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Milong Melong CS, Peloewetse E, Russo G, Tamgue O, Tchoumbougnang F, Paganotti GM. An overview of artemisinin-resistant malaria and associated Pfk13 gene mutations in Central Africa. Parasitol Res 2024; 123:277. [PMID: 39023630 DOI: 10.1007/s00436-024-08301-2] [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: 04/02/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
Malaria caused by Plasmodium falciparum is one of the deadliest and most common tropical infectious diseases. However, the emergence of artemisinin drug resistance associated with the parasite's Pfk13 gene, threatens the public health of individual countries as well as current efforts to reduce malaria burdens globally. It is of concern that artemisinin-resistant parasites may be selected or have already emerged in Africa. This narrative review aims to evaluate the published evidence concerning validated, candidate, and novel Pfk13 polymorphisms in ten Central African countries. Results show that four validated non-synonymous polymorphisms (M476I, R539T, P553L, and P574L), directly associated with a delayed therapy response, have been reported in the region. Also, two Pfk13 polymorphisms associated to artemisinin resistance but not validated (C469F and P527H) have been reported. Furthermore, several non-validated mutations have been observed in Central Africa, and one allele A578S, is commonly found in different countries, although additional molecular and biochemical studies are needed to investigate whether those mutations alter artemisinin effects. This information is discussed in the context of biochemical and genetic aspects of Pfk13, and related to the regional malaria epidemiology of Central African countries.
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Affiliation(s)
- Charlotte Sabine Milong Melong
- Department of Biochemistry, Faculty of Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- Botswana-University of Pennsylvania Partnership, P.O. Box 45498, Gaborone, Riverwalk, Botswana
| | - Elias Peloewetse
- Department of Biological Sciences, Faculty of Sciences, University of Botswana, Private Bag, 0022, Gaborone, UB, Botswana
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy
| | - Ousman Tamgue
- Department of Biochemistry, Faculty of Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
| | - Francois Tchoumbougnang
- Department of Processing and Quality Control of Aquatic Products, Institute of Fisheries and Aquatic Sciences, University of Douala, P.O. Box 7236, Douala, Cameroon
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, P.O. Box 45498, Gaborone, Riverwalk, Botswana.
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Yade MS, Dièye B, Coppée R, Mbaye A, Diallo MA, Diongue K, Bailly J, Mama A, Fall A, Thiaw AB, Ndiaye IM, Ndiaye T, Gaye A, Tine A, Diédhiou Y, Mbaye AM, Doderer-Lang C, Garba MN, Bei AK, Ménard D, Ndiaye D. Ex vivo RSA and pfkelch13 targeted-amplicon deep sequencing reveal parasites susceptibility to artemisinin in Senegal, 2017. Malar J 2023; 22:167. [PMID: 37237307 PMCID: PMC10223908 DOI: 10.1186/s12936-023-04588-1] [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: 02/01/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Malaria control is highly dependent on the effectiveness of artemisinin-based combination therapy (ACT), the current frontline malaria curative treatment. Unfortunately, the emergence and spread of parasites resistant to artemisinin (ART) derivatives in Southeast Asia and South America, and more recently in Rwanda and Uganda (East Africa), compromise their long-term use in sub-Saharan Africa, where most malaria deaths occur. METHODS Here, ex vivo susceptibility to dihydroartemisinin (DHA) was evaluated from 38 Plasmodium falciparum isolates collected in 2017 in Thiès (Senegal) expressed in the Ring-stage Survival Assay (RSA). Both major and minor variants were explored in the three conserved-encoding domains of the pfkelch13 gene, the main determinant of ART resistance using a targeted-amplicon deep sequencing (TADS) approach. RESULTS All samples tested in the ex vivo RSA were found to be susceptible to DHA (parasite survival rate < 1%). The non-synonymous mutations K189T and K248R in pfkelch13 were observed each in one isolate, as major (99%) or minor (5%) variants, respectively. CONCLUSION The results suggest that ART is still fully effective in the Thiès region of Senegal in 2017. Investigations combining ex vivo RSA and TADS are a useful approach for monitoring ART resistance in Africa.
