Advances in cholera toxin inhibitor design: insights from molecular modelling.

INTRODUCTION: The recent surge in cholera outbreaks worldwide, partly driven by climate change, highlights its potential as a significant public health threat. The absence of definitive treatments underscores the urgent need for developing effective targeted therapeutics. The cholera holotoxin comprises a catalytically active A1 subunit, which mediates ADP-ribosylation to induce secretory diarrhea, and a pentameric B subunit responsible for toxin-host cell attachment via GM1 receptors. A1 activation requires binding to human ADP-ribosylation factor 6 (ARF6). Although the inhibition of B-pentamer - GM1 binding has been extensively investigated, several structural and pharmacokinetic challenges remain.

AREAS COVERED: This article is based on a keyword-based literature survey across relevant research repositories, covering studies published up to 2025. It summarizes the structure- and ligand-based molecular modeling approaches employed for identifying inhibitors targeting toxin-host binding, including GM1 mimetics, glycomimetics, and natural compounds. Alternative avenues of toxin inhibition, including occlusion of the B-pentamer pore, A1 catalytic site, and the A1-ARF6 interface to disrupt toxin assembly, ADP-ribosylation, and A1 activation, respectively, are also discussed.

EXPERT OPINION: Targeting the B-pentamer pore, A1 active site, or A1-ARF6 interface holds significant therapeutic potential against cholera-induced dehydration and hypovolaemic shock. These underexplored yet promising druggable targets warrant further investigation for developing effective, targeted therapies.