Taste, A New Incentive to Switch to (R)-Praziquantel in Schistosomiasis Treatment

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Abstract
Praziquantel (PZQ) is the drug compound of choice in the control and treatment of schistosomiasis. PZQ is administered as a racemate, i. e. 1∶1 mixture of enantiomers. The schistosomicidal activity arises from one PZQ-enantiomer, whereas the other enantiomer does not contribute to the activity. The WHO's Special Programme for Research and Training in Tropical Diseases (TDR) has assigned the low-cost preparation of pure schistosomicidal (−)-PZQ a key priority for future R&D on PZQ, but so far this transition has not happened. PZQ has two major administration drawbacks, the first being the high dose needed, and its well documented bitter and disgusting taste. Attempts of taste-masking by low-cost means have not been successful. We hypothesized that the non-schistosomicidal component in PZQ would be the main contributor to the unpleasant taste of the drug. If the hypothesis was confirmed, the two major administration drawbacks of PZQ, the high dose needed and its bitter taste, could be addressed in one go by removing the component contributing to the bitter taste. PZQ was separated into its schistosomicidal and the non-schistosomicidal component, the absolute stereochemical configuration of (−)-PZQ was determined to be (R)-PZQ by X-ray crystallography, and the extent of bitterness was determined for regular racemic PZQ and the schistosomicidal component in a taste study in humans. Finding: The schistosomicidal component alone is significantly less bitter than regular, racemic PZQ. Our hypothesis is confirmed. We propose to use only the pure schistosomicidal component of PZQ, offering the advantage of halving the dose and expectedly improving the compliance due to the removal of the bitter taste. Therefore, (R)-PZQ should be specifically suitable for the treatment of school-age children against schistosomiasis. With this finding, we would like to offer an additional incentive to the TDR's recommendation to switch to the pure schistosomicidal (R)-PZQ. Schistosomiasis, or Bilharzia, is a parasitic disease caused by flatworms, which affects about 200 million people worldwide. Praziquantel (PZQ) is the drug compound of choice in the control and treatment of this disease. Only half of the drug dose currently administered actually has activity against schistosomiasis, whereas the other half has no activity. Therefore, the WHO has assigned the low-cost preparation of the pure active component a key priority for future PZQ research and development. PZQ has two major administration drawbacks, the first being the high dose needed, the second its well documented bitter taste. Attempts of masking the unpleasant taste have not been successful. We hypothesized that the non-active component in PZQ would be the main contributor to the unpleasant taste of the drug. We determined the extent of bitterness for regular PZQ compared to the pure active component in a taste study in humans. We found that the pure active component alone is significantly less bitter than regular PZQ. This new finding should serve as an additional incentive for the PZQ research and development community to provide a low-cost, large-scale preparation route to the pure active component of PZQ.

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