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van Loon W, Bisimwa BC, Byela V, Kirby R, Bugeme PM, Balagizi A, Lupande D, Malembaka EB, Mockenhaupt FP, Bahizire E. Detection of Artemisinin Resistance Marker Kelch-13 469Y in Plasmodium falciparum, South Kivu, Democratic Republic of the Congo, 2022. Am J Trop Med Hyg 2024; 110:653-655. [PMID: 38377612 PMCID: PMC10993838 DOI: 10.4269/ajtmh.23-0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/06/2023] [Indexed: 02/22/2024] Open
Abstract
Partial artemisinin resistance has emerged in East Africa, posing a threat to malaria control across the continent. The Democratic Republic of the Congo carries one of the heaviest malaria burdens globally, and the South Kivu province directly borders current artemisinin resistance hot spots, but indications of such resistance have not been observed so far. We assessed molecular markers of antimalarial drug resistance in 256 Plasmodium falciparum isolates collected in 2022 in South Kivu, Democratic Republic of the Congo. One isolate carried the P. falciparum Kelch-13 469Y variant, a marker associated with partial artemisinin resistance and decreased lumefantrine susceptibility in Uganda. In addition, the multidrug resistance-1 mutation pattern suggested increased lumefantrine tolerance.
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Affiliation(s)
- Welmoed van Loon
- Institute of International Health, Center for Global Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Bertin C. Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Institut Supérieur des Techniques Médicales de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Valéry Byela
- Institut Supérieur des Techniques Médicales de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Rebecca Kirby
- University of California, San Diego School of Medicine, San Diego, California
| | - Patrick M. Bugeme
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Aimé Balagizi
- Hôpital Général de Référence de Nyantende, Nyantende, Democratic Republic of the Congo
| | - David Lupande
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Espoir B. Malembaka
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Frank P. Mockenhaupt
- Institute of International Health, Center for Global Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Esto Bahizire
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Centre de Recherche en Sciences Naturelles de Lwiro, Bukavu, Democratic Republic of the Congo
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
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van Loon W, Schallenberg E, Igiraneza C, Habarugira F, Mbarushimana D, Nshimiyimana F, Ngarambe C, Ntihumbya JB, Ndoli JM, Mockenhaupt FP. Escalating Plasmodium falciparum K13 marker prevalence indicative of artemisinin resistance in southern Rwanda. Antimicrob Agents Chemother 2024; 68:e0129923. [PMID: 38092677 PMCID: PMC10869333 DOI: 10.1128/aac.01299-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/10/2023] [Indexed: 12/20/2023] Open
Abstract
In 2023, we updated data collected since 2010 on Plasmodium falciparum K13 and MDR1 drug resistance markers in Huye district, southern Rwanda. Artemisinin resistance-associated PfK13 markers occurred in 17.5% of 212 malaria patients (561H, 9.0%; 675V, 5.7%; and 469F, 2.8%), nearly double the frequency from 2019. PfMDR1 N86, linked with lumefantrine tolerance, was close to fixation at 98%. In southern Rwanda, markers signaling resistance to artemisinin and lumefantrine are increasing, albeit at a relatively slow rate.
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Affiliation(s)
- Welmoed van Loon
- Charité Center for Global Health, Institute of International Health, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Emma Schallenberg
- Charité Center for Global Health, Institute of International Health, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | - Frank P. Mockenhaupt
- Charité Center for Global Health, Institute of International Health, Charité—Universitaetsmedizin Berlin, Berlin, Germany
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Si K, He X, Chen L, Zhang A, Guo C, Li M. The structure of Plasmodium falciparum multidrug resistance protein 1 reveals an N-terminal regulatory domain. Proc Natl Acad Sci U S A 2023; 120:e2219905120. [PMID: 37527341 PMCID: PMC10410737 DOI: 10.1073/pnas.2219905120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
Plasmodium falciparum multidrug resistance protein 1 (PfMDR1), an adenosine triphosphate (ATP)-binding cassette (ABC) transporter on the digestive vacuole (DV) membrane of the parasite, is associated with the resistance to antimalarial drugs. To understand the mechanisms of PfMDR1, we determined the cryo-electron microscopy structures of this transporter in different states. The transporter in the apo state shows an inward-facing conformation with a large cavity opening to the cytoplasm. Upon ATP binding and dimerization of the nucleotide-binding domains (NBDs), PfMDR1 displays an outward-facing conformation with a cavity toward the DV lumen. Drug resistance-associated mutations were investigated in both structures for their effects, and Y184F was identified as an allosteric activity-enhancing mutation. The amphiphilic substrate-binding site of PfMDR1 was revealed by the complex structure with the antimalarial drug mefloquine and confirmed by mutagenesis studies. Remarkably, a helical structure was found to hinder NBD dimerization and inhibit PfMDR1 activity. The location of this regulatory domain in the N terminus is different from the well-studied R domain in the internal linker region of other ABC transporter family members. The lack of the phosphorylation site of this domain also suggests a different regulation mechanism.
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Affiliation(s)
- Kaixue Si
- Harbin Institute of Technology Center for Life Sciences, School of Life Science and Technology, Harbin Institute of Technology, Harbin150080, China
| | - Xishuo He
- Harbin Institute of Technology Center for Life Sciences, School of Life Science and Technology, Harbin Institute of Technology, Harbin150080, China
| | - Liping Chen
- Harbin Institute of Technology Center for Life Sciences, School of Life Science and Technology, Harbin Institute of Technology, Harbin150080, China
| | - Anqi Zhang
- Harbin Institute of Technology Center for Life Sciences, School of Life Science and Technology, Harbin Institute of Technology, Harbin150080, China
| | - Changyou Guo
- Harbin Institute of Technology Center for Life Sciences, School of Life Science and Technology, Harbin Institute of Technology, Harbin150080, China
| | - Minghui Li
- Harbin Institute of Technology Center for Life Sciences, School of Life Science and Technology, Harbin Institute of Technology, Harbin150080, China
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4
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Chen YA, Shiu TJ, Tseng LF, Cheng CF, Shih WL, de Assunção Carvalho AV, Tsai KH. Dynamic changes in genetic diversity, drug resistance mutations, and treatment outcomes of falciparum malaria from the low-transmission to the pre-elimination phase on the islands of São Tomé and Príncipe. Malar J 2021; 20:467. [PMID: 34906134 PMCID: PMC8672503 DOI: 10.1186/s12936-021-04007-3] [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: 08/30/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background With effective vector control and case management, substantial progress has been made towards eliminating malaria on the islands of São Tomé and Príncipe (STP). This study assessed the dynamic changes in the genetic diversity of Plasmodium falciparum, the anti-malarial drug resistance mutations, and malaria treatment outcomes between 2010 and 2016 to provide insights for the prevention of malaria rebounding. Methods Polymorphic regions of merozoite surface proteins 1 and 2 (msp1 and msp2) were sequenced in 118 dried blood spots (DBSs) collected from malaria patients who had visited the Central Hospital in 2010–2016. Mutations in the multi-drug resistance I (pfmdr1), chloroquine resistance transporter (pfcrt), and kelch 13 (pfk13) genes were analysed by polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) and sequencing in 111 DBSs. A total of 7482 cases that completed a 28-day follow-up were evaluated for treatment outcomes based on the microscopic results. Regression models were used to characterize factors associated with levels of parasite density and treatment failures. Results Parasite strains in STP showed significant changes during and after the peak incidence in 2012. The prevalent allelic type in msp1 changed from K1 to MAD20, and that in msp2 changed from 3D7/IC to FC27. The dominant alleles of drug-resistance markers were pfmdr1 86Y, 184F, D1246, and pfcrt 76 T (Y-F-D-T, 51.4%). The average parasite density in malaria cases declined threefold from low-transmission (2010–2013) to pre-elimination period (2014–2016). Logistic regression models showed that patients with younger age (OR for age = 0.97–0.98, p < 0.001), higher initial parasite density (log10-transformed, OR = 1.44, p < 0.001), and receiving quinine treatment (compared to artemisinin-based combination therapy, OR = 1.91–1.96, p < 0.001) were more likely to experience treatment failures during follow-up. Conclusions Plasmodium falciparum in STP had experienced changes in prevalent strains, and increased mutation frequencies in drug-resistance genes from the low-transmission to the pre-elimination settings. Notably, patients with younger age and receiving quinine treatment were more likely to show parasitological treatment failure during follow-up. Therapeutic efficacy should be carefully monitored to inform future treatment policy in STP. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-04007-3.
