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Al-Mekhlafi HM, Madkhali AM, Abdulhaq AA, Atroosh WM, Ghzwani AH, Zain KA, Ghailan KY, Hamali HA, Mobarki AA, Alharazi TH, Eisa ZM, Lau YL. Polymorphism analysis of pfmdr1 gene in Plasmodium falciparum isolates 11 years post-adoption of artemisinin-based combination therapy in Saudi Arabia. Sci Rep 2022; 12:517. [PMID: 35017593 PMCID: PMC8752599 DOI: 10.1038/s41598-021-04450-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022] Open
Abstract
A total of 227 Plasmodium falciparum isolates from Jazan region, southwestern Saudi Arabia were amplified for the P. falciparum multi-drug resistance 1 (pfmdr1) gene to detect point mutations 11 years after the introduction of artemisinin-based combination therapy (ACT) in Saudi Arabia. The pfmdr1 86Y mutation was found in 11.5% (26/227) of the isolates while the N86 wild allele was detected in 88.5%. Moreover, 184F point mutations dominated (86.3%) the instances of pfmdr1 polymorphism while no mutation was observed at codons 1034, 1042 and 1246. Three pfmdr1 haplotypes were identified, NFSND (74.9%), NYSND (13.7%) and YFSND (11.4%). Associations of the prevalence of 86Y mutation and YFSND haplotype with participants' nationality, residency and parasitaemia level were found to be significant (P < 0.05). The findings revealed significant decline in the prevalence of the pfmdr1 86Y mutation in P. falciparum isolates from Jazan region over a decade after the implementation of ACT treatment. Moreover, the high prevalence of the NFSND haplotype might be indicative of the potential emergence of CQ-sensitive but artemether-lumefantrine-resistant P. falciparum strains since the adoption of ACT. Therefore, continuous monitoring of the molecular markers of antimalarial drug resistance in Jazan region is highly recommended.
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Affiliation(s)
- Hesham M Al-Mekhlafi
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia.
- Vector-Borne Diseases Research Group, Jazan University, Jazan, Kingdom of Saudi Arabia.
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Aymen M Madkhali
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia.
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Ahmed A Abdulhaq
- Vector-Borne Diseases Research Group, Jazan University, Jazan, Kingdom of Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | | | - Khalid Ammash Zain
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Khalid Y Ghailan
- Vector-Borne Diseases Research Group, Jazan University, Jazan, Kingdom of Saudi Arabia
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Hassan A Hamali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Abdullah A Mobarki
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Talal H Alharazi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, Hail, Kingdom of Saudi Arabia
- Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, Taiz University, Taiz, Yemen
| | - Zaki M Eisa
- Saudi Centre for Disease Prevention and Control, Ministry of Health, Jazan, Kingdom of Saudi Arabia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Madkhali AM, Abdulhaq AA, Atroosh WM, Ghzwani AH, Zain KA, Ghailan KY, Hamali HA, Mobarki AA, Eisa ZM, Lau YL, Al-Mekhlafi HM. The return of chloroquine-sensitive Plasmodium falciparum parasites in Jazan region, southwestern Saudi Arabia over a decade after the adoption of artemisinin-based combination therapy: analysis of genetic mutations in the pfcrt gene. Parasitol Res 2021; 120:3771-3781. [PMID: 34561749 DOI: 10.1007/s00436-021-07323-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
This study investigated the polymorphism in the P. falciparum chloroquine resistance transporter (pfcrt) gene 11 years after chloroquine (CQ) cessation in Jazan region, southwestern Saudi Arabia. Two hundred and thirty-five P. falciparum isolates were amplified to detect mutations in the pfcrt gene. The pfcrt 76 T molecular marker for CQ resistance was detected in 66.4% (156/235) of the isolates, while the K76 CQ-sensitive wild type was detected in 33.6%. The pfcrt 74I and pfcrt 75E point mutations were each found to be present in 56.2% of isolates, while only four isolates (1.7%) were found to carry the pfcrt 72S mutation. Moreover, four pfcrt haplotypes were identified as follows: the CVIET triple-allele (56.2%), SVMET double-allele (1.7%) and CVMNT single-allele (8.5%) mutant haplotypes and the CVMNK wild haplotype (33.6%). The analysis also revealed significant associations between the prevalence of mutant pfcrt alleles and haplotypes and the age group, governorate and nationality of the patients as well as the parasitaemia level (p < 0.05). The findings provide evidence of the potential re-emergence of CQ-susceptible P. falciparum strains in Jazan region over a decade after CQ discontinuation, with about one third of the isolates analysed carrying the pfcrt K76 CQ-sensitive wild allele and the CVMNK ancestral wild haplotype. Although the reintroduction of CQ cannot be recommended at present in Saudi Arabia, these findings support the rationale for a potential future role for CQ in malaria treatment. Therefore, continuous molecular and in vitro monitoring mutations of pfcrt polymorphism in Jazan region is highly recommended.
