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Sima-Biyang YV, Ontoua SS, Longo-Pendy NM, Mbou-Boutambe C, Makouloutou-Nzassi P, Moussadji CK, Lekana-Douki JB, Boundenga L. Epidemiology of malaria in Gabon: A systematic review and meta-analysis from 1980 to 2023. J Infect Public Health 2024; 17:102459. [PMID: 38870682 DOI: 10.1016/j.jiph.2024.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
The objective of this were conducted to elucidate spatiotemporal variations in malaria epidemiology in Gabon since 1980. For that, five databases, were used to collect and identify all studies published between 1980 and 2023 on malaria prevalence, antimalarial drug resistance, markers of antimalarial drug resistance and insecticide resistance marker. The findings suggest that Gabon continues to face malaria as an urgent public health problem, with persistently high prevalence rates. Markers of resistance to CQ persist despite its withdrawal, and markers of resistance to SP have emerged with a high frequency, reaching 100 %, while ACTs remain effective. Also, recent studies have identified markers of resistance to the insecticides Kdr-w and Kdr-e at frequencies ranging from 25 % to 100 %. Ace1R mutation was reported with a frequency of 0.4 %. In conclusion, the efficacy of ACTs remains above the threshold recommended by the WHO. Organo-phosphates and carbamates could provide an alternative for vector control.
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Affiliation(s)
- Yann Vital Sima-Biyang
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon
| | - Steede Seinnat Ontoua
- Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon; Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Neil Michel Longo-Pendy
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Clark Mbou-Boutambe
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon
| | - Patrice Makouloutou-Nzassi
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Animal Biology and Ecology, Tropical Ecology Research Institute (IRET/CENAREST), Libreville BP 13354, Gabon
| | - Cyr Kinga Moussadji
- Primatology Center, Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Jean-Bernard Lekana-Douki
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Parasitology-Mycology-Tropical Medicine, University of Health Sciences, Faculty of Medicine, BP 4009 Libreville, Gabon
| | - Larson Boundenga
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Anthropology, Durham University, South Road, Durham DH1 3LE, UK.
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Ontoua SS, Kouna LC, Oyegue-Liabagui SL, Voumbo-Matoumona DF, Moukodoum DN, Imboumy-Limoukou RK, Lekana-Douki JB. Differential Prevalences of Pfmdr1 Polymorphisms in Symptomatic and Asymptomatic Plasmodium falciparum Infections in Lastoursville: A Rural Area in East-Central Gabon. Infect Drug Resist 2021; 14:2873-2882. [PMID: 34335033 PMCID: PMC8318719 DOI: 10.2147/idr.s304361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Plasmodium falciparum malaria remains a major public health challenge in sub-Saharan Africa. Plasmodium falciparum drug resistance mediated by polymorphisms in the Pfmdr1 gene contributes to the persistence of the disease on the African continent. This study investigated P. falciparum infection features and differences in the Pfmdr1 genotypes between symptomatic and asymptomatic malaria cases in a rural area in east-central Gabon. Patients and Methods A total of 875 children aged from 5 to 185 months were screened for P falciparum infection using Optima-IT® rapid diagnostic tests and standard microscopy. Pfmdr1 polymorphisms at codons 86, 184 and 1246 were investigated using PCR-RFLP. Results Among the 448 P. falciparum-infected children, 57.08% (n=250) were symptomatic and 42.92% (n=198) were asymptomatic (p < 0.0001). In a sub-set of 79 isolates, the Pfmdr1 wild-type N86 was more prevalent in symptomatic (100%) than in asymptomatic infections (70.7%) (p=0.007). The mutant 86Y and mixed 86N/Y genotypes were observed only in asymptomatic infections. The Y184 and 184F genotype prevalences (39.1% vs 19.4% and 60.9% vs 80.6%, respectively) were not significantly different between the two groups (p=0.097). The prevalence of the wild-type D1246 differed significantly between symptomatic (10.3%) and asymptomatic (100%) (p < 0.0001). The NFD and YFD haplotypes were more prevalent in asymptomatic than in symptomatic infections [(61.9% vs 31%; p=0.005) and (16.7% vs 0.0%; p=0.01)], whereas the NYD and YYD haplotypes were not significantly different between the two groups [(21.4% vs 14.3%, p=0.39) and (0.0% vs 7.1%, p=0.24)]. Conclusion Our results confirm a high transmission of P. falciparum infection in rural Gabon, with a high prevalence of asymptomatic carriage. The higher prevalences of wild-type N86 in symptomatic infections and of D1246 in asymptomatic infections suggest a pathogenicity associated with polymorphisms in Pfmdr1. These results highlight the need to monitor the efficacy of artemisinin-based combination therapies in Gabon.