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Affiliation(s)
- Ying-An Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsen-Ju Shiu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lien-Fen Tseng
- Taiwan Anti-Malaria Advisory Mission, São Tomé, São Tomé and Príncipe
| | - Chien-Fu Cheng
- Taiwan Anti-Malaria Advisory Mission, São Tomé, São Tomé and Príncipe
| | - Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Kun-Hsien Tsai
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Taiwan Anti-Malaria Advisory Mission, São Tomé, São Tomé and Príncipe. .,Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, Taipei, Taiwan. .,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Changing Pattern of Plasmodium falciparum pfmdr1 Gene Polymorphisms in Southern Rwanda. Antimicrob Agents Chemother 2021; 65:e0090121. [PMID: 34228534 DOI: 10.1128/aac.00901-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Plasmodium falciparum multidrug resistance-1 gene (pfmdr1) polymorphisms associate with altered antimalarial susceptibility. Between 2010 and 2018/2019, we observed that the prevalence of the wild-type allele N86 and the wild-type combination NYD increased 10-fold (4% versus 40%) and more than 2-fold (18% versus 44%), respectively. Haplotypes other than NYD or NFD declined by up to >90%. Our molecular data suggest the pfmdr1 pattern shifted toward one associated with artemether-lumefantrine resistance.
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Boonyalai N, Thamnurak C, Sai-Ngam P, Ta-Aksorn W, Arsanok M, Uthaimongkol N, Sundrakes S, Chattrakarn S, Chaisatit C, Praditpol C, Fagnark W, Kirativanich K, Chaorattanakawee S, Vanachayangkul P, Lertsethtakarn P, Gosi P, Utainnam D, Rodkvamtook W, Kuntawunginn W, Vesely BA, Spring MD, Fukuda MM, Lanteri C, Walsh D, Saunders DL, Smith PL, Wojnarski M, Sirisopana N, Waters NC, Jongsakul K, Gaywee J. Plasmodium falciparum phenotypic and genotypic resistance profile during the emergence of Piperaquine resistance in Northeastern Thailand. Sci Rep 2021; 11:13419. [PMID: 34183715 PMCID: PMC8238947 DOI: 10.1038/s41598-021-92735-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/15/2021] [Indexed: 11/09/2022] Open
Abstract
Malaria remains a public health problem in Thailand, especially along its borders where highly mobile populations can contribute to persistent transmission. This study aimed to determine resistant genotypes and phenotypes of 112 Plasmodium falciparum isolates from patients along the Thai-Cambodia border during 2013-2015. The majority of parasites harbored a pfmdr1-Y184F mutation. A single pfmdr1 copy number had CVIET haplotype of amino acids 72-76 of pfcrt and no pfcytb mutations. All isolates had a single pfk13 point mutation (R539T, R539I, or C580Y), and increased % survival in the ring-stage survival assay (except for R539I). Multiple copies of pfpm2 and pfcrt-F145I were detected in 2014 (12.8%) and increased to 30.4% in 2015. Parasites containing either multiple pfpm2 copies with and without pfcrt-F145I or a single pfpm2 copy with pfcrt-F145I exhibited elevated IC90 values of piperaquine. Collectively, the emergence of these resistance patterns in Thailand near Cambodia border mirrored the reports of dihydroartemisinin-piperaquine treatment failures in the adjacent province of Cambodia, Oddar Meanchey, suggesting a migration of parasites across the border. As malaria elimination efforts ramp up in Southeast Asia, host nations militaries and other groups in border regions need to coordinate the proposed interventions.
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Affiliation(s)
- Nonlawat Boonyalai
- 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
| | - Piyaporn Sai-Ngam
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Winita Ta-Aksorn
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Montri Arsanok
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nichapat Uthaimongkol
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Siratchana Sundrakes
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sorayut Chattrakarn
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chaiyaporn Chaisatit
- 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
| | - Watcharintorn Fagnark
- 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
| | - Suwanna Chaorattanakawee
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Pattaraporn Vanachayangkul
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Paphavee Lertsethtakarn
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Panita Gosi
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Darunee Utainnam
- Royal Thai Army Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Wuttikon Rodkvamtook
- Royal Thai Army Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Worachet Kuntawunginn
- 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
| | - Michele D Spring
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mark M Fukuda
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Charlotte Lanteri
- Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Douglas Walsh
- Department of Dermatology, Syracuse VA medical center, Syracuse, USA
| | - David L Saunders
- U.S. Army Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Philip L Smith
- Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Mariusz Wojnarski
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Narongrid Sirisopana
- Royal Thai Army Component, 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
| | - Krisada Jongsakul
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Jariyanart Gaywee
- Royal Thai Army Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Characterization of pfmdr1, pfcrt, pfK13, pfubp1, and pfap2mu in Travelers Returning from Africa with Plasmodium falciparum Infections Reported in China from 2014 to 2018. Antimicrob Agents Chemother 2021; 65:e0271720. [PMID: 33903109 DOI: 10.1128/aac.02717-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The artemisinin-based combination therapies (ACTs) used to treat Plasmodium falciparum in Africa are threatened by the emergence of parasites in Asia that carry variants of the Kelch 13 (K13) locus with delayed clearance in response to ACTs. Single nucleotide polymorphisms (SNPs) in other molecular markers, such as ap2mu and ubp1, were associated with artemisinin resistance in rodent malaria and clinical failure in African malaria patients. Here, we characterized the polymorphisms in pfmdr1, pfcrt, pfK13, pfubp1, and pfap2mu among African isolates reported in Shandong and Guangxi provinces in China. Among 144 patients with P. falciparum returning from Africa from 2014 to 2018, pfmdr1 N86Y (8.3%) and pfcrt K76T (2.1%) were the major mutant alleles. The most common genotype for pfcrt was I74E75T76 (8.3%), followed by E75T76 (2.1%). For K13 polymorphisms, a limited number of mutated alleles were observed, and A578S was the most frequently detected allele in 3 isolates (2.1%). A total of 27.1% (20/144) of the isolates were found to contain pfubp1 mutations, including 6 nonsynonymous and 2 synonymous mutations. The pfubp1 genotypes associated with artemisinin resistance were D1525E (10.4%) and E1528D (8.3%). Furthermore, 11 SNPs were identified in pfap2mu, and S160N was the major polymorphism (4.2%). Additionally, 4 different types of insertions were found in pfap2mu, and the codon AAT, encoding aspartic acid, was more frequently observed at codons 226 (18.8%) and 326 (10.7%). Moreover, 4 different types of insertions were observed in pfubp1 at codon 1520, which was the most common (6.3%). These findings indicate a certain degree of variation in other potential molecular markers, such as pfubp1 and pfap2mu, and their roles in either the parasite's mechanism of resistance or the mode of action should be evaluated or elucidated further.
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Alvarez-Fernandez A, Bernal MJ, Fradejas I, Martin Ramírez A, Md Yusuf NA, Lanza M, Hisam S, Pérez de Ayala A, Rubio JM. KASP: a genotyping method to rapid identification of resistance in Plasmodium falciparum. Malar J 2021; 20:16. [PMID: 33407529 PMCID: PMC7789257 DOI: 10.1186/s12936-020-03544-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The emergence and spread of anti-malarial resistance continues to hinder malaria control. Plasmodium falciparum, the species that causes most human malaria cases and most deaths, has shown resistance to almost all known anti-malarials. This anti-malarial resistance arises from the development and subsequent expansion of Single Nucleotide Polymorphisms (SNPs) in specific parasite genes. A quick and cheap tool for the detection of drug resistance can be crucial and very useful for use in hospitals and in malaria control programmes. It has been demonstrated in different contexts that genotyping by Kompetitive Allele Specific PCR (KASP), is a simple, fast and economical method that allows a high-precision biallelic characterization of SNPs, hence its possible utility in the study of resistance in P. falciparum. METHODS Three SNPs involved in most cases of resistance to the most widespread anti-malarial treatments have been analysed by PCR plus sequencing and by KASP (C580Y of the Kelch13 gene, Y86N of the Pfmdr1 gene and M133I of the Pfcytb gene). A total of 113 P. falciparum positive samples and 24 negative samples, previously analysed by PCR and sequencing, were selected for this assay. Likewise, the samples were genotyped for the MSP-1 and MSP-2 genes, and the Multiplicity of Infection (MOI) and parasitaemia were measured to observe their possible influence on the KASP method. RESULTS The KASP results showed the same expected mutations and wild type genotypes as the reference method, with few exceptions that correlated with very low parasitaemia samples. In addition, two cases of heterozygotes that had not been detected by sequencing were found. No correlation was found between the MOI or parasitaemia and the KASP values of the sample. The reproducibility of the technique shows no oscillations between repetitions in any of the three SNPs analysed. CONCLUSIONS The KASP assays developed in this study were efficient and versatile for the determination of the Plasmodium genotypes related to resistance. The method is simple, fast, reproducible with low cost in personnel, material and equipment and scalable, being able to core KASP arrays, including numerous SNPs, to complete the main pattern of mutations associated to P. falciparum resistance.