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Affiliation(s)
- Aymen M Madkhali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia.,Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed A Abdulhaq
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | | | - Khalid Ammash Zain
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Khalid Y Ghailan
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Hassan A Hamali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Abdullah A Mobarki
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Zaki M Eisa
- Saudi Centre for Disease Prevention and Control, Ministry of Health, Jazan, Kingdom of Saudi Arabia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hesham M Al-Mekhlafi
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
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Maraka M, Akala HM, Amolo AS, Juma D, Omariba D, Cheruiyot A, Opot B, Okello Okudo C, Mwakio E, Chemwor G, Juma JA, Okoth R, Yeda R, Andagalu B. A seven-year surveillance of epidemiology of malaria reveals travel and gender are the key drivers of dispersion of drug resistant genotypes in Kenya. PeerJ 2020; 8:e8082. [PMID: 32201636 PMCID: PMC7073242 DOI: 10.7717/peerj.8082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022] Open
Abstract
Malaria drug resistance is a global public health concern. Though parasite mutations have been associated with resistance, other factors could influence the resistance. A robust surveillance system is required to monitor and help contain the resistance. This study established the role of travel and gender in dispersion of chloroquine resistant genotypes in malaria epidemic zones in Kenya. A total of 1,776 individuals presenting with uncomplicated malaria at hospitals selected from four malaria transmission zones in Kenya between 2008 and 2014 were enrolled in a prospective surveillance study assessing the epidemiology of malaria drug resistance patterns. Demographic and clinical information per individual was obtained using a structured questionnaire. Further, 2 mL of blood was collected for malaria diagnosis, parasitemia quantification and molecular analysis. DNA extracted from dried blood spots collected from each of the individuals was genotyped for polymorphisms in Plasmodium falciparum chloroquine transporter gene (Pfcrt 76), Plasmodium falciparum multidrug resistant gene 1 (Pfmdr1 86 and Pfmdr1 184) regions that are putative drug resistance genes using both conventional polymerase chain reaction (PCR) and real-time PCR. The molecular and demographic data was analyzed using Stata version 13 (College Station, TX: StataCorp LP) while mapping of cases at the selected geographic zones was done in QGIS version 2.18. Chloroquine resistant (CQR) genotypes across gender revealed an association with chloroquine resistance by both univariate model (p = 0.027) and by multivariate model (p = 0.025), female as reference group in both models. Prior treatment with antimalarial drugs within the last 6 weeks before enrollment was associated with carriage of CQR genotype by multivariate model (p = 0.034). Further, a significant relationship was observed between travel and CQR carriage both by univariate model (p = 0.001) and multivariate model (p = 0.002). These findings suggest that gender and travel are significantly associated with chloroquine resistance. From a gender perspective, males are more likely to harbor resistant strains than females hence involved in strain dispersion. On the other hand, travel underscores the role of transport network in introducing spread of resistant genotypes, bringing in to focus the need to monitor gene flow and establish strategies to minimize the introduction of resistance strains by controlling malaria among frequent transporters.
