AWZ1066S, a highly specific anti- Wolbachia drug candidate for a short-course treatment of filariasis
W David Hong, Farid Benayoud, Gemma L Nixon, Louise Ford, Kelly L Johnston, Rachel H Clare, Andrew Cassidy, Darren A N Cook, Amy Siu, Motohiro Shiotani, Peter J H Webborn, Stefan Kavanagh, Ghaith Aljayyoussi, Emma Murphy, Andrew Steven, John Archer, Dominique Struever, Stefan J Frohberger, Alexandra Ehrens, Marc P Hübner, Achim Hoerauf, Adam P Roberts, Alasdair T M Hubbard, Edward W Tate, Remigiusz A Serwa, Suet C Leung, Li Qie, Neil G Berry, Fabian Gusovsky, Janet Hemingway, Joseph D Turner, Mark J Taylor, Stephen A Ward, Paul M O'Neill, W David Hong, Farid Benayoud, Gemma L Nixon, Louise Ford, Kelly L Johnston, Rachel H Clare, Andrew Cassidy, Darren A N Cook, Amy Siu, Motohiro Shiotani, Peter J H Webborn, Stefan Kavanagh, Ghaith Aljayyoussi, Emma Murphy, Andrew Steven, John Archer, Dominique Struever, Stefan J Frohberger, Alexandra Ehrens, Marc P Hübner, Achim Hoerauf, Adam P Roberts, Alasdair T M Hubbard, Edward W Tate, Remigiusz A Serwa, Suet C Leung, Li Qie, Neil G Berry, Fabian Gusovsky, Janet Hemingway, Joseph D Turner, Mark J Taylor, Stephen A Ward, Paul M O'Neill
Abstract
Onchocerciasis and lymphatic filariasis are two neglected tropical diseases that together affect ∼157 million people and inflict severe disability. Both diseases are caused by parasitic filarial nematodes with elimination efforts constrained by the lack of a safe drug that can kill the adult filaria (macrofilaricide). Previous proof-of-concept human trials have demonstrated that depleting >90% of the essential nematode endosymbiont bacterium, Wolbachia, using antibiotics, can lead to permanent sterilization of adult female parasites and a safe macrofilaricidal outcome. AWZ1066S is a highly specific anti-Wolbachia candidate selected through a lead optimization program focused on balancing efficacy, safety and drug metabolism/pharmacokinetic (DMPK) features of a thienopyrimidine/quinazoline scaffold derived from phenotypic screening. AWZ1066S shows superior efficacy to existing anti-Wolbachia therapies in validated preclinical models of infection and has DMPK characteristics that are compatible with a short therapeutic regimen of 7 days or less. This candidate molecule is well-positioned for onward development and has the potential to make a significant impact on communities affected by filariasis.
Keywords: anti-Wolbachia; drug discovery; lymphatic filariasis; macrofilaricide; onchocerciasis.
Conflict of interest statement
Conflict of interest statement: An international patent (WO2018134685) that includes chemical compounds described in this manuscript has been filed by the authors (W.D.H., F.B., M.J.T., P.M.O., and S.A.W.). Some authors (F.B., A. Siu, M.S., and F.G.) of this manuscript are full-time employees of Eisai, Inc.
Copyright © 2019 the Author(s). Published by PNAS.
Figures
References
- Taylor MJ, Hoerauf A, Bockarie M. Lymphatic filariasis and onchocerciasis. Lancet. 2010;376:1175–1185.
- Bockarie MJ, Deb RM. Elimination of lymphatic filariasis: Do we have the drugs to complete the job? Curr Opin Infect Dis. 2010;23:617–620.
- Mackenzie CD, Homeida MM, Hopkins AD, Lawrence JC. Elimination of onchocerciasis from Africa: Possible? Trends Parasitol. 2012;28:16–22.
- Taylor MJ, Bandi C, Hoerauf A. Wolbachia bacterial endosymbionts of filarial nematodes. Adv Parasitol. 2005;60:245–284.
- Boussinesq M, Fobi G, Kuesel AC. Alternative treatment strategies to accelerate the elimination of onchocerciasis. Int Health. 2018;10:i40–i48.
- Taylor MJ, et al. Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: A double-blind, randomised placebo-controlled trial. Lancet. 2005;365:2116–2121.
- Turner JD, et al. A randomized, double-blind clinical trial of a 3-week course of doxycycline plus albendazole and ivermectin for the treatment of Wuchereria bancrofti infection. Clin Infect Dis. 2006;42:1081–1089.
- Debrah AY, et al. Macrofilaricidal effect of 4 weeks of treatment with doxycycline on Wuchereria bancrofti. Trop Med Int Health. 2007;12:1433–1441.
