KAF156 exerts low nanomolar potency against a panel of drug susceptible and drug-resistant P.

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1 KAF inhibits malaria parasite at multiple stages Supplemental Material TABLE S KAF is highly potent against P. falciparum. P. falciparum strain Drug Resistance KAF IC 0 (nm) D SFX.0 ±.0 W CQ, PYR, QN, SFX. ± 0. Dd MEF, CQ, PYR. ±. HB PYR. ±. FCB CQ. ± 0. Camp R PYR. ±. D0 None known. ±. D None known 0. ±. K CQ, PYR, SFX. ± 0. NF None known. ±. TMC PYR. ± 0. BAG CQ, PYR. ±. C PYR. ± 0. FCR CG, CQ, PYR. ±. G CG, CQ.0 ± 0. KAF exerts low nanomolar potency against a panel of drug susceptible and drug-resistant P. falciparum strains. CG, cycloguanil; CQ, chloroquine; MEF, mefloquine; PYR, pyrimethamine; QN, quinine; SFX, sulfadoxine. Data shown as median ± SD based on at least independent experiments. 0 Kuhen et al. 0_Supplemental Material Page

2 KAF inhibits malaria parasite at multiple stages TABLE S In vivo effective doses of KAF in a P. berghei experimental mouse model Compound ED 0 (mg/kg) ED 0 (mg/kg) ED (mg/kg) Chloroquine*... Mefloquine*... Artesunate*. 0.. KAF Experimental doses resulting in a 0%, 0% and % decrease in parasitemia relative to control values were determined for KAF and standard antimalarials. Values were determined after treatment of mice with a single dose hours after infection with P. berghei ANKA bloodstage parasites. Parasitemia was determined by microscopy on day ( hours after infection) to determine effective dose values. Data are shown as means calculated from at least two independent experiments. * T/A (Ethanol/Tween 0/water //0); % Solutol HS; GFP- ANKA was used in the reference study with chloroquine, mefloquine, and artesunate and parasitemia was determined by FACS analysis Kuhen et al. 0_Supplemental Material Page

3 KAF inhibits malaria parasite at multiple stages TABLE S KAF resistance mechanism is unique and standard drugs do not show cross resistance. Selection Agent Culture # SNP* (Pfcarl) Artemisinin IC 0 (nm) Mefloquine IC 0 (nm) DMSO None (Dd, WT) ±. ±. KAF AR QH, S0R ±.. ±. BR PT, S0R. ±..0 ±. BR S0I ±.0.0 ±.0 AR ED. ±.. ±. BR ED. ±.. ±. 0 Five independent cultures of P. falciparum strain Dd were cultured in the presence of increasing concentrations of KAF over months. Parasitemia was monitored daily and compound concentration was increased -fold when the parasitemia reached %. For each of the resistant strains the SNPs detected and antimalarial activity (IC 0 ) is indicated for artemisinin and mefloquine (data are shown as median ± SD for or more independent experiments). Strain Dd is resistant to pyrimethamine (IC 0 >. µm). *Single nucleotide polymorphisms (SNPs) were confirmed by capillary sequencing of Pfcarl (PFC00w). Kuhen et al. 0_Supplemental Material Page

4 KAF inhibits malaria parasite at multiple stages TABLE S Frequency of resistance to KAF. Strain Starting inoculum / flask Resistance acquisition Parasitemia >% Dd x 0 parasites 0 / cultures - Dd x 0 parasites / cultures* Day Dd x 0 parasites / cultures Day - Dd x 0 parasites / cultures Day - Dd. x 0 parasites / cultures Day - 0 Dd. x 0 parasites / cultures Day Dd x 0 parasites / cultures Day FCR. x 0 parasites 0 / cultures - P. falciparum cultures of either Dd or FCR strains were seeded at various starting parasite loads (in triplicate) and exposed to 0 nm KAF continuously for up to 0 days. The emergence of parasites was detected by Giemsa smear and the time required to reach >% parasitemia was noted. * For selections starting with x 0 parasites, one positive culture was obtained, however these parasites did not display a shift in KAF IC 0 relative to the parent strain and did not possess SNPs in pfcarl. 0 Kuhen et al. 0_Supplemental Material Page

5 KAF inhibits malaria parasite at multiple stages FIG S SNPs identified in pfcarl by whole genome sequencing, capillary sequencing or tiling array analysis (). Schematic of pfcarl showing the transmembrane domain. SNPs identified in () are shown above the schematic, novel SNPs identified in KAF-resistant clones are shown below. 0 Kuhen et al. 0_Supplemental Material Page

6 KAF inhibits malaria parasite at multiple stages FIG S KAF blocks parasite transmission in a rodent malaria model. Number of oocysts found in the midguts of mosquitoes fed on mice treated with a single oral dose of KAF at 00 mg/kg ( closed triangles) and mosquitoes fed on untreated mice ( closed circles).* Two-tailed P-value determined in a non-parametric Mann-Whitney test (% confidence limit). Kuhen et al. 0_Supplemental Material Page

7 KAF inhibits malaria parasite at multiple stages References. Meister, S, Plouffe, DM, Kuhen, KL, Bonamy, GM, Wu, T, Barnes, SW, Bopp, SE, Borboa, R, Bright, AT, Che, J, Cohen, S, Dharia, NV, Gagaring, K, Gettayacamin, M, Gordon, P, Groessl, T, Kato, N, Lee, MC, McNamara, CW, Fidock, DA, Nagle, A, Nam, TG, Richmond, W, Roland, J, Rottmann, M, Zhou, B, Froissard, P, Glynne, RJ, Mazier, D, Sattabongkot, J, Schultz, PG, Tuntland, T, Walker, JR, Zhou, Y, Chatterjee, A, Diagana, TT, Winzeler, EA. 0. Imaging of Plasmodium liver stages to drive next-generation antimalarial drug discovery. Science : - 0 Kuhen et al. 0_Supplemental Material Page