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Affiliation(s)
- Moureen Maraka
- School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Siaya, Kenya
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Hoseah M. Akala
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Asito S. Amolo
- School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Siaya, Kenya
| | - Dennis Juma
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Duke Omariba
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Agnes Cheruiyot
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Benjamin Opot
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Charles Okello Okudo
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Edwin Mwakio
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Gladys Chemwor
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Jackline A. Juma
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Raphael Okoth
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Redemptah Yeda
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Ben Andagalu
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
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Kashyap A, Kaur R, Baldi A, Jain UK, Chandra R, Madan J. Chloroquine diphosphate bearing dextran nanoparticles augmented drug delivery and overwhelmed drug resistance in Plasmodium falciparum parasites. Int J Biol Macromol 2018; 114:161-168. [DOI: 10.1016/j.ijbiomac.2018.03.102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/17/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
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Alareqi LM, Mahdy MA, Lau YL, Fong MY, Abdul-Ghani R, Mahmud R. Molecular markers associated with resistance to commonly used antimalarial drugs among Plasmodium falciparum isolates from a malaria-endemic area in Taiz governorate-Yemen during the transmission season. Acta Trop 2016; 162:174-179. [PMID: 27343362 DOI: 10.1016/j.actatropica.2016.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 12/28/2022]
Abstract
Since 2005, artesunate (AS) plus sulfadoxine/pyrimethamine (SP) combination has been adopted as the first-line treatment for uncomplicated malaria in Yemen in response to the high level of Plasmodium falciparum resistance to chloroquine (CQ). Therefore, the aim of the present study was to determine the frequency distribution of molecular markers associated with resistance to CQ and AS plus SP combination among P. falciparum isolates from a malaria-endemic area in Taiz governorate, Yemen. Fifty P. falciparum isolates were collected during a cross-sectional study in Mawza district, Taiz, in the period from October 2013 to April 2014. The isolates were investigated for drug resistance-associated molecular markers in five genes, including P. falciparum CQ resistance transporter (pfcrt) 76T and P. falciparum multidrug resistance 1 (pfmdr1) 86Y as markers of resistance to CQ, mutations in the Kelch 13 (K13) propeller domain for resistance to AS, and P. falciparum dihydrofolate reductase (pfdhfr) and P. falciparum dihydropteroate synthase (pfdhps) genes for resistance to SP. Nested polymerase chain reaction was used to amplify target genes in DNA extracts of the isolates followed by restriction fragment length polymorphism for detecting 76T and 86Y mutations in pfcrt and pfmdr1, respectively, and by DNA sequencing for detecting mutations in K13, pfdhfr and pfdhps. All the investigated isolates from Mawza district were harboring the pfcrt 76T mutant and the pfmdr1 N86 wild-type alleles. The pfdhfr 51I/108N double mutant allele was found in 2.2% (1/45) of the isolates; however, no mutations were detected at codons 436, 437, 540, 581 and 613 of pfdhps. All P. falciparum isolates that were successfully sequenced (n=47) showed the K13 Y493, R539, I543 and C580 wild-type alleles. In conclusion, the pfcrt 76T mutant allele is fixed in the study area about six years after the official withdrawal of CQ, possibly indicating its over-the-counter availability and continued use as a self-medication in the study area. However, the almost predominant wild-type alleles of the genes associated with resistance to AS and SP among P. falciparum isolates in the present study indicates the sustained efficacy of the currently adopted first-line treatment of AS plus SP in the study area.
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Atroosh WM, Al-Mekhlafi HM, Al-Jasari A, Sady H, Dawaki SS, Elyana FN, Al-Areeqi MA, Nasr NA, Abdulsalam AM, Subramaniam LR, Azzani M, Ithoi I, Lau YL, Surin J. Different patterns of pfcrt and pfmdr1 polymorphism in Plasmodium falciparum isolates from Tehama region, Yemen. PeerJ 2016; 4:e2191. [PMID: 27478699 PMCID: PMC4950566 DOI: 10.7717/peerj.2191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/08/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction. Despite the efforts of the malaria control programme, malaria morbidity is still a common health problem in Yemen, with 60% of the population at risk. Plasmodium falciparum is responsible for 99% of malaria cases. The emergence in Yemen of parasite resistance to chloroquine (CQ) prompted the adoption of artemisinin combination therapy (ACT) in 2009, which involves the use of artesunate plus sulphadoxine-pyrimethamine (AS + SP). However, CQ was retained as the drug of choice for vivax malaria. To assess the impact of the change in the malaria treatment policy five years after its introduction, the present study investigated the mutations in the CQ resistance transporter (pfcrt) and multidrug resistance 1 (pfmdr1) genes. Method. A molecular investigation of 10 codons of pfcrt (72–76, 220, 271, 326, 356, and 371) and five codons of pfmdr1 (86, 184, 1034, 1042, and 1246) was conducted on P. falciparum isolates from districts with the highest malaria endemicity in the Hodeidah and Al-Mahwit governorates in Tehama region, Yemen. A total of 86 positive cases of falciparum monoinfection were