Goats and Soda : NPR

Patients infected with malaria and dengue virus are treated in an isolation ward of a hospital in Pakistan. Drugs known as artemisinins have proven remarkably effective in helping malaria patients recover, but there are concerns that the malaria parasite may develop resistance. A new drug called GanLum appears to offer a promising alternative.

Zubair Abbasi/AFP via Getty Images

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Zubair Abbasi/AFP via Getty Images

At the turn of the millennium, a new class of drugs derived from ancient Chinese herbal medicine revolutionized malaria care. Artemisinin, as it is called, is based on extracts of sweet wormwood. They arrived just as drugs used since the 1970s were becoming useless for many, as the parasite that causes malaria developed resistance.

“The deaths we saw in the late 1990s and early 2000s – about 2 million per year – were a direct result of drug failure,” says George Jagoe, executive vice president of access and product stewardship at Medicines for Malaria Venture, a nonprofit. “No one ever wants to be behind the 8 ball again.”

Since then, artemisinins have saved millions of lives and now form the basis of malaria treatment worldwide. But there are worrying signs that these drugs are following in the footsteps of their predecessors. To prevent history from repeating itself, new drugs that target the malaria parasite differently are needed, says Jagoe.

“I would call it being prepared, having a fire extinguisher in the back that you’re ready to use, but maybe not necessarily deploy, when the house is on fire and you have nothing,” Jagoe says.

After more than two decades, researchers are on the verge of developing this fire extinguisher.

A new drug, called GanLum, was found to be more than 97% effective in treating malaria in clinical trials in 12 African countries, researchers at the American Society for Tropical Medicine and Hygiene in Toronto reported Wednesday. This is as good, if not better, than the current processing standard. If approved by regulators, it could be a powerful new tool against a disease that kills about half a million people each year.

“It’s a big problem,” says Kasturi Haldar, a biologist at the University of Notre Dame who has studied malaria for decades and was not involved in this study. “It’s also quite timely.”

This is because of artemisinin resistance. First discovered in Southeast Asia in the late 2000s, it has recently spread to the continent hardest hit by malaria. “Partial resistance to artemisinin has spread quite aggressively in many parts of Africa,” says David Fidock, a microbiologist at Columbia University who was not involved in the study. “We have sounded the alarm about the need to deploy new drugs if resistance were to lead to therapeutic failure. [GanLum] this will help curb this significantly.

GanLum stands for ganaplacid/lumefantrine, a combination of two drugs, one new and one old (most antimalarial treatments are combinations of drugs, to target the parasite at different stages of infection). The new one, ganaplacid, was discovered by Novartis scientists after screening more than 2.3 million molecules. for its antimalarial properties. It appears to work by disrupting the ability of malaria parasites to live in human red blood cells.

In the laboratory, researchers showed that it could kill all known forms of the parasite, including those with mutations linked to artemisinin resistance. It also attacks the stage of the parasite responsible for transmission. “It’s very desirable for a drug,” says Haldar, because it can prevent spread, in addition to just treating the patient.

In clinical trials, the drug also showed good results.

The research team recruited more than 16,000 adults and children over 2 years old with malaria in a dozen African countries. Half took GanLum for three days and the other half received the current standard treatment with artemisinin. The team found that the two drugs were about equally effective, with GanLum coming in slightly ahead. Both drugs had similar levels of side effects, including nausea and diarrhea. But the GanLum group experienced more vomiting.

The drug still needs to clear additional regulatory hurdles before reaching patients. The team thinks it will take about a year and a half. Even if approved and deployed, GanLum likely won’t completely replace artemisinin-based treatments anytime soon, as artemisinin-based treatments still work in many areas. “But at this stage it looks good enough that it could be used where there is a lack of responsiveness to the current situation. [artemisinin-based] drugs,” says Haldar.

Ultimately, this could extend the life of both drugs and help countries avoid the kind of surge in deaths that occurs when resistance overwhelms existing tools.