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Affiliation(s)
- Ana Alvarez-Fernandez
- Malaria & Parasitic Emerging Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - María J Bernal
- Malaria & Parasitic Emerging Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Fradejas
- Department of Clinical Microbiology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Alexandra Martin Ramírez
- Malaria & Parasitic Emerging Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Noor Azian Md Yusuf
- Parasitology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institute of Health, Setia Alam, Selangor, Malaysia
| | - Marta Lanza
- Malaria & Parasitic Emerging Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Shamilah Hisam
- Parasitology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institute of Health, Setia Alam, Selangor, Malaysia
| | - Ana Pérez de Ayala
- Department of Clinical Microbiology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - José M Rubio
- Malaria & Parasitic Emerging Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain.
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Windle ST, Lane KD, Gadalla NB, Liu A, Mu J, Caleon RL, Rahman RS, Sá JM, Wellems TE. Evidence for linkage of pfmdr1, pfcrt, and pfk13 polymorphisms to lumefantrine and mefloquine susceptibilities in a Plasmodium falciparum cross. Int J Parasitol Drugs Drug Resist 2020; 14:208-217. [PMID: 33197753 PMCID: PMC7677662 DOI: 10.1016/j.ijpddr.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Lumefantrine and mefloquine are used worldwide in artemisinin-based combination therapy (ACT) of malaria. Better understanding of drug susceptibility and resistance is needed and can be obtained from studies of genetic crosses. METHODS Drug response phenotypes of a cross between Plasmodium falciparum lines 803 (Cambodia) and GB4 (Ghana) were obtained as half-maximal effective concentrations (EC50s) and days to recovery (DTR) after 24 h exposure to 500 nM lumefantrine. EC50s of mefloquine, halofantrine, chloroquine, and dihydroartemisinin were also determined. Quantitative trait loci (QTL) analysis and statistical tests with candidate genes were used to identify polymorphisms associated with response phenotypes. RESULTS Lumefantrine EC50s averaged 5.8-fold higher for the 803 than GB4 parent, and DTR results were 3-5 and 16-18 days, respectively. In 803 × GB4 progeny, outcomes of these two lumefantrine assays showed strong inverse correlation; these phenotypes also correlated strongly with mefloquine and halofantrine EC50s. By QTL analysis, lumefantrine and mefloquine phenotypes mapped to a chromosome 5 region containing codon polymorphisms N86Y and Y184F in the P. falciparum multidrug resistance 1 protein (PfMDR1). Statistical tests of candidate genes identified correlations between inheritance of PfK13 Kelch protein polymorphism C580Y (and possibly K189T) and lumefantrine and mefloquine susceptibilities. Correlations were detected between lumefantrine and chloroquine EC50s and polymorphisms N326S and I356T in the CVIET-type P. falciparum chloroquine resistance transporter (PfCRT) common to 803 and GB4. CONCLUSIONS Correlations in this study suggest common mechanisms of action in lumefantrine, mefloquine, and halofantrine responses. PfK13 as well as PfMDR1 and PfCRT polymorphisms may affect access and/or action of these arylaminoalcohol drugs at locations of hemoglobin digestion and heme metabolism. In endemic regions, pressure from use of lumefantrine or mefloquine in ACTs may drive selection of PfK13 polymorphisms along with versions of PfMDR1 and PfCRT associated with lower susceptibility to these drugs.
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Affiliation(s)
- Sean T Windle
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Kristin D Lane
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Nahla B Gadalla
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Anna Liu
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Jianbing Mu
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Ramoncito L Caleon
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Rifat S Rahman
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Juliana M Sá
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA
| | - Thomas E Wellems
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20892, USA.
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Adamu A, Jada MS, Haruna HMS, Yakubu BO, Ibrahim MA, Balogun EO, Sakura T, Inaoka DK, Kita K, Hirayama K, Culleton R, Shuaibu MN. Plasmodium falciparum multidrug resistance gene-1 polymorphisms in Northern Nigeria: implications for the continued use of artemether-lumefantrine in the region. Malar J 2020; 19:439. [PMID: 33256739 PMCID: PMC7708160 DOI: 10.1186/s12936-020-03506-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
Background The analysis of single nucleotide polymorphism (SNPs) in drug-resistance associated genes is a commonly used strategy for the surveillance of anti-malarial drug resistance in populations of parasites. The present study was designed and performed to provide genetic epidemiological data of the prevalence of N86Y-Y184F-D1246Y SNPs in Plasmodium falciparum multidrug resistance 1 (pfmdr1) in the malaria hotspot of Northern Nigeria. Methods Plasmodium falciparum-positive blood samples on Whatman-3MM filter papers were collected from 750 symptomatic patients from four states (Kano, Kaduna, Yobe and Adamawa) in Northern Nigeria, and genotyped via BigDye (v3.1) terminator cycle sequencing for the presence of three SNPs in pfmdr1. SNPs in pfmdr1 were used to construct NYD, NYY, NFY, NFD, YYY, YYD, YFD and YFY haplotypes, and all data were analysed using Pearson Chi square and Fisher’s exact (FE) tests. Results The prevalence of the pfmdr1 86Y allele was highest in Kaduna (12.50%, 2 = 10.50, P = 0.02), whilst the 184F allele was highest in Kano (73.10%, 2 = 13.20, P = 0.00), and the pfmdr1 1246Y allele was highest in Yobe (5.26%, 2 = 9.20, P = 0.03). The NFD haplotype had the highest prevalence of 69.81% in Kano (2 = 36.10, P = 0.00), followed by NYD with a prevalence of 49.00% in Adamawa, then YFD with prevalence of 11.46% in Kaduna. The YYY haplotype was not observed in any of the studied states. Conclusion The present study suggests that strains of P. falciparum with reduced sensitivity to the lumefantrine component of AL exist in Northern Nigeria and predominate in the North-West region.
