Malaria persists as one of the most devastating global infectious diseases. The pyrimidine biosynthetic enzyme dihydroorotate dehydrogenase (DHODH) has been identified as a new malaria drug target, and a triazolopyrimidine-based DHODH inhibitor 1 (DSM265) is in clinical development. We sought to identify compounds with higher potency against Plasmodium DHODH while showing greater selectivity toward animal DHODHs. Herein we describe a series of novel triazolopyrimidines wherein the p-SF5-aniline was replaced with substituted 1,2,3,4-tetrahydro-2-naphthyl or 2-indanyl amines. These compounds showed strong species selectivity, and several highly potent tetrahydro-2-naphthyl derivatives were identified. Compounds with halogen substitutions displayed sustained plasma levels after oral dosing in rodents leading to efficacy in the P. falciparum SCID mouse malaria model. These data suggest that tetrahydro-2-naphthyl derivatives have the potential to be efficacious for the treatment of malaria, but due to higher metabolic clearance than 1, they most likely would need to be part of a multidose regimen.
Malaria persists as one of the most devastating global infectious diseases. The pyrimidine biosynthetic enzyme dihydroorotate dehydrogenase (DHODH) has been identified as a new malaria drug target, and a triazolopyrimidine-based DHODH inhibitor 1 (DSM265) is in clinical development. We sought to identify compounds with higher potency against Plasmodium DHODH while showing greater selectivity toward animal DHODHs. Herein we describe a series of novel triazolopyrimidines wherein the p-SF5-aniline was replaced with substituted 1,2,3,4-tetrahydro-2-naphthyl or 2-indanyl amines. These compounds showed strong species selectivity, and several highly potent tetrahydro-2-naphthyl derivatives were identified. Compounds with halogen substitutions displayed sustained plasma levels after oral dosing in rodents leading to efficacy in the P. falciparumSCIDmousemalaria model. These data suggest that tetrahydro-2-naphthyl derivatives have the potential to be efficacious for the treatment of malaria, but due to higher metabolic clearance than 1, they most likely would need to be part of a multidose regimen.
Malaria is one of the
most deadly infectious diseases in human
history with 3.2 billion people in 97 countries at risk.[1] An estimated 444,000 deaths from malaria were
reported by the WHO in 2015 and ∼90% of these occurred in sub-Saharan
Africa, mostly among children under the age of five. Human malaria,
which is transmitted by the female Anopheles mosquito, can be caused
by five species of Plasmodia; however, Plasmodium
falciparum and Plasmodium vivax are the
most signficant.[2,3]P. falciparum is dominant in Africa and accounts for most of the deaths, while P. vivax has a larger global distribution. To simplify treatment
options it is desirable that new drugs be efficacious against all
human infective species.[4] Malaria is a
treatable disease and malarial control programs depend on drug therapy
for treatment and chemoprevention, and on insecticides (including
insecticide impregnated bed nets) to prevent transmission.[2] A large collection of drugs has been used for
the treatment of malaria, but many of the most important compounds
have been lost to drug resistance (e.g., chloroquine and pyrimethamine).[4−6] Artemisinin combination therapies (ACT) replaced older treatments,
becoming highly effective, crucial tools in global efforts that have
led to the decline in malaria deaths over the past decade. However,
resistance to the artemisinin components (associated with Kelch13
propeller protein mutations[7−9]) has been found in Southeast Asia
putting at risk malaria treatment programs. To combat drug resistance
a significant effort is underway to identify new compounds that can
be used for the treatment of malaria, with several new entities currently
in clinical development.[4,5,10]The triazolopyrimidineDSM265 (1) (Figure ) developed by our group is
the first antimalarial agent that targets dihydroorotate dehydrogenase
(DHODH) to reach clinical development, validating this target for
the treatment of malaria.[11,12] DHODH is a mitochondrial
enzyme that is required for the fourth step of de novo pyrimidine
biosynthesis, catalyzing the flavin-dependent oxidation of dihydroorotate
to orotic acid with mitochondrially derived coenzyme Q (CoQ) serving
as a second substrate.[13] Pyrimidines are
essential for both RNA and DNA biosynthesis, and because Plasmodia do not encode pyrimidine salvage enzymes, which are found in humans
and other organisms, the de novo pyrimidine pathway
and DHODH are essential to the parasite. We identified the triazolopyrimidine
DHODH inhibitor series by a target-based high throughput screen, and
the initial lead DSM1 (2) (Figure ) was shown to selectively inhibit P. falciparum DHODH and to kill parasites in vitro, but it was ineffective in vivo due to poor metabolic
properties.[14−16] The series was subsequently optimized to improve
its in vivo properties resulting in the identification
of DSM74 (3), which while metabolically stable lacked
potency.[16] X-ray structures of 2 and 3 bound to PfDHODH were then used
to guide the medicinal chemistry program in the search for more potent
analogues, resulting in the identification of 1.[11,12,17]
Figure 1
Structures of selected triazolopyrimidine PfDHODH
inhibitors. Shown structures include, 2-(1,1-difluoroethyl)-5-methyl-N-[4-(pentafluoro-λ6-sulfanyl)phenyl]-[1,2,4]triazolo[1,5-a]pyrimidin-7-amine (1), (5-methyl[1,2,4]triazolo[1,5-a]pyrimidin-7-yl)naphthalen-2-ylamine (2),
and (5-methyl[1,2,4]triazolo[1,5-a]pyrimidin-7-yl)(4-trifluoromethylphenyl)amine
(3).
Structures of selected triazolopyrimidine PfDHODH
inhibitors. Shown structures include, 2-(1,1-difluoroethyl)-5-methyl-N-[4-(pentafluoro-λ6-sulfanyl)phenyl]-[1,2,4]triazolo[1,5-a]pyrimidin-7-amine (1), (5-methyl[1,2,4]triazolo[1,5-a]pyrimidin-7-yl)naphthalen-2-ylamine (2),
and (5-methyl[1,2,4]triazolo[1,5-a]pyrimidin-7-yl)(4-trifluoromethylphenyl)amine
(3).While 1 has
progressed successfully to Phase II clinical
trials,[4] we sought to identify potential
backup compounds if unforeseen issues arise during its clinical development.
Importantly, 1 has potent activity on PfDHODH and P. falciparum parasites in vivo, and its pharmacokinetic properties support its use as a single
dose treatment or once weekly prophylactic.[12] However, while 1 has excellent selectivity against
human DHODH and thus is not expected to show on target activity in
humans, it does have some activity against rodent DHODHs that has
complicated animal toxicity testing. We therefore sought to identify
compounds that have broad selectivity against all mammalian DHODHs,
while if possible identifying compounds with higher potency against PfDHODH that could potentially reduce the dose required
for treatment. We describe herein a series of triazolopyrimidines
where the SF5-aniline moiety of 1 has been
replaced by either substituted 1,2,3,4-tetrahydro-2-naphthyl or 2-indanyl
amines. Compounds from both series are inactive against a range of
mammalian DHODHs, while several of the identified tetrahydronapthalenes
are more potent than 1 against P. falciparum parasites in vitro and indeed are among the most
potent compounds that have been identified in the series. However,
these compounds are less metabolically stable than 1 in
mouse liver microsomes, suggesting the likelihood of higher clearance
in mice and explaining the requirement for higher doses to inhibit
parasites in the in vivo mouse model of malaria.
Chemistry
The focus of the study was to examine the structure–activity
relationships (SARs) of replacing the p-SF5-aniline of 1 with substituted 1,2,3,4-tetrahydro-2-naphthyl
or 2-indanyl amines with the goal of eliminating activity on rodent
DHODHs, while potentially improving potency against P. falciparum DHODH and thereby lowering the dose required for in vivo efficacy. The clinical candidate 1 is a potent inhibitor
of PfDHODH with only minimal activity detected against
human DHODH (selectivity window > 5000-fold; Table ). However, 1 showed inhibitory
activity against rodent and to a lesser extent dog DHODHs, although
potency toward these enzymes remained considerably less than for PfDHODH.[12] Because these species
are required for toxicity testing in preclinical studies we sought
to eliminate rodent and dog DHODH inhibitory activity for any potential
candidate that might be developed as a backup to 1. We
previously reported that substitution of the p-SF5-aniline with p-CF3 aniline in
the context of either mono or difluoro groups at the meta position
led to greater inhibition of the mammalian enzymes.[18] X-ray structural data suggested that increasing hydrophobicity
drove the interaction of these compounds with the mammalian enzymes.
We hypothesized based on these structures that increasing the size
of the aromatic amine might prevent binding to mammalian DHODHs, while
increasing potency toward the parasite enzyme. We previously tested
several tetrahydro-2-naphthyl and 2-indanyl amines as substitutes
for the CF3-aniline of 3 but found these compounds
lacked potency, and furthermore, the one analogue containing 1,2,3,4-tetrahydro-2-naphthyl
also lacked metabolic stability in mouse microsomes.[19] However, these amines were never tested within the context
of haloalkyl groups (CF2CH3 or CF3) at the C2 position of the triazolopyrimidine ring, which was a
key substitution required to boost the potency of the series.[11] We therefore synthesized a series of tetrahydro-2-naphthyl
or 2-indanyl analoues with halo alkyl groups at the C2 position. Substituents
(halo, haloalkyl, Me, CF3, OMe, SO2Me, and SO2NMe2) were incorporated onto the tetrahydro-2-naphthyl
or 2-indanyl aromatic rings to improve metabolic stability over the
unsubstituted analogues.