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Affiliation(s)
- Mamadou Samb Yade
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Baba Dièye
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Romain Coppée
- Université Paris Cité and Sorbonne Paris Nord, Inserm, IAME, 75018 Paris, France
| | - Aminata Mbaye
- Université Gamal Abdel Nasser de Conakry/Centre for Research and Training in Infectiology of Guinea (CERFIG), Conakry, Guinea
| | - Mamadou Alpha Diallo
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Khadim Diongue
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
- Service of Parasitology-Mycology, Faculty of Medecine, Pharmacy, and Odontostomatology, Cheikh Anta Diop University of Dakar, Dakar, 10700 Senegal
| | | | - Atikatou Mama
- Université de Paris, Institut Cochin, Inserm U1016, Service de Parasitologie Hôpital Cochin, 75014 Paris, France
| | - Awa Fall
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Alphonse Birane Thiaw
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Ibrahima Mbaye Ndiaye
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Tolla Ndiaye
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Amy Gaye
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Abdoulaye Tine
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Younouss Diédhiou
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Amadou Mactar Mbaye
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Cécile Doderer-Lang
- Université de Strasbourg, Institute of Parasitology and Tropical Diseases, UR7292 Dynamics of Host-Pathogen Interactions, 67000 Strasbourg, France
| | - Mamane Nassirou Garba
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
| | - Amy Kristine Bei
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Didier Ménard
- Université de Strasbourg, Institute of Parasitology and Tropical Diseases, UR7292 Dynamics of Host-Pathogen Interactions, 67000 Strasbourg, France
- CHU Strasbourg, Laboratory of Parasitology and Medical Mycology, 67000 Strasbourg, France
- Institut Pasteur, Université Paris Cité, Malaria Genetics and Resistance Unit, INSERM U1201, 75015 Paris, France
- Institut Pasteur, Université de Paris, Malaria Parasite Biology and Vaccines Unit, Paris, France
| | - Daouda Ndiaye
- Laboratory of Parasitology-Mycology, Aristide le Dantec Hospital, Université Cheikh Anta Diop, Dakar, Senegal
- International Research Training Center on Genomics and Health Surveillance (CIGASS), Dakar, Senegal
- Service of Parasitology-Mycology, Faculty of Medecine, Pharmacy, and Odontostomatology, Cheikh Anta Diop University of Dakar, Dakar, 10700 Senegal
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Murmu LK, Panda M, Meher BR, Purohit P, Behera J, Barik TK. Molecular surveillance of Kelch-13 gene in Plasmodium falciparum field isolates from Mayurbhanj District, Odisha, India, and in silico artemisinin-Kelch-13 protein interaction study. Parasitol Res 2023; 122:717-727. [PMID: 36729138 DOI: 10.1007/s00436-023-07784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
The global malaria control and elimination program faces major threats due to the emergence and transmission of the anti-malarial drug-resistant strain of Plasmodium falciparum. Monitoring of artemisinin (ART) resistance marker Kelch-13 in the malaria-endemic region is essential in mitigating the disease's morbidity and mortality. The current study aimed to generate baseline information for further surveillance in the future. The current research was designed and conducted from July 2019 to June 2021 to monitor Pfkelch13 mutation at the molecular level in the eastern region of India. We also conducted an in silico study to understand the drug-protein interactions between ART and the protein crystal of PfKelch13 (KELCH) with PDB id:4ZGC. The kelch-13 gene was amplified by nested polymerase chain reaction (PCR) and sequenced through the Sanger sequencing method. Reference 3D7 clone (PF3D7_1343700) was used to align and probe all the sequences. The sequence analysis showed the absence of validated or associated mutation in the Kelch-13 propeller domain. The absence of natural selection in drug resistance was confirmed by the Tajima test. Further, in silico interaction studies between the drug ART and the Kelch propeller domain of P. falciparum were evaluated by structure predictions, molecular docking, molecular dynamics (MD) simulations, and estimations of binding free energies for the KELCH-ART complex. The results were compared with the apoprotein (KELCH-APO). The study confirmed the favorable binding of ART with the Kelch-13 propeller domain.