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Affiliation(s)
- Steede Seinnat Ontoua
- Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre Interdisciplinaire des Recherches Médicales de Franceville (CIRMF), Franceville, BP 769, Gabon
| | - Lady Charlene Kouna
- Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre Interdisciplinaire des Recherches Médicales de Franceville (CIRMF), Franceville, BP 769, Gabon
| | - Sandrine Lydie Oyegue-Liabagui
- Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre Interdisciplinaire des Recherches Médicales de Franceville (CIRMF), Franceville, BP 769, Gabon.,Ecole Doctorale Régionale d'Afrique Centrale en Infectiologie Tropicale (ECODRAC), Université de Sciences et Techniques de Masuku (USTM), Franceville, BP 876, Gabon
| | - Dominique Fatima Voumbo-Matoumona
- Départements des Masters/Licences, Parcours-Types des Sciences Biologiques, Faculté des Sciences et Techniques, Université Marien Ngouabi, Brazzaville, BP 69, Congo
| | - Diamella Nancy Moukodoum
- Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre Interdisciplinaire des Recherches Médicales de Franceville (CIRMF), Franceville, BP 769, Gabon
| | - Romeo Karl Imboumy-Limoukou
- Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre Interdisciplinaire des Recherches Médicales de Franceville (CIRMF), Franceville, BP 769, Gabon
| | - Jean Bernard Lekana-Douki
- Unité d'Evolution, Epidémiologie et Résistance Parasitaire (UNEEREP), Centre Interdisciplinaire des Recherches Médicales de Franceville (CIRMF), Franceville, BP 769, Gabon.,Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, BP 4009, Gabon
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Obaldía N, Dow GS, Gerena L, Kyle D, Otero W, Mantel PY, Baro N, Daniels R, Mukherjee A, Childs LM, Buckee C, Duraisingh MT, Volkman SK, Wirth DF, Marti M. Altered drug susceptibility during host adaptation of a Plasmodium falciparum strain in a non-human primate model. Sci Rep 2016; 6:21216. [PMID: 26880111 PMCID: PMC4754742 DOI: 10.1038/srep21216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/19/2016] [Indexed: 01/07/2023] Open
Abstract
Infections with Plasmodium falciparum, the most pathogenic of the Plasmodium species affecting man, have been reduced in part due to artemisinin-based combination therapies. However, artemisinin resistant parasites have recently emerged in South-East Asia. Novel intervention strategies are therefore urgently needed to maintain the current momentum for control and elimination of this disease. In the present study we characterize the phenotypic and genetic properties of the multi drug resistant (MDR) P. falciparum Thai C2A parasite strain in the non-human Aotus primate model, and across multiple passages. Aotus infections with C2A failed to clear upon oral artesunate and mefloquine treatment alone or in combination, and ex vivo drug assays demonstrated reduction in drug susceptibility profiles in later Aotus passages. Further analysis revealed mutations in the pfcrt and pfdhfr loci and increased parasite multiplication rate (PMR) across passages, despite elevated pfmdr1 copy number. Altogether our experiments suggest alterations in parasite population structure and increased fitness during Aotus adaptation. We also present data of early treatment failures with an oral artemisinin combination therapy in a pre-artemisinin resistant P. falciparum Thai isolate in this animal model.
