artesunate (AS) and it is significantly more potent than chloroquine (CQ), whilst possessing a resistance index value of 14, indicative of a significant loss of activity against the CQ resistant strain. Contrary, the promising hybrid 10, containing a 2-methylpiperazine linker, had gametocytocidal activity, comparable to CQ and was found to be six-fold more potent than CQ against the Dd2 strain, with a resistance index (RI) value of 2, whilst it further showed highly selective action towards the parasitic cells. Compound 10 was also found to possess anticancer activity against the HeLa cell line, comparable to DHA and AS, but fivefold higher than that of CQ, with the same levels of hepatotoxicity and neurotoxicity. The artemisinin-acridine hybrids displayed superior antimalarial activity, compared to the derived 9-aminoacridines against both the Plasmodium strains. They, however, did not have the ability to overcome resistance, reduce the toxicity of acridine, nor induce synergistic activity. The hybrids, indeed displayed promising anticancer activity against HeLa cells. It is anticipated that these compounds may stand as drug candidates for further investigation in the search for new anti-cervical cancer drugs, rather than as antimalarials. / MSc (Pharmaceutical Chemistry), North-West University, Potchefstroom Campus, 2014

Malaria endemic areas not only pose a public health threat, but affects 3.3 billion people worldwide. In 2011, estimated malaria related deaths amounted to 660 000 out of 219 million reported cases, with 81% of these and 91% of malaria related mortality occurred in the African region. Those most affected were pregnant women, children under the age of five and immunocompromised individuals. Malaria is the fifth deadliest disease worldwide and accounts for the second highest death rate in Africa, following HIV/Aids. To combat this parasitic infection of antiquity, the ideal malaria pharmacotherapy would be a cost effective and easily obtainable monotherapy. The malaria parasite, however, has an intrinsic ability to develop drug resistance through various mechanisms. Widespread resistance towards antimalarial drugs has rendered traditionally used drugs therapeutically ineffective, hence accentuating the efficacy of the artemisinins as first line treatment option for uncomplicated Plasmodium falciparum (P. falciparum). A devastating reality of the challenging battle against malaria is the confirmed prolonged parasitic clearance times of the artemisinins, despite adequate drug exposure, which emphasises the urgent need for identifying and developing new, effective and safe therapies. During this study, 9-aminoacridines and artemisinin-acridine hybrids were successfully synthesised through nucleophillic substitution and their chemical structures confirmed by means of nuclear magnetic resonance spectroscopy (NMR), high resolution mass spectroscopy (HRMS) and infrared spectroscopy (IR). The hybrid compounds were synthesised through microwave assisted radiation, by covalently linking the artemisinin- and amino-functionalised acridine pharmacophores by means of a liable aminoethyl ether chain. The target compounds were screened in vitro for antimalarial activity against both the chloroquine sensitive (NF54) and chloroquine resistant (Dd2) strains of P. falciparum. Their cytotoxicities were assessed against various mammalian cells of different origins, viz. the Chinese hamster ovarian cells (CHO) from animal origin, and from human origin, hepatocellular- (HepG2), neuroblastoma- (SH-SY5Y) and cervical cancer (HeLa) cells. The synthesised hybrids exhibited antimalarial activity against both Plasmodium strains. Compound 7, featuring an ethylenediamine moiety in the linker, was the most active hybrid, with 50% inhibitory concentration (IC50) values of 2.6 nM and 35.3 nM against the NF54 and Dd2 strains, respectively. It had gametocytocidal activity against the NF54 strain, comparable to dihydroartemisinin (DHA) and artesunate (AS) and it is significantly more potent than chloroquine (CQ), whilst possessing a resistance index value of 14, indicative of a significant loss of activity against the CQ resistant strain. Contrary, the promising hybrid 10, containing a 2-methylpiperazine linker, had gametocytocidal activity, comparable to CQ and was found to be six-fold more potent than CQ against the Dd2 strain, with a resistance index (RI) value of 2, whilst it further showed highly selective action towards the parasitic cells. Compound 10 was also found to possess anticancer activity against the HeLa cell line, comparable to DHA and AS, but fivefold higher than that of CQ, with the same levels of hepatotoxicity and neurotoxicity. The artemisinin-acridine hybrids displayed superior antimalarial activity, compared to the derived 9-aminoacridines against both the Plasmodium strains. They, however, did not have the ability to overcome resistance, reduce the toxicity of acridine, nor induce synergistic activity. The hybrids, indeed displayed promising anticancer activity against HeLa cells. It is anticipated that these compounds may stand as drug candidates for further investigation in the search for new anti-cervical cancer drugs, rather than as antimalarials. / MSc (Pharmaceutical Chemistry), North-West University, Potchefstroom Campus, 2014

published_or_final_version / Chemistry / Doctoral / Doctor of Philosophy