Giardia parasites are ubiquitous protozoans of global importance that impact a wide range of animals including humans. They are the most common enteric pathogen of cats and dogs in developed countries and infect ∼1 billion people worldwide. While Giardia infections can be asymptomatic, they often result in severe and chronic diseases. There is also mounting evidence that they are linked to postinfection disorders. Despite growing evidence of the widespread morbidity associated with Giardia infections, current treatment options are limited to compound classes with broad antimicrobial activity. Frontline anti-Giardia drugs are also associated with increasing drug resistance and treatment failures. To improve the health and well-being of millions, new selective anti-Giardia drugs are needed alongside improved health education initiatives. Here we discuss current treatment options together with recent advances and gaps in drug discovery. We also propose criteria to guide the discovery of new anti-Giardia compounds.

Giardia duodenalis is an intestinal parasite that causes giardiasis, a widespread human gastrointestinal disease. Treatment of giardiasis relies on a small arsenal of compounds that can suffer from limitations including side-effects, variable treatment efficacy and parasite drug resistance. Thus new anti-Giardia drug leads are required. The search for new compounds with anti-Giardia activity currently depends on assays that can be labour-intensive, expensive and restricted to measuring activity at a single time-point. Here we describe a new in vitro assay to assess anti-Giardia activity. This image-based assay utilizes the Perkin-Elmer Operetta® and permits automated assessment of parasite growth at multiple time points without cell-staining. Using this new approach, we assessed the “Malaria Box” compound set for anti-Giardia activity. Three compounds with sub-μM activity (IC50 0.6–0.9 μM) were identified as potential starting points for giardiasis drug discovery.

Background:Garcinia cambogia (synonym Garcinia gummi-gutta) is commonly known as brindleberry and Malabar tamarind. It has received considerable recent interest due to its potential in the prevention and treatment of obesity and obesity related diseases. The fruit pericarp also has traditional uses in the treatment of a wide variety of diseases and medical conditions, yet these have received relatively little investigation to date. Methods: Garcinia cambogia fruit extracts were investigated for their ability to inhibit the growth of a panel of bacteria of medicinal importance. The extracts were also tested for their ability to block the proliferation of the CaCo 2 and HeLa human carcinoma cell lines. Results: Garcinia cambogia methanolic, aqueous and ethyl acetate extracts displayed broad spectrum antimicrobial activity, inhibiting the growth of between 16 (64 %; ethyl acetate extract) and 22 (88 % aqueous extract) of the 25 bacterial species tested. Strong inhibitory activity was detected with minimum inhibitory concentration (MIC) values <1000 µg/ml against many bacteria. All extracts were effective against both Gram negative and Gram positive bacteria, although Gram negative bacteria were more sensitive. All extracts displayed anti-proliferative activity against CaCo 2 and HeLa carcinoma cells, yet were non-toxic in the Artemia franciscana bioassay, with LC50 values greatly in excess of 1000 µg/ml. Conclusion: The inhibitory bioactivity against a range of microbes, the anti-proliferative activity against CaCo 2 and HeLa cells, as well as the lack of toxicity, indicate the potential for G. cambogia in the discovery and development of new natural pharmaceuticals.

On an annual basis the flagellate protozoan, Giardia duodenalis, is responsible for an estimated one billion human infections of which approximately two hundred million cause disease. However, the treatment of Giardia infections is reliant on a small group of chemotherapeutic classes that have a broad spectrum of antimicrobial activity and increasing treatment failure rates. To improve this situation, we need new drugs. In this study we screened the Compounds Australia Scaffolds Library for compounds with potent and selective activity against these parasites. Unlike previous drug discovery efforts that have focused on drug repurposing, this library is comprised of commercially available synthetic compounds arranged into lead-like scaffolds to facilitate structure activity relationship assessments and de novo drug discovery. A screen of 2451 compounds in this library identified 40 hits (>50% inhibitory activity at 10 µM, over 48 h). Secondary testing identified three compounds with IC50 values <1 μM and >50-fold selectivity for parasites over mammalian cells and a hit series, CL9406, comprising compounds with potent (lowest IC50 180 nM) and selective activity for Giardia parasites. The most promising compound in this series, SN00797640, displayed selective activity against assemblage A, B, and metronidazole resistant parasites which was parasiticidal (minimum lethal concentration 625 nM) and synergistic with albendazole. SN00797640 was well-tolerated when administered to mice at doses of 50 mg/kg daily for three days paving the way for pre-clinical in vivo activity assessment.

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A screen for compounds with antigiardial activity in the Compounds Australia Scaffolds library identified SN00797640 (supplied structure being 8-acylaminodibenzoxazepinone 1) as a hit compound with potent anti-parasitic activity (concentration for 50% growth inhibition of Giardia duodenalis, IC50 0.18 μM). To further explore the structure–activity relationships in this series, compound 1 and analogues, including its 7-acylaminodibenzoxazepinone regioisomer (2), were synthesized and assessed for anti-Giardia activity. While regioisomer 2 demonstrated antigiardial activity, resynthesized 1 and other 8-acylaminodibenzoxazepinone analogues were inactive. Comparison of spectroscopic and physical properties demonstrated the correct structure of SN00797640 to be 7-acylamino regioisomer 2. These results highlight the importance of independent synthesis in verifying the structure and activity of screening hits.