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Affiliation(s)
- Laxman Kumar Murmu
- P.G. Department of Zoology, Berhampur University, Berhampur, Odisha, 760007, India
| | - Madhusmita Panda
- Computational Biology & Bioinformatics Laboratory, P.G. Dept. of Botany, Berhampur University, Berhampur, Odisha, 760007, India
| | - Biswa Ranjan Meher
- Computational Biology & Bioinformatics Laboratory, P.G. Dept. of Botany, Berhampur University, Berhampur, Odisha, 760007, India
| | - Prasant Purohit
- Multi-Disciplinary Research Unit, M.K.C.G Medical College, Berhampur, Odisha, India
| | - Jayantiprava Behera
- Department of Pharmacology, M.K.C.G Medical College, Berhampur, Odisha, India
| | - Tapan Kumar Barik
- P.G. Department of Zoology, Berhampur University, Berhampur, Odisha, 760007, India.
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Yade MS, Dièye B, Coppée R, Mbaye A, Diallo MA, Diongue K, Bailly J, Mama A, Fall A, Thiaw AB, Ndiaye IM, Ndiaye T, Gaye A, Tine A, Diédhiou Y, Mbaye AM, Doderer-Lang C, Garba MN, Bei AK, Ménard D, Ndiaye D. Ex vivo RSA and Pfkelch13 targeted-amplicon deep sequencing reveal parasites susceptibility to artemisinin in Senegal, 2017. RESEARCH SQUARE 2023:rs.3.rs-2538775. [PMID: 36798264 PMCID: PMC9934778 DOI: 10.21203/rs.3.rs-2538775/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Malaria control is highly dependent on the effectiveness of artemisinin-based combination therapies (ACTs), the current frontline malaria curative treatments. Unfortunately, the emergence and spread of parasites resistant to artemisinin (ART) derivatives in Southeast Asia and South America, and more recently in Rwanda and Uganda (East Africa), compromise their long-term use in Sub-Saharan Africa where most malaria deaths occur. METHODS Here, we evaluated ex vivo susceptibility to dihydroartemisinin (DHA) from 38 P. falciparum isolates collected in 2017 in Thiès (Senegal) expressed with the Ring-stage Survival Assay (RSA). We explored major and minor variants in the full Pfkelch13 gene, the main determinant of ART resistance using a targeted-amplicon deep sequencing (TADS) approach. RESULTS All samples tested in the ex vivo RSA were found to be susceptible to DHA. Both non-synonymous mutations K189T and K248R were observed each in one isolate, as major (99%) or minor (5%) variants, respectively. CONCLUSION Altogether, investigations combining ex vivo RSA and TADS are a useful approach for monitoring ART resistance in Africa.
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Affiliation(s)
- Mamadou Samb Yade
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Baba Dièye
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Romain Coppée
- Université Paris Cité and Sorbone Paris Nord, Inserm, IAME
| | - Aminata Mbaye
- Centre for Research and Training in Infectiology of Guinea (CRTIG)
| | - Mamadou Alpha Diallo
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | | | | | | | - Awa Fall
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Alphonse Birane Thiaw
- Department of Biochemistry and Functional Genomics, Faculty of Medicine and Health Sciences
| | - Ibrahima Mbaye Ndiaye
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Tolla Ndiaye
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Amy Gaye
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Abdoulaye Tine
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Younouss Diédhiou
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | - Amadou Mactar Mbaye
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | | | - Mamane Nassirou Garba
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
| | | | - Didier Ménard
- Université de Strasbourg, UR7292 Dynamics of Host-Pathogen Interactions
| | - Daouda Ndiaye
- Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar
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Nzoumbou-Boko R, Velut G, Imboumy-Limoukou RK, Manirakiza A, Lekana-Douki JB. Malaria research in the Central African Republic from 1987 to 2020: an overview. Trop Med Health 2022; 50:70. [PMID: 36131331 PMCID: PMC9490699 DOI: 10.1186/s41182-022-00446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
