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Narang G, Jakhan J, Tamang S, Yadav K, Singh V. Characterization of drug resistance genes in Indian Plasmodium falciparum and Plasmodium vivax field isolates. Acta Trop 2024; 255:107218. [PMID: 38636585 DOI: 10.1016/j.actatropica.2024.107218] [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: 11/14/2023] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
One of the major challenges for malaria control and elimination is the spread and emergence of antimalarial drug resistance. Mutations in Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) field isolates for five drug resistance genes viz. crt, mdr1, dhps, dhfr and kelch known to confer resistance to choloroquine (CQ), sulfadoxine-pyrimethamine (SP) and artemisinin (ART) and its derivatives were analyzed. A total of 342 symptomatic isolates of P. falciparum (Pf) and P. vivax (Pv) from 1993 to 2014 were retrieved from malaria parasite repository at National Institute of Malaria Research (NIMR). Sample DNA was extracted from dried blood spots and various targeted single nucleotide polymorphisms (SNPs) associated with antimalarial drug resistance were analysed for these isolates. 72S (67.7%) and 76T (83.8%) mutations along with SVMNT haplotype (67.7%) predominated the study population for Pfcrt. The most prevalent SNPs were 108N (73.2%) and 437G (24.8%) and the most prevalent haplotypes were ACNRNI (51.9%) and SAKAA (74.5%) in Pfdhfr and Pfdhps respectively. Only two mutations in Pfmdr1, 86Y (26.31%) and 184F (56.26%), were seen frequently in our study population. No mutations associated with Pfk13 were observed. For Pv, all the studied isolates showed two Pvdhps mutations, 383G and 553G, and two Pfdhfr mutations, 58R and 117N. Similarly, three mutations, viz. 958M, 908L and 1076L were found in Pvmdr1. No variations were observed in Pvcrt-o and Pvk12 genes. Overall, our study demonstrates an increase in mutations associated with SP resistance in both Pf and Pv, however, no single nucleotide polymorphisms (SNPs) associated with ART resistance have been observed for either species. Various SNPs associated with CQ resistance were seen in Pf; whereas only Pvmdr1 associated resistant SNPs were observed in Pv. Therefore, molecular characterization of drug resistance genes is essential for timely monitoring and prevention of malaria by identifying the circulating drug resistant parasites in the country.
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Affiliation(s)
- Geetika Narang
- ICMR-National Institute of Malaria Research (NIMR), Sector-8, Dwarka, New Delhi 110077, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - Jahnvi Jakhan
- ICMR-National Institute of Malaria Research (NIMR), Sector-8, Dwarka, New Delhi 110077, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - Suman Tamang
- ICMR-National Institute of Malaria Research (NIMR), Sector-8, Dwarka, New Delhi 110077, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - Karmveer Yadav
- ICMR-National Institute of Malaria Research (NIMR), Sector-8, Dwarka, New Delhi 110077, India
| | - Vineeta Singh
- ICMR-National Institute of Malaria Research (NIMR), Sector-8, Dwarka, New Delhi 110077, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India.