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Affiliation(s)
- Nicanor Obaldía
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States.,Center for the Evaluation of Antimalarial Drugs and Vaccines, Tropical Medicine Research/Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Republic of Panama
| | - Geoffrey S Dow
- Walter Reed Army Institute of Research, Silver Springs, MD, United States
| | - Lucia Gerena
- Walter Reed Army Institute of Research, Silver Springs, MD, United States
| | - Dennis Kyle
- Department of Global Health, University of South Florida, Tampa, FL, United States
| | - William Otero
- Center for the Evaluation of Antimalarial Drugs and Vaccines, Tropical Medicine Research/Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Republic of Panama
| | - Pierre-Yves Mantel
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
| | - Nicholas Baro
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
| | - Rachel Daniels
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
| | - Angana Mukherjee
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
| | - Lauren M Childs
- Center for Communicable Disease Dynamics and Harvard
- T.H. Chan School of Public Health, Boston, MA, United States.,Department of Epidemiology, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
| | - Caroline Buckee
- Center for Communicable Disease Dynamics and Harvard
- T.H. Chan School of Public Health, Boston, MA, United States.,Department of Epidemiology, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
| | - Manoj T Duraisingh
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah K Volkman
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States.,The Broad Institute of MIT and Harvard, Cambridge, MA, United States.,School of Nursing and Health Sciences, Simmons College, Boston, MA United States
| | - Dyann F Wirth
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States.,The Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Matthias Marti
- Department of Immunology and Infectious Diseases, Harvard
- T.H. Chan School of Public Health, Boston, MA, United States
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Trafficked Proteins-Druggable in Plasmodium falciparum? Int J Cell Biol 2013; 2013:435981. [PMID: 23710183 PMCID: PMC3655585 DOI: 10.1155/2013/435981] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 03/12/2013] [Indexed: 01/09/2023] Open
Abstract
Malaria is an infectious disease that results in serious health problems in the countries in which it is endemic. Annually this parasitic disease leads to more than half a million deaths; most of these are children in Africa. An effective vaccine is not available, and the treatment of the disease is solely dependent on chemotherapy. However, drug resistance is spreading, and the identification of new drug targets as well as the development of new antimalarials is urgently required. Attention has been drawn to a variety of essential plasmodial proteins, which are targeted to intra- or extracellular destinations, such as the digestive vacuole, the apicoplast, or into the host cell. Interfering with the action or the transport of these proteins will impede proliferation of the parasite. In this mini review, we will shed light on the present discovery of chemotherapeutics and potential drug targets involved in protein trafficking processes in the malaria parasite.
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Yeka A, Tibenderana J, Achan J, D'Alessandro U, Talisuna AO. Efficacy of quinine, artemether-lumefantrine and dihydroartemisinin-piperaquine as rescue treatment for uncomplicated malaria in Ugandan children. PLoS One 2013; 8:e53772. [PMID: 23349741 PMCID: PMC3551967 DOI: 10.1371/journal.pone.0053772] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 12/05/2012] [Indexed: 01/09/2023] Open
Abstract
Background The treatment of falciparum malaria poses unique challenges in settings where malaria transmission intensity is high because recurrent infections are common. These could be new infections, recrudescences, or a combination of the two. Though several African countries continue to use quinine as the second line treatment for patients with recurrent infections, there is little information on its efficacy when used for rescue therapy. Moreover, such practice goes against the World Health Organisation (WHO) recommendation to use combination therapy for uncomplicated malaria. Methods We conducted a nested, randomized, open label, three-arm clinical trial of rescue therapy in children 6–59 months old with recurrent malaria infection during 28 days post treatment with artemisinin combination treatment (ACT). Patients were randomly assigned to receive either quinine, artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHAPQ), and actively followed up for 28 days. Findings Among 220 patients enrolled, 217 (98.6 %) were assigned an efficacy outcome and 218 (99.1 %) were assessed for safety. The risk of recurrent infection was significantly higher in patients treated with quinine (70 %, 74/110, HR = 3.9; 95 % CI: 2.4–6.7, p<0.0001) and AL (60%, 21/35, HR = 3.3; 95 % CI: 1.8–6.3, p<0.0002), compared to DHAPQ (25%, 18/72). Recrudescence tended to be lower in the DHAPQ (1%, 1/72) than in the quinine (7%, 8/110) or AL (6 %, 2/35) group, though it was not statistically significant. No serious adverse events were reported. Conclusion Recurrent infections observed after the administration of an ACT can be successfully treated with an alternative ACT rather than with quinine. Trial Registration Current Controlled Trials ISRCTN99046537
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Affiliation(s)
- Adoke Yeka
- Uganda Malaria Surveillance Project, Kampala, Uganda.