Background The national malaria control policy in the Central African Republic (CAR) promotes basic, clinical, and operational research on malaria in collaboration with national and international research institutions. Preparatory work for the elaboration of National Strategic Plans for the implementation of the national malaria control policy includes developing the research component, thus requiring an overview of national malaria research. Here, this survey aims to provide an inventory of malaria research as a baseline for guiding researchers and health authorities in choosing the future avenues of research. Methods Data sources and search strategy were defined to query the online Medline/PubMed database using the “medical subject headings” tool. Eligibility and study inclusion criteria were applied to the selected articles, which were classified based on year, research institute affiliations, and research topic. Results A total of 118 articles were retrieved and 51 articles were ultimately chosen for the bibliometric analysis. The number of publications on malaria has increased over time from 1987 to 2020. These articles were published in 32 different journals, the most represented being the Malaria Journal (13.73%) and the American Journal of Tropical Medicine and Hygiene (11.76%). The leading research topics were drug evaluation (52.94%), expatriate patients (23.54%), malaria in children (17.65%), morbidity (13.7%), and malaria during pregnancy (11.76%). The publications’ authors were mainly affiliated with the Institut Pasteur of Bangui (41%), the French Military Medical Service (15.5%), and the University of Bangui (11.7%). Collaborations were mostly established with France, the UK, and the USA; some collaborations involved Switzerland, Austria, Pakistan, Japan, Sri Lanka, Benin, Cameroun, Ivory Coast, and Madagascar. The main sources of research funding were French agencies (28.6%) and international agencies (18.3%). Most studies included were not representative of the whole country. The CAR has the capacity to carry out research on malaria and to ensure the necessary collaborations. Conclusion Malaria research activities in the CAR seem to reflect the priorities of national policy. One remaining challenge is to develop a more representative approach to better characterize malaria cases across the country. Finally, future research and control measures need to integrate the effect of COVID-19.
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Affiliation(s)
- Romaric Nzoumbou-Boko
- Laboratoire de Parasitologie, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic.
| | - Guillaume Velut
- French Military Health Service, French Armed Forces Centre for Epidemiology and Public Health (CESPA), Marseille, France
| | - Romeo-Karl Imboumy-Limoukou
- Unité Évolution, Épidémiologie Et Résistances Parasitaires (UNEEREP), Centre International de Recherche Médicale de Franceville (CIRMF), BP769, Franceville, Gabon
| | - Alexandre Manirakiza
- Service d'épidémiologie, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
| | - Jean-Bernard Lekana-Douki
- Unité Évolution, Épidémiologie Et Résistances Parasitaires (UNEEREP), Centre International de Recherche Médicale de Franceville (CIRMF), BP769, Franceville, Gabon.,Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, Libreville, B.P. 4009, Franceville, Gabon
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Murmu LK, Barik TK. An analysis of Plasmodium falciparum-K13 mutations in India. J Parasit Dis 2022; 46:296-303. [PMID: 35299922 PMCID: PMC8901923 DOI: 10.1007/s12639-021-01425-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022] Open
Abstract
Malaria is one of the deadliest parasitic diseases in human. Currently, Artemisinin-based combination therapy is considered as the gold standard and most common treatment option. However, the origin and transmission of Plasmodium falciparum from the Greater Mekong Subregion, which has decreased artemisinin (ART) sensitivity, has sparked global concern. The reduced ART sensitivity has been associated with mutations in the Atpase6 and Kelch13 propeller domain of Plasmodium falciparum. A molecular marker is critically needed to monitor the spread of artemisinin resistance. In this article, we reviewed the k13 mutations and potential marker for ART resistance in India. There have been fourteen mutations identified, three of which have been validated by the World Health Organization (WHO) as artemisinin resistance mutations (F446I, R561H/C, and R539T). Among them, the role of F446I and R561H/C in ART resistance is conflicting. R539T and G625R mutation has been identified as an ART- resistance marker in India.