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Acharya A, Naskar A, Chaudhury A, Sardar AA, Samanta A, Guha SK, Maji AK, Bera DK, Saha P. Prevalence of polymorphisms in marker genes associated with antimalarial drug resistance in Plasmodium falciparum following 10 years of artemisinin-based combination therapy implementation in urban Kolkata. Trop Parasitol 2024; 14:23-29. [PMID: 38444799 PMCID: PMC10911185 DOI: 10.4103/tp.tp_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 03/07/2024] Open
Abstract
Context Resistance to antimalarial drugs is one of the major challenges for malaria elimination. In India, artemisinin combination therapy (artesunate-sulfadoxin pyrimethamine) was introduced in place of chloroquine (CQ) for the treatment of uncomplicated falciparum malaria in 2010. Periodical monitoring of polymorphisms in antimalarial drug resistance marker genes will be useful for assessing drug pressure, mapping and monitoring of drug resistance status; and will be helpful for searching alternative treatments. Objectives This study was conducted to study the polymorphisms in antimalarial drug resistance marker genes among clinical Plasmodium falciparum isolates collected from Kolkata after 10 years of artemisinin-based combination therapie (ACT) implementation. Materials and Methods Blood samples were collected from P. falciparum mono-infected patients and polymorphisms in P. falciparum CQ resistance transporter (pfcrt), P. falciparum multidrug resistance (pfmdr-1), P. falciparum dihydrofolate reductase (pfdhfr), P. falciparum dihydropteroate synthetase (pfdhps), pfATPase6 and pfK-13 propeller genes were analysed by polymerase chain reaction and DNA sequencing. Results In pfcrt gene, C72S, and K76T mutation was recorded in 100% isolates and no mutations was detected in any of the targeted codons of pfmdr-1 gene. A double mutant pfcrt haplotype SVMNT and wildtype haplotype NYD in pfmdr-1 were prevalent in 100% of study isolates. Triple mutant pfdhfr-pfdhps haplotype ANRNI-SGKAA was recorded. No polymorphism in pfK13 gene was documented in any of the isolates. Conclusions Observed wild codon N86 along with Y184 and D1246 of pfmdr-1 gene might be an indication of the reappearance of CQ sensitivity. The absence of quadruple and quintuple haplotypes in pfdhfr-pfdhps gene along with the wild haplotype of pfK13 is evidence of ACT effectivity. Hence, similar studies with large sample size are highly suggested for monitoring the drug resistance status of P. falciparum.
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Affiliation(s)
| | - Arindam Naskar
- Department of Tropical Medicine, Kolkata, West Bengal, India
| | - Abhijit Chaudhury
- Department of Microbiology, Sri Venkateswara Institute of Medical Sciences and Sri Padmavathi Medical College (Women), Tirupati, Andhra Pradesh, India
| | | | | | | | | | | | - Pabitra Saha
- Department of Microbiology, Kolkata, West Bengal, India
- Department of Zoology, P. R. Thakur Government College, North 24 Parganas, West Bengal, India
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Barati S, Haghi AM, Nateghpour M, Zamani Z, Khodaveisi S, Etemadi S. Induction of Artesunate Resistance in Plasmodium falciparum 3D7 Strain Using Intermittent Exposure Method and Comparing P.fk13 Sequence between Susceptible and Resistant Strains. IRANIAN JOURNAL OF PARASITOLOGY 2023; 18:445-455. [PMID: 38169593 PMCID: PMC10758072 DOI: 10.18502/ijpa.v18i4.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/18/2023] [Indexed: 01/05/2024]
Abstract
Background Resistance to artemisinin has threatened major achievements in malaria control, more investigations is needed about resistant strains and related genes. We aimed to induce resistance to artesunate in the Plasmodium falciparum 3D7 strain using intermittent exposure method and comparing P.fk13 gene sequence between susceptible and resistance strains. Methods P. falciparum 3D7 strain was cultured according to Trager & Jensen method with some modifications. Serial concentrations between 10-2 mol/l, to 10-7mol/l were prepared, then P. falciparum 3D7 was exposed to each of the dilution to determine IC50 and lethal dose. Sensitivity reduction process was started from the concentration of 10-7mol/l and ended at 10-2mol/l. Exposed parasites were collected after at least 27 days after cultivation in each drug concentration. DNA extraction, PCR and sequencing process were performed to investigate any possible mutations in the P.fk13 gene sequence. Results Effectiveness of 10-2mol/l concentration of artemisinin was found as a lethal dose. IC50 value was equal to 5×10-4 mol/l. The resistant strain was provided in the lab, sequenced and registered in the gene bank as P.f Art -2, (accession number MH796123. 1). Alignment of this registered sample showed no mutation in P.f kelch13 gene in comparison with standard strain submitted in the GenBank. Conclusion Resistance to artesunate in malaria parasite may occur but with no mutation in the P.f kelch13 gene. Therefore, whole genome sequencing should be applied to determine mutations in resistant strains.
