Most people immediately think of mosquitoes when they hear the word "malaria." They transmit the parasite, so keeping them at bay—with window screens and bednets, by denying them places to breed, or by killing them outright—is a critical element in preventing the disease. Another crucial front in the struggle is pharmaceutical: prompt, effective treatment of malaria infections means fewer human reservoirs of the parasite, which in turn means fewer opportunities for mosquitoes to pick up the disease and pass it on.
But just as insecticide resistance has hamstrung vector control in many parts of the world, malaria parasites have evolved resistance to the various drugs we've deployed over the years.
Chloroquine, one of the earliest and most used synthetic antimalarials is today useless in much the world against P. falciparum, the most deadly and most common malaria parasite. Resistance is also common to the drugs that came after choroquine. The latest additions to the arsenal are artemisinin-based therapies, which cure infections rapidly and reliably. Much hope has been placed in these therapies, but already pockets of resistance have been detected in Cambodia.
Given this history, a recent Science paper offers cause for cautious optimism. "Spiroindolones, a potent compound class for the treatment of malaria" reports a new class of molecules — the so-called "spiroindolones" — that can cure malaria in a single dose, at least in mice. On top of that, these compounds appear to have unique mode of action. This is important because it means they should be effective even against malaria strains that are resistant to other drugs. Finally, the most promising spiroindolone, known as NITD609, "shows pharmacokinetic properties compatible with once-daily oral dosing". Translation: it should be possible to make pills out of this stuff, and just one of those pills ought to be enough to cure a patient.
This is great news, but it would be premature to start the victory celebration. There's no guarantee that NITD609 or a related compound will make it through the tests and trials that are needed for a new drug to be approved. And even if NITD609 is destined to replace artimisinin, it will take years to complete those tests.
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