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Affiliation(s)
- Laxman Kumar Murmu
- P.G. Department of Zoology, Berhampur University, Berhampur, Ganjam, 760007 Odisha India
| | - Tapan Kumar Barik
- P.G. Department of Zoology, Berhampur University, Berhampur, Ganjam, 760007 Odisha India
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Maniga JN, Akinola SA, Odoki M, Odda J, Adebayo IA. Limited Polymorphism in Plasmodium falciparum Artemisinin Resistance Kelch13-Propeller Gene Among Clinical Isolates from Bushenyi District, Uganda. Infect Drug Resist 2021; 14:5153-5163. [PMID: 34908849 PMCID: PMC8665267 DOI: 10.2147/idr.s341357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Drug resistance remains a major challenge in malaria treatment, especially after the emergence of resistance to artemisinin-based combined therapies. Plasmodium falciparum Kelch13 gene mutations are implicated in conferring artemisinin resistance. Thus, this study was aimed at determining the occurrence of Kelch13 (K13) propeller resistance gene polymorphism mutations in Bushenyi district, Uganda. Methods Participants suspected to have malaria were recruited. P. falciparum was confirmed using antigen histidine-rich protein 2 (HRP2) (Pf) (Access Bio, Inc, USA) and microscopy. Malaria-positive patients were treated with artemeter-lumefantrine (AL). Blood was withdrawn from participants who tested positive for parasites after day 3 and kept in blood filter papers (ET31CHR; Whatman Limited, Kent, UK). DNA was extracted using chelex-suspension method. Nested polymerase chain reaction (PCR) was conducted and the second-round products sequenced using Sanger’s method. Sequenced products were analyzed using DNAsp 5.10.01 software and then blasted on to the NCBI for K13-propeller gene sequence identity using the Basic Local Alignment Search Tool (BLAST). Results Out of 283 enrolled participants, 194 completed the follow-up schedule. A total of 134 (69%) had no parasites on day 3, while 60 (31%) had parasites on that day. Out of the 60 samples, 40 (62%) were positively amplified as P. falciparum, with polymorphisms in the K13-propeller gene detected in 3 (7.5%) out of the 40 amplicons. Polymorphisms at codon 1929, 1788 and 1801 were detected separately in one sample each. Sequences have been deposited in NCBI with accession numbers PRJNA720348 and PRJNA720800. Conclusion Polymorphisms in the K13-propeller gene previously reported to be associated with artemisinin resistance were not detected in the P. falciparum isolates from Bushenyi district, Uganda. More studies need to be conducted on the new mutations detected so as to understand their association, if any, with ACT resistance.
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Affiliation(s)
- Josephat Nyabayo Maniga
- Department of Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda
| | - Saheed Adekunle Akinola
- Department of Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda.,Faculty of Natural and Agricultural Sciences, North- West University, Mmabatho, South Africa
| | - Martin Odoki
- Department of Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda
| | - John Odda
- Department of Pharmacology and Toxicology, Kampala International University Western Campus, Bushenyi, Uganda.,Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Ismail Abiola Adebayo
- Department of Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda
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Owoloye A, Olufemi M, Idowu ET, Oyebola KM. Prevalence of potential mediators of artemisinin resistance in African isolates of Plasmodium falciparum. Malar J 2021; 20:451. [PMID: 34856982 PMCID: PMC8638531 DOI: 10.1186/s12936-021-03987-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background The devastating public health impact of malaria has prompted the need for effective interventions. Malaria control gained traction after the introduction of artemisinin-based combination therapy (ACT). However, the emergence of artemisinin (ART) partial resistance in Southeast Asia and emerging reports of delayed parasite sensitivity to ACT in African parasites signal a gradual trend towards treatment failure. Monitoring the prevalence of mutations associated with artemisinin resistance in African populations is necessary to stop resistance in its tracks. Mutations in Plasmodium falciparum genes pfk13, pfcoronin and pfatpase6 have been linked with ART partial resistance. Methods Findings from published research articles on the prevalence of pfk13, pfcoronin and pfatpase6 polymorphisms in Africa were collated. PubMed, Embase and Google Scholar were searched for relevant articles reporting polymorphisms in these genes across Africa from 2014 to August 2021, for pfk13 and pfcoronin. For pfatpase6, relevant articles between 2003 and August 2021 were retrieved. Results Eighty-seven studies passed the inclusion criteria for this analysis and reported 742 single nucleotide polymorphisms in 37,864 P. falciparum isolates from 29 African countries. Five validated-pfk13 partial resistance markers were identified in Africa: R561H in Rwanda and Tanzania, M476I in Tanzania, F446I in Mali, C580Y in Ghana, and P553L in an Angolan isolate. In Tanzania, three (L263E, E431K, S769N) of the four mutations (L263E, E431K, A623E, S769N) in pfatpase6 gene associated with high in vitro IC50 were reported. pfcoronin polymorphisms were reported in Senegal, Gabon, Ghana, Kenya, and Congo, with P76S being the most prevalent mutation. Conclusions This meta-analysis provides an overview of the prevalence and widespread distribution of pfk13, pfcoronin and pfatpase6 mutations in Africa. Understanding the phenotypic consequences of these mutations can provide information on the efficacy status of artemisinin-based treatment of malaria across the continent. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03987-6.
