With
over 200 million cases and close to half a million deaths
each year, malaria is a threat to global health, particularly in developing
countries. Plasmodium falciparum, the
parasite that causes the most severe form of the disease, has developed
resistance to all antimalarial drugs. Resistance to the first-line
antimalarial artemisinin and to artemisinin combination therapies
is widespread in Southeast Asia and is emerging in sub-Saharan Africa.
The P. falciparum proteasome is an
attractive antimalarial target because its inhibition kills the parasite
at multiple stages of its life cycle and restores artemisinin sensitivity
in parasites that have become resistant through mutation in Kelch
K13. Here, we detail our efforts to develop noncovalent, macrocyclic
peptide malaria proteasome inhibitors, guided by structural analysis
and pharmacokinetic properties, leading to a potent, species-selective,
metabolically stable inhibitor.