Table 1
Structure–Activity
Relationshipsa
IC50 (μM)
compd
R
Ar/R1
PfDHODH
PvDHODH
hDHODH
EC50 (μM) Pf3D7 cellsd
1
CF2CH3
4-SF5–Ph
0.0089 (0.0073–0.011)
0.027 (0.023–0.032)
>100
0.0043–0.0078
2
H
2-naphthyl
0.047
0.23
>100
0.068
3
H
4-CF3–Ph
0.28
2.6
>100
0.34
5
CF2CH3
H
0.021 (0.019–0.024)
0.035 (0.030- 0.041)
ND
0.0028 (0.0022–0.0037)
6
CF2CH3
6-F
0.024 (0.021–0.027)
0.056 (0.048–0.066)
>100
0.0075 (0.0063–0.0089)
7
CF2CH3
6-Cl (E-I)
0.0037 (0.0021–0.0066)
0.029 (0.019–0.042)
>100
0.0038 (0.0030–0.0049)
8
CF2CH3
6-Cl (E-II)
1.34 (1.1–1.7)
ND
>100
0.42 (0.37–0.47)
9
CF2CH3
7-Cl (E-I, S)
0.0063 (0.005–0.008)
0.010 (0.0083- 0.013)
>100
0.0012 (0.0011–0.0013)
10
CF2CH3
7-Cl (E-II, R)
0.79 (0.70–0.94)
ND
>100
2.8 (1.0–7.8)
11
CF2CH3
6-Br (E-I)b
0.0046 (0.0038-
0.0056)
0.024 (0.021–0.027)
>100
0.0026 (0.0016–0.0042)
12
CF2CH3
6-Br (E-II)c
0.79 (0.59–1.1)
2.1 (1.8–2.5)
>100
0.14 (0.090–0.21)
13
CF2CH3
7-Br (E-I)
0.0046 (0.0036–0.006)
0.012 (0.010–0.013)
>100
0.00039 (0.00034–0.00044)
14
CF2CH3
7-Br (E-II)
0.64 (0.53–0.77)
ND
>100
1.4 (1.2–1.5)
15
CF2CH3
6-OMe
0.14 (0.11–0.16)
0.22 (0.20–0.25)
>100
0.017 (0.014–0.019)
16
CF2CH3
7-OMe (E-I)
0.021 (0.018–0.024)
0.13 (0.11–0.15)
>100
0.025 (0.023–0.026)
17
CF2CH3
7-OMe (E-II)
1.0
(0.86–1.2)
ND
ND
0.64 (0.56–0.75)
18
CF2CH3
6,7-di-F (E-I)
2.3 (1.9–2.8)
ND
ND
>2.5
19
CF2CH3
6,7-di-F
(E-II)
0.060 (0.049–0.072)
0.071 (0.066–0.076)
ND
0.022 (0.018–0.026)
20
CF2CH3
6-F,7- CF3
0.089 (0.078–0.10)
0.39 (0.34–0.44)
>100
0.097 (0.080–0.12)
21
CF2CH3
6- CF3, 7-F
0.087 (0.067–0.11)
0.82 (0.69–0.96)
>100
3.3 (2.97–3.63)
22
CF3
H
0.17 (0.12–0.23)
ND
>100
0.021 (0.017–0.025)
23
CF3
6-F
0.077 (0.066–0.089)
0.28 (0.25–0.33)
ND
0.066 (0.062–0.07)
24
CF3
7-Cl (E-I)
0.015 (0.012–0.018)
ND
>50
0.033 (0.030–0.035)
25
CF3
7-Cl (E-II)
1.1 (0.98–1.2)
ND
ND
1.5 (1.2–1.7)
26
CF2CH3
H
0.048 (0.040–0.059)
ND
>100
0.036 (0.031–0.042)
27
CF2CH3
5-Br
0.11 (0.083–0.14)
ND
ND
0.59 (0.25–1.4)
28
CF2CH3
5-Cl
0.085 (0.075–0.097)
ND
ND
0.12 (0.0.045–0.20)
29
CF2CH3
5,6-di-Cl
0.14 (0.11–0.17)
ND
ND
0.58 (0.22–1.5)
30
CF2CH3
5-SO2Me
4.0 (2.7–6.1)
ND
ND
6.5 (4.9–8.1)
31
CF2CH3
5-SO2NMe2
8.0 (6.7–9.7)
ND
ND
ND
32
CF2CH3
4,7-di-Me
0.014 (0.012- 0.017)
0.024 (0.022- 0.027)
>100
0.00039 (0.00021–0.00075)
33
CF2CH3
4,7-di-F
0.065 (0.057–0.075)
0.15 (0.14–0.16)
>100
0.046 (0.002–0.0048)
34
CF2CH3
4-F
0.052 (0.041–0.066)
0.3 (0.26–0.34)
>100
0.064 (0.061–0.066)
35
CF2CH3
5,6-di-F
0.052 (0.042–0.064)
0.37 (0.28–0.50)
>100
0.040 (0.035–0.044)
36
CF2CH3
4-CF3
0.066 (0.054–0.080)
0.28 (0.22–0.34)
>100
0.0043 (0.0029–0.0056)
37
CF3
5,6-di-F
0.12 (0.11–0.14)
ND
ND
0.15 (0.092–0.23)
DHODH IC50 and P. falciparum EC50 values were determined from
triplicate data points at each concentration in the dose titration.
Values in parentheses represent the 95% confidence interval of the
fit.
Enantiomer-I is the
second eluted
on the chiral column.
Enantiomer-II
is the first eluted
on the chiral column.
Data
were collected using albumax
unless otherwise stated. Data for 2(15) and 3(16) were taken
from previous reports. Compound 1 has been previously
profiled in these assays, and parasite data were previously reported.[11,12] Enzyme data were recollected herein to serve as a direct comparator.
DHODH IC50 and P. falciparum EC50 values were determined from
triplicate data points at each concentration in the dose titration.
Values in parentheses represent the 95% confidence interval of the
fit.Enantiomer-I is the
second eluted
on the chiral column.Enantiomer-II
is the first eluted
on the chiral column.Data
were collected using albumax
unless otherwise stated. Data for 2(15) and 3(16) were taken
from previous reports. Compound 1 has been previously
profiled in these assays, and parasite data were previously reported.[11,12] Enzyme data were recollected herein to serve as a direct comparator.The synthetic strategy to generate
the appropriately substituted
triazolopyrimidines has previously been described.[11,15,16] For the studies described herein, 7-chloro-2-(1,1-difluoroethyl)-5-methyl[1,2,4]triazolo[1,5-a] pyrimidine (4a) and 7-chloro-2-(trifluoromethyl)-5-methyl[1,2,4]triazolo[1,5-a] pyrimidine (4b) were prepared using these
methods (Scheme )
and were reacted with the requisite amines to afford the final products
containing either the 1,2,3,4-tetrahydro-2-naphthyl (5–25) or 2-indanyl (26–37) amines in place of the p-SF5-aniline of 1. Most amines utilized for the study were
commercially available with the exception that amines for compounds 29–37 were synthesized as described in Scheme and Supplementary Scheme S1. The 1,2,3,4-tetrahydro-2-naphthyls
contained a chiral center, and for select compounds, individual enantiomers
were purified using a chiral column as described in the Experimental Section.
Scheme 1
General Synthetic Method
Scheme 2
Synthesis of 5-(Methylsulfonyl)-2,3-dihydro-1H-inden-2-amine·HCl
(43)
Synthesis of 5-(Methylsulfonyl)-2,3-dihydro-1H-inden-2-amine·HCl
(43)
Reagents and conditions: (i)
Ac2O, NaOAc, AcOH, RT, 12 h; (ii) ClSO3H, CHCl3, RT, 1 h; (iii) (a) SnCl2·2H2O,
AcOH, HCl, RT, 2 h; (b) NaOMe, MeI, MeOH; (iv) mCPBA, CHCl3; (v) 3 N HCl.The amine precursor 5-(methylsulfonyl)-2,3-dihydro-1H-inden-2-amine·HCl 43 was prepared in
five steps
(Scheme ). First,
2-aminoindane 38 was acetylated with acetic anhydride-sodium
acetate to yield the acetamido derivative 39. Further,
regioselective chlorosulfonylation of 39 led to the sulfonyl
chloride intermediate 40. Reduction of the sulfonyl chloride
to the thiol was achieved by tin chloride, which was converted to
a methylthio derivative 41 using sodium methoxide and
methyl iodide. Next, oxidation of methylthio intermediate 41 with mCPBA gave the acetyl protected methanesulfonyl derivative 42. Upon deprotection of this acetyl group using 3 N HCl,
the required amine precursor 43 was obtained.