investigated for the presence of mutations related to CQ and other antimalarials using a PCR-RFLP assay. Results. There was a wide prevalence of pfcrt gene mutations with the pfcrt 76T CQ resistance marker being predominant (97.7%). The prevalence of other pfcrt mutations varied from high (75E: 88%) to moderate (74I: 79.1%, 220S: 69.8%, 271E and 371I: 53.5%) or low (326S: 36%, 72S: 10.5%). Mutated pfcrt 72–76 amino acids haplotypes were highly prevalent (98.8%). Among these, the CVIET classic, old-world African/Southeast Asian haplotype was the most predominant, and was mostly found in the isolates from the Khamis Bani Saad district of Al-Mahwit (93.1%) and the AdDahi district of Hodeidah (88.9%). However, it was only found in 26.3% of the isolates from the Bajil district of Hodeidah. Surprisingly, the SVMNT new-world South American haplotype was exclusively detected in 9.3% of the isolates from the Bajil district of Hodeidah. Mutations at Y184F of pfmdr1 were found in all isolates (100%) from all districts. The mutation for codons 1034C and 86Y were found only in the isolates from the AdDahi and Khamis Bani Saad districts. Overall, the AdDahi and Khamis Bani Saad districts were similar in terms of carrying most of the mutations in the pfcrt and pfmdr1 genes, while there was a lower prevalence of mutation in the isolates from the Bajil district. Conclusion. The high prevalence of mutations in pfcrt 5 years after the official cessation of CQ use against P. falciparum suggests that there is sustained CQ pressure on P. falciparum isolates in the study area. Moreover, the low prevalence of mutations in the pfmdr1 gene could be a good indicator of the high susceptibility of P. falciparum isolates to antimalarials other than CQ. A new strategy to ensure the complete nationwide withdrawal of CQ from the private drug market is recommended.
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Affiliation(s)
- Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Unit of Microbiology and Parasitology, Department of Para-Clinic, Faculty of Medicine and Health Sciences, University of Aden, Khormaksar, Aden, Yemen
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Endemic and Tropical Diseases Unit, Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia; Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Adel Al-Jasari
- National Malaria Control Programme, Ministry of Health and Population , Sana'a , Yemen
| | - Hany Sady
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Salwa S Dawaki
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Fatin N Elyana
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Mona A Al-Areeqi
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Nabil A Nasr
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Awatif M Abdulsalam
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Lahvanya R Subramaniam
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Meram Azzani
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Init Ithoi
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Yee Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Johari Surin
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Centre for Research and Innovation, Taylor's University, Subang Jaya, Selangor, Malaysia
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Antony HA, Das S, Parija SC, Padhi S. Sequence analysis of pfcrt and pfmdr1 genes and its association with chloroquine resistance in Southeast Indian Plasmodium falciparum isolates. GENOMICS DATA 2016; 8:85-90. [PMID: 27222806 PMCID: PMC4856815 DOI: 10.1016/j.gdata.2016.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/13/2016] [Accepted: 04/16/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Due to the widespread resistance of Plasmodium falciparum to chloroquine drug, artemisinin-based combination therapy (ACT) has been recommended as the first-line treatment. This study aims to evaluate the extent of chloroquine resistance in P. falciparum infection after the introduction of ACT. This study was carried out based on the mutation analysis in P. falciparum chloroquine resistant transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes. Identification of these molecular markers plays a significant role in monitoring and assessment of drug resistance as well as in designing an effective antimalarial drug policy in India. METHODS Sixty blood samples were collected from patients infected with P. falciparum from JIPMER, Puducherry and MKCG Medical College, Odisha. Polymerase chain reaction-restriction fragment length polymorphism was performed, targeting the point mutation of K76T in pfcrt and N86Y in pfmdr1 gene. The PCR products were sequenced, genotyped and further analysed for amino acid changes in these codons. RESULTS The frequency of pfcrt mutation at 76th position was dominant for mutant T allele with 56.7% and wild type K, 43.3%. Majority of pfmdr1 86 allele were wild type, with N (90%) and mutant, Y (10%). Additionally, we found three haplotypes for CQ resistance, SVMNT, CVIET and CVIKT in association with the pfcrt gene. However, a poorly studied SNP in pfmdr1 gene (Y184F) associated with CQ resistance showed high frequency (70%) in P. falciparum isolates. CONCLUSIONS The point mutation K76T of pfcrt is high in P. falciparum suggesting a sustained high CQ resistance even after five years of the introduction of ACTs for antimalarial therapy. The present study suggests a strong association of CQ resistance with pfcrt T76, but not with the pfmdr1 Y86 mutation. However, sequence analysis showed that Y184F mutation on pfmdr1 gene was found to be associated with high resistance. Also, a new pfcrt haplotype 'CVIKT' associated with CQ resistance was found to be present in Indian strains of P. falciparum. The data obtained from this study helps in continuous monitoring of drug resistance in malaria and also suggests the need for careful usage of CQ in Plasmodium vivax malarial treatment.