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Affiliation(s)
- Sahar Barati
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Motevalli Haghi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Nateghpour
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Zamani
- Biochemistry Department, Pasteur Institute of Iran, Pasteur Avenue, Tehran, Iran
| | - Sadegh Khodaveisi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Etemadi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Kale S, Uplekar SM, Bandyopadhyay N, Rao PN, Ali SZ, Sharma S, Tandel N, Patel A, Singh R, Dank A, Ravishankaran S, Lakshmi Priya GS, Asokan A, Eapen A, Singh OP, Carlton JM, Mallick PK. Antimalarial Drug Resistance Profiling of Plasmodium falciparum Infections in India Using Next-Generation Sequencing. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.08.23288321. [PMID: 37066213 PMCID: PMC10104178 DOI: 10.1101/2023.04.08.23288321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Tracking the emergence and spread of antimalarial drug resistance has become critical to sustaining progress towards the control and eventual elimination of malaria in South Asia, especially India. Methods An amplicon sequencing protocol was used for high-throughput molecular surveillance of antimalarial drug resistance in a total of 158 isolates at three sites in India: Chennai, Nadiad and Rourkela. Five genes of the Plasmodium falciparum implicated in antimalarial resistance were investigated here; Pfcrt for chloroquine resistance, Pfdhfr for pyrimethamine resistance, Pfdhps for sulfadoxine resistance, Pfk13 for artemisinin resistance and Pfmdr1 for resistance to multiple antimalarials. Results Mutations in the propeller domain of PfK13 were observed in two samples only, however these mutations are not validated for artemisinin resistance. A high proportion of parasites from the P. falciparum dominant site Rourkela showed wild-type Pfcrt and Pfdhfr haplotypes, while mutant Pfcrt and Pfdhfr haplotypes were fixed at the P. vivax dominant sites Chennai and Nadiad. The wild-type PfDHPS haplotype was predominant across all study sites. Finally, we observed the largest proportion of suspected multi-clonal infections at Rourkela, which has the highest transmission of P. falciparum among our study sites. Conclusion This is the first simultaneous high-throughput next generation sequencing of five complete P. falciparum genes from infected patients in India.
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Affiliation(s)
- Sonal Kale
- National Institute of Malaria Research, Indian Council of Medical Research, Sector 8, Dwarka, New Delhi, India
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Disease, NIH, Bethesda, Maryland, USA
| | - Swapna M. Uplekar
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Nabamita Bandyopadhyay
- National Institute of Malaria Research, Indian Council of Medical Research, Sector 8, Dwarka, New Delhi, India
| | - Pavitra N. Rao
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Syed Z. Ali
- National Institute of Malaria Research Field Unit, Sector 1 Health Center, Rourkela, Odisha, India
| | - S.K. Sharma
- National Institute of Malaria Research Field Unit, Sector 1 Health Center, Rourkela, Odisha, India
| | - Nikunj Tandel
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Ankita Patel
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Ranvir Singh
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Aaron Dank
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Sangamithra Ravishankaran
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - G Sri Lakshmi Priya
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Aswin Asokan
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Alex Eapen
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Om. P. Singh
- National Institute of Malaria Research, Indian Council of Medical Research, Sector 8, Dwarka, New Delhi, India
| | - Jane M. Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, USA
| | - Prashant K. Mallick
- National Institute of Malaria Research, Indian Council of Medical Research, Sector 8, Dwarka, New Delhi, India
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Ghanchi NK, Qurashi B, Raees H, Beg MA. Molecular surveillance of drug resistance: Plasmodium falciparum artemisinin resistance single nucleotide polymorphisms in Kelch protein propeller (K13) domain from Southern Pakistan. Malar J 2021; 20:176. [PMID: 33827592 PMCID: PMC8028081 DOI: 10.1186/s12936-021-03715-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND K13 propeller (k13) polymorphism are useful molecular markers for tracking the emergence and spread of artemisinin resistance in Plasmodium falciparum. Polymorphisms are reported from Cambodia with rapid invasion of the population and almost near fixation in south East Asia. The study describes single nucleotide polymorphisms in Kelch protein propeller domain of P. falciparum associated with artemisinin resistance from Southern Pakistan. METHODS Two hundred and forty-nine samples were collected from patients with microscopy confirmed P. falciparum malaria attending Aga Khan University Hospital during September 2015-April 2018. DNA was isolated using the whole blood protocol for the QIAmp DNA Blood Kit. The k13 propeller gene (k13) was amplified using nested PCR. Double-strand sequencing of PCR products was performed using Sanger sequencing methodology. Sequences were analysed with MEGA 6 and Bio edit software to identify specific SNP combinations. RESULTS All isolates analysed for k13 propeller allele were observed as wild-type in samples collected post implementation of ACT in Pakistan. C580Y, A675V, Y493H and R539T variants associated with reduced susceptibility to artemisinin-based combination therapy (ACT) were not found. Low frequency of M476I and C469Y polymorphisms was found, which is significantly associated with artemisinin resistance. CONCLUSION Low frequencies of both nonsynonymous and synonymous polymorphisms were observed in P. falciparum isolates circulating in Southern Pakistan. The absence of known molecular markers of artemisinin resistance in this region is favourable for anti-malarial efficacy of ACT. Surveillance of anti-malarial drug resistance to detect its emergence and spread need to be strengthened in Pakistan.