Results
Optimization
of Inhibitor Potency and Selectivity
Compounds
were first analyzed for potency against P. falciparum, P. vivax, and human DHODH, and for activity on P. falciparum parasites in vitro (Table ). Compounds in the
series showed IC50s against PfDHODH in
the range of 0.005–8 μM and EC50s against P. falciparum 3D7 parasites in whole cell assays between
0.00039–6.5 μM (Table ). Generally, the tetrahydro-2-naphthyl compounds (5–25) were more potent in both assays
than the 2-indanyls (26–37). The
most potent analogues based on the whole cell P. falciparum assay were 9 and 13, both of which contain
a halogen (chloro or bromo, respectively) in the 7 position. Compound 13 is the most potent analogue identified in the triazolopyrimidine
series that has been reported. Overall the trend was for 7-substituted
tetrahydro-2-naphthyls to be more potent than those with substitutions
at the 6 position. Compounds with Br and Cl substituents (7, 9, 11, 13) were more potent
than those with fluoro 6, OMe (15, 16) or with disubstitutions (19, 20, 21), with the least active tetrahydro-2-naphthyl 21 containing a 6-CF3, 7-F. Potency of 21 in the whole cell parasite assay was worse than expected based on
the inhibitory activity against PfDHODH, suggesting
that the compound may be poorly transported into the parasite. Analogues
with CF3 at C2 (22, 23, 24) on the triazolopyrimidine ring were less active than those
with CF2CH3 (5, 6, 9) at this position. Within the indanyl series the most potent
compounds were 32 and 36 containing 4,7-dimethyl
or 4-CF3 substituents, respectively, while the least active
compounds were 30 and 31 containing 5-SO2Me or 5-SO2NMe2 substituents, respectively.For the tetrahydro-2-naphthyls where individual enantiomers were
characterized, differences in potency between the active enantiomer
(7, 9, 11, 13, 16, 19, 24) and the inactive enantiomer
(8, 10, 12, 14, 17, 18, 25) ranged from
20- to 360-fold toward PfDHODH and from 30- to 2000-fold
against P. falciparum 3D7 parasites. The small molecule
X-ray structure of the active enantiomer 9 was solved
demonstrating that it was in the S configuration
(Figure S1 and Table S1). We did not isolate
the individual enantiomers for compounds from the indane series (27, 28, 30, 31, 34, and 36), and it is likely that the purified
active enantiomers would also show higher activity for these compounds
as well. Thus, the reported potency data for the racemic mixture likely
overestimates the true IC50 by ∼2-fold.Overall
we observed a good correlation between potency on PfDHODH and potency on 3D7 P. falciparum parasites
(Figure S2). There was a tendency
for the most potent compounds on the parasite to show lower potency
against PfDHODH, but this difference is likely caused
by the complication of stoichiometric binding for compounds with IC50s at or below the concentration of enzyme used in the assay
(PfDHODH = 5 nM). In order to confirm that, for the
most potent compounds, parasite killing is due to DHODH inhibition,
we tested select compounds (9 and 13) for
their ability to inhibit growth of a genetically engineered parasite
strain that expresses yeast DHODH (D10 yDHODH[20]). This strain is resistant to DHODH inhibitors if their mechanism
of action is on target. The EC50s (D10 yDHODH EC50 = 8.6 and 7.4 μM for 9 and 13, respectively)
for both compounds were increased by >600-fold against this parasite
strain relative to the wild-type 3D7 parasites, supporting DHODH inhibition
as their mechanism of action (Table and Figure S3). The addition
of proguanil did not reverse the resistance of this strain, which
is also consistent with DHODH as the mechanism of parasite killing.
In contrast, it has been previously reported that proguanil reverses
the atovaquone resistance phenotype of the D10 yDHODH parasite strain,
providing a mechanism to distinguish between DHODH and bc1 targeted
parasite growth inhibition.[20] The weak
but detectable activity observed on the D10 yDHODH parasites for both
compounds suggests that at high concentrations there is a secondary
target. For a couple of select compounds (9 and 35) whole cell activity was also tested on several additional
cell lines including chloroquine and pyrimethamine resistant parasites
(Table S2). Both compounds were equally
active on all tested strains.Species selectivity was first
evaluated by testing against human
and P. vivax DHODH (Table ) and then for a selection of the more potent
compounds, inhibitor activity was also measured for mouse, rat, and
dog DHODH (Table ).
None of the compounds showed any inhibition of human DHODH up to the
highest tested concentration (100 μM), which is similar to results
for 1. However, unlike 1, none of the compounds
showed any activity against either the rodent or dog DHODHs (Table ), demonstrating that
we had achieved our objective of eliminating mammalian DHODH activity.
Measured IC50s for P. vivax DHODH ranged
from 1.5–10-fold higher than for PfDHODH.
The 7-position substituted tetrahydro-2-naphthyls, 9 and 13 showed minimal differences (1.5–3-fold) between
the two enzymes suggesting that they would show good activity against
both P. falciparum and P. vivax parasites,
whereas the 6 position compounds (7 and 11) had 5–8-fold lower activity on P. vivax than P. falciparum DHODH.
Table 2
Activity
of Select Triazolopyrimidines
on Various Mammalian DHODHs
DHODH IC50 (μM)
compd
human
rat
mouse
dog
1a
∼100
2.6 ± 0.39
2.3 ± 0.64
16 ± 6.5
35
>100
>100
>100
>100
11
>100
>100
>100
>100
13
>100
>100
>100
>100
7
>100
>100
>100
>100
9
>100
>100
>100
>100
Errors represent
standard deviation
for four independent replicates using different batches. Each replicate
IC50 was determined from triplicate data points at each
concentration in the dose titration.
Errors represent
standard deviation
for four independent replicates using different batches. Each replicate
IC50 was determined from triplicate data points at each
concentration in the dose titration.
X-ray Structure of 13 Bound to PfDHODH
In order to understand the structural basis for the
superior potency of 13 we solved its X-ray structure
bound to PfDHODH. The structure was solved to 2.32
Å resolution at an Rwork and Rfree of 0.18 and 0.21, respectively (Figure and Table S3). Strong electron density was observed
for the entirety of 13 (Figure S4A). Compound 13 was oriented in the pocket similarly
to other triazolopyrimidines (e.g., 1–3(12,17,18)) with the triazolopyrimidine
ring bound adjacent to the flavin cofactor in position to form H-bond
interactions with Arg-265 and His-185 (Figures and S4B). The
tetrahydro-2-naphthyl moiety bound in a hydrophobic pocket forming
edge-to-face stacking interactions with Phe-227 and Phe-188 and was
in a very similar orientation to what we previously observed for the
naphthyl moiety of 2 (Figure ). Some modest conformational differences
in ring geometry were observed reflecting the difference between the
fully planar and aromatic naphthyl and the puckered configuration
of the nonaromatic ring of the tetrahydro-2-naphthyl. A halogen bond
was observed between the 7-bromo group on the tetrahydro-2-naphthyl
of 13 and Cys-233 SH, which likely provides significant
binding energy to the enzyme inhibitor interaction. This is a novel
interaction that has not been previously observed.
Figure 2
X-ray structure of PfDHODH bound to 13 (PfDHODH-13). Limited residues from
the 4 Å shell around 13 are shown, and the structure
has been aligned to the PfDHODH structure bound to 2 (PDB 3I65) to allow comparison of the binding modes. Only the inhibitor 2 from 3I65 is displayed. PfDHODH amino acid, FMN, and orotate
carbons are shown in purple, the carbons of 13 are shown
in tan, and the carbons of 2 are shown in green. Nitrogens
are blue, oxygens are red, sulfur is light yellow, fluorines are light
blue, and bromine is deep red. Protein residues are labeled with their
amino acid number.
X-ray structure of PfDHODH bound to 13 (PfDHODH-13). Limited residues from
the 4 Å shell around 13 are shown, and the structure
has been aligned to the PfDHODH structure bound to 2 (PDB 3I65) to allow comparison of the binding modes. Only the inhibitor 2 from 3I65 is displayed. PfDHODH amino acid, FMN, and orotate
carbons are shown in purple, the carbons of 13 are shown
in tan, and the carbons of 2 are shown in green. Nitrogens
are blue, oxygens are red, sulfur is light yellow, fluorines are light
blue, and bromine is deep red. Protein residues are labeled with their
amino acid number.
Physicochemical Properties
and Plasma Protein Binding
Selected compounds were evaluated
for their physicochemical properties
to determine if they had good drug-like properties. Analysis included in silico calculations, chromatographic estimation of Log
D (pH 7.4), aqueous solubility, and plasma protein binding (Tables and 4). Tested compounds had physicochemical properties that are
suggestive of good oral absorption (MW < 430, H bond donors ≤
2, H bond acceptors ≤ 6, polar surface area < 70 Å2). Log D ranged from 3.1–4.1, and the more potent analogues
tended to have higher Log D values. Aqueous solubility (pH 6.5) was
poor (1.6–6.3 μg/mL) to moderate (12.5–25 μg/mL),
and in general, compounds in this series had lower kinetic solubility
than 1 (Table ). More extensive solubility studies in simulated gastric
and intestinal fluids was conducted on a selection of the most potent
analogues from the 2-indanyl (35) and the tetrahydro-2-naphthyl
(7, 9, 11, 13)
series (Table ). All
five compounds had better solubility than 1 in 0.1 N
HCl. Solubility in fasted-state simulated intestinal fluid was similar
to or slightly improved compared to 1. The tetrahydro-2-naphthyl
compounds substituted at the 6 position (11 and 7) showed considerably better solubility in fed-state simulated
intestinal fluid than either 1 or the 7 position (9 and 13) substituted compounds.
