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Tran THT, Hien BTT, Dung NTL, Huong NT, Binh TT, Van Long N, Ton ND. Evaluation of Dihydroartemisinin-Piperaquine Efficacy and Molecular Markers in Uncomplicated Falciparum Patients: A Study across Binh Phuoc and Dak Nong, Vietnam. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1013. [PMID: 38929629 PMCID: PMC11205605 DOI: 10.3390/medicina60061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Malaria continues to be a significant global health challenge. The efficacy of artemisinin-based combination therapies (ACTs) has declined in many parts of the Greater Mekong Subregion, including Vietnam, due to the spread of resistant malaria strains. This study was conducted to assess the efficacy of the Dihydroartemisinin (DHA)-Piperaquine (PPQ) regimen in treating uncomplicated falciparum malaria and to conduct molecular surveillance of antimalarial drug resistance in Binh Phuoc and Dak Nong provinces. Materials and Methods: The study included 63 uncomplicated malaria falciparum patients from therapeutic efficacy studies (TES) treated following the WHO treatment guidelines (2009). Molecular marker analysis was performed on all 63 patients. Methods encompassed Sanger sequencing for pfK13 mutations and quantitative real-time PCR for the pfpm2 gene. Results: This study found a marked decrease in the efficacy of the DHA-PPQ regimen, with an increased rate of treatment failures at two study sites. Genetic analysis revealed a significant presence of pfK13 mutations and pfpm2 amplifications, indicating emerging resistance to artemisinin and its partner drug. Conclusions: The effectiveness of the standard DHA-PPQ regimen has sharply declined, with rising treatment failure rates. This decline necessitates a review and possible revision of national malaria treatment guidelines. Importantly, molecular monitoring and clinical efficacy assessments together provide a robust framework for understanding and addressing detection drug resistance in malaria.
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Affiliation(s)
- Thu Huyen Thi Tran
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi 100000, Vietnam; (T.H.T.T.); (B.T.T.H.); (N.T.L.D.); (N.V.L.)
- Department of Biotechnology, Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi 100000, Vietnam
| | - Bui Thi Thu Hien
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi 100000, Vietnam; (T.H.T.T.); (B.T.T.H.); (N.T.L.D.); (N.V.L.)
| | - Nguyen Thi Lan Dung
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi 100000, Vietnam; (T.H.T.T.); (B.T.T.H.); (N.T.L.D.); (N.V.L.)
| | - Nguyen Thi Huong
- National Burn Hospital, Vietnam Military Medical University, Hanoi 100000, Vietnam
| | - Tran Thanh Binh
- 103 Hospital, Vietnam Military Medical University, Hanoi 100000, Vietnam;
| | - Nguyen Van Long
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi 100000, Vietnam; (T.H.T.T.); (B.T.T.H.); (N.T.L.D.); (N.V.L.)
| | - Nguyen Dang Ton
- Department of Biotechnology, Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi 100000, Vietnam
- Institute of Genome Research, Vietnam Academy of Science and Technology, Hanoi 100000, Vietnam
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Liu H, Xu JW, Deng DW, Wang HY, Nie RH, Yin YJ, Li M. Dihydroartemisinin-piperaquine efficacy in Plasmodium falciparum treatment and prevalence of drug-resistant molecular markers along China-Myanmar border in 2014-2023. J Glob Antimicrob Resist 2023; 35:271-278. [PMID: 37816434 DOI: 10.1016/j.jgar.2023.10.001] [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: 03/16/2023] [Revised: 08/23/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES The study aims to monitor dihydroartemisinin-piperaquine (DHA-PPQ) efficacy in Plasmodium falciparum and detect molecular markers associated with its resistance. METHODS The World Health Organization's standard protocol for therapeutic efficacy studies (TES) was performed from 2014 to 2018; integrated drug efficacy surveillance (iDES) was performed from from 2019 to July 2023. Molecular markers were detected by polymerase chain reaction. The association between gene mutations and delayed parasite clearance was analysed by multivariate logistic regression analysis. RESULTS A total of 226 P. falciparum patients were enrolled in the TES from 2014 to 2018, and 26 patients with P. falciparum from Africa were recruited in the iDES from 2019 to July 2023. The PCR-adjusted clinical and parasitological cure rate was 93.7% (95% CI: 92.6-99.5%) in the TES and 96.2% (95% CI: 80.4-99.9%) in the iDEs. Twelve mutants and an overall 55.0% prevalence of pfK13 mutations were detected. Of them, G533S, C447R, C447S, N458Y, C469Y, and A676D were first detected out along the China-Myanmar border. Referred to the wild strain, adjusted odds ratios of treatment failure for G533S, N458Y, and P574L by 42 days were 7.54 (95% CI: 1.605-45.86), 13.68 (95% CI: 1.95-130.72), and 89.00 (95% CI: 1.98-2482.1), respectively. CONCLUSION The efficacy of DHA-PPQ from 2014 to 2018 declined in comparison with 2003 to 2013, but it is still effective for treatment of P. falciparum malaria. Results of the iDES indicate a risk of artemisinin resistance in Africa. G533S, N458Y, and P574L are associated with delayed parasite clearance and treatment failure.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Dao-Wei Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Heng-Ye Wang
- People's Hospital of Puer Municipality, Puer, China
| | - Ren-Hua Nie
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Yi-Jie Yin
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Mei Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.
