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To design and discover a new compound can used as a COX with TNF-α and IL-6 inhibitors is highly challenge. A series of spiroindolone-bearing benzofuran moieties were resynthesized from the chalcone-based benzo[b]furan with substituted isatin, and amino acids. The requisite spiroindolone analogues were tested for their potential inhibitory activities against lipid metabolizing enzymes such as cyclooxygenase COX-1, COX-2, and the release of pro-inflammatory cytokines interleukin IL-6, and tumor necrosis factor TNF-α. Among the tested compounds, 5a, 5c, 5h, 5i, 5l, and 5p exhibited COX-1 inhibitor selectively with percent of inhibition 40.81–83.4% and IC50 values ranging from 20.42 µM to 38.24 µM. In addition, all the synthesized target compounds possessed lipopolysaccharide-induced TNF-α, and IL-6 expression with a varying degree of COX-1 inhibition. Compounds 5d, 5e, 5f, 5g, and 5k markedly inhibited TNF-α, and IL-6 release in WI-38 fibroblast cells. Molecular docking of the most effective and highly selective compounds were investigated and shown important binding mechanisms which could affect pro-inflammatory enzymes and cytokines via the inhibition of COX-1, COX-2, IL-6, and TNF-α. Keywords: Spirooxindole, Lipid metabolic enzymes, Pro-inflammatory cytokines, COX-1, COX-2, IL-6, TNF-α

The intraerythrocytic malaria parasite, Plasmodium falciparum, maintains a low cytosolic Na+ concentration and the plasma membrane P-type cation translocating ATPase ‘PfATP4’ has been implicated as playing a key role in this process. PfATP4 has been the subject of significant attention in recent years as mutations in this protein confer resistance to a growing number of new antimalarial compounds, including the spiroindolones, the pyrazoles, the dihydroisoquinolones, and a number of the antimalarial agents in the Medicines for Malaria Venture's ‘Malaria Box’. On exposure of parasites to these compounds there is a rapid disruption of cytosolic Na+. Whether, and if so how, such chemically distinct compounds interact with PfATP4, and how such interactions lead to parasite death, is not yet clear. The fact that multiple different chemical classes have converged upon PfATP4 highlights its significance as a potential target for new generation antimalarial agents. A spiroindolone (KAE609, now known as cipargamin) has progressed through Phase I and IIa clinical trials with favourable results. In this review we consider the physiological role of PfATP4, summarise the current repertoire of antimalarial compounds for which PfATP4 is implicated in their mechanism of action, and provide an outlook on translation from target identification in the laboratory to patient treatment in the field., Graphical abstract, Highlights • PfATP4 is proposed to function as a Na+/H+-ATPase, regulating parasite Na+. • There is evidence that multiple, unrelated chemical classes target PfATP4. • One such compound, cipargamin, exhibited promising results in Phase II trials. • The precise mechanism by which such compounds kill parasites remains unclear.

The resurgence in antimalarial drug discovery research to address the threat of resistance to current therapies has led to a boon in the number of new drugs entering the global malaria pipeline ( www.mmv.org) . Among these potential new therapies are the spiroindolones, a unique class of antimalarials which work through a previously unknown mechanism of action and currently in Phase II clinical trials. The lead compound was identified from the Novartis compound libraries after a high throughput screening campaign on the malaria parasite, Plasmodium falciparum . Its progression from hit to drug candidate in less than four and a half years also resulted in the discovery of a new drug target, Pf ATP4 (P-type ATPase cation transporter).