Table 3
Physicochemical Properties, in Vitro Metabolism,
and hERG Activity
compd
log DpH 7.4
kinetic solubility
pH 6.5 (μg/mL)a
PPBb (H/R/M, % bound)
blood to
plasma ratio (Rat)
in
vitro CLint (H/R/M, μL/min/mg protein)c
predicted in vivo CLint (H/R/M, mL/min/kg)d
hERG (μM)
1e
3.6
12.5–25
99.9/97.7/99.7
0.8
4.3/1.8/2.8
3.5/3.1/7.2
1.6, 6.2
2e
3.2
12.5–25
NDf
ND
96/ND/229
79/ND/591
ND
3e
2.5
6.3–12.5
ND
ND
7.5/ND/ND
6.2/ND/ND
ND
6
3.5
6.3–12.5
ND
ND
14/39/122
12/67/315
0.7
7
3.9
3.1–6.3
98.8/99.2/ND
0.7
<7/33/44
<5.8/57/114
1.4
9
3.9
3.1–6.3
96.7/96.4/97.4
1.5
<7/38/31
<5.8/65/80
1.5
11
4.0
3.1–6.3
99.0/99.7/99.2
0.7
<7/11/26
<5.8/19/67
0.5
12
4.0
3.1–6.3
ND
ND
<7/13/40
<5.8/22/103
ND
13
4.0
1.6–3.1
96.3/97.2/ND
1.5
<7/39/32
5.8/67/83
1.1
16
3.3
12.5–25
ND
ND
18/19/25
15/33/65
1.8
19
ND
ND
ND
ND
11/24/59
9.1/41/152
ND
20
4.0
3.1–6.3
ND
ND
<7/13/17
<5.8/22/44
ND
21
4.1
1.6–3.1
ND
ND
<7/<7/<7
<5.8/<12/<18
ND
24
4.1
1.6–3.1
ND
ND
9/ND24
7.4/ND/62
ND
26
3.1
25–50
ND
ND
24/245/1004
20/422/2590
ND
28
3.5
6.3–12.5
ND
ND
10/54/43
8.2/93/111
ND
32
3.8
6.3–12.5
ND
ND
168/178/1000
138/306/2580
ND
33
3.2
6.3–12.5
ND
ND
33/1013/1500
27/1740/3870
ND
34
3.3
12.5–25
ND
ND
11/72/76
9.1/124/196
ND
35
3.4
6.3–12.5
93.4/94.2/95.3
1.2
<7/<7/21
<5.8/<12/54
1.7
36
3.7
6.3–12.5
ND
ND
30/61/119
25/105/307
ND
Kinetic solubility range following
30 min at room temperature.
Protein binding by ultracentrifugation
in human (H), rat (R), and mouse (M) plasma.
In vitro intrinsic
clearance in human (H), rat (R), and mouse (M) liver microsomes.
Predicted in vivo intrinsic clearance obtained using physiological scaling factors.[21]
Values
for compounds 1–3 have been previously
reported.[12,15,16]
ND, not determined.
Table 4
Solubility in Physiologically
Relevant
Mediaa
solubility
(μg/mL)
media
1b
35
11
13
7
9
0.1 N HCl
6.8
180
189
52
429
105
FeSSIF
pH 5.0
27.6c
65c
211c
39
211
36
FaSSIF pH 6.5
5.1
15
13
8.3
47
12
Solubility after 5–6 h at
37 °C. FaSSIF = fasted state simulated intestinal fluid. FeSSIF
= fed state simulated intestinal fluid.
Data from ref (12).
pH 5.8.
Kinetic solubility range following
30 min at room temperature.Protein binding by ultracentrifugation
in human (H), rat (R), and mouse (M) plasma.In vitro intrinsic
clearance in human (H), rat (R), and mouse (M) liver microsomes.Predicted in vivo intrinsic clearance obtained using physiological scaling factors.[21]Values
for compounds 1–3 have been previously
reported.[12,15,16]ND, not determined.Solubility after 5–6 h at
37 °C. FaSSIF = fasted state simulated intestinal fluid. FeSSIF
= fed state simulated intestinal fluid.Data from ref (12).pH 5.8.Human, rat, and mouse plasma protein
binding (PPB) was assessed
for the more potent compounds that were progressed to in vivo pharmacokinetic testing (7, 9, 11, 13, 35). The tetrahydro-2-naphthyl compounds
substituted at the 6 position (7 and 11)
showed higher protein binding compared to the compounds substituted
at the 7 position (9 and 13). Binding was
similar across the species tested for each of the compounds. By comparison, 1 exhibited high protein binding in human and mouse plasma
but lower binding in rat plasma. The indanyl analogue 35 had considerably lower protein binding compared to either 1 or the tetrahydro-2-naphthyl compounds.
In
Vitro Metabolism
To obtain a preliminary
indication of the likelihood that compounds would show good in vivo pharmacokinetic properties, selected compounds were
analyzed for metabolic stability in vitro using human,
rat, and mouse liver microsomes. We previously found that the in vitro microsomal stability of compounds from the triazolopyrimidine
series provided a good rank order estimation of which compounds would
have the highest in vivo exposure.[11,15,16,19] We report
in Table the in vitro intrinsic clearance (CLint, μL/min/mg
microsomal protein) and the predicted in vivo intrinsic
clearance (mL/min/kg) obtained using physiologically based scaling
factors as previously described.[21] Given
the early stage of optimization for the series, protein binding was
not determined for all compounds, and therefore, no attempt was made
to predict the in vivo blood clearance (which requires
corrections for both plasma and microsomal binding). In vitro CLint values of <20 μL/min/mg protein were taken
as being suggestive of good metabolic stability, assuming that clearance
only occurs via hepatic metabolism. Overall, the substituted tetrahydro-2-naphthyls
showed good metabolic stability in human liver microsomes, but they
were less stable in mouse microsomes (Table ). Chloro-, bromo-, and CF3-substituted
compounds (7, 9, 11, 12, 13, 20, 21) were
marginally more metabolically stable than the fluoro- (6, 19) or OMe-substituted (16) compounds.With the exception of 35, the indanyl analogues were
generally metabolically unstable showing high intrinsic clearance
in mouse liver microsomes and moderate to high values in human and
rat microsomes. The least stable compounds were the unsubstituted
2-indanyl 26 and the 4,7 dimethyl substituted derivative 32. Replacement of both methyl groups with fluorine 33 did not improve stability, although perhaps surprisingly
the single 4-F derivative 34 was significantly more stable.
Substantial improvement in metabolic stability was obtained by moving
the fluorine to the 5 and 6 positions of the ring 35,
leading to low intrinsic clearance in human and rat microsomes and
moderate clearance in mouse microsomes. These data suggested that 35 would show good plasma exposure in both mice and rats.
hERG Channel Activity and CYP Inhibition
In order to
evaluate any potential cardiac risks, select compounds were tested
for inhibition of the human ether-a-go-go-related gene (hERG) K+ channel in a standard patch clamp assay. hERG channel inhibition
has been associated with QT prolongation and arrhythmias, and patch
clamp assays have become a routine method to provide an initial analysis
that a compound may potentially be associated with QT syndromes in
humans.[22] Compounds in both the tetrahydro-2-naphthyl
and 2-indanyl series inhibited the hERG channel with IC50s in the range of 0.5–1.8 μM (Table ).In order to test for the potential
for drug–drug interactions, select compounds were tested for
their ability to inhibit cytochrome P450 isoforms in human liver microsomes
(Table ). All tested
compounds showed moderate inhibition of isoforms 2C9 and 2D6. The
most significant inhibition was observed for 9 and 13 as both inhibited these two isoforms in the 2–4
μM range.
Table 5
Inhibition of Cytochrome P450 Enzymes
in Human Liver Microsomes
IC50 (μM)
CYP
35
11
13
7
9
1A2
>20
>20
>20
>20
>20
2B6
>20
17.7
>20
18.4
>20
2C8
ND
18.7
16.9
>20
>20
2C9
18.5
8.7
3.1
10.2
2.1
2C19
>20
>20
>20
>20
>20
2D6
5.9
>20
3.9
20
2.7
3A4
>20
>20
>20
>20
>20
In Vivo Pharmacokinetic Studies in Rats and
Mice
Five of the most potent compounds were selected for
assessment of their in vivo pharmacokinetic properties
based on their good in vitro metabolic stability.
Mice were dosed orally while rats were dosed orally, and intravenously
to allow determination of the clearance, volume of distribution, and
oral bioavailability. Compounds included one from the indanyl series
(35) and four from the tetrahydro-2-naphthyl series (7, 9, 11, 13).All five compounds showed good exposure over 24 h in both mice and
rats after oral administration (Tables and 7; Figures and 4). Compounds
were well tolerated at the administered doses, and no adverse reactions
were observed. In mice, Cmax and AUC24h values were highest for 35 and lower for the
tetrahydro-2-naphthyl compounds. Compared to 1 and taking
into account the differences in dose, total Cmax and AUC24h values were similar or lower for
the tetrahydro-2-naphthyl compounds, whereas unbound Cmax and AUC24h were similar (for 7) or somewhat higher (3–4-fold for 9, 11, and 13). The indanyl (35) had the highest
plasma exposure in mice in terms of both total and unbound Cmax and AUC24h and significantly
higher exposure compared to 1. Similar to 1, the terminal elimination half-life (t1/2) in mice was ∼2 h for all five compounds (Table and Figure ).
Table 6
Mouse Plasma Pharmacokinetic Parameters
after a Single Oral Dosea
parameter
1b
35
11
13
7
9
dose (mg/kg)
10
20
20
20
20
20
mouse PPB (% bound)
99.7
95.3
99.2
97.2c
99.2c
97.4
Tmax (h)
1.5
1
1
1
1
1
apparent T1/2 (h)
2.5
2.3
2.1
2.1
1.9
1.5
Cmax (μM)
3.1 (0.01)
29 (1.4)
8.6 (0.07)
4.5 (0.13)c
7.0 (0.06)c
5.0 (0.13)
AUC0-inf (μM·h)
22.6 (0.07)
169 (7.9)
51 (0.41)
16.7 (0.47)c
19.7 (0.16)c
22.7 (0.59)
Values in parentheses
have been
corrected for plasma protein binding and represent unbound values.
