Suramin: A Comprehensive Pharmacological and Therapeutic Review

1. Executive Summary

Suramin is a complex, polyanionic symmetrical urea derivative with a storied history spanning over a century. Originally developed in the early 20th century primarily for the treatment of parasitic diseases, notably Human African Trypanosomiasis (HAT) and onchocerciasis, its unique chemical structure and multifaceted interactions with biological systems have led to its investigation for a remarkably diverse array of other conditions, including various cancers, viral infections, and, more recently, neurodevelopmental disorders such as Autism Spectrum Disorder (ASD).[1]

The pharmacological profile of suramin is characterized by its polypharmacology, interacting with a multitude of molecular targets rather than a single specific receptor or enzyme. This broad activity underpins its potential in diverse therapeutic areas but also contributes to its significant and often dose-limiting toxicity profile.[1] Key pharmacokinetic features include its parenteral route of administration (due to poor oral bioavailability), extensive plasma protein binding, and an exceptionally long elimination half-life, which necessitates careful dosing and monitoring to avoid accumulation and toxicity.[1]