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Affiliation(s)
- Najia Karim Ghanchi
- Section of Microbiology, Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Bushra Qurashi
- Section of Microbiology, Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | | | - Mohammad Asim Beg
- Section of Microbiology, Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
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Zaw MT, Lin Z, Emran NA. Importance of kelch 13 C580Y mutation in the studies of artemisinin resistance in Plasmodium falciparum in Greater Mekong Subregion. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:676-681. [DOI: 10.1016/j.jmii.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/04/2019] [Accepted: 07/16/2019] [Indexed: 01/15/2023]
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Characterization of drug resistance and genetic diversity of Plasmodium falciparum parasites from Tripura, Northeast India. Sci Rep 2019; 9:13704. [PMID: 31548652 PMCID: PMC6757058 DOI: 10.1038/s41598-019-50152-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/06/2019] [Indexed: 01/23/2023] Open
Abstract
Monitoring of anti-malarial drug resistance is vital in Northeast India as this region shares its international border with Southeast Asia. Genetic diversity of Plasmodium parasites regulates transmission dynamics, disease severity and vaccine efficacy. P. falciparum chloroquine resistance transporter (Pfcrt), multidrug resistance-1 (Pfmdr-1) and kelch 13 propeller (PfK-13) genes which govern antimalarial drug resistance and three genetic diversity markers, merozoite surface protein 1 and 2 (Pfmsp-1, Pfmsp-2) and glutamate rich protein (Pfglurp) were evaluated from Tripura, Northeast India using molecular tools. In the Pfcrt gene, 87% isolates showed triple mutations at codons M74I, N75E and K76T. 12.5% isolates in Pfmdr-1 gene showed mutation at N86Y. No polymorphism in PfK-13 propeller was found. Polyclonal infections were observed in 53.85% isolates and more commonly in adults (p = 0.0494). In the Pfmsp-1 locus, the K1 allelic family was predominant (71.2%) followed by the 3D7/IC family (69.2%) in the Pfmsp-2 locus. RII region of Pfglurp exhibited nine alleles with expected heterozygosity of 0.85. The multiplicity of infection for Pfmsp-1, Pfmsp-2 and Pfglurp were 1.56, 1.31 and 1.06 respectively. Overall, the study demonstrated a high level of chloroquine resistance and extensive parasite diversity in the region, necessitating regular surveillance in this population group.
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Das S, Manna S, Saha B, Hati AK, Roy S. Novel pfkelch13 Gene Polymorphism Associates With Artemisinin Resistance in Eastern India. Clin Infect Dis 2018; 69:1144-1152. [PMID: 30535043 DOI: 10.1093/cid/ciy1038] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/06/2018] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Artesunate-sulfadoxine-pyrimethamine (ASSP) is the frontline artemisinin combination therapy (ACT) in India. Random, irrational, subtherapeutic artemisinin doses and self-medication with ACT along with predominance of sulfadoxine-pyrimethamine resistance parasite invoked a strong possibility of emerging artemisinin-resistant malaria parasites.