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Affiliation(s)
- Auwal Adamu
- Department of Biochemistry, Ahmadu Bello University, Zaria, Nigeria
| | - Mahmoud Suleiman Jada
- Department of Biochemistry, Modibbo Adama University of Technology Yola, Yola, Nigeria
| | | | | | | | | | - Takaya Sakura
- Institute of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Daniel Ken Inaoka
- Institute of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kiyoshi Kita
- Institute of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Richard Culleton
- Department of Molecular Parasitology, Proteo-Science Center, Ehime University, Ehime, Japan
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Maraka M, Akala HM, Amolo AS, Juma D, Omariba D, Cheruiyot A, Opot B, Okello Okudo C, Mwakio E, Chemwor G, Juma JA, Okoth R, Yeda R, Andagalu B. A seven-year surveillance of epidemiology of malaria reveals travel and gender are the key drivers of dispersion of drug resistant genotypes in Kenya. PeerJ 2020; 8:e8082. [PMID: 32201636 PMCID: PMC7073242 DOI: 10.7717/peerj.8082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022] Open
Abstract
Malaria drug resistance is a global public health concern. Though parasite mutations have been associated with resistance, other factors could influence the resistance. A robust surveillance system is required to monitor and help contain the resistance. This study established the role of travel and gender in dispersion of chloroquine resistant genotypes in malaria epidemic zones in Kenya. A total of 1,776 individuals presenting with uncomplicated malaria at hospitals selected from four malaria transmission zones in Kenya between 2008 and 2014 were enrolled in a prospective surveillance study assessing the epidemiology of malaria drug resistance patterns. Demographic and clinical information per individual was obtained using a structured questionnaire. Further, 2 mL of blood was collected for malaria diagnosis, parasitemia quantification and molecular analysis. DNA extracted from dried blood spots collected from each of the individuals was genotyped for polymorphisms in Plasmodium falciparum chloroquine transporter gene (Pfcrt 76), Plasmodium falciparum multidrug resistant gene 1 (Pfmdr1 86 and Pfmdr1 184) regions that are putative drug resistance genes using both conventional polymerase chain reaction (PCR) and real-time PCR. The molecular and demographic data was analyzed using Stata version 13 (College Station, TX: StataCorp LP) while mapping of cases at the selected geographic zones was done in QGIS version 2.18. Chloroquine resistant (CQR) genotypes across gender revealed an association with chloroquine resistance by both univariate model (p = 0.027) and by multivariate model (p = 0.025), female as reference group in both models. Prior treatment with antimalarial drugs within the last 6 weeks before enrollment was associated with carriage of CQR genotype by multivariate model (p = 0.034). Further, a significant relationship was observed between travel and CQR carriage both by univariate model (p = 0.001) and multivariate model (p = 0.002). These findings suggest that gender and travel are significantly associated with chloroquine resistance. From a gender perspective, males are more likely to harbor resistant strains than females hence involved in strain dispersion. On the other hand, travel underscores the role of transport network in introducing spread of resistant genotypes, bringing in to focus the need to monitor gene flow and establish strategies to minimize the introduction of resistance strains by controlling malaria among frequent transporters.
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Affiliation(s)
- Moureen Maraka
- School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Siaya, Kenya
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Hoseah M. Akala
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Asito S. Amolo
- School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Siaya, Kenya
| | - Dennis Juma
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Duke Omariba
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Agnes Cheruiyot
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Benjamin Opot
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Charles Okello Okudo
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Edwin Mwakio
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Gladys Chemwor
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Jackline A. Juma
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Raphael Okoth
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Redemptah Yeda
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
| | - Ben Andagalu
- Department of Emerging Infectious Diseases (DEID), United States Army Medical Research Directorate-Africa Kenya (USAMRD-A Kenya)/Kenya Medical Research Institute (KEMRI), Kisumu, Kisumu, Kenya
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Lin LY, Li J, Huang HY, Liang XY, Jiang TT, Chen JT, Ehapo CS, Eyi UM, Zheng YZ, Zha GC, Xie DD, Wang YL, Chen WZ, Liu XZ, Lin M. Trends in Molecular Markers Associated with Resistance to Sulfadoxine-Pyrimethamine (SP) Among Plasmodium falciparum Isolates on Bioko Island, Equatorial Guinea: 2011-2017. Infect Drug Resist 2020; 13:1203-1212. [PMID: 32431521 PMCID: PMC7197940 DOI: 10.2147/idr.s236898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/19/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Antimalarial drug resistance is one of the major challenges in global efforts to control and eliminate malaria. In 2006, sulfadoxine-pyrimethamine (SP) replaced with artemisinin-based combination therapy (ACT) on Bioko Island, Equatorial Guinea, in response to increasing SP resistance, which is associated with mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes. PATIENTS AND METHODS To evaluate the trend of molecular markers associated with SP resistance on Bioko Island from 2011 to 2017, 179 samples collected during active case detection were analysed by PCR and DNA sequencing. RESULTS Pfdhfr and Pfdhps gene sequences were obtained for 90.5% (162/179) and 77.1% (138/179) of the samples, respectively. For Pfdhfr, 97.5% (158/162), 95.7% (155/162) and 98.1% (159/162) of the samples contained N51I, C59R and S108N mutant alleles, respectively. And Pfdhps S436A, A437G, K540E, A581G, and A613S mutations were observed in 25.4% (35/138), 88.4% (122/138), 5.1% (7/138), 1.4% (2/138), and 7.2% (10/138) of the samples, respectively. Two classes of previously described Pfdhfr-Pfdhps haplotypes associated with SP resistance and their frequencies were identified: partial (IRNI-SGKAA, 59.4%) and full (IRNI-SGEAA, 5.5%) resistance. Although no significant difference was observed in different time periods (p>0.05), our study confirmed a slowly increasing trend of the frequencies of these SP-resistance markers in Bioko parasites over the 7 years investigated. CONCLUSION The findings reveal the general existence of SP-resistance markers on Bioko Island even after the replacement of SP as a first-line treatment for uncomplicated malaria. Continuous molecular monitoring and additional control efforts in the region are urgently needed.
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Affiliation(s)
- Li-Yun Lin
- School of Food Engineering and Biotechnology, Hanshan Normal University, Chaozhou, Guangdong Province, People’s Republic of China
- University of Chinese Academy of Sciences, Beijing, People’s Republic of China
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong Provincial Key Laboratory of Applied Marine Biology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, People’s Republic of China
| | - Jian Li
- Department of Human Parasitology, School of Basic Medical Sciences; Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Hui-Ying Huang
- Department of Medical Laboratory, Chaozhou People’s Hospital Affiliated to Shantou University Medical College, Chaozhou, Guangdong Province, People’s Republic of China
- Department of Medical Genetics, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Xue-Yan Liang
- Department of Medical Laboratory, Chaozhou People’s Hospital Affiliated to Shantou University Medical College, Chaozhou, Guangdong Province, People’s Republic of China
- Department of Medical Genetics, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Ting-Ting Jiang
- Department of Human Parasitology, School of Basic Medical Sciences; Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Jiang-Tao Chen
- The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People’s Republic of China
- Department of Medical Laboratory, Huizhou Central Hospital, Huizhou, Guangdong Province, People’s Republic of China
| | - Carlos Salas Ehapo
- Department of Medical Laboratory, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | - Urbano Monsuy Eyi
- Department of Medical Laboratory, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | - Yu-Zhong Zheng
- School of Food Engineering and Biotechnology, Hanshan Normal University, Chaozhou, Guangdong Province, People’s Republic of China
| | - Guang-Cai Zha
- School of Food Engineering and Biotechnology, Hanshan Normal University, Chaozhou, Guangdong Province, People’s Republic of China
| | - Dong-De Xie
- The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People’s Republic of China
- Department of Medical Laboratory, Huizhou Central Hospital, Huizhou, Guangdong Province, People’s Republic of China
| | - Yu-Ling Wang
- The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People’s Republic of China
- Department of Medical Laboratory, Huizhou Central Hospital, Huizhou, Guangdong Province, People’s Republic of China
| | - Wei-Zhong Chen
- Department of Medical Laboratory, Chaozhou People’s Hospital Affiliated to Shantou University Medical College, Chaozhou, Guangdong Province, People’s Republic of China
- Department of Medical Genetics, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Xiang-Zhi Liu
- Department of Medical Laboratory, Chaozhou People’s Hospital Affiliated to Shantou University Medical College, Chaozhou, Guangdong Province, People’s Republic of China
- Department of Medical Genetics, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
| | - Min Lin
- School of Food Engineering and Biotechnology, Hanshan Normal University, Chaozhou, Guangdong Province, People’s Republic of China
- Department of Medical Laboratory, Chaozhou People’s Hospital Affiliated to Shantou University Medical College, Chaozhou, Guangdong Province, People’s Republic of China
- Department of Medical Genetics, Shantou University Medical College, Shantou, Guangdong Province, People’s Republic of China
- Correspondence: Min Lin School of Food Engineering and Biotechnology, Hanshan Normal University, Chaozhou, Guangdong Province, People’s Republic of China Tel/Fax +86 768-2317422 Email
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Valenzuela G, Castro LE, Valencia-Zamora J, Vera-Arias CA, Rohrbach P, Sáenz FE. Genotypes and phenotypes of resistance in Ecuadorian Plasmodium falciparum. Malar J 2019; 18:415. [PMID: 31822269 PMCID: PMC6905098 DOI: 10.1186/s12936-019-3044-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria continues to be endemic in the coast and Amazon regions of Ecuador. Clarifying current Plasmodium falciparum resistance in the country will support malaria elimination efforts. In this study, Ecuadorian P. falciparum parasites were analysed to determine their drug resistance genotypes and phenotypes. METHODS Molecular analyses were performed to search for mutations in known resistance markers (Pfcrt, Pfdhfr, Pfdhps, Pfmdr1, k13). Pfmdr1 copy number was determined by qPCR. PFMDR1 transporter activity was characterized in live parasites using live cell imaging in combination with the Fluo-4 transport assay. Chloroquine, quinine, lumefantrine, mefloquine, dihydroartemisinin, and artemether sensitivities were measured by in vitro assays. RESULTS The majority of samples from this study presented the CVMNT genotype for Pfcrt (72-26), NEDF SDFD mutations in Pfmdr1 and wild type genotypes for Pfdhfr, Pfdhps and k13. The Ecuadorian P. falciparum strain ESM-2013 showed in vitro resistance to chloroquine, but sensitivity to quinine, lumefantrine, mefloquine, dihydroartemisinin and artemether. In addition, transport of the fluorochrome Fluo-4 from the cytosol into the digestive vacuole (DV) of the ESM-2013 strain was minimally detected in the DV. All analysed samples revealed one copy of Pfmdr1. CONCLUSION This study indicates that Ecuadorian parasites presented the genotype and phenotype for chloroquine resistance and were found to be sensitive to SP, artemether-lumefantrine, quinine, mefloquine, and dihydroartemisinin. The results suggest that the current malaria treatment employed in the country remains effective. This study clarifies the status of anti-malarial resistance in Ecuador and informs the P. falciparum elimination campaigns in the country.
