The story behind Ranbaxy’s new anti-malarial drug

From the previous post about Ranbaxy’s new anti-malarial drug, we know that Synriam is a fixed-dose combination of two known molecules, arterolane maleate and piperquine phosphate. The highlight of the media coverage has been to call this India’s first new drug, which isn’t entirely correct. What makes Synriam special, though, is that it is the first ever drug based on arterolane, a cheaper and better alternative to what is currently available.

Credit: InPharma

Before we look at arterolane, let’s take a quick look at malaria and anti-malarial drugs. According to a World Health Organization (WHO) report, every year 250 million new cases of malaria are reported and it causes 800,000 deaths. It is the biggest killer among the diseases that affect children less than 5-years of age. Anti-malarial drugs have existed for over 300 years, but it is only in the last century that there has been a rise in drug-resistance among the parasites responsible for the disease. This spurred research into developing new drugs and therapies.

One key finding from the increased attention that malaria received was the role of combination therapy. It was found that a judicious combination of drugs could help delay the development of resistance to drugs. To ensure that the new drugs that have been developed do not develop resistance, according to WHO guidelines, the artemisinin class of drugs must always be used in combination with other drugs. Arterolane falls in that class.

Funded by a Swiss non-profit, Medicines for Malaria Venture (MMV), arterolane (codenamed OZ277) was revealed in 2004 in a paper published in Nature. It was developed as part of a collaborative drug discovery project that consisted of researchers in the US, the UK, Switzerland and Australia. The aim of the project was to discover a new chemical entity (NCE) that could overcome the limitations of artemisinin, a widely-used antimalarial drug.

Among the many limitations of artemisinin is its price. It is produced from a plant-based source, making it an expensive solution to a poor man’s disease. Arterolane, on the other hand, can be synthesised from commercial chemicals and more cheaply (As a side, arterolane also has one of the funkiest chemical structures among drug molecules). With this molecule, MMV had achieved its goals of finding an NCE with desired qualities, but without further development through clinical trials, it would not have become a marketable drug. That is when Ranbaxy entered the scene. MMV tied up with Ranbaxy in 2003 and supported the development of the drug up until 2007.

According to LiveMint, MMV decided to stop funding the project after it reviewed preliminary data and other portfolio priorities. According to results that were presented at a conference in 2006, MMV found that results of Ranbaxy’s trials were not very satisfactory compared to other drug candidates available in the agency’s many collaborative projects. By this time, Ranbaxy had spent about $16 million. Despite losing MMV’s support, it planned to continue the development of the drug.

The IP-related issues surrounding arterolane remain unclear. In a conversation with Jonathan Vennerstrom, who led the study that was published in Nature, I was told that MMV owns the patent for arterolane (see here and here). By 2007, given that MMV had lost interest in arterolane might mean that it licensed the molecule to Ranbaxy at a low price.

Looking at the lack of confidence that MMV showed in the drug, in 2007, Ranbaxy was taking a risk by continuing research because there was no guarantee that the final clinical trials would be successful. It deserves credit to have been brave enough to plough in a further $15 million (of which $1 million came from the Department of Science Technology) to bring Synriam to the market. Whether they did that to avoid losses or because they truly believed that Synriam was going to be successful, I am not sure.

The drug is claimed to be more effective than any other drug currently available. The recommended dosage is one pill a day for three days, which is less than other for other drugs. Ranbaxy has also ensured that the price remains low at Rs. 130 for the three-day treatment. It is interesting to note that this is much cheaper than Cipla’s Mefliam Plus, which is priced at Rs. 300. Ranbaxy gets more points also because Mefliam Plus is a combination of artesunate and mefloquine, both of which are known molecules that have been used in different fixed-dose combinations previously.

Although Synriam does not qualify as ‘India’s first new drug’ (because none of its active ingredients were wholly developed in India), Ranbaxy deserves credit for being the first Indian pharmaceutical company to launch an NCE before it was launched anywhere else in the world.

This was published as a guest post on SpicyIP's blog. SpicyIP aims to be a leading repository of resources pertaining to Indian intellectual property (IP) law and policy.

Has India's new anti-malarial drug really been 'indigenously' developed?

I woke up to the news that Ranbaxy India has launched it's first indigenously developed drug: Synriam. A drug for malaria treatment, it is a combination consisting of arterolane maleate 150 mg and piperaquine phosphate 750 mg. I was pleased to hear that India's drug discovery initiatives had matured enough to produce new drugs and that the drug companies were acting very responsibly by working on a poor man's disease. Naturally, I dug into the story a little more.