Average from two studies as
previously
reported.[12]
Protein binding in mouse plasma
is an approximation based on rat and human plasma protein binding
data. Calculated unbound parameters (in italics) are therefore approximations
only.
Table 7
Rat Plasma
Pharmacokinetic Parameters
after Intravenous (IV) or Oral (PO) Administrationa
intravenous administration
parameter
1b
35
11
13
7
9
dose (mg/kg)
2.6
1.8
2.0
1.1
1.9
1.6
rat PPB (% bound)
97.7
94.2
99.7
97.2
99.2
96.4
blood/plasma
0.8
1.2
0.7
1.5
0.7
1.5
apparent T1/2 (h)
12.6
11.2
6.2
6.1
7.1
5.9
AUC0-inf (μM·h)
17.4 (0.40)
27.1 (1.57)
30 (0.09)
2.0 (0.05)
24 (0.19)
3.5 (0.12)
CLp (mL/min/kg)
6.0 (263)
3.0 (52)
2.8 (933)
22.4 (800)
3.5 (438)
21.2 (589)
Vss (L/kg)
5.9 (257)
2.7 (47)
1.1 (367)
8.7 (311)
1.5 (188)
6.7 (186)
Values represent the average n = 2 rats per dose group. Values in parentheses have been
corrected for plasma protein binding and represent unbound values.
Data from ref (12).
Figure 3
Plasma concentration versus time profiles following
a single oral
dose of 20 mg/kg to male Swiss outbred mice. Data represent the mean
concentrations for two mice at each time point.
Figure 4
Plasma concentration versus time profiles following a single intravenous
(IV) or oral (PO) dose to male Sprague–Dawley rats. Dose levels
are shown in Table . Each data point represents the mean of data from two rats, and
error bars represent the range.
Plasma concentration versus time profiles following
a single oral
dose of 20 mg/kg to male Swiss outbred mice. Data represent the mean
concentrations for two mice at each time point.Plasma concentration versus time profiles following a single intravenous
(IV) or oral (PO) dose to male Sprague–Dawley rats. Dose levels
are shown in Table . Each data point represents the mean of data from two rats, and
error bars represent the range.Values in parentheses
have been
corrected for plasma protein binding and represent unbound values.Average from two studies as
previously
reported.[12]Protein binding in mouse plasma
is an approximation based on rat and human plasma protein binding
data. Calculated unbound parameters (in italics) are therefore approximations
only.Values represent the average n = 2 rats per dose group. Values in parentheses have been
corrected for plasma protein binding and represent unbound values.Data from ref (12).In rats, the oral bioavailability was high for all
compounds tested,
ranging from 63–100% compared to 57% for 1 (Table and Figure ). The plasma clearance and
volume of distribution were significantly lower for the tetrahydro-2-naphthyl
compounds substituted on the 6 position (7 and 11) than for those substituted on the 7 position (9 and 13); however, when corrected for differences in
plasma protein binding, values across the four tetrahydro-naphthyl
compounds were comparable (within 2-fold). The 6 position compounds
also had lower blood to plasma partitioning consistent with their
higher plasma protein binding compared to the 7 position analogues.
Unbound clearance values for the tetrahydro-2-naphthyl compounds were
somewhat lower for the two chloro-substituted compounds (438 and 589
mL/min/kg for 7 and 9, respectively) compared
to the bromo compounds (933 and 800 mL/min/kg for 11 and 13, respectively), and all were higher than for 1 (263 mL/min/kg). As a result, unbound AUC values for the tetrahydro-2-naphthyls
were approximately 2–4-fold lower than 1 after
oral dosing at approximately 20 mg/kg. The t1/2 for the tetrahydro-2-naphthyl compounds ranged from 6 to
7 h in comparison to 13 h for 1. The indanyl compound
(35) had low unbound clearance and volume of distribution,
and overall unbound oral exposure was superior to 1 and
to the tetrahydro-2-naphthyls (Table ).
In Vivo Efficacy in the
SCID Mouse Model of P. falciparum
Based
on the observation of good
oral exposure after dosing in mice, we tested three compounds in the
SCIDmouseP. falciparum efficacy model, which has
become the standard model for evaluating the efficacy of new antimalarial
compounds.[23] The tetrahydro-2-naphthyl
compounds substituted at the 7 position (9 and 13) were more potent against P. falciparum in the in vitro parasite assay than those substituted
on the 6 position (7 and 11) and showed
fairly equivalent exposure in mice after oral dosing. We therefore
decided to test both a 6- and 7-substituted tetrahydro-2-naphthyl
(7 and 9) in the P. falciparumSCIDmouse model. Because 35 showed significantly higher
plasma exposure in mice than the remaining compounds, we also selected
this compound for an efficacy study despite the 10-fold lower potency
in the P. falciparum parasite assay.All three
compounds were dosed orally once a day for 4 days and tested for efficacy
and blood concentrations at two doses (10 and 30 mg/kg). Each was
well tolerated, and there were no adverse reactions. The effective
dose that led to 90% parasite clearance (ED90) was calculated
24 h after the last dose (Table and Figure A). Pharmacokinetic sampling was performed on day 1 to allow
the total blood AUC at the ED90 to be assessed (Tables and S4; Figure B). Because of the complicated nature of blood in the
SCIDmouse model (i.e., mice contain a mixture of human and mouse
plasma and erythrocytes and a hematocrit of 70–80%), it was
not possible to accurately convert blood concentrations to plasma
concentrations or to correct concentrations for differences in plasma
protein binding.
Table 8
SCID Mouse Efficacy Data Based on
Once Daily (QD) Dosing for 4 Daysa
compd
ED90 (mg/kg/day)
AUCED90 (μM·h/day)
9b
∼19
10.3
35b
∼35
∼137
7b
>30
>23
1 QDc
8.1
45.7
1 BIDd
3.0
30.8
chloroquined
4.3
3.1
ED90 was calculated from
parasitemia levels measured 24 h after the last dose. AUC data are
based on Day 1 pharmacokinetic data.
Based on only two dose levels administered.
1 QD data were taken
from ref (11) and converted
to different units for consistency.
1 BID and chloroquine
data were taken from ref (12) and converted to different units for consistency.
Figure 5
SCID mouse in vivo efficacy data. Mice
were infected
with P. falciparum Pf3D70087/N9 parasites
by intravenous injection on day zero, and dosing was once daily for
4 days starting on day 3 postinfection. (A) Blood parasitemia levels
were monitored daily by flow cytometry. (B) Pharmacokinetic analysis
was performed after the first dose. Pharmacokinetic parameters are
reported in Table S4.
SCIDmouse in vivo efficacy data. Mice
were infected
with P. falciparum Pf3D70087/N9 parasites
by intravenous injection on day zero, and dosing was once daily for
4 days starting on day 3 postinfection. (A) Blood parasitemia levels
were monitored daily by flow cytometry. (B) Pharmacokinetic analysis
was performed after the first dose. Pharmacokinetic parameters are
reported in Table S4.ED90 was calculated from
parasitemia levels measured 24 h after the last dose. AUC data are
based on Day 1 pharmacokinetic data.Based on only two dose levels administered.1 QD data were taken
from ref (11) and converted
to different units for consistency.1 BID and chloroquine
data were taken from ref (12) and converted to different units for consistency.All three compounds showed efficacy
in this model; however, 9 significantly outperformed
the other two compounds based
on ED90 (Tables and S4; Figure ). The ED90 was higher for all
three compounds than for 1 ranging from ∼19 mg/kg
for 9 to >30 mg/kg for 7 and 35. The pharmacokinetic data indicated that, as expected, 35 exhibited higher total blood concentrations than the other two compounds.
Both 7 and 9 were approximately dose linear
for both Cmax and AUC, whereas 35 showed significant nonlinearity and evidence of a second peak at
8 h at the lower dose (Table S4). Despite
requiring a higher dose, 9 showed higher apparent efficacy
compared to 1 based on the total blood AUC at the ED90, which was 5-fold lower than that required for 1 in the once daily dosing regimen (Table ). However, when accounting for differences
in the plasma unbound fractions for 1 and 9 (approximately 0.002 for 1 and 0.03 for 9, Table ), 1 likely has lower unbound concentrations at the ED90 and hence higher intrinsic efficacy. In contrast, 35 was significantly less effective than 1 suggesting
that the lower intrinsic potency of 35 could not be overcome
by higher exposure levels. The pharmacokinetic/pharmacodynamic relationship
for 7 could not be evaluated in detail as the ED90 was not reached in this study.
Discussion
Malaria
is one of the most serious global infectious diseases,
and while a number of effective drugs have been used to treat malaria,
drug resistance has led to the loss of most agents that have been
in widespread use.[2] A robust drug pipeline
is therefore key to malaria control and elimination efforts.[4] DHODH has emerged as a key new target in efforts
to identify antimalarial drugs that work on clinical isolates resistant
to standard therapies, and as noted, the triazolopyrimidine 1 is currently in clinical development.[12] In order to identify potential backup compounds to 1 in case issues arise in its clinical development, we sought
to identify additional compounds within the triazolopyrimidine series
with the potential to advance into preclinical development. One identified
potential liability of 1 has been the finding that, while
it does not inhibit human DHODH, it does show moderate inhibition
of the mouse and rat enzymes, which complicates toxicity testing in
animals. We therefore sought to identify new derivatives that showed
broad selectivity against all of the key mammalian enzymes. Herein
we describe a series of tetrahydro-2-naphthyl and 2-indanyl triazolopyrimidine
analogues, which display a range of potencies against Plasmodium DHODH but importantly lack activity against human DHODH or any of
the key mammalian enzymes from species that are important for toxicological
profiling (mouse, rat, and dog). Pharmacologic profiling and in vivo efficacy assays suggest that several of the identified
analogues have potential, with 9 showing the most promising
profile.In evaluating the tetrahydro-2-naphthyl and 2-indanyl
triazolopyrimidine
analogues we found that the tetrahydro-2-naphthyls (e.g., 7, 9, 11, 13) had significantly
greater potency on PfDHODH and Plasmodium parasites in whole cell assays than the 2-indanyl analogues (e.g., 35). The most potent of the tetrahydro-2-naphthyl derivatives
also showed good activity (within 1.5-fold) against P. vivax DHODH suggesting that they would be useful for the treatment of
both P. falciparum and P. vivax.