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Affiliation(s)
- Gabriela Valenzuela
- Centro de Investigación para la Salud en América Latina, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado, 17-01-2184, Quito, Ecuador
| | | | | | - Claudia A Vera-Arias
- Centro de Investigación para la Salud en América Latina, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado, 17-01-2184, Quito, Ecuador
| | - Petra Rohrbach
- Institute of Parasitology, McGill University, Montreal, Canada
| | - Fabián E Sáenz
- Centro de Investigación para la Salud en América Latina, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado, 17-01-2184, Quito, Ecuador.
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Jiang T, Chen J, Fu H, Wu K, Yao Y, Eyi JUM, Matesa RA, Obono MMO, Du W, Tan H, Lin M, Li J. High prevalence of Pfdhfr-Pfdhps quadruple mutations associated with sulfadoxine-pyrimethamine resistance in Plasmodium falciparum isolates from Bioko Island, Equatorial Guinea. Malar J 2019; 18:101. [PMID: 30914041 PMCID: PMC6434785 DOI: 10.1186/s12936-019-2734-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sulfadoxine-pyrimethamine (SP) is recommended for intermittent preventive treatment of malaria in Africa. However, increasing SP resistance (SPR) affects the therapeutic efficacy of the SP. As molecular markers, Pfdhfr (dihydrofolate reductase) and Pfdhps (dihydropteroate synthase) genes are widely used for SPR surveillance. This study aimed to assess the prevalence of Pfdhfr and Pfdhps genes mutations and haplotypes in Plasmodium falciparum isolates collected from Bioko Island, Equatorial Guinea (EG). METHODS In total, 180 samples were collected in 2013-2014. The single nucleotide polymorphisms (SNPs) of the Pfdhfr and Pfdhps genes were identified with nested PCR and Sanger sequencing. The genotypes and linkage disequilibrium (LD) tests were also analysed. RESULTS Sequences of Pfdhfr and Pfdhps genes were obtained from 92.78% (167/180) and 87.78% (158/180) of the samples, respectively. For Pfdhfr, 97.60% (163/167), 87.43% (146/167) and 97.01% (162/167) of the samples carried N51I, C59R and S108N mutant alleles, respectively. The prevalence of the Pfdhps S436A, A437G, K540E, A581G, and A613S mutations were observed in 20.25% (32/158), 90.51% (143/158), 5.06% (8/158), 0.63% (1/158), and 3.16% (5/158) of the samples, respectively. In total, 3 unique haplotypes at the Pfdhfr locus and 8 haplotypes at the Pfdhps locus were identified. A triple mutation (CIRNI) in Pfdhfr was the most prevalent haplotype (86.83%), and a single mutant haplotype (SGKAA; 62.66%) was predominant in Pfdhps. A total of 130 isolates with 12 unique haplotypes were found in the Pfdhfr and Pfdhps combined haplotypes, 65.38% (85/130) of them carried quadruple allele combinations (CIRNI-SGKAA), whereas only one isolate (0.77%, 1/130) was found to carry the wild-type (CNCSI-SAKAA). For LD analysis, the Pfdhfr N51I was significantly associated with the Pfdhps A437G (P < 0.05). CONCLUSION Bioko Island possesses a high prevalence of the Pfdhfr triple mutation (CIRNI) and Pfdhps single mutation (SGKAA), which will undermine the pharmaceutical effect of SP for malaria treatment strategies. To avoid an increase in SPR, continuous molecular monitoring and additional control efforts are urgently needed in Bioko Island, Equatorial Guinea.
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Affiliation(s)
- Tingting Jiang
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Jiangtao Chen
- The Chinese Medical Aid Team To the Republic of Equatorial Guinea; Laboratory Medical Center, Huizhou Municipal Central Hospital, Huizhou, 516001, People's Republic of China
| | - Hongxia Fu
- Clinical Laboratory, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Kai Wu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, People's Republic of China
| | - Yi Yao
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | | | - Rocio Apicante Matesa
- Department of Medical Laboratory, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | | | - Weixing Du
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Huabing Tan
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Min Lin
- Department of Histology and Embryology, Shantou University Medical College, Shantou, People's Republic of China.
| | - Jian Li
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.
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Surveillance of Antimalarial Resistance Pfcrt, Pfmdr1, and Pfkelch13 Polymorphisms in African Plasmodium falciparum imported to Shandong Province, China. Sci Rep 2018; 8:12951. [PMID: 30154519 PMCID: PMC6113250 DOI: 10.1038/s41598-018-31207-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/14/2018] [Indexed: 12/23/2022] Open
Abstract
Antimalarial drug resistance is a major public health problem in China. From 2012 to 2015, more than 75% of malaria cases in Shandong Province were P. falciparum returned from Africa. However, molecular marker polymorphisms of drug resistance in imported P. falciparum cases have not been evaluated. In this study, we analyzed polymorphisms of the Pfcrt, Pfmdr1, and Pfkelch13 genes in 282 P. falciparum cases returned from Africa to Shandong between 2012 and 2015. Among the isolates, polymorphisms were detected in codons 74–76 of Pfcrt and 86, 184, 1246 of Pfmdr1, among which K76T (36.6%) and Y184F (60.7%) were the most prevalent, respectively. Six Pfcrt haplotypes and 11 Pfmdr1 haplotypes were identified and a comparison was made on the prevalence of haplotypes among East Africa, West Africa, Central Africa and South Africa. One synonymous and 9 nonsynonymous mutations in Pfkelch13 were detected in the isolates (4.6%), among which a candidate artemisinin (ART) resistance mutation P553L was observed. The study establishes fundamental data for detection of chloroquine resistance (CQR) and ART resistance with molecular markers of the imported P. falciparum in China, and it also enriches the genetic data of antimalarial resistance for the malaria endemic countries in Africa.