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Affiliation(s)
- Afolabi Owoloye
- Genomic Research in Biomedicine Laboratory, Biochemistry and Nutrition Department, Nigerian Institute of Medical Research, Lagos, Nigeria.,Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Lagos, Nigeria
| | - Michael Olufemi
- Genomic Research in Biomedicine Laboratory, Biochemistry and Nutrition Department, Nigerian Institute of Medical Research, Lagos, Nigeria.,Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Lagos, Nigeria
| | - Emmanuel T Idowu
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Lagos, Nigeria
| | - Kolapo M Oyebola
- Genomic Research in Biomedicine Laboratory, Biochemistry and Nutrition Department, Nigerian Institute of Medical Research, Lagos, Nigeria. .,Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Lagos, Nigeria. .,Sickle Cell Branch, National Heart Lung and Blood Institute, US National Institutes of Health, Bethesda, MD, USA.
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9
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Noreen N, Ullah A, Salman SM, Mabkhot Y, Alsayari A, Badshah SL. New insights into the spread of resistance to artemisinin and its analogues. J Glob Antimicrob Resist 2021; 27:142-149. [PMID: 34517141 DOI: 10.1016/j.jgar.2021.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/19/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
Plasmodium falciparum, the causative agent of malaria, has been developing resistance to several drugs worldwide for more than five decades. Initially, resistance was against drugs such as chloroquine, pyrimethamine, sulfadoxine, mefloquine and quinine. Research studies are now reporting parasites with resistance to the most effective and novel drug used against malaria infection worldwide, namely artemisinin. For this reason, the first-line treatment strategy of artemisinin-based combination therapy is becoming unsuccessful in areas where drug resistance is highly prevalent. The increase in artemisinin-resistant P. falciparum strains has threatened international efforts to eliminate malarial infections and to reduce the disease burden. Detection of several phenotypes that display artemisinin resistance, specification of basic genetic factors, the discovery of molecular pathways, and evaluation of its clinical outcome are possible by the current series of research on genomics and transcriptomic levels in Asia and Africa. In artemisinin resistance, slow parasite clearance among malaria-infected patients and enhanced in vitro survival of parasites occurs at the early ring stage. This resistance is due to single nucleotide polymorphisms within the Kelch 13 gene of the parasite and is related to significantly upregulated resistance signalling pathways; thus, the pro-oxidant action of artemisinins can be antagonised. New strategies are required to halt the spread of artemisinin-resistant malarial parasites.
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Affiliation(s)
- Noreen Noreen
- Department of Chemistry, Islamia College University, Peshawar 25120, Pakistan
| | - Asad Ullah
- Department of Chemistry, Islamia College University, Peshawar 25120, Pakistan
| | | | - Yahia Mabkhot
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University, P.O. Box 960, Abha 61421, Saudi Arabia.
| | - Abdulrhman Alsayari
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Syed Lal Badshah
- Department of Chemistry, Islamia College University, Peshawar 25120, Pakistan.