In contrast, the best of the 2-indanyl analogues (35)
was 7-fold less active on P. vivax DHODH suggesting
it might not have good activity against the P. vivax parasite.The X-ray structure of the 7-bromo analogue 13 showed
that, in addition to the previously observed H-bonds and stacking
interactions observed for other analogues in the series,[11,12,17,18] a good halogen bond was formed between the bromo group of 13 and Cys-233 that is likely to provide considerable binding
energy to the interaction. Indeed halogen bonding to protein residues
that include Lewis bases (e.g., sulfur) are commonly observed in protein
structures deposited in the PDB.[24] The
overall binding mode of 13 is very similar to that of 2, which was expected based on their close structural similarity.
Like the naphthyl of 2, the tetrahydro-2-naphthyl of 13 better fills the available binding pocket than the SF5-aniline of 1, which supports our initial hypothesis
that compounds with improved potency could be identified by substitution
of the SF5-aniline with bulkier aromatic groups.Comparison of the tetrahydro-2-naphthyl compounds containing 7
position (9 and 13) versus 6 position (7 and 11) substitutions identified a number of
interesting differences. Analogues substituted in the 7 position were
more potent than 6 position analogues, and indeed 13 with
subnanomolar activity against the parasite in whole cell assays is
the most potent analogue that has been identified in the series. However,
these assays did not take into account potential differences in protein
binding. The 6 position analogues exhibited consistently higher plasma
protein binding than the 7 position compounds and a similar trend
is also likely for binding to albumax present in the in vitro test medium. Assessment of the pharmacologic properties showed that
while the 7 position tetrahydro-2-naphthyls had greater apparent antimalarial
potency, analogues substituted at the 6 position had somewhat improved
physicochemical properties. The 6 position analogues 7 and 11 were more soluble (in 0.1 N HCl and FeSSIF media)
than either of the 7 position analogues (9 and 13). While the total plasma exposure (AUC and Cmax) in rats was higher for the 6 position analogues,
correction of the data for protein binding indicated that the unbound
exposure and unbound clearance were similar (within 2-fold) for the
6 and 7 position analogues with the chloro-substituted compounds (7 and 9) showing about 2-fold lower unbound clearance
than the bromo-substituted compounds (11 and 13). So while total exposure appears greater for the 6 position analogues,
unbound concentrations are comparable across the tetrahydro-naphthyl
compounds tested. Protein binding data in mouse plasma was only available
for 9, 11, and 35, and binding
for each of these compounds was similar in each of the three species
tested. Mouse plasma protein binding was therefore estimated for 7 and 13 using the average of the human and rat
values, suggesting that unbound concentrations for each of the compounds
are likely to be within a similar range (Table ). The best of the 2-indanyl analogues (35) had considerably higher unbound plasma exposure in rats
compared to the tetrahydro-2-naphthyls and to 1 and had
similarly low unbound clearance.The in vitro data generated in liver microsomes
provided a mechanism to rank compounds based on their relative metabolic
stability. The compounds selected for in vivo testing
were expected to have good exposure, and this was seen following dosing
to both rats and mice indicating that, qualitatively, the in vitro data were informative. Converting the in
vitro intrinsic clearance determined in rat microsomes to
a plasma clearance using physiologically based scaling factors and
taking into account binding to rat plasma and microsomal proteins
(as per ref (21)) and
blood to plasma partitioning ratio led to an under prediction of the
actual in vivo clearance by a factor of 3- to 16-fold
for the five compounds tested. These trends are similar to what had
been observed previously for 1(16) and suggest that in vivo clearance mechanisms for
the series also involve additional non-CYP pathways not fully represented
by the microsomal test system. In the case of 1, hepatocyte
assays also led to an under prediction of in vivo clearance highlighting the difficulties in obtaining accurate clearance
predictions based on in vitro data alone. Further
studies with the current compounds using hepatocytes may have provided
additional insight into their clearance mechanisms.In vivo efficacy was assessed in the P.
falciparum SCIDmouse model. Of the three tested compounds, 9 (7 position) had the most potent in vivo activity. The total blood AUC required to reach ED90 was
lower than for 1; however, it took a higher dose (∼19
mg/kg versus 8.1 mg/kg for QD dosing) to achieve this activity, possibly
due to a higher unbound clearance of 9 compared to 1 as seen in rats. The binding trends in human and mouse plasma
would suggest that unbound concentrations of 9 in the
SCIDmouse are likely to be considerably higher compared to those
for 1 at the same total blood concentration. Therefore,
the true in vivo potency of 1 based
on unbound concentrations is likely to be greater than that for 9. In spite of the high blood exposure, the 2-indanyl (35) lacked sufficient intrinsic potency to provide good activity
in the in vivo model. In order to improve patient
compliance, single dose treatments are being sought by the international
organizations that are promoting new drug discovery for malaria.[4] While all three tested compounds (7, 9, and 35) showed in vivo antimalarial activity, it is unlikely that any of these compounds
have the necessary properties to support a single dose treatment regimen
at a practical dose level in humans.Preliminary safety analysis
included characterizing hERG channel
activity to assess potential cardiac effects and CYP inhibition studies
to determine the potential for drug–drug interactions. All
five of the profiled compounds showed some CYP inhibition, with CYP
isoform 2D6 being inhibited to the greatest extent. CYP2D6 inhibition
was modest with the most potent inhibition observed in the 3–6
μM range, but does suggest some potential for drug–drug
interactions with compounds that are substrates for this enzyme. Tested
compounds in these series also showed some hERG inhibition (0.5–1.5
μM range). This inhibitory activity is similar to what was observed
for 1, where subsequent studies using the rabbit wedge
model and dog cardiovascular studies showed no evidence for QT prolongation,
arrhythmias, or cardiac effects.[12] Additionally,
for 1 the unbound plasma concentration at likely therapeutic
doses is 70–320-fold lower than the IC50 for hERG
channel inhibition, suggesting it would be very unlikely that 1 would inhibit the channel in vivo. Insufficient
efficacy data is available for compounds 7 and 35 to determine the safety margin relative to unbound concentrations
at an efficacious dose; however, for 9 the Cmax at the ED90 in the SCID study (unbound
concentration of approximately 0.05 μM) is ∼30-fold lower
than the IC50 on the hERG channel, again suggesting a low
likelihood the channel would be inhibited in vivo. However, given the hERG channel activity, careful evaluation of
cardiac safety would be an important component of preclinical development
if any of these compounds were to be advanced.Several potential
avenues remain feasible for additional optimization
of the triazolopyrimidine series. First, only the chloro-substituted
tetrahydro-2-naphthyls were tested in the SCID efficacy model, leaving
open the possibility that one of the bromo analogues might have shown
better in vivo efficacy. Additional optimization
of the series might focus on reducing lipophilicity as this could
lead to reduced intrinsic clearance and better in vivo exposure and also could lead to reduced hERG activity. Reduced lipophilicity
would also likely result in improved aqueous solubility thereby simplifying
formulation approaches for oral administration. Decreasing lipophilicity
will likely require the SF5-anline of 1 to
be replaced with more hydrophilic aromatic amines, provided potency
can be maintained. Within the tetrahydro-2-naphthyls, it might yet
be possible to identify more metabolically stable analogues by identifying
the specific sites of metabolism and attempting to block them.
Conclusion
We have described the identification of several tetrahydro-2-naphthyl
and 2-indanyl triazolopyrimidine analogues that are potent inhibitors
of Plasmodium DHODH and that have improved species
selectivity over the mammalian enzymes in comparison to the clinical
candidate 1. The compounds have potent activity against P. falciparum in parasite assays and showed antimalarial
activity in the P. falciparumSCIDmouse model of
disease. These compounds showed good plasma exposure after oral dosing
in mice and rats and were well tolerated in the in vivo studies that were performed. Several of the identified compounds,
most notably 9, have the potential to be further developed
for treatment of malaria. However, the findings that 9 is less intrinsically potent than 1in vivo (based on expected unbound concentrations) and that the unbound
clearance in rat is 2-fold higher than for 1 suggest
that this compound is unlikely to meet the strict criteria required
for a single dose cure at a reasonable dose.
Experimental
Section
DHODH Purification
Plasmodium and mammalian DHODHs
were expressed in E. coli as N-terminal truncations
(lacking the mitochondrial transmembrane domains) fused to His6-purification tags as previously described.[11,17,18,25] Protein (PfDHODHΔ384–413) for crystallization
studies was further truncated to remove a proteolytically sensitive
loop (amino acids 384–421) that prevents crystallization as
previously described.[17,26] Proteins were expressed in E. coli BL21 phage-resistant cells (Novagen), and they were
purified by Ni2+-agarose column chromatography (GE Healthcare
Life Sciences, HisTrap HP) and gel-filtration column chromatography
(GE Healthcare Life Sciences, HiLoad 16/600 Superdex 200 pg) as previously
described.[11,17,18] Protein was concentrated to 10–30 mg/mL and stored at −80
°C.