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Zhang Y, Yao Y, Du W, Wu K, Xu W, Lin M, Tan H, Li J. Development of loop-mediated isothermal amplification with Plasmodium falciparum unique genes for molecular diagnosis of human malaria. Pathog Glob Health 2017; 111:247-255. [PMID: 28683669 PMCID: PMC5560202 DOI: 10.1080/20477724.2017.1347379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In order to achieve better outcomes for treatment and in the prophylaxis of malaria, it is imperative to develop a sensitive, specific, and accurate assay for early diagnosis of Plasmodium falciparum infection, which is the major cause of malaria. In this study, we aimed to develop a loop-mediated isothermal amplification (LAMP) assay with P. falciparum unique genes for sensitive, specific, and accurate detection of P. falciparum infection. The unique genes of P. falciparum were randomly selected from PlasmoDB. The LAMP primers of the unique genes were designed using PrimerExplorer V4. LAMP assays with primers from unique genes of P. falciparum and conserved 18S rRNA gene were developed and their sensitivity was assessed. The specificity of the most sensitive LAMP assay was further examined using genomic DNA from Plasmodium vivax, Plasmodium yoelii and Toxoplasma gondii. Finally, the unique gene-based LAMP assay was validated using clinical samples of P. falciparum infection cases. A total of 31 sets of top-scored LAMP primers from nine unique genes were selected from the pools of designed primers. The LAMP assay with PF3D7_1253300-5 was the most sensitive with the detection limit 5 parasites/μl, and it displayed negative LAMP assay with the genomic DNA samples of P. vivax, P. yoelii, and T. gondii. The LAMP assay with PF3D7_0112300 (18S rRNA) was less sensitive with the detection limit 50 parasites/μl, and it displayed negative LAMP assay with the genomic DNA samples of P. yoelii and T. gondii, but displayed positive LAMP detection with P. vivax. The positive detection rate of the LAMP assay with PF3D7_1253300-5 was 90% (27/30), higher than that (80%, 24/30) of the positive rate of PF3D7_0112300 (18S rRNA) in examining clinical samples of P. falciparum infection cases. The LAMP assay with the primer set PF3D7_1253300-5 was more sensitive, specific, and accurate than those with PF3D7_0112300 (18S rRNA) in examining P. falciparum infection, and therefore it is a promising tool for diagnosis of P. falciparum infection.
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Affiliation(s)
- Yijing Zhang
- Department of Human Parasitology, College of Basic Medicine; Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Yi Yao
- Department of Human Parasitology, College of Basic Medicine; Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Weixing Du
- Department of Human Parasitology, College of Basic Medicine; Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Kai Wu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, People’s Republic of China
| | - Wenyue Xu
- The Department of Pathogenic Biology, Third Military Medical University, Chongqing, People’s Republic of China
| | - Min Lin
- Department of Histology and Embryology, Shantou University Medical College, Shantou, People’s Republic of China
| | - Huabing Tan
- Department of Human Parasitology, College of Basic Medicine; Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
| | - Jian Li
- Department of Human Parasitology, College of Basic Medicine; Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China
- Corresponding author.
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Pholwat S, Liu J, Stroup S, Jacob ST, Banura P, Moore CC, Huang F, Laufer MK, Houpt E, Guler JL. The Malaria TaqMan Array Card Includes 87 Assays for Plasmodium falciparum Drug Resistance, Identification of Species, and Genotyping in a Single Reaction. Antimicrob Agents Chemother 2017; 61:e00110-17. [PMID: 28264857 PMCID: PMC5404514 DOI: 10.1128/aac.00110-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/02/2017] [Indexed: 11/20/2022] Open
Abstract
Antimalarial drug resistance exacerbates the global disease burden and complicates eradication efforts. To facilitate the surveillance of resistance markers in countries of malaria endemicity, we developed a suite of TaqMan assays for known resistance markers and compartmentalized them into a single array card (TaqMan array card, TAC). We included 87 assays for species identification, for the detection of Plasmodium falciparum mutations associated with chloroquine, atovaquone, pyrimethamine, sulfadoxine, and artemisinin resistance, and for neutral single nucleotide polymorphism (SNP) genotyping. Assay performance was first optimized using DNA from common laboratory parasite lines and plasmid controls. The limit of detection was 0.1 to 10 pg of DNA and yielded 100% accuracy compared to sequencing. The tool was then evaluated on 87 clinical blood samples from around the world, and the malaria TAC once again achieved 100% accuracy compared to sequencing and in addition detected the presence of mixed infections in clinical samples. With its streamlined protocol and high accuracy, this malaria TAC should be a useful tool for large-scale antimalarial resistance surveillance.
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Affiliation(s)
- Suporn Pholwat
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Suzanne Stroup
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Shevin T Jacob
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Patrick Banura
- Department of Community Health, Masaka Regional Referral Hospital, Masaka, Uganda
| | - Christopher C Moore
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Fang Huang
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| | - Miriam K Laufer
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eric Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer L Guler
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Department of Biology, University of Virginia, Charlottesville, Virginia, USA
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Berzosa P, Esteban-Cantos A, García L, González V, Navarro M, Fernández T, Romay-Barja M, Herrador Z, Rubio JM, Ncogo P, Santana-Morales M, Valladares B, Riloha M, Benito A. Profile of molecular mutations in pfdhfr, pfdhps, pfmdr1, and pfcrt genes of Plasmodium falciparum related to resistance to different anti-malarial drugs in the Bata District (Equatorial Guinea). Malar J 2017; 16:28. [PMID: 28086777 PMCID: PMC5237300 DOI: 10.1186/s12936-016-1672-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/30/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The emergence of drug resistance in Plasmodium falciparum has been a major contributor to the global burden of malaria. Drug resistance complicates treatment, and it is one of the most important problems in malaria control. This study assessed the level of mutations in P. falciparum genes, pfdhfr, pfdhps, pfmdr1, and pfcrt, related to resistance to different anti-malarial drugs, in the Continental Region of Equatorial Guinea, after 8 years of implementing artesunate combination therapies as the first-line treatment. RESULTS A triple mutant of pfdhfr (51I/59R/108N), which conferred resistance to sulfadoxine/pyrimethamine (SP), was found in 78% of samples from rural settings; its frequency was significantly different between urban and rural settings (p = 0.007). The 164L mutation was detected for the first time in this area, in rural settings (1.4%). We also identified three classes of previously described mutants and their frequencies: the partially resistant (pfdhfr 51I/59R/108N + pfdhps 437G), found at 54% (95% CI 47.75-60.25); the fully resistant (pfdhfr 51I/59R/108N + pfdhps 437G/540E), found at 28% (95% CI 7.07-14.93); and the super resistant (pfdhfr 51I/59R/108N + pfdhps 437G/540E/581G), found at 6% (95% CI 0.48-4.32). A double mutation in pfmdr1 (86Y + 1246Y) was detected at 2% (95% CI 0.24-3.76) frequency, distributed in both urban and rural samples. A combination of single mutations in the pfmdr1 and pfcrt genes (86Y + 76T), which was related to resistance to chloroquine and amodiaquine, was detected in 22% (95% CI 16.8-27.2) of samples from the area. CONCLUSIONS The high level of mutations detected in P. falciparum genes related to SP resistance could be linked to the unsuccessful withdrawal of SP treatment in this area. Drug resistance can reduce the efficacy of intermittent prophylactic treatment with SP for children under 5 years old and for pregnant women. Although a high number of mutations was detected, the efficacy of the first-line treatment, artemisinin/amodiaquine, was not affected. To avoid increases in the numbers, occurrence, and spread of mutations, and to protect the population, the Ministry of Health should ensure that health centres and hospitals are supplied with appropriate first-line treatments for malaria.