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Zatra R, Lekana-douki JB, Lekoulou F, Bisvigou U, Ngoungou EB, Ndouo FST. In vitro antimalarial susceptibility and molecular markers of drug resistance in Franceville, Gabon. BMC Infect Dis 2012; 12:307. [PMID: 23153201 PMCID: PMC3534593 DOI: 10.1186/1471-2334-12-307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/29/2012] [Indexed: 01/15/2023] Open
Abstract
Background Malaria remains a major public health problem, due largely to emergence and widespread P. falciparum drug resistance. WHO recommends artemisinine combination based therapy (ACT) to overcome P. falciparum drug resistance, but reports of declining ACT efficacy have been published. A thorough understanding of the molecular bases of P. falciparum resistance to existing drugs is therefore needed. The aims of this study were to analyze the in vitro sensitivity of P. falciparum field isolates from Franceville, Gabon, to chloroquine (CQ), mefloquine (MF), dihydroartemisinine (DHA) and monodesethylamodiaquine (MDAQ), and to investigate polymorphisms associated with drug resistance. Methods We conducted a cross-sectional study of 53 field isolates. Field isolates sensitivity to CQ, MF, DHA and MDAQ was assessed using the colorimetric DELI test. The Pfmdr1 codons 86 and 1246, Pfcrt (haplotype codon 72 to 76) and the PfATPAse6 codons 110 and 2694 were analysed by PCR-RFLP. Associations between drug sensitivity and parasite gene polymorphisms were evaluated with the Chi square test, and routine hematological parameters were analyzed with Fisher’s exact test implemented with Epinfo software. In all statistical tests, significance was assumed at p<0.05. Results A total of 46 P. falciparum isolates were successfully cultured in vitro and their sensitivity was tested. The proportions of isolates resistant to CQ, MF and MDAQ were 43.5%, 23.4% and 56.5%, respectively. Some isolates (23.9%) had DHA IC50 values higher than 10 nM. The median IC50 values were 71.67 (interquartile range (IQR, 1–438.2), 6.59 (IQR, 0.08-96), 64.79 (IQR, 0.09-448) and 6.45 nM (IQR, 0.09-23) for CQ, MF, MDAQ and DHA, respectively. The strongest correlation between diminished DHA sensitivity and MF resistance was observed (r2=0.73), followed by correlation between diminished DHA sensitivity and CQ resistance. Cross-resistance between CQ and MF was also observed. The prevalence of the 86Y and 1246Y mutations in Pfmdr1, 76T in Pfcrt, and 110A and 2694T in PfATPase6 was respectively 42% and 17.1%, 97.8%, and 0% and 22.2%. Conclusion These high levels of antimalarial drug resistance in Franceville, Gabon, call for reinforced surveillance of drug efficacy.
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Affiliation(s)
- Rafika Zatra
- Unité de Parasitologie Médicale (UPARAM), Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
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Lekana-Douki JB, Dinzouna Boutamba SD, Zatra R, Zang Edou SE, Ekomy H, Bisvigou U, Toure-Ndouo FS. Increased prevalence of the Plasmodium falciparum Pfmdr1 86N genotype among field isolates from Franceville, Gabon after replacement of chloroquine by artemether-lumefantrine and artesunate-mefloquine. INFECTION GENETICS AND EVOLUTION 2011; 11:512-7. [PMID: 21251998 DOI: 10.1016/j.meegid.2011.01.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 01/01/2011] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
Despite global antimalarial measures, Plasmodium falciparum malaria remains a major public health problem. WHO has recommended the use of arteminisin-based combination therapy to limit the emergence of antimalarial drug resistance. However, ACT treatment failures have been linked to the selection of the wild types 86N genotype of P. falciparum multidrug resistance 1 (Pfmdr1) and the 76K genotype of P. falciparum chloroquine resistance (Pfcrt) genes. The aim of this study was to investigate the molecular impact of widespread implementation of artemether-lumefantrine and artesunate-mefloquine on local