4-Nitrobenzoate inhibits 4-hydroxybenzoate polyprenyltransferase in malaria parasites and enhances atovaquone efficacy

Ubiquinone (UQ) is a critical component of the electron transport chain in Plasmodium falciparum , the etiological agent of human malaria. The first step in UQ biosynthesis is the condensation of 4-hydroxybenzoate (4-HB) and an isoprenic chain by the enzyme 4-hydroxybenzoate polyprenyltransferase (4-HPT; COQ2 gene). Atovaquone (AV), an antimalarial drug, competes with ubiquinol (UQH ₂ ) for binding to the mitochondrial bc1 complex, preventing the redox recycling of UQ. In clinical practice, AV is combined with proguanil, a dehydrofolate reductase inhibitor, in a single formulation. However, parasitic resistance to this combination has been demonstrated, indicating the need for new pharmacological combinations to potentiate AV. Previously, 4-nitrobenzoate (4-NB) demonstrated the ability to inhibit UQ biosynthesis in P. falciparum parasites as well as potentiate AV efficacy in vitro . However, both its pharmacodynamics and whether this potentiation could be useful in vivo remained obscure. Here we show that 4-NB enhances AV antiplasmodial efficacy to kill parasites, increases its selectivity compared with animal cells, and preserves proguanil efficacy. 4-NB specifically inhibited the 4-HPT enzymatic activity in mutant strains of Saccharomyces cerevisiae complemented with Pf COQ2. Finally, 4-NB also improved AV antimalarial efficacy in mice infected with Plasmodium berghei parasites. Finally, work with various 4-HB analogs delineated the chemical requirements to potentiate AV activity. These findings clarify the importance of UQ biosynthesis for malaria parasites and suggest that Pf COQ2 could be a therapeutic target to enhance the efficacy of AV.