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Affiliation(s)
- Pedro Berzosa
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Andrés Esteban-Cantos
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
| | - Luz García
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Vicenta González
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Marisa Navarro
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
| | - Taiomara Fernández
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
| | - María Romay-Barja
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
| | - Zaida Herrador
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
| | - José Miguel Rubio
- National Centre of Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Policarpo Ncogo
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
- Ministry of Health and Social Welfare of Equatorial Guinea, Malabo, Equatorial Guinea
| | - María Santana-Morales
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de la Laguna, Tenerife, Spain
| | - Basilio Valladares
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de la Laguna, Tenerife, Spain
| | - Matilde Riloha
- Ministry of Health and Social Welfare of Equatorial Guinea, Malabo, Equatorial Guinea
| | - Agustín Benito
- Malaria Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029 Madrid, Spain
- Network Collaborative Research in Tropical Diseases, RICET, Madrid, Spain
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Bhagavathula AS, Elnour AA, Shehab A. Alternatives to currently used antimalarial drugs: in search of a magic bullet. Infect Dis Poverty 2016; 5:103. [PMID: 27809883 PMCID: PMC5095999 DOI: 10.1186/s40249-016-0196-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 09/20/2016] [Indexed: 01/09/2023] Open
Abstract
Malaria is a major cause of morbidity and mortality in many African countries and parts of Asia and South America. Novel approaches to combating the disease have emerged in recent years and several drug candidates are now being tested clinically. However, it is long before these novel drugs can hit the market, especially due to a scarcity of safety and efficacy data.To reduce the malaria burden, the Medicines for Malaria Venture (MMV) was established in 1999 to develop novel medicines through industry and academic partners' collaboration. However, no reviews were focused following various preclinical and clinical studies published since the MMV initiation (2000) to till date.We identify promising approaches in the global portfolio of antimalarial medicines, and highlight challenges and patient specific concerns of these novel molecules. We discuss different clinical studies focusing on the evaluation of novel drugs against malaria in different human trials over the past five years.The drugs KAE609 and DDD107498 are still being evaluated in Phase I trials and preclinical developmental studies. Both the safety and efficacy of novel compounds such as KAF156 and DSM265 need to be assessed further, especially for use in pregnant women. Synthetic non-artemisinin ozonides such as OZ277 raised concerns in terms of its insufficient efficacy against high parasitic loads. Aminoquinoline-based scaffolds such as ferroquine are promising but should be combined with good partner drugs for enhanced efficacy. AQ-13 induced electrocardiac events, which led to prolonged QTc intervals. Tafenoquine, the only new anti-relapse scaffold for patients with a glucose-6-phosphate dehydrogenase deficiency, has raised significant concerns due to its hemolytic activity. Other compounds, including methylene blue (potential transmission blocker) and fosmidomycin (DXP reductoisomerase inhibitor), are available but cannot be used in children.At this stage, we are unable to identify a single magic bullet against malaria. Future studies should focus on effective single-dose molecules that can act against all stages of malaria in order to prevent transmission. Newer medicines have also raised concerns in terms of efficacy and safety. Overall, more evidence is needed to effectively reduce the current malaria burden. Treatment strategies that target the blood stage with transmission-blocking properties are needed to prevent future drug resistance.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, University of Gondar-College of Medicine and Health Sciences, School of Pharmacy, Gondar, Ethiopia
| | - Asim Ahmed Elnour
- Pharmacy College, Fatima College of Health Sciences, Al Ain, Abu Dhabi United Arab Emirates
| | - Abdulla Shehab
- Department of Internal medicine, College of Medicine and Health Sciences, UAE University, Al Ain, Abu Dhabi United Arab Emirates
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Yang S, Jiao D, Liu C, Lv M, Li S, Chen Z, Deng Y, Zhao Y, Li J. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses, and Treponema pallidum infections among blood donors at Shiyan, Central China. BMC Infect Dis 2016; 16:531. [PMID: 27716251 PMCID: PMC5045580 DOI: 10.1186/s12879-016-1845-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 09/17/2016] [Indexed: 12/26/2022] Open
Abstract
Background Ordinary screening of transfusion-transmissible infections (TTIs) among blood donors is essential for blood transfusion. Although there is several TTIs studies focus on human immunodeficiency virus, hepatitis B and C viruses, and Treponema pallidum infections in China, it is no data to illustrate any firm conclusion from Shiyan City, Central China. It aims to verify the seroprevalence of TTIs among blood donors at Shiyan. Methods A retrospective analysis of blood donors’ information was conducted for the presence of HIV, HBV, HCV and T. pallidum. Logistic regression analysis was used to demonstrate risk factors including age, gender and occupation associated with them. The variation tendency in seroprevalence of these TTIs over the study period was evaluated by Cochran-Armitage trend test. Results Of 211 639 blood donors, 2 858 (1.35 %) had serological evidence of TTIs. The seroprevalence of HIV, HBV, HCV and T. pallidum were 0.08 %, 0.51 %, 0.20 % and 0.57 %, respectively. However, the co-infection prevalence of TTIs has not been detected. The HIV seropositivity significantly increased among female donors (OR = 1.63, P < 0.001) and farmers (OR = 2.02, P = 0.020). Significantly increased HBV seropositivity was only observed framers (OR = 1.87, P <0.001) compared to workers. Analogously, significantly increased HCV seropositivity was observed among farmers (OR = 2.59, P < 0.001), students (OR = 2.43, P < 0.001), merchants (OR = 1.70, P = 0.014) and others (OR = 1.78, P =0.001). The T. pallidum seroprevalence was notably increased among female (OR = 1.54, P < 0.001), and farmers (OR = 1.70, P <0.001). Moreover, significantly increasing trends of HIV (Z = −6.88, P < 0.01), HBV (Z = −4.52, P < 0.01), HCV (Z = −4.16, P < 0.01) and T. pallidum (Z = −1.36, P < 0.01) seropositivity were observed over the study period. Conclusions It originally offers a substantial prevalence of TTIs among blood donors at Shiyan, Central China. Severe blood donor selection and all-inclusive screening of blood are highly recommended. It might be helpful for developing and updating guidance for blood safety. Trial registration Retrospectively registered.
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Affiliation(s)
- Shuguo Yang
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Danmei Jiao
- Shiyan Blood Transfusion Center, Laboratory Medical Center, Shiyan, 442000, China
| | - Changjun Liu
- Department of Preventive Medicine, College of Public Health and Management, Hubei University of Medicine, Shiyan, 442000, China
| | - Ming Lv
- Shiyan Blood Transfusion Center, Laboratory Medical Center, Shiyan, 442000, China
| | - Shan Li
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Zongyun Chen
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Yao Deng
- Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Yanqing Zhao
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Jian Li
- Institute of Basic Medical Science, College of Basic Medicine; Department of Infectious Disease, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, China.
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21
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Li J, Chen J, Xie D, Eyi UM, Matesa RA, Ondo Obono MM, Ehapo CS, Yang L, Yang H, Lin M. Limited artemisinin resistance-associated polymorphisms in Plasmodium falciparum K13-propeller and PfATPase6 gene isolated from Bioko Island, Equatorial Guinea. Int J Parasitol Drugs Drug Resist 2016; 6:54-59. [PMID: 27054064 PMCID: PMC4805774 DOI: 10.1016/j.ijpddr.2015.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/03/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE With emergence and geographically expanding of antimalarial resistance worldwide, molecular markers are essential tool for surveillance of resistant Plasmodium parasites. Recently, single-nucleotide polymorphisms (SNPs) in the PF3D7_1343700 kelch propeller (K13-propeller) domain are shown to be associated with artemisinin (ART) resistance in vivo and in vitro. This study aims to investigate the ART resistance-associated polymorphisms of K13-propeller and PfATPase6 genes in Plasmodium falciparum isolates from Bioko Island, Equatorial Guinea (EG). METHODS A total of 172 samples were collected from falciparum malaria patients on Bioko Island between 2013 and 2014. The polymorphisms of K13-propeller and PfATPase6 genes were analyzed by Nest-PCR and sequencing. RESULTS Sequences of K13-propeller and PfATPase6 were obtained from 90.74% (98/108) and 91.45% (139/152) samples, respectively. The 2.04% (2/98) cases had non-synonymous K13-propeller A578S mutation but no found the mutations associated with ART resistance in Southeast Asia. For PfATPase6, the mutations were found at positions N569K and A630S with the mutation prevalence of 7.91% (11/139) and 1.44% (2/139), respectively. In addition, a sample with the mixed type at position I723V was discovered (0.72%, 1/139). CONCLUSIONS This study initially offers an insight of K13-propeller and PfATPase6 polymorphisms on Bioko Island, EG. It suggests no widespread ART resistance or tolerance in the region, and might be helpful for developing and updating guidance for the use of ART-based combination therapies (ACTs).
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Affiliation(s)
- Jian Li
- Institute of Basic Medical Sciences, College of Basic Medicine, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, People's Republic of China
| | - Jiangtao Chen
- Laboratory Medical Center, Huizhou Municipal Central Hospital, Huizhou 516001, People's Republic of China; The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou 510000, People's Republic of China
| | - Dongde Xie
- The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou 510000, People's Republic of China
| | - Urbano Monsuy Eyi
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo 999115, Equatorial Guinea
| | - Rocio Apicante Matesa
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo 999115, Equatorial Guinea
| | - Maximo Miko Ondo Obono
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo 999115, Equatorial Guinea
| | - Carlos Sala Ehapo
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo 999115, Equatorial Guinea
| | - Liye Yang
- Laboratory Medical Center, Chaozhou Central Hospital, Southern Medical University, Chaozhou 521021, People's Republic of China
| | - Huitian Yang
- Laboratory Medical Center, Chaozhou Central Hospital, Southern Medical University, Chaozhou 521021, People's Republic of China
| | - Min Lin
- Laboratory Medical Center, Chaozhou Central Hospital, Southern Medical University, Chaozhou 521021, People's Republic of China; Department of Histology and Embryology, Shantou University Medical College, Shantou 515000, Guangdong, People's Republic of China.