Ranbaxy's press release (which is where most news sources have got their information from) claims:

1. Synriam has been approved by Drug Controller General of India (DCGI) for marketing in India and conforms to the recommendations of the World Health Organization (WHO) for using combination therapy in malaria.
2. Synriam has a high cure rate of 95%.
3. Phase III clinical trials were conducted in India, Bangladesh and Thailand.
4. Dose regimen is better than anything out there. Three pills over three days.

Arterolane's chemical structure
Credit: Wikipedia

So far so good. Out of curiosity I looked up the chemical structure of arterolane and was surprised to see that it features both an ozonide and an adamantane group in it. In all my synthetic organic chemistry work, I hadn't seen a drug like that. After all, organic ozonides (3 oxygen atoms in a 5-atom ring) are more explosive than organic peroxides (R-O-O-R)!

It turned out that Derek Lowe of the famous In the Pipeline blog had written about arterolane in 2009. At the time it was in Phase III trial, which I assumed were the trials that Ranbaxy was conducting. But it turned out that arterolane was developed by a collaboration between researchers in the US, the UK, Switzerland and Australia who were funded by the World Health Organization and Medicines for Malaria Venture (a Swiss non-profit). They published this work in Nature in 2004 and further SAR (Structure Activity Relationship) studies in J Med Chem in 2010.

So Ranbaxy did not develop the drug from scratch? But the press release quotes Arun Sawhney, CEO and Managing Director of Ranbaxy which misleads people to think so: "It is indeed gratifying to see that Ranbaxy’s scientists have been able to gift our great nation its first new drug, to treat malaria, a disease endemic to our part of the world. This is a historic day for science and technology in India as well as for the pharmaceutical industry in the country. Today, India joins the elite and exclusive club of nations of the world that have demonstrated the capability of developing a new drug".

So Ranbaxy mixes a known active compound (piperaquine) with a new compound that someone else found to be active (arterolane) and claims that they developed a new drug? In an interview in LiveMint, Sawhney says, "Ranbaxy spent around $30 million on Synriam and the contribution from DST [India's Department of Science & Technology] was Rs.5 crore. The drug went through several phases of development since the project began in 2003. We did not look at this as a commercial development. Instead, this is a CSR [Corporate Social Responsibility] venture for us." That's a give away because developing a new drug from scratch has to cost more than $30 million + Rs.50 million. Why wasn't this put in the press release?

The initial high that I got from the news that Ranbaxy launches first 'made in India' drug just got murdered. India is yet to see a drug that it has 'indigenously' developed. I am sure that Synriam will do a lot of good for India and the many developing nations that suffer from a malaria epidemic, but it will be because of a 'made in India' drug not one that has been 'developed in India'. It's a shame that Ranbaxy did not acknowledge that the development of arterolane was funded by WHO and that their scientist have worked on developing a combination of two compounds both of which weren't developed in their lab. They should make it clear that they are claiming the combination to be a 'new drug', not the molecules that make up the combination.

Like an Apple product says, "Made in China. Designed in California.", Synriam should say, "Made in India. Developed by WHO + MMV + Ranbaxy."

UPDATE: Vidya Krishnan, LiveMint reporter who covered this story, answered my question about patentability. She said that Ranbaxy has a joint patent with the Government of India for the 'unique' combination that they have developed, not for arterolane itself.

UPDATE 2: I spoke to the lead author of the Nature and J Med Chem paper Jonathan Vennerstrom who confirmed that MMV holds the patent for arterolane and has licensed it to Ranbaxy since 2003. Thus, the clinical trials mentioned in both the papers were Ranbaxy's work even though arterolane was developed by other researchers.

Oral cancer in India: A public health menace

Oral cancer is the most prevalent of all cancers in India, which sees 5.6 million cancer deaths every year. A cheap and widely available chewing tobacco product, gutka, has some 5 million children addicted to it. The government of one state in India has woken up to its ill-effects, and, in a drastic step, it has banned sale of all chewing tobacco products.

I have an article published on the Economist's Asia blog, Banyan, discussing this.

References for the article:

1. Most cancer patients in India die without medical attention: study, Down to Earth, March 29, 2012
2. Madhya Pradesh bans gutkha and other chewing tobacco products, Down to Earth, April 3, 2012
3. SC bans plastic gutka sachets from March 1, Times of India, December 8, 2010
4. Global Adult Tobacco Survey: India, World Health Organization, October 19, 2010
5. Gutka still sold in plastic sachets, The Hindu, March 13, 2011
6. 2011 Census Data: Madhya Pradesh, Government of India

How does epigenetics shape life?