DHODH Kinetic Analysis
Steady-state kinetic analysis
was performed using a dye-based spectrophotometric method in assay
buffer (100 mM HEPES, pH 8.0, 150 mM NaCl, 10% glycerol, 0.05% Triton
X-100) as previously described.[11] All buffers
were degassed prior to use. Enzyme and substrate concentrations were
DHODH (E = 5 nM), substrates (0.2 mM l-dihydroorotate, 0.02
mM CoQd, and 0.12 mM 2,5-dichloroindophenol (DCIP)). Inhibitor
stock solutions (100 mM) were made in DMSO and protected from light
in dark amber vials. Serial dilutions were than performed to generate
a 3-fold dilution series of 100× stocks also in DMSO that were
used in the final assay (final inhibitor concentration range was 0.01–100
μM). Data were collected in triplicate for each concentration
in the titration. Data were fitted to the log[I]
vs response (three parameters) equation to determine the concentration
that gave 50% enzyme inhibition (IC50) except for compounds
where the IC50 > 10 μM, which were instead fitted
to the standard IC50 equation (Y = 1/(1
+ X/IC50)) in Graphpad Prism. Error represents
the 95% confidence interval of the fit.
P. falciparum Growth Assays
P. falciparum parasites
were grown in RPMI-1640 containing
0.5% Albumax-II as previously described.[11] Inhibitor stock solutions were prepared as described above for DHODH
kinetic analysis except that a 500× dilution series prepared
in DMSO was used to generate a 10× dilution series in RPMI so
that final DMSO concentration in the media was 0.2%. Growth assays
for P. falciparum 3D7 cells and drug-resistant parasites
were performed using the SYBR-green 72 h growth assay.[18] Data were collected in triplicate to quadruplicate
for each concentration in the titration. Data were fitted to the log[I] vs response variable slope (four parameter) equation
in graph pad prism to determine the effective concentration (EC50) that led to 50% reduction in parasitemia. Error represents
the 95% confidence interval of the fit.
In Vitro Metabolism and Physicochemical Assessment
In Vitro Metabolism
Selected compounds
were incubated at a concentration of 1 μM with mouse, rat, or
pooled human liver microsomes (BD Gentest, Woburn, MA or XenoTech
LLC, Lenexa, Kansas City) at a microsomal protein concentration of
0.4 mg/mL.[11] Substrate depletion was assessed
by LC–MS. Measured in vitro intrinsic clearance
values (μL/min/mg microsomal protein) were converted to predicted in vivo intrinsic clearances (mL/min/kg) using published
physiologically-based scaling factors.[21]
Solubility
Aqueous solubility of compounds was assessed
by nephelometry as described previously.[27] Compound stock solutions were prepared in DMSO, which was then spiked
into pH 6.5 phosphate buffer giving a final DMSO concentration of
1%. Solubility measurements in physiologically relevant media were
conducted for selected compounds. Media included 0.1 N HCl to represent
a simulated gastric condition, fasted (FaSSIF, pH 6.5) and fed (FeSSIF,
pH 5.0 or 5.8) state simulated intestinal fluids prepared as described
previously.[28] Solid material was incubated
in media for a period of 5–6 h at 37 °C with periodic
mixing and sample supernatant concentrations determined by HPLC with
UV detection following two separate centrifugations to remove undissolved
compound.
Plasma Protein Binding and Partitioning
Select compounds
were analyzed for plasma protein binding (PPB) in human, rat, or mouse
plasma using an ultracentrifugation method at 37 °C as previously
described[11] followed by LC–MS analysis
as described below. Protein binding was calculated by comparing the
unbound concentration in the ultracentrifuged samples to the total
plasma concentration in control samples incubated at 37 °C for
the same time period. For compounds progressing to rat pharmacokinetic
studies, blood to plasma partitioning ratios in rat blood were also
assessed as described previously.[16]
Pharmacokinetic
Analysis in Mice and Rats
Pharmacokinetic
studies for select compounds were performed in mice and rats in accordance
with the Australian Code of Practice for the Care and Use of Animals
for Scientific Purposes, and the study protocols were approved by
the Monash Institute of Pharmaceutical Sciences Animal Ethics Committee.Oral doses were administered as a suspension in a vehicle containing
0.5% w/v carboxymethylcellulose, 0.5% v/v benzyl alcohol (as a preservative),
and 0.4% v/v Tween 80, and intravenous doses were administered in
cosolvent vehicle containing 40% propylene glycol, 10% ethanol, 0.4%
Tween 80 in water. IV doses to rats were administered as a 10 min
constant rate infusion of 1 mL into an indwelling jugular vein cannula,
and oral doses were administered by gavage as 10 mL/kg (both rats
and mice). Blood was collected from rats via a cannula inserted into
the carotid artery on the day prior to dosing, and from mice via either
submandibular bleed or terminal cardiac puncture (maximum of two samples
per mouse) into tubes containing heparin as an anticoagulant, and
plasma was separated by centrifugation. Compound concentrations were
quantitated by LC–MS using a Waters Xevo TQ mass spectrometer
coupled to a Waters Acquity UPLC. Chromatography was conducted using
a Supelco Ascentis Express RP Amide column (50 × 2.1 mm, 2.7
μm)
with a mobile phase consisting of 0.05% formic acid in water and 0.05%
formic acid in methanol mixed via a linear gradient with a cycle time
of 4 min. The flow rate was 0.4 mL/min, and the injection volume was
3 μL. Detection was via positive electrospray ionization mass
spectrometry with multiple-reaction monitoring using a cone voltage
of 30–40 V and collision energy of 25–35 V. Calibration
curves were prepared using blank rat or mouse plasma, and validation
studies confirmed the accuracy, precision, and limit of quantitation
to be within acceptable ranges.
Cyp Inhibition Assays
Inhibition of cytochrome P450
(CYP) enzymes was assessed in human liver microsomes using a substrate
specific approach where the formation of metabolites specific to a
particular CYP isoform was monitored. Microsomes were suspended in
phosphate buffer and incubated at 37 °C in the presence of probe
substrates,[29] and reactions were initiated
by the addition of an NADPH-regenerating system. Reactions were quenched
at appropriate times using acetonitrile. Samples were centrifuged
and concentrations of the metabolites assessed by LC–MS. The
IC50 value for each compound or control inhibitor was the
concentration at which there was a 50% reduction in the amount of
metabolite formed relative to the maximum metabolite formation in
the absence of inhibitor.
hERG Analysis
Select compounds were
tested for activity
against the human ether-a-go-go related gene (hERG) K+ channel
in a IonWorks patch clamp electrophysiology assay under contract to
Essen BioScience (Welwyn Garden City Hertfordshire, UK).
SCID Mouse
Efficacy Studies
NOD-scid IL-2Rγnull (NSG) mice (Jackson Laboratory, USA) (23–36 g) were engrafted
with human erythrocytes and then infected with P. falciparum Pf3D70087/N9 parasites (20 × 106) by
intravenous injection as described.[23] Compounds
(7, 9, and 35) were administered
by oral gavage once daily (QD) for four consecutive days starting
on day 3 postinfection in vehicle (0.5% w/v sodium carboxymethylcellulose,
0.5% v/v benzyl alcohol, 0.4% v/v Tween 80 in water). Parasitemia
was monitored by flow cytometry. To verify the actual doses administered,
formulation concentrations were measured. Compound levels in the formulations
or in the blood of infected mice were measured by LC–MS/MS
as described above. Human biological samples were sourced ethically,
and their research use was in accordance with the terms of the informed
consents.
Small Molecule X-ray Structure Determination
and Refinement
of 9
Compound 9 was crystallized
from ethanol. A colorless prism, measuring 0.20 × 0.13 ×
0.10 mm3 was mounted on a loop with oil. Data was collected
at −173 °C on a Bruker APEX II single crystal X-ray diffractometer,
Mo-radiation. Crystal-to-detector distance was 40 mm, and exposure
time was 15 s per frame for all sets. The scan width was 0.5°.
Data collection was 99.9% complete to 25° in θ. A total
of 113483 reflections were collected covering the indices, h = −11 to 11, k = −38 to
38, l = −18 to 18. Of that, 16915 reflections
were symmetry independent and the Rint = 0.0703 indicated that the data was of average quality (0.07).
Indexing and unit cell refinement indicated a primitive monoclinic
lattice. The space group was found to be P21 (No. 4). The data were integrated and scaled using SAINT aand SADABS
within the APEX2 software package by Bruker.[30] Solution by direct methods (SHELXS, SIR97)[31,32] produced a complete heavy atom phasing model consistent with the
proposed structure. The structure was completed by difference Fourier
synthesis with SHELXL97.[33,34] Scattering factors
are from Waasmair and Kirfel.[35] Hydrogen
atoms were placed in geometrically idealized positions and constrained
to ride on their parent atoms with C···H distances
in the range 0.95–1.00 Å. Isotropic thermal parameters
Ueq were fixed such that they were 1.2Ueq of
their parent atom Ueq for CH’s and 1.5Ueq of their parent atom Ueq in the case of methyl groups.
All non-hydrogen atoms were refined anisotropically by full-matrix
least-squares.
PfDHODH Crystallization,
Data Collection, Structure
Determination and Refinement for the PfDHODH-13 Bound Structure
Preliminary crystallization conditions
were found using the random crystallization screen Cryos suite (Nextal). Then the condition was refined by variation of pH,
precipitant, and protein concentrations to find optimal conditions.