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22
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Xie DD, Li J, Chen JT, Eyi UM, Matesa RA, Obono MMO, Ehapo CS, Yang LY, Yang H, Yang HT, Lin M. Seroprevalence of Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and Treponema pallidum Infections among Blood Donors on Bioko Island, Equatorial Guinea. PLoS One 2015; 10:e0139947. [PMID: 26448460 PMCID: PMC4598168 DOI: 10.1371/journal.pone.0139947] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Regular screening of transfusion-transmissible infections (TTIs), such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C virus (HBV and HCV, respectively), and Treponema pallidum, in blood donors is essential to guaranteeing clinical transfusion safety. This study aimed to determine the seroprevalence of four TTIs among blood donors on Bioko Island, Equatorial Guinea (EG). Methods A retrospective survey of blood donors from January 2011 to April 2013 was conducted to assess the presence of HIV, HBV, HCV and T. pallidum. The medical records were analyzed to verify the seroprevalence of these TTIs among blood donations stratified by gender, age and geographical region. Results Of the total 2937 consecutive blood donors, 1098 (37.39%) had a minimum of one TTI and 185 (6.29%) harbored co-infections. The general seroprevalence of HIV, HBV, HCV and T. pallidum were 7.83%, 10.01%, 3.71% and 21.51%, respectively. The most frequent TTI co-infections were HBV-T. pallidum 60 (2.04%) and HIV-T. pallidum 46 (1.57%). The seroprevalence of HIV, HBV, HCV and T. pallidum were highest among blood donors 38 to 47 years, 18 to 27 years and ≥ 48 years age, respectively (P<0.05). The seroprevalence of TTIs varied according to the population from which the blood was collected on Bioko Island. Conclusions Our results firstly provide a comprehensive overview of TTIs among blood donors on Bioko Island. Strict screening of blood donors and improved hematological examinations using standard operating procedures are recommended.
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Affiliation(s)
- Dong-De Xie
- Laboratory Medical Center, The People’s Hospital of Jiangmen, Jiangmen; The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Li
- Department of Infectious Diseases, Renmin Hospital; Department of Parasitology, College of Basic Medicine, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China
| | - Jiang-Tao Chen
- Laboratory Medical Center, The People’s Hospital of Jiangmen, Jiangmen; The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou, Guangdong Province, People’s Republic of China
- Laboratory Medical Center, Huizhou Municipal Central Hospital, Guangdong, Huizhou, Guangdong, People’s Republic of China
| | - Urbano Monsuy Eyi
- Central Blood Transfusion Service; Medical Laboratory, Malabo Regional Hospital, Malabo, the Republic of Equatorial Guinea
| | - Rocio Apicante Matesa
- Central Blood Transfusion Service; Medical Laboratory, Malabo Regional Hospital, Malabo, the Republic of Equatorial Guinea
| | - Maximo Miko Ondo Obono
- Central Blood Transfusion Service; Medical Laboratory, Malabo Regional Hospital, Malabo, the Republic of Equatorial Guinea
| | - Carlos Sala Ehapo
- Central Blood Transfusion Service; Medical Laboratory, Malabo Regional Hospital, Malabo, the Republic of Equatorial Guinea
| | - Li-Ye Yang
- Central Laboratory, Chaozhou Central Hospital, Southern Medical University, Chaozhou, Guangdong, People’s Republic of China
| | - Hui Yang
- Central Laboratory, Chaozhou Central Hospital, Southern Medical University, Chaozhou, Guangdong, People’s Republic of China
| | - Hui-Tian Yang
- Central Laboratory, Chaozhou Central Hospital, Southern Medical University, Chaozhou, Guangdong, People’s Republic of China
| | - Min Lin
- Central Laboratory, Chaozhou Central Hospital, Southern Medical University, Chaozhou, Guangdong, People’s Republic of China
- * E-mail:
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Li J, Chen J, Xie D, Eyi UM, Matesa RA, Obono MMO, Ehapo CS, Yang L, Yang H, Lin M, Wu W, Wu K, Li S, Chen Z. Molecular mutation profile of Pfcrt and Pfmdr1 in Plasmodium falciparum isolates from Bioko Island, Equatorial Guinea. INFECTION GENETICS AND EVOLUTION 2015; 36:552-556. [PMID: 26325683 DOI: 10.1016/j.meegid.2015.08.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/11/2015] [Accepted: 08/27/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Antimalarial drug resistance is a primary public health problem. Haplotypes of pfcrt and pfmdr1 gene have been implicated to be molecular markers of chloroquine (CQ) resistance. This study aims to explore mutation distribution of Pfcrt and Pfmdr1 in Bioko Island, Equatorial Guinea (EG). METHODS Blood samples were collected from different districts of Bioko. The single nucleotide polymorphisms in Pfcrt (codons 72 to 76) and Pfmdr1 (codons 86, 130, 184, 1034, 1042, 1109 and 1246) were assessed by nested PCR with DNA sequencing and haplotype prevalences were also determined. RESULTS Analysis of Pfcrt and Pfmdr1 mutations was successful in 151 and 157 samples respectively out of the 172 samples taken for this study. The mutations of Pfcrt and Pfmdr1 were found in 98.67% and 89.81% isolates, respectively. The Pfcrt 74-76, Pfmdr1 86, and Pfmdr1 184 were 92.05%, 50.32%, and 87.26% found mostly of mutation type, respectively. Three haplotypes coding 72-76 of Pfcrt were found including CVMNK, CVIET, and CVM/I N/E K/T, which accounted for 1.33%, 92.05%, and 6.62%, respectively. No mutation in Pfmdr1-N1 codon at 130 and Pfmdr1-N2 (S1034C, N1042D, V1109I, and D1246Y) was detected. The types coding 86 and 184 in Pfmdr1 were found including NY, YY, NF, YF, NY/F and YY/F, which accounted for 10.19%, 2.55%, 33.76%, 45.22%, 5.73% and 2.55%, respectively. CONCLUSION High prevalence of Pfcrt CVIET and Pfmdr1 86Y, 184F double mutations confirm high-level CQ resistance (CQR) and might suggest reduced susceptibility of Plasmodium falciparum isolates to AQ in Bioko, EG. It establishes fundamental data for detection of P. falciparum CQR with molecular markers and will promotes the surveillance level of drug resistance in Bioko, EG.
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Affiliation(s)
- Jian Li
- Department of Parasitology, College of Basic Medicine, Department of Infectious Diseases, Shiyan Renmin Hospital, Hubei University of Medicine, Shiyan 442000, People's Republic of China
| | - Jiangtao Chen
- The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou 510000, People's Republic of China
| | - Dongde Xie
- The Chinese Medical Aid Team to the Republic of Equatorial Guinea, Guangzhou 510000, People's Republic of China
| | - Urbano Monsuy Eyi
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | - Rocio Apicante Matesa
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | - Maximo Miko Ondo Obono
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | - Carlos Sala Ehapo
- Central Blood Transfusion Service, Department of Medical Laboratory Science, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | - Liye Yang
- Laboratory Medical Center, Chaozhou Central Hospital, Southern Medical University, Chaozhou 521021, People's Republic of China
| | - Huitian Yang
- Laboratory Medical Center, Chaozhou Central Hospital, Southern Medical University, Chaozhou 521021, People's Republic of China
| | - Min Lin
- Laboratory Medical Center, Chaozhou Central Hospital, Southern Medical University, Chaozhou 521021, People's Republic of China.
| | - Wanjun Wu
- Department of Parasitology, College of Basic Medicine, Department of Infectious Diseases, Shiyan Renmin Hospital, Hubei University of Medicine, Shiyan 442000, People's Republic of China
| | - Kai Wu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Control and Prevention, Wuhan 430015, People's Republic of China
| | - Shan Li
- Department of Parasitology, College of Basic Medicine, Department of Infectious Diseases, Shiyan Renmin Hospital, Hubei University of Medicine, Shiyan 442000, People's Republic of China
| | - Zongyun Chen
- Department of Parasitology, College of Basic Medicine, Department of Infectious Diseases, Shiyan Renmin Hospital, Hubei University of Medicine, Shiyan 442000, People's Republic of China
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