An orally available PfPKG inhibitor blocks sporozoite infection of the liver

Abstract

Malaria remains a global health threat exacerbated by emerging resistance to antimalarial therapies and insecticides, climate-driven outbreaks, and limited chemoprotective options. Here, we report the characterization of RUPB-61, the first orally bioavailable inhibitor of Plasmodium falciparum cGMP-dependent protein kinase (PfPKG). RUPB-61 prevents infection by P. falciparum and P. cynomolgi sporozoites, including the formation of hypnozoites by the latter. A single oral dose blocks liver infection by P. berghei sporozoites in vivo, demonstrating efficacy consistent with further development as a once-weekly prophylaxis based on pharmacokinetic modeling. The compound retains activity against field isolates resistant to chloroquine, mefloquine, cycloguanil, sulfadoxine and pyrimethamine, suggesting low likelihood of cross-resistance to existing antimalarials. Structural studies and free energy-based modeling guided-compound design prospectively validated the predictive accuracy of an in silico model of PfPKG interactions with this chemotype. While selectivity profiling identified off-target activity against human kinases, structural modeling provides a clear path for optimization. These results establish PfPKG inhibitors as promising candidates for chemoprevention and support further preclinical development of the RUPB-61 chemotype. Author SummaryMalaria remains a serious global health threat, made worse by growing resistance to existing drugs and the spread of insecticide-resistant mosquitoes. A critical gap in our prevention toolkit is the lack of safe, long-acting oral drugs that stop malaria parasites from infecting the liver - the first and obligatory step of every new infection. Here, we report the characterization of RUPB-61, a compound that blocks an enzyme that the malaria parasite needs to invade and survive in the liver. We show that a single oral dose completely prevents liver infection in mice, and that the compound remains active against parasites that are resistant to several currently used antimalarial drugs. Using X-ray crystallography and computer-based modeling, we determined how RUPB-61 binds to its target in atomic detail, providing a roadmap for designing improved versions. While the compound shows some unwanted interactions with human proteins, our structural data offer clear strategies to solve this challenge. Together, these findings provide a solid foundation for developing a new class of once-weekly oral malaria prevention drugs.