Crystallization was setup with hanging drop vapor diffusion at 20
°C. Crystals of PfDHODHΔ384–413-13 complex grew at condition with 0.16 M ammonium sulfate,
0.1 M sodium acetate, pH 4.2, 9.5% PEG4000 (w/v), 24% glycerol (v/v),
and 10 mM DTT. The crystallization drop was mixed with an equal volume
of reservoir solution and PfDHODHΔ384–413 (27 mg/mL) pre-equilibrated with 1 mM 13 (0.1 M stock
solution in DMSO) and 2 mM dihydroorotate (DHO, 0.1 M stock solution
in DMSO). All commercially available reagents were obtained from Sigma.
Crystals typically grew in 1 week.Diffraction data were collected
at 100 K on beamline 19ID at Advanced Photon Source (APS) using an
ADSC Q315 detector. The crystal of PfDHODHΔ384–413-13 diffracted to 2.32 Å and has a space group
of P64 with the cell dimension of a = b = 86.1, c = 139.1
(Table S3). The structure contains only
one molecule of PfDHODH in the asymmetric unit. Diffraction
data were integrated, and intensities were scaled with HKL2000 package.[36]Crystallographic phases for PfDHODH inhibitors
were solved by molecular replacement with Phaser[37] using the previously reported structure of PfDHODHΔ384–413 bound to DSM1 (PDB ID 3I65(17)) as a search model (ligands were removed from the search
model). Structures were rebuilt with COOT[38] and refined in PHENIX[39] to Rwork and Rfree of 0.18 and
0.21, respectively (Table S3). Electron
density for residues 159–160, 344–354, and 567–569
were missing and thus not built into the final structure. The final
structure contained 2972 atoms and 73 water molecules. Atomic representations
were created using PyMOL Molecular Graphics System (Version 1.7, Schrödinger).
Chemistry General Methods
All reagents and starting
materials were obtained from commercial suppliers and used without
further purification unless otherwise stated. Reaction progress was
monitored by thin layer chromatography (TLC) on preloaded silica gel
60 F254 plates. Visualization was achieved with UV light
and iodine vapor. Flash chromatography was carried out using prepacked
Teledyne Isco Redisep Rf silica-gel columns as the stationary phase
and analytical grade solvents as the eluent unless otherwise stated.
Yields were of purified product and were not optimized. 1H NMR spectra were recorded on Bruker Avance 300 and 500 MHz spectrometer
at ambient temperature. Chemical shifts are reported in parts per
million (δ) and coupling constants in Hz. 1H NMR
spectra were referenced to the residual solvent peaks as internal
standards (7.26 ppm for CDCl3, 2.50 ppm for DMSO-d6, and 3.34 ppm for MeOD). Spin multiplicities
are described as s (singlet), brs (broad singlet), d (doublet), t
(triplet), q (quartet), dd (doublet of doublets), dt (doublet of triplets),
and m (multiplet). Total ion current traces were obtained for electrospray
positive and negative ionization (ES+/ES−) on a Bruker Esquire
Liquid Chromatograph-Ion trap mass spectrometer. Analytical chromatographic
conditions used for the LC–MS analysis are as follows: Column,
Zorbax Extend C18 from Agilent technologies, 2.1 × 100 mm. The
stationary phase particle size is 3.5 μM. Solvents were A, aqueous
solvent = water + 5% acetonitrile + 1% acetic acid; B, organic solvent
= acetonitrile + 1% acetic acid; Methods, 14 min run time (0–10
min 20–100% B, flow rate 0.275 mL/min; 10–12 min 100%
B, flow rate 0.350 mL/min; 12–12.50 min 100–20% B, flow
rate 0.350 mL/min; 12.50–14.0 min 20% B, flow rate 0.350 mL/min).
The following additional parameters were used: injection volume (10
μL), column temperature (30 °C), UV wavelength range (254–330
nm). Analytical HPLC analyses were performed on a SupelcoSIL LC18
column (5 μm, 4.6 mm × 25 cm) with a linear elution gradient
ranging from 0 to 100% ACN over 27 min, using a SupelcoSIL LC18 column
(5 μm, 4.6 mm × 25 cm) at a flow rate of 1 mL/min. A purity
of >95% has been established for all reported compounds (Table ). The two enantiomers
were separated for selected compounds on a semipreparative chiral
HPLC on Chiralcel OD-H (250 × 20) mm column eluting with 0.1%
diethylamine in hexane (A)/ethanol (B) in 36 min run time (0–10
min, 20% B; 10–20 min, 20–35% B; 20–30 min, 35%
B; 30.01–36 min 20% B; flow rate 5 mL/min).
2-(1,1-Difluoroethyl)-N-(6-bromo-1,2,3,4-tetrahydronaphthalen-2-yl)-5-methyl-[1,2,4]triazolo[1,5-a]pyrimidin-7-amine (11) (Enantiomer-I Is the
Second Eluted on the Chiral Column)
2-(1,1-Difluoroethyl)-N-(6-bromo-1,2,3,4-tetrahydronaphthalen-2-yl)-5-methyl-[1,2,4]triazolo[1,5-a]pyrimidin-7-amine (12) (Enantiomer-II Is
the First Eluted on the Chiral Column)
2,3-Dihydro-1H-inden-2-amine hydrochloride
(38) (50 g, 295 mmol), 45 mL of acetic anhydride, and
25 g of sodium acetate were suspended in 100 mL of acetic acid and
stirred overnight at RT. The mixture was poured into 3 vols of ice–water
and neutralized with ammonium hydroxide. The mixture was extracted
with chloroform, and the combined organic layers were washed with
water, diluted HCl, water, dried, and evaporated. The residue was
recrystallized from CHCl3–Et2O to yield N-(2,3-dihydro-1H-inden-2-yl)acetamide
(39) (43 g, 66% yield).
To a stirred, cooled solution
of N-(2,3-dihydro-1H-inden-2-yl)acetamide
(39) (24.4 g, 139 mmol) in 400 mL of chloroform was added
dropwise 55 mL of chlorosulfonic acid below 0 °C. The solution
was stirred while cooling and then allowed to reach RT slowly by stirring
overnight. The excess of chlorosulfonic acid decomposed by adding
the mixture dropwise to stirred iced water. The layers were separated,
and the aqueous layer was extracted several times with chloroform.
The chloroform layers were washed, dried, and evaporated. The concentrate
was heated and diluted with additional chloroform but was still containing
some undissolved gum. It was filtered, washed with Et2O,
and dried to yield 2-acetamido-2,3-dihydro-1H-indene-5-sulfonyl
chloride (40) as crystals (25.6 g, 67% yield).
A solution of 2-acetamido-2,3-dihydro-1H-indene-5-sulfonyl chloride (40) (13.7 g,
50 mmol) in 250 mL of acetic acid was stirred and warmed to 75 °C
whereupon a solution of 50 g of tin(II) chloride dihydrate in 45 mL
of conc. HCl was added in one portion. The solution was stirred 90–120
min at r.t. The solution was poured into several vols of water containing
some conc. HCl and a yellowish-white solid precipitated. The mixture
was filtered (became rapidly gummy when dried on a clay plate), washed
with cold water, and dissolved in 250 mL of MeOH. To the solution,
under nitrogen, was added 3 g of sodium methoxide in 4 mL (>0.05
mol)
of methyl iodide. The mixture was stirred 2 h at RT and left standing
overnight. The mixture was concentrated and then partitioned between
water and chloroform. After drying and evaporation, 8.6 g of oil were
obtained, which was purified by chromatography on neutral alumina
eluting with EtOAc. N-(5-(Methylthio)-2,3-dihydro-1H-inden-2-yl)acetamide (41) was obtained as
a white solid after washing with Et2O and recrystallization
from chloroform-Et2O (3.7 g, 33% yield).
A solution
of N-(5-(methylthio)-2,3-dihydro-1H-inden-2-yl)acetamide (41) (2.2 g, 9.9 mmol) and m-chloroperbenzoic acid (5 g) in 900 mL of chloroform was
stirred at RT for 2 h. The solution was washed with aq. 5% Na2CO3 and water, dried, and evaporated. The residue
was triturated with Et2O, filtered, and dried to yield
the N-(5-(methylsulfonyl)-2,3-dihydro-1H-inden-2-yl)acetamide (42) as a white solid (1.87g,
75% yield).
A mixture of 1.9 g (7.5 mmol)
of N-(5-(methylsulfonyl)-2,3-dihydro-1H-inden-2-yl)acetamide (42) and 20 mL of 3 N HCl was
stirred under reflux for 2.5 h. The solution was cooled, and the residue
was azeotroped with EtOH. Recrystallization from MeOH-EtOH yielded
5-(methylsulfonyl)-2,3-dihydro-1H-inden-2-amine hydrochloride
(43) as crystals (0.87g, 55% yield).1H NMR (500 MHz, DMSO-d6) δ 8.17
(br. s., 2H), 7.84 (s, 1H), 7.79–7.71 (m, 1H), 7.54 (d, J = 8.0 Hz, 1H), 4.06 (ddd, J = 2.5, 5.0,
7.6 Hz, 1H), 3.40–3.34 (m, 2H), 3.17 (s, 3H), 3.10–2.98
(m, 2H). ESIMS m/z: 212.1 (MH)+.
Authors: Suresh M Ganesan; Joanne M Morrisey; Hangjun Ke; Heather J Painter; Kamal Laroiya; Margaret A Phillips; Pradipsinh K Rathod; Michael W Mather; Akhil B Vaidya Journal: Mol Biochem Parasitol Date: 2011-01-18 Impact factor: 1.759
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