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Cao VAT, Nguyen TQ, Le Quyen D, Boon WPC, Moors EHM, Dondorp AM, de Haan F, Amaratunga C. Exploring the feasibility of introducing triple artemisinin-based combination therapy in the malaria treatment policy in Vietnam. Malar J 2023; 22:326. [PMID: 37898749 PMCID: PMC10613363 DOI: 10.1186/s12936-023-04763-4] [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: 07/03/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND This study investigates the processes regarding changing malaria treatment policies in Vietnam. Moreover, it explores the feasibility of introducing triple artemisinin-based combination therapy (TACT) in Vietnam to support the national malaria control and elimination plan. METHODS Data were collected via 12 in-depth interviews with key stakeholders, combined with a review of policy documents. RESULTS TACT is considered as a useful backup strategy in case future treatment failures with current artemisinin-based combination therapy (ACT) would occur. Moreover, TACT is also considered as a promising strategy to prevent the re-establishment of malaria. However, regulatory procedures and implementation timelines for TACT were expected to be lengthy. Therefore, strategies to engage national decision-makers, regulators, and suppliers should be initiated soon, stipulating the benefits of TACT deployment. In Vietnam, a procedure to apply for an import permit without registration that has previously been applied to the introduction of artesunate-pyronaridine was proposed to accelerate the introduction of TACT. Global-level support through the World Health Organization recommendations and prequalification were considered critical for supporting the introduction of TACT in Vietnam. CONCLUSIONS Appropriate approach strategies and early stakeholder engagement will be needed to accelerate the introduction of TACT in Vietnam.
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Affiliation(s)
- Van Anh Thi Cao
- The University of North Carolina Project Office, Hanoi, Vietnam.
| | - Thieu Quang Nguyen
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Wouter P C Boon
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Ellen H M Moors
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Freek de Haan
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Chanaki Amaratunga
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Huynh LN, Tran LB, Nguyen HS, Ho VH, Parola P, Nguyen XQ. Mosquitoes and Mosquito-Borne Diseases in Vietnam. INSECTS 2022; 13:1076. [PMID: 36554986 PMCID: PMC9781666 DOI: 10.3390/insects13121076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/31/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
Mosquito-borne diseases pose a significant threat to humans in almost every part of the world. Key factors such as global warming, climatic conditions, rapid urbanisation, frequent human relocation, and widespread deforestation significantly increase the number of mosquitoes and mosquito-borne diseases in Vietnam, and elsewhere around the world. In southeast Asia, and notably in Vietnam, national mosquito control programmes contribute to reducing the risk of mosquito-borne disease transmission, however, malaria and dengue remain a threat to public health. The aim of our review is to provide a complete checklist of all Vietnamese mosquitoes that have been recognised, as well as an overview of mosquito-borne diseases in Vietnam. A total of 281 mosquito species of 42 subgenera and 22 genera exist in Vietnam. Of those, Anopheles, Aedes, and Culex are found to be potential vectors for mosquito-borne diseases. Major mosquito-borne diseases in high-incidence areas of Vietnam include malaria, dengue, and Japanese encephalitis. This review may be useful to entomological researchers for future surveys of Vietnamese mosquitoes and to decision-makers responsible for vector control tactics.