Identical twins, despite being biologically identical at birth, grow up to become unique individuals. Sure they may have a lot more things in common than two randomly picked individuals, yet there are many characteristics which belong only to one or the other. If the twins have the exact same DNA, then what is that makes them different?

The common answer to this question is it’s the environment that they live in which shapes them differently. Researchers have found that such environmental factors cause chemical modifications to the genome without affecting the nucleotide sequence, leading to the unique characteristics that we observe. This field of research is called epigenetics, and beyond the DNA, it’s what shapes our lives.

Rat mothers nurture their pups by licking and grooming. Researchers in Canada studying epigenetic changes found that rats whose mothers licked them more than normal expressed hundreds of genes differently from those who were licked less than normal. These differences were consistent and predictable, and led to a number of behavioural changes among the rats, including one where highly licked rats’ response to stress was a lot better than the less‐licked rats’.

Epigenetic changes don’t just occur through environmental factors but are also a different form of inheritance, one that doesn’t have to suffer from the randomness of natural selection. The licking of the rat encodes specific information onto her pup’s DNA without modifying to the sequence of base pairs. Mom’s behaviour programs the pup’s DNA in a way that will make it more likely to succeed. Such information is stored in the DNA in many ways, one of which is through DNA methylation. Through this process methyl groups are attached on to the DNA, and their attachment at specific positions leads to genes being turned on or off. This makes epigenetic changes reversible. For example, you can take a low‐nutured rat, inject its brain with a drug that removes methyl groups, and make it act like a high‐nurtured rat.

DNA methylation also plays a key role in cell division and cancer cells are known to divide faster than normal cells. Researchers in the US have developed drugs to interfere with DNA methylation as a treatment for cancer. They use molecules that mimic cytosine, one of the four bases of DNA. In cell replication, the fake cytosine swaps places with real cytosine in the growing stand of DNA, which then in turn traps DNA methyltransferase. When used in low enough doses, the drug allows the formation of the cell but with less methylated DNA. These drugs are currently being used to treat myelodysplastic syndrome, a prelukemia condition.

As Brona McVittie says, like the conductor of an orchestra controls the performance of musicians, epigenetic factors govern how the cell plays the notes in DNA. A better understanding of these factors has  he potential of revolutionising evolutionary and developmental biology, thus affecting practices from medicine to agriculture.

Further reading:

1. Learn Genetics, The University of Utah
2. Introduction to epigenetics from Science magazine
3. More ways to fight cancer through epigenetics, The Economist

Image credit: SciShark

In search for life through the twists of light

Finding Earth-like planets is common place now. What about detecting life on them?

Two centuries ago a French engineer noticed something special about light from the sun. As it reflected from the window and passed through a crystal of calcium carbonate, depending on the angle at which the crystal was placed, the image it created grew stronger or weaker. Étienne-Louis Malus had discovered a phenomenon called polarisation of light. The simplest example of this can be seen in the above images whereremoval of certain polarised light increases the contrast with clouds.

Sunlight is unpolarised which means that the electromagnetic waves that make up sunlight are not restricted in their spatial orientation. But when this light interacts with biological molecules like sugars, amino acids or chlorophyll it changes its spatial orientation, and, more importantly, we are able to detect the change and measure it.

This week researchers using the Very Large Telescope in Chile used this characteristic of light to show the presence of water, clouds, and vegetation in Earthshine – the sunlight that’s been reflected off of Earth to the dark portion of the Moon’s face and then back to our planet – through a method dubbed spectropolarimetry. Michael Sterzik, an astronomer at the European Southern Observatory in Santiago, Chile, said that the state of polarisation contains a lot of information that hasn’t been used very often.

Comparing their measurements of Earthshine with models of how various land and sea surfaces reflect polarised light, the researchers could discern which part of our planet was covered with oceans and which with land mass. They also identified the biosignature of chlorophyll which showed up when land masses on Earth were illuminated.

The upshot is that it might be possible to use this technique to spot the presence of water and other biological molecules on the many Earth-like planets that have been discovered recently. The techniques currently available can only detect the presence of water and other simpler molecules which is not enough to ascertain the existence of life. The occurrence of biological molecules on the other hand increases the probability of finding life by many factors.

But as these planets are usually many light years away, the light received from them is very faint. Researchers will have to wait for the next generation of telescopes, such as the European Extremely Large Telescope planned for 2022, to gather the required data. But possibly, within a decade, the twists of light will help us seal the fate of life beyond our planet.

First published on Science Oxford Online.

Sterzik, M., Bagnulo, S., & Palle, E. (2012). Biosignatures as revealed by spectropolarimetry of Earthshine Nature, 483 (7387), 64-66 DOI: 10.1038/nature10778