Methods
This study involved 226 patients with uncomplicated Plasmodium falciparum infection who had successfully completed the 42 days follow-up after ASSP combination therapy from April 2014 to January 2016. We assessed the ASSP treatment efficacy by evaluating parasite clearance half-life, pfkelch13, and other (pfdhfr, pfdhps, pfmdr1, pfcrt) gene mutations and survival of parasites as detected by an ex vivo ring-stage survival assay (RSA).
Findings
Slow-clearing infections with longer parasite clearance half-lives (>5 hours) were observed in 12% isolates. Cure rate after ASSP treatment was declining to about 84.1%. ASSP failure was recorded in 15.9% (early treatment failure, 7.9%; late treatment failure, 7.9%) of isolates. In sum, 24 patients (10.6%) had parasite clearance half-lives greater than 5 hours with pfkelch13 polymorphism after 441 codon; in 15 of those patients (6.6%), parasites had not cleared by 72 hours after initiation of therapy. Median ex vivo ring-stage survival rate of these isolates was very high (12.2%; 95% confidence interval [CI], 10.9–13.8) from that of cured patients (0.9%; 95% CI, 0.09–1.07). Of these 15 patients, 13 patients had pfkelch13 G625R polymorphism, whereas 2 patients contained R539T polymorphism. As per the World Health Organization guideline, these 15 isolates were true artemisinin-resistant isolates.
Interpretation
Identification of artemisinin-resistant isolates in India together with new mutations and increasing combination therapy failures blow alarms for urgent malaria control.
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Affiliation(s)
- Sabyasachi Das
- Immunology and Microbiology Laboratory, Department of Human Physiology with Community Health, Vidyasagar University, Midnapore, West Bengal
| | - Subhankar Manna
- Immunology and Microbiology Laboratory, Department of Human Physiology with Community Health, Vidyasagar University, Midnapore, West Bengal
| | - Bhaskar Saha
- National Centre for Cell Science, Ganeshkhind, Pune
| | - Amiya Kumar Hati
- Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| | - Somenath Roy
- Immunology and Microbiology Laboratory, Department of Human Physiology with Community Health, Vidyasagar University, Midnapore, West Bengal
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Rosenthal PJ. Artemisinin Resistance Outside of Southeast Asia. Am J Trop Med Hyg 2018; 99:1357-1359. [PMID: 30426924 PMCID: PMC6283499 DOI: 10.4269/ajtmh.18-0845] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Philip J. Rosenthal
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Patel P, Bharti PK, Bansal D, Ali NA, Raman RK, Mohapatra PK, Sehgal R, Mahanta J, Sultan AA, Singh N. Prevalence of mutations linked to antimalarial resistance in Plasmodium falciparum from Chhattisgarh, Central India: A malaria elimination point of view. Sci Rep 2017; 7:16690. [PMID: 29192183 PMCID: PMC5709362 DOI: 10.1038/s41598-017-16866-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/19/2017] [Indexed: 11/09/2022] Open
Abstract
Antimalarial drug resistance is a major global challenge in malaria control and elimination. Mutations in six different genes of Plasmodium falciparum (crt, mdr1, dhfr, dhps, ATPase6 and K-13 propeller) that confer resistance to chloroquine, sulphadoxine-pyrimethamine and artemisinin-based combination therapy were analyzed in samples from Chhattisgarh. Seventy-eight percent of the samples were found to have a pfcrt mutation (53% double, 24% triple and 1% single mutant), and 59% of pfmdr1 genes were found to have an N86Y mutation. Double mutations were recorded in pfdhfr gene among 76% of the samples while only 6% of the samples harbored mutant genotypes in pfdhps. No mutation was found in the K-13 propeller gene, while only one sample showed a mutant genotype for the PfATPase6 gene. The Tajima test confirmed that there is no role of evolutionary natural selection in drug resistance, and gene pairwise linkage of disequilibrium showed significant intragenic association. The high level of pfcrt mutations suggests that parasite resistance to chloroquine is almost at a fixed level, whereas resistance to SP is evolving in the population and parasites remain sensitive to artemisinin derivatives. These findings provide potential information and understanding of the evolution and spread of different drug resistance alleles in Chhattisgarh.