parasite population in Franceville, Gabon. We analyzed 230 pediatric field isolates (96 from 2004 and 134 from 2009). Routine hematological parameters were collected. Pfmdr1 codons 86 and 1246 and Pfcrt codon 76 were genotyped using PCR-RFLP and the prevalence of the genotypes was compared. The children's mean age did not differ between 2004 and 2009 (respectively 31.8 (6-84) months vs 38.6 (6-84) months, p=0.32), and neither did mean parasitemia [16,750 (1000-96,234) and 14,587 (1093-83,941) parasites/μL, respectively (p=0.21)]. The mean hemoglobin level was higher in 2009 than in 2004 (11.0 ± 2.4 vs 7.8 ± 2.0 g/dL, respectively; p=0.04). More interesting, the prevalence of Pfmdr1 wild type 86N increased from 15.6% (n=15/96) in 2004 to 31.3% (n=42/134) in 2009 (p=0.007). A significant increase combining pure and mixed genotypes (86N+86N/Y) was also found between 2004 and 2009 (p=0.02), while the prevalence of genotypes Pfmdr1 1246D, Pfcrt wild type 76T and all mixed genotypes (Pfmdr1 86N/Y and 1246D/Y, and 76K/T) remained stable. The complexity of isolates was high (around 2.9 and 2.4) and the FC27 allele of Pfmsp2 was more prevalent. These findings show a substantial benefice of artemether-lumefantrine and artesunate-mefloquine and of new control measures. The selection, in the general population, of wild type Pfmdr1 86N, which is associated with antiplasmodial resistance against some drugs, has been induced underlining the need for molecular surveillance of the impact of ACT on antimalarial resistance.
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Affiliation(s)
- Jean Bernard Lekana-Douki
- Unité de Parasitologie Médicale (UPARAM), Centre International de Recherches Médicales de Franceville (CIRMF), B.P. 769 Franceville, Gabon.
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Okombo J, Kiara SM, Rono J, Mwai L, Pole L, Ohuma E, Borrmann S, Ochola LI, Nzila A. In vitro activities of quinine and other antimalarials and pfnhe polymorphisms in Plasmodium isolates from Kenya. Antimicrob Agents Chemother 2010; 54:3302-7. [PMID: 20516285 PMCID: PMC2916339 DOI: 10.1128/aac.00325-10] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/25/2010] [Accepted: 05/23/2010] [Indexed: 01/24/2023] Open
Abstract
Resistance to the amino alcohol quinine has been associated with polymorphisms in pfnhe, a sodium hydrogen exchanger. We investigated the role of this gene in quinine resistance in vitro in isolates from Kenya. We analyzed pfnhe whole-gene polymorphisms, using capillary sequencing, and pfcrt at codon 76 (pfcrt-76) and pfmdr1 at codon 86 (pfmdr1-86), using PCR-enzyme restriction methodology, in 29 isolates from Kilifi, Kenya, for association with the in vitro activities of quinine and 2 amino alcohols, mefloquine and halofantrine. In vitro activity was assessed as the drug concentration that inhibits 50% of parasite growth (IC50). The median IC50s of quinine, halofantrine, and mefloquine were 92, 22, and 18 nM, respectively. The presence of 2 DNNND repeats in microsatellite ms4760 of pfnhe was associated with reduced susceptibility to quinine (60 versus 227 nM for 1 and 2 repeats, respectively; P<0.05), while 3 repeats were associated with restoration of susceptibility. The decrease in susceptibility conferred by the 2 DNNND repeats was more pronounced in parasites harboring the pfmdr1-86 mutation. No association was found between susceptibility to quinine and the pfcrt-76 mutation or between susceptibility to mefloquine or halofantrine and the pfnhe gene and the pfcrt-76 and pfmdr1-86 mutations. Using previously published data on the in vitro activities of chloroquine, lumefantrine, piperaquine, and dihydroartemisinin, we investigated the association of their activities with pfnhe polymorphism. With the exception of a modulation of the activity of lumefantrine by a mutation at position 1437, pfnhe did not modulate their activities. Two DNNND repeats combined with the pfmdr1-86 mutation could be used as an indicator of reduced susceptibility to quinine.