- Hoerauf A, et al. Wolbachia endobacteria depletion by doxycycline as antifilarial therapy has macrofilaricidal activity in onchocerciasis: A randomized placebo-controlled study. Med Microbiol Immunol (Berl) 2008;197:295–311, and erratum (2008) 197:335.
- Turner JD, et al. Macrofilaricidal activity after doxycycline only treatment of Onchocerca volvulus in an area of Loa loa co-endemicity: A randomized controlled trial. PLoS Negl Trop Dis. 2010;4:e660.
- Tamarozzi F, et al. Long term impact of large scale community-directed delivery of doxycycline for the treatment of onchocerciasis. Parasit Vectors. 2012;5:53.
- Walker M, et al. Therapeutic efficacy and macrofilaricidal activity of doxycycline for the treatment of river blindness. Clin Infect Dis. 2015;60:1199–1207.
- Johnston KL, Ford L, Taylor MJ. Overcoming the challenges of drug discovery for neglected tropical diseases: The A·WOL experience. J Biomol Screen. 2014;19:335–343.
- Halliday A, et al. A murine macrofilaricide pre-clinical screening model for onchocerciasis and lymphatic filariasis. Parasit Vectors. 2014;7:472.
- Johnston KL, et al. Identification and prioritization of novel anti-Wolbachia chemotypes from screening a 10,000-compound diversity library. Sci Adv. 2017;3:eaao1551.
- Hong WD, et al. 2018. Anti-Wolbachia compounds. International Bureau (IB) Patent WO2018134685.
- Clare RH, et al. Development and validation of a high-throughput anti-Wolbachia whole-cell screen: A route to macrofilaricidal drugs against onchocerciasis and lymphatic filariasis. J Biomol Screen. 2015;20:64–69.
- Sharma R, et al. Minocycline as a re-purposed anti-Wolbachia macrofilaricide: Superiority compared with doxycycline regimens in a murine infection model of human lymphatic filariasis. Sci Rep. 2016;6:23458, and erratum (2018) 8:46934.
- Turner JD, et al. Albendazole and antibiotics synergize to deliver short-course anti-Wolbachia curative treatments in preclinical models of filariasis. Proc Natl Acad Sci USA. 2017;114:E9712–E9721.
- Hübner MP, Torrero MN, McCall JW, Mitre E. Litomosoides sigmodontis: A simple method to infect mice with L3 larvae obtained from the pleural space of recently infected jirds (Meriones unguiculatus) Exp Parasitol. 2009;123:95–98.
- Aljayyoussi G, et al. Short-course, high-dose rifampicin achieves Wolbachia depletion predictive of curative outcomes in preclinical models of lymphatic filariasis and onchocerciasis. Sci Rep. 2017;7:210, and erratum (2018) 8:1384.
- Debrah AY, et al. Macrofilaricidal activity in Wuchereria bancrofti after 2 weeks treatment with a combination of rifampicin plus doxycycline. J Parasitol Res. 2011;2011:201617.
- Bowes J, et al. Reducing safety-related drug attrition: The use of in vitro pharmacological profiling. Nat Rev Drug Discov. 2012;11:909–922.
- Johnston KL, et al. Repurposing of approved drugs from the human pharmacopoeia to target Wolbachia endosymbionts of onchocerciasis and lymphatic filariasis. Int J Parasitol Drugs Drug Resist. 2014;4:278–286.
- Griffiths KG, Alworth LC, Harvey SB, Michalski ML. Using an intravenous catheter to carry out abdominal lavage in the gerbil. Lab Anim (NY) 2010;39:143–148.
- McGarry HF, Egerton GL, Taylor MJ. Population dynamics of Wolbachia bacterial endosymbionts in Brugia malayi. Mol Biochem Parasitol. 2004;135:57–67.
- Basarab GS, et al. Optimization of pyrrolamide topoisomerase II inhibitors toward identification of an antibacterial clinical candidate (AZD5099) J Med Chem. 2014;57:6060–6082.
- Doyle K, et al. Discovery of second generation reversible covalent DPP1 inhibitors leading to an oxazepane amidoacetonitrile based clinical candidate (AZD7986) J Med Chem. 2016;59:9457–9472.
- Ajendra J, et al. NOD2 dependent neutrophil recruitment is required for early protective immune responses against infectious Litomosoides sigmodontis L3 larvae. Sci Rep. 2016;6:39648.
- Schiefer A, et al. Corallopyronin A specifically targets and depletes essential obligate Wolbachia endobacteria from filarial nematodes in vivo. J Infect Dis. 2012;206:249–257.
- Neely MN, van Guilder MG, Yamada WM, Schumitzky A, Jelliffe RW. Accurate detection of outliers and subpopulations with Pmetrics, a nonparametric and parametric pharmacometric modeling and simulation package for R. Ther Drug Monit. 2012;34:467–476.
Source: PubMed