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Affiliation(s)
- Hiasindh Ashmi Antony
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Sindhusuta Das
- Department of Microbiology, Maharaja Krishna Chandra Gajapati Medical College (MKCG Medical College), Odisha 760004, India
| | - Subhash Chandra Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Sanghamitra Padhi
- Department of Microbiology, Maharaja Krishna Chandra Gajapati Medical College (MKCG Medical College), Odisha 760004, India
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Bamaga OAA, Mahdy MAK, Lim YAL. Frequencies distribution of dihydrofolate reductase and dihydropteroate synthetase mutant alleles associated with sulfadoxine-pyrimethamine resistance in Plasmodium falciparum population from Hadhramout Governorate, Yemen. Malar J 2015; 14:516. [PMID: 26693691 PMCID: PMC4688959 DOI: 10.1186/s12936-015-1035-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/04/2015] [Indexed: 12/23/2022] Open
Abstract
Background Malaria in Yemen is mainly caused by Plasmodium falciparum and 25 % of the population is at high risk. Sulfadoxine–pyrimethamine (SP) had been used as monotherapy against P. falciparum. Emergence of chloroquine resistance led to the shift in anti-malarial treatment policy in Yemen to artemisinin-based combination therapy, that is artesunate (AS) plus SP as first-line therapy for uncomplicated malaria and artemether–lumefantrine as second-line treatment. This study aimed to screen mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) genes associated with SP resistance among P. falciparum population in Hadhramout governorate, Yemen. Methods Genomic DNA was extracted from dried blood spots of 137 P. falciparum isolates collected from a community-based study. DNA was amplified using nested polymerase chain reaction (PCR) and subsequently sequenced for Pfdhfr and Pfdhps genes. Sequences were analysed for mutations in Pfdhfr gene codons 51, 59, 108, and 164 and in Pfdhps gene codons 436, 437, and 540. Results A total of 128 and 114 P. falciparum isolates were successfully sequenced for Pfdhfr and Pfdhps genes, respectively. Each Pfdhfr mutant allele (I51 and N108) in P. falciparum population had a frequency of 84 %. PfdhfrR59 mutant allele was detected in one isolate. Mutation at codon 437 (G437) in the Pfdhps gene was detected in 44.7 % of falciparum malaria isolates. Frequencies of Pfdhfr double mutant genotype (I51C59N108I164) and Pfdhfr/Pfdhps triple mutant genotype (I51C59N108I164-S436G437K540) were 82.8 and 39.3 %, respectively. One isolate harboured Pfdhfr triple mutant genotype (I51, R59, N108, I164) and Pfdhfr/Pfdhps quadruple mutant genotype (I51R59N108I164-S436G437K540). Conclusion High frequencies of Pfdhfr and Pfdhps mutant alleles and genotypes in P. falciparum population in Hadhramout, Yemen, highlight the risk of developing resistance for SP, the partner drug of AS, which subsequently will expose the parasite to AS monotherapy increasing then the potential of the emergence of AS resistance. Study findings necessitate the continuous monitoring of the efficacy of the national anti-malarial drugs policy in Yemen. In addition, monitoring SP efficacy using molecular markers that has shown to be a practical and informative method for monitoring the partner drug of AS.
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Affiliation(s)
- Omar A A Bamaga
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mohammed A K Mahdy
- Department of Parasitology, Faculty of Medicine, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Centre, University of Science and Technology, Taiz, Yemen.
| | - Yvonne A L Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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