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Affiliation(s)
- Ly Na Huynh
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 13005 Marseille, France
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Institute of Malariology, Parasitology and Entomology, Quy Nhon (IMPE-QN), MoH Vietnam, Zone 8, Nhon Phu Ward, Quy Nhon City 590000, Vietnam
| | - Long Bien Tran
- Institute of Malariology, Parasitology and Entomology, Quy Nhon (IMPE-QN), MoH Vietnam, Zone 8, Nhon Phu Ward, Quy Nhon City 590000, Vietnam
| | - Hong Sang Nguyen
- Institute of Malariology, Parasitology and Entomology, Quy Nhon (IMPE-QN), MoH Vietnam, Zone 8, Nhon Phu Ward, Quy Nhon City 590000, Vietnam
| | - Van Hoang Ho
- Institute of Malariology, Parasitology and Entomology, Quy Nhon (IMPE-QN), MoH Vietnam, Zone 8, Nhon Phu Ward, Quy Nhon City 590000, Vietnam
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 13005 Marseille, France
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
| | - Xuan Quang Nguyen
- Institute of Malariology, Parasitology and Entomology, Quy Nhon (IMPE-QN), MoH Vietnam, Zone 8, Nhon Phu Ward, Quy Nhon City 590000, Vietnam
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Boonyalai N, Kirativanich K, Thamnurak C, Praditpol C, Vesely BA, Wojnarski M, Griesenbeck JS, Waters NC. A single point mutation in the Plasmodium falciparum 3'-5' exonuclease does not alter piperaquine susceptibility. Malar J 2022; 21:130. [PMID: 35459163 PMCID: PMC9034581 DOI: 10.1186/s12936-022-04148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background The rise in Plasmodium falciparum resistance to dihydroartemisinin–piperaquine (DHA–PPQ) treatment has been documented in the Greater Mekong Subregion with associations with mutations in the P. falciparum chloroquine resistance transporter (pfcrt) and plasmepsin 2 (pfpm2) genes. However, it is unclear whether other genes also play a role with PPQ resistance, such as the E415G mutation in the exonuclease (pfexo) gene. The aim of this study was to investigate the role of this mutation in PPQ resistance by generating transgenic parasites expressing the pfexo-E415G mutant allele. Methods Transgenic parasite clones carrying the E415G mutation in PfEXO of the B5 isolate were derived by CRISPR-Cas9 gene editing and verified using PCR and gene sequencing. Polymorphisms of pfkelch-13, pfcrt, and pfexo were examined by PCR while the copy number variations of pfpm2 were examined by both relative quantitative real-time PCR and the duplication breakpoint assay. Drug sensitivity against a panel of antimalarials, the ring-stage survival assay (RSA), the PPQ survival assay (PSA), and bimodal dose-response curves were used to evaluate antimalarial susceptibility. Results The transgenic line, B5-rexo-E415G-B8, was successfully generated. The PPQ-IC90, %PPQ survival, and the bimodal dose-response clearly showed that E415G mutation in PfEXO of B5 isolate remained fully susceptible to PPQ. Furthermore, growth assays demonstrated that the engineered parasites grew slightly faster than the unmodified parental isolates whereas P. falciparum isolates harbouring pfkelch-13, pfcrt, and pfexo mutations with multiple copies of pfpm2 grew much more slowly. Conclusions Insertion of the E415G mutation in PfEXO did not lead to increased PPQ-IC90 and %PPQ survival, suggesting that this mutation alone may not be associated with PPQ resistance, but could still be an important marker if used in conjunction with other markers for monitoring PPQ-resistant parasites. The results also highlight the importance of monitoring and evaluating suspected genetic mutations with regard to parasite fitness and resistance. Supplementary information The online version contains supplementary material available at 10.1186/s12936-022-04148-z.
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Affiliation(s)
- Nonlawat Boonyalai
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
| | - Kirakarn Kirativanich
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chatchadaporn Thamnurak
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chantida Praditpol
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Brian A Vesely
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mariusz Wojnarski
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - John S Griesenbeck
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Norman C Waters
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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