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Affiliation(s)
- Priyanka Patel
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.,Symbiosis School of Biomedical Sciences, Symbiosis International University, Lavale, Maharashtra, 412115, India
| | - Praveen K Bharti
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India
| | - Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Nazia A Ali
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India
| | - Rajive K Raman
- Medical Officer, Community Health Centre Janakpur, District Baikunthpur, Chhattisgarh, India
| | - Pradyumna K Mohapatra
- Regional Medical Research Centre, NE, Indian Council of Medical Research, Post Box no. 105, Dibrugarh, 786 001, Assam, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, Punjab, India
| | - Jagadish Mahanta
- Regional Medical Research Centre, NE, Indian Council of Medical Research, Post Box no. 105, Dibrugarh, 786 001, Assam, India
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Neeru Singh
- National Institute for Research in Tribal Health, Indian Council of Medical Research, Nagpur Road, Garha, Jabalpur, 482003, Madhya Pradesh, India.
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Sharma S, Bharti RS, Bhardwaj N, Anvikar AR, Valecha N, Mishra N. Correlation of in vitro Sensitivity of Chloroquine and other Antimalarials with the Partner Drug Resistance to Plasmodium falciparum Malaria in Selected Sites of India. Indian J Med Microbiol 2017; 35:485-490. [DOI: 10.4103/ijmm.ijmm_17_160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nyunt MH, Soe MT, Myint HW, Oo HW, Aye MM, Han SS, Zaw NN, Cho C, Aung PZ, Kyaw KT, Aye TT, San NA, Ortega L, Thimasarn K, Bustos MDG, Galit S, Hoque MR, Ringwald P, Han ET, Kyaw MP. Clinical and molecular surveillance of artemisinin resistant falciparum malaria in Myanmar (2009-2013). Malar J 2017; 16:333. [PMID: 28806957 PMCID: PMC5557565 DOI: 10.1186/s12936-017-1983-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022] Open
Abstract
Background Emergence of artemisinin-resistant malaria in Southeast Asian countries threatens the global control of malaria. Although K13 kelch propeller has been assessed for artemisinin resistance molecular marker, most of the mutations need to be validated. In this study, artemisinin resistance was assessed by clinical and molecular analysis, including k13 and recently reported markers, pfarps10, pffd and pfmdr2. Methods A prospective cohort study in 1160 uncomplicated falciparum patients was conducted after treatment with artemisinin-based combination therapy (ACT), in 6 sentinel sites in Myanmar from 2009 to 2013. Therapeutic efficacy of ACT was assessed by longitudinal follow ups. Molecular markers analysis was done on all available day 0 samples. Results True recrudescence treatment failures cases and day 3 parasite positivity were detected at only the southern Myanmar sites. Day 3 positive and k13 mutants with higher prevalence of underlying genetic foci predisposing to become k13 mutant were detected only in southern Myanmar since 2009 and comparatively fewer mutations of pfarps10, pffd, and pfmdr2 were observed in western Myanmar. K13 mutations, V127M of pfarps10, D193Y of pffd, and T448I of pfmdr2 were significantly associated with day 3 positivity (OR: 6.48, 3.88, 2.88, and 2.52, respectively). Conclusions Apart from k13, pfarps10, pffd and pfmdr2 are also useful for molecular surveillance of artemisinin resistance especially where k13 mutation has not been reported. Appropriate action to eliminate the resistant parasites and surveillance on artemisinin resistance should be strengthened in Myanmar. Trial registration This study was registered with ClinicalTrials.gov, identifier NCT02792816.
