We have drugs that can cure malaria, and yet the disease still kills about 1 million (pdf) people each year.
Treating the mosquito-borne illness—which can cause whole-body symptoms like chills, fatigue, vomiting, and diarrhea, and in severe cases, seizures, kidney, and heart failure—requires patients to take eight pills a day for three days. So even when patients do have access to these pills, the treatment process is cumbersome; those are 24 extra tasks that must be completed throughout the day.
But now, researchers from MIT, Harvard Medical School, and Brigham and Women’s Hospital have developed a swallowable capsule that can stay in the stomach and deliver slow doses of malaria medication over time. Their work was published in Science Translational Medicine on Nov. 16.
Failing to use medication as directed is fairly common: Some estimates suggest that people don’t take the pills they are prescribed 30% to 60% of the time. Even fewer patients remember to take pills when they don’t feel sick.
To get around this, researchers have already developed some drugs that are taken once and released slowly over time. Birth control for women is a classic example: intrauterine devices, arm implants, and vaginal rings all release steady amounts of hormones to prevent pregnancy.
But those devices need to be implanted by a medical professional. Most people who contract malaria live in tropical regions, like central and south America, southeast Asia, and central and southern Africa, often in rural or remote areas. Solving the malaria problem requires some way to easily deliver drugs to patients in hard-to-reach places—and ensuring those patients stay on their drug program. So, over the course of three years, the team worked together to develop an unfolding, edible capsule that can act as a vessel for long-term medications.
They created a swallowable pill about the size of a fish oil tablet that, after reaching the stomach, expands into a star shape and release doses of medication for 10 to 14 days, without blocking the passage of food or harming the organ’s walls. At the end of the treatment period, the pill breaks down and passes through your system.
For this paper, they gave the pill, loaded with Ivermectin—a type of malaria treatment—to 15 different pigs a total of 107 times. Ivermectin is a particularly potent malarial drug; mosquitoes who transmit malaria are repelled by it, and won’t bite patients with it in their blood streams, which could help stop the spread of the illness.
They fed the pigs normal diets, and checked the levels of Ivermectin in their blood over time. It seemed to work: the blood levels of Ivermectin remained constant. The capsules continued to release regular doses medication despite normal stomach churning and a highly acidic environment, thanks to handy chemical protections the team added to the pill. At the end of 10 days, the capsule dissolved and passed safely through the rest of the pigs’ digestive tracts. (The researchers did note that it would be particularly dangerous if the capsule prematurely slipped into the small intestine and released all the medication at once, but that never happened in the trial.)
“Sometimes taking your medicine is a reminder of an illness,” says Andrew Bellinger, a cardiologist at MIT and Brigham and Women’s Hospital and co-author of the paper. “That’s really not how patients want to think about themselves, and it’s not the way that we as physicians want them to think about their medicine.” A one-time pill that can deliver a full course of medication, Bellinger thinks, is easier for doctors to give out, and for patients to take, than 24 separate pills over three days. Lyndra, a health care company he co-founded, is currently licensing the technology from MIT and Brigham and Women’s Hospital.
The team is working on a proof-of-concept trial in humans, and also has plans to expand their efforts to other types of drugs, too. In particular, medication for neurological problems could be more effectively given in a slow-release pill. “Sometimes, the disease process can actually impair the patient’s ability to remember to take that medication,” Traverso says. Without the burden of remembering to take medication, more patients are likely to stick with it, and stay well.