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Affiliation(s)
- John Okombo
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Steven M. Kiara
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Josea Rono
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Leah Mwai
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Lewa Pole
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Eric Ohuma
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Steffen Borrmann
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Lynette Isabella Ochola
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Alexis Nzila
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Collaborative Research Program, P.O. Box 230, 80108 Kilifi, Kenya, University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom, Institute of Hygiene, University of Heidelberg School of Medicine, Heidelberg, Germany
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Sriwilaijaroen N, Kondo S, Nanthasri P, Auparakkitanon S, Suzuki Y, Wilairat P. Antiplasmodial effects of Brucea javanica (L.) Merr. and Eurycoma longifolia Jack extracts and their combination with chloroquine and quinine on Plasmodium falciparum in culture. Trop Med Health 2010. [DOI: 10.2149/tmh.2009-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Caramello P, Canta F, Cavecchia I, Sergi G, Balbiano R, Ariaudo S, Audagnotto S, Di Perri G. Chemosusceptibility analysis of Plasmodium falciparum imported malaria in Italy. Diagn Microbiol Infect Dis 2005; 52:107-12. [PMID: 15964498 DOI: 10.1016/j.diagmicrobio.2005.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 01/24/2005] [Indexed: 10/25/2022]
Abstract
A constant surveillance of susceptibility to antimalarials allows to optimize prevention and treatment of malaria in nonendemic countries. In vitro susceptibility of imported Plasmodium falciparum isolates to chloroquine, quinine, mefloquine, halofantrin, pyronaridine, and amodiaquine was analyzed by WHO Micro-test Mark III; IC50 and IC90 were calculated by WHO Log-probit. Sixty-seven tests were performed. All the infections were acquired in Africa: 14.9% in East Africa and 85.1% in West Africa (WA). IC50 and IC90 (micromol/L) were chloroquine: 0.129 and 0.648; amodiaquine: 1.134 and 5.445; mefloquine: 0.38 and 0.868; quinine: 0.193 and 0.478; halofantrin: 3.27 and 25.35; pyronaridine: 11.504 and 51.996. Higher IC50 and IC90 were observed in East Africa versus West Africa strains. All strains were susceptible to quinine and mefloquine; chloroquine resistance, 14%; amodiaquine resistance, 33%, with cross-resistance to chloroquine (r = 0.93; P < .0001); halofantrin resistance, 3.6%, no cross-resistance with chloroquine; low susceptibility to pyronaridine (66.7%), with cross-resistance with chloroquine (r = 0.38, P < 0.05). Lower levels of chloroquine resistance were observed in 2000-2003 as compared with prior data; thus, the reemergence of chloroquine susceptibility in Africa may be hypothesized.
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Affiliation(s)
- Pietro Caramello
- Divisione A di Malattie Infettive, Dipartimento di Malattie Infettive, Ospedale Amedeo di Savoia, Turin, Italy.
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Affiliation(s)
- Martin P Grobusch
- Institute of Tropical Medicine, Department of Parasitology, Tübingen University, Germany.
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Ramharter M, Wernsdorfer WH, Kremsner PG. In vitro activity of quinolines against Plasmodium falciparum in Gabon. Acta Trop 2004; 90:55-60. [PMID: 14739023 DOI: 10.1016/j.actatropica.2003.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The assessment of drug sensitivity of Plasmodium falciparum to antimalarial drugs is of vital interest for malaria endemic regions. We conducted a follow-up study to monitor the in vitro activity of the most commonly used quinolines against fresh P. falciparum isolates in Lambaréné, Gabon by measuring schizont maturation inhibition in 2002. Mean 50% effective concentration levels for chloroquine, quinine, and mefloquine were 5.5micromol/l blood, 286nmol/l blood medium mixture (BMM), and 1.1micromol/l blood, respectively. All isolates (n=40) were found to be highly resistant to chloroquine. One isolate was resistant to mefloquine and five isolates were presenting borderline-resistance. All isolates were inhibited by quinine concentrations below the threshold of resistance (n=43). Besides the observation of an increasing number of borderline resistant isolates to mefloquine, an extremly high parasite resistance to chloroquine-still officially the first line antimalarial in Gabon-seems to be of particular concern.
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Affiliation(s)
- M Ramharter
- Department of Parasitology, Institute for Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, 72074, Tübingen, Germany.
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