Author: Warhurst, David C.

Source: Science Progress, Volume 85, Number 1, February 2002 , pp. 89-111(23)

Publisher: Science Reviews 2000 Ltd

Abstract:

Every year there are 270 million clinical attacks of malaria and 2 million deaths, caused by the protozoan Plasmodium falciparum. Most of these cases occur in Africa. Chloroquine-resistance has led to reliance on antimalarial antifolates, in particular the synergistic combination sulfadoxine/pyrimethamine (S/P) which targets enzymatic synthesis of folate co-factors through dihydropteroate synthase (DHPS) and dihydrofolate reductase (DHFR). Resistance to S/P is now increasing and replacement antimalarials are needed. Crystal structures are not yet available for these key enzymes in the folate pathway. This review focuses on the activity of drugs on DHFR in malaria parasites, attempts to interpret differences in activity of pyrimethamine and its related drugs, and to clarify how residue changes due to point mutations determine the development of resistance. In homology-modelled P. falciparum DHFR (PfDHFR) , the typical structure of four α-helices, 8-stranded β-sheet, four Loops and eight Turns is clearly seen. Long polar sequences specific for Plasmodium are inserted in Turns 1 and 2. Structures immediately concerned in drug binding are β-A, L1, α-β, α-C, T-3, β-E, α-F, and β-F. The roles of several mutations associated with resistance are discussed. In view of sequence differences in turn 3 in PfDHFR and in the human enzyme, and the marked interaction with residues of T3 of the experimental flexible antifolate WR99210 effective in pyrimethamine and cycloguanil resistance, further drug development in this area is indicated.

Document Type: Research article

DOI: http://dx.doi.org/10.3184/003685002783238906

Affiliations: 1: Science Review, PO Box 314, St. Albans, Herts AL1 4ZG, UK

Publication date: 2002-02-15

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