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Affiliation(s)
- Myat Htut Nyunt
- Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea.,Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Myat Thu Soe
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Hla Win Myint
- Magway District Hospital, Ministry of Health and Sports, Magway, Republic of the Union of Myanmar
| | - Htet Wai Oo
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Moe Moe Aye
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Soe Soe Han
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Ni Ni Zaw
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Cho Cho
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Phyo Zaw Aung
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Khin Thiri Kyaw
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Thin Thin Aye
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | - Naychi Aung San
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
| | | | - Krongthong Thimasarn
- World Health Organization Country Office for Myanmar, Yangon, Republic of the Union of Myanmar
| | | | - Sherwin Galit
- Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines
| | - Mohammad Rafiul Hoque
- Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | | | - Eun-Taek Han
- Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea.
| | - Myat Phone Kyaw
- Department of Medical Research, Yangon, Republic of the Union of Myanmar
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Therapeutic efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria from three highly malarious states in India. Malar J 2016; 15:498. [PMID: 27737665 PMCID: PMC5064902 DOI: 10.1186/s12936-016-1555-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/04/2016] [Indexed: 11/23/2022] Open
Abstract
Background Anti-malarial drug resistance continues to be a leading threat to malaria control efforts and calls for continued monitoring of waning efficacy of artemisinin-based combination therapy (ACT). Artesunate + sulfadoxine/pyrimethamine (AS + SP) is used for the treatment of uncomplicated Plasmodium falciparum malaria in India. However, resistance against AS + SP is emerged in northeastern states. Therefore, artemether–lumefantrine (AL) is the recommended first line treatment for falciparum malaria in north eastern states. This study investigates the therapeutic efficacy and safety of AL for the treatment of uncomplicated falciparum malaria in three malaria-endemic states in India. The data generated through this study will benefit the immediate implementation of second-line ACT as and when required. Methods This was a one-arm prospective evaluation of clinical and parasitological responses for uncomplicated falciparum malaria using WHO protocol. Patients diagnosed with uncomplicated mono P. falciparum infection were administered six-dose regimen of AL over 3 days and subsequent follow-up was carried out up to 28 days. Molecular markers msp-1 and msp-2 were used to differentiate recrudescence and re-infection and K13 propeller gene was amplified and sequenced covering the codon 450–680. Results A total of 402 eligible patients were enrolled in the study from all four sites. Overall, adequate clinical and parasitological response (ACPR) was 98 % without PCR correction and 99 % with PCR correction. At three study sites, ACPR rates were 100 %, while at Bastar, cure rate was 92.5 % on day 28. No early treatment failure was found. The PCR-corrected endpoint finding confirmed that one late clinical failure (LCF) and two late parasitological failures (LPF) were recrudescences. The PCR corrected cure rate was 96.5 %. The mean fever clearance time was 27.2 h ± 8.2 (24–48 h) and the mean parasite clearance time was 30.1 h ± 11.0 (24–72 h). Additionally, no adverse event was recorded. Analysis of total 186 samples revealed a mutation in the k13 gene along with non-synonymous mutation at codon M579T in three (1.6 %) samples. Conclusion AL is an efficacious drug for the treatment of uncomplicated falciparum malaria. However, regular monitoring of AL is required in view of malaria elimination initiatives, which will be largely dependent on therapeutic interventions, regular surveillance and targeted vector control. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1555-4) contains supplementary material, which is available to authorized users.
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Ogouyèmi-Hounto A, Damien G, Deme AB, Ndam NT, Assohou C, Tchonlin D, Mama A, Hounkpe VO, Moutouama JD, Remoué F, Ndiaye D, Gazard DK. Lack of artemisinin resistance in Plasmodium falciparum in northwest Benin after 10 years of use of artemisinin-based combination therapy. ACTA ACUST UNITED AC 2016; 23:28. [PMID: 27443837 PMCID: PMC4956913 DOI: 10.1051/parasite/2016028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 06/28/2016] [Indexed: 12/20/2022]
Abstract
AIM In Benin, artemisinin-based combination therapy (ACT) has been recommended as the first-line treatment for uncomplicated Plasmodium falciparum malaria since 2004. The emergence in Southeast Asia of parasites that are resistant to artemisinins poses a serious threat to global control of this disease. The presence of artemisinin resistance genotypes in parasite populations in Benin is currently unknown. The present study investigated the prevalence of relevant K13-propeller gene polymorphisms in parasite isolates from the north-western region of Benin. METHOD Plasmodium falciparum isolates were collected from children with a confirmed diagnosis of malaria aged 6 months to 5 years in two towns, Cobly and Djougou, in the north-western part of Benin. The study was conducted during the rainy season from July to November 2014 in local health facilities. The K13-propeller gene was amplified in parasite isolates using nested PCR and subsequently sequenced. RESULTS A total of 108 children were recruited into the study. The efficiency of amplification reactions was 72% (78/108). The propeller domain of the K13 gene was successfully sequenced in 78 P. falciparum isolates; all of them were wild type with no polymorphisms detectable. CONCLUSION The absence of mutations in the K13 gene indicates that P. falciparum parasite populations in the study area are still fully susceptible to artemisinins.
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Affiliation(s)
- Aurore Ogouyèmi-Hounto
- Unité d'Enseignement et de Recherche en Parasitologie - Mycologie/Faculté des Sciences de la Santé; 01 BP 188 Cotonou, Bénin - Laboratoire du centre de lutte intégrée contre le paludisme; 01 BP 188 Cotonou, Bénin
| | - Georgia Damien
- Institut de Recherche pour le Développement. UMR 224-MIVEGEC; 08 BP 841 Cotonou, Bénin
| | - Awa Bineta Deme
- Laboratory of Parasitology Mycology, Aristide le Dantec Hospital, BP 16477 Dakar, Senegal
| | - Nicaise T Ndam
- UMR 216 MERIT-IRD Parasitology Department Noguchi Memorial Institute for Medical Research College of Health Sciences, University of Ghana, P.O. Box LG581 Legon, Accra, Ghana
| | - Constance Assohou
- Institut de Recherche pour le Développement. UMR 224-MIVEGEC; 08 BP 841 Cotonou, Bénin
| | - Didier Tchonlin
- Laboratoire du centre de lutte intégrée contre le paludisme; 01 BP 188 Cotonou, Bénin
| | - Atika Mama
- Laboratoire du centre de lutte intégrée contre le paludisme; 01 BP 188 Cotonou, Bénin
| | | | | | - Franck Remoué
- Institut de Recherche pour le Développement. UMR 224-MIVEGEC; 08 BP 841 Cotonou, Bénin
| | - Daouda Ndiaye
- Laboratory of Parasitology Mycology, Aristide le Dantec Hospital, BP 16477 Dakar, Senegal
| | - Dorothée Kinde Gazard
- Unité d'Enseignement et de Recherche en Parasitologie - Mycologie/Faculté des Sciences de la Santé; 01 BP 188 Cotonou, Bénin - Laboratoire du centre de lutte intégrée contre le paludisme; 01 BP 188 Cotonou, Bénin
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A Method for Amplicon Deep Sequencing of Drug Resistance Genes in Plasmodium falciparum Clinical Isolates from India. J Clin Microbiol 2016; 54:1500-1511. [PMID: 27008882 PMCID: PMC4879288 DOI: 10.1128/jcm.00235-16] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/20/2016] [Indexed: 11/20/2022] Open
Abstract
A major challenge to global malaria control and elimination is early detection and containment of emerging drug resistance. Next-generation sequencing (NGS) methods provide the resolution, scalability, and sensitivity required for high-throughput surveillance of molecular markers of drug resistance. We have developed an amplicon sequencing method on the Ion Torrent PGM platform for targeted resequencing of a panel of six Plasmodium falciparum genes implicated in resistance to first-line antimalarial therapy, including artemisinin combination therapy, chloroquine, and sulfadoxine-pyrimethamine. The protocol was optimized using 12 geographically diverse P. falciparum reference strains and successfully applied to multiplexed sequencing of 16 clinical isolates from India. The sequencing results from the reference strains showed 100% concordance with previously reported drug resistance-associated mutations. Single-nucleotide polymorphisms (SNPs) in clinical isolates revealed a number of known resistance-associated mutations and other nonsynonymous mutations that have not been implicated in drug resistance. SNP positions containing multiple allelic variants were used to identify three clinical samples containing mixed genotypes indicative of multiclonal infections. The amplicon sequencing protocol has been designed for the benchtop Ion Torrent PGM platform and can be operated with minimal bioinformatics infrastructure, making it ideal for use in countries that are endemic for the disease to facilitate routine large-scale surveillance of the emergence of drug resistance and to ensure continued success of the malaria treatment policy.
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