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10
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Ndwiga L, Kimenyi KM, Wamae K, Osoti V, Akinyi M, Omedo I, Ishengoma DS, Duah-Quashie N, Andagalu B, Ghansah A, Amambua-Ngwa A, Tukwasibwe S, Tessema SK, Karema C, Djimde AA, Dondorp AM, Raman J, Snow RW, Bejon P, Ochola-Oyier LI. A review of the frequencies of Plasmodium falciparum Kelch 13 artemisinin resistance mutations in Africa. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2021; 16:155-161. [PMID: 34146993 PMCID: PMC8219943 DOI: 10.1016/j.ijpddr.2021.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022]
Abstract
Artemisinin resistance (AR) emerged in South East Asia 13 years ago and the identification of the resistance conferring molecular marker, Plasmodium falciparum Kelch 13 (Pfk13), 7 years ago has provided an invaluable tool for monitoring AR in malaria endemic countries. Molecular Pfk13 surveillance revealed the resistance foci in the Greater Mekong Subregion, an independent emergence in Guyana, South America, and a low frequency of mutations in Africa. The recent identification of the R561H Pfk13 AR associated mutation in Tanzania, Uganda and in Rwanda, where it has been associated with delayed parasite clearance, should be a concern for the continent. In this review, we provide a summary of Pfk13 resistance associated propeller domain mutation frequencies across Africa from 2012 to 2020, to examine how many other countries have identified these mutations. Only four African countries reported a recent identification of the M476I, P553L, R561H, P574L, C580Y and A675V Pfk13 mutations at low frequencies and with no reports of clinical treatment failure, except for Rwanda. These mutations present a threat to malaria control across the continent, since the greatest burden of malaria remains in Africa. A rise in the frequency of these mutations and their spread would reverse the gains made in the reduction of malaria over the last 20 years, given the lack of new antimalarial treatments in the event artemisinin-based combination therapies fail. The review highlights the frequency of Pfk13 propeller domain mutations across Africa, providing an up-to-date perspective of Pfk13 mutations, and appeals for an urgent and concerted effort to monitoring antimalarial resistance markers in Africa and the efficacy of antimalarials by re-establishing sentinel surveillance systems.
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Affiliation(s)
- Leonard Ndwiga
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya
| | - Kelvin M Kimenyi
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Centre for Biotechnology and Bioinformatics, University of Nairobi, Nairobi, Kenya
| | - Kevin Wamae
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya
| | - Victor Osoti
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya
| | - Mercy Akinyi
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Irene Omedo
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Deus S Ishengoma
- National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Nancy Duah-Quashie
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ben Andagalu
- United States Army Medical Research Directorate-Africa, Kenya Medical Research Institute/Walter Reed Project, Kisumu, Kenya
| | - Anita Ghansah
- Department of Parasitology, Noguchi Memorial Institute for Medical Research (NMIMR), Accra, Ghana
| | | | | | | | - Corine Karema
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Quality and Equity Healthcare, Kigali, Rwanda
| | - Abdoulaye A Djimde
- Malaria Research and Training Centre, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaishree Raman
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Disease, Sandringham, Gauteng, South Africa; Wits Research Institute for Malaria, Univerisity of Witwatersrand, Johannesburg, South Africa
| | - Robert W Snow
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Philip Bejon
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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11
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L'Episcopia M, Kelley J, Djeunang Dongho BG, Patel D, Schmedes S, Ravishankar S, Perrotti E, Modiano D, Lucchi NW, Russo G, Talundzic E, Severini C. Targeted deep amplicon sequencing of antimalarial resistance markers in Plasmodium falciparum isolates from Cameroon. Int J Infect Dis 2021; 107:234-241. [PMID: 33940188 DOI: 10.1016/j.ijid.2021.04.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent studies showed the first emergence of the R561H artemisinin-associated resistance marker in Africa, which highlights the importance of continued molecular surveillance to assess the selection and spread of this and other drug resistance markers in the region. METHOD In this study, we used targeted amplicon deep sequencing of 116 isolates collected in two areas of Cameroon to genotype the major drug resistance genes, k13, crt, mdr1, dhfr, and dhps, and the cytochrome b gene (cytb) in Plasmodium falciparum. RESULTS No confirmed or associated artemisinin resistance markers were observed in Pfk13. In comparison, both major and minor alleles associated with drug resistance were found in Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps. Notably, a high frequency of other nonsynonymous mutations was observed across all the genes, except for Pfcytb, suggesting continued selection pressure. CONCLUSIONS The results from this study supported the continued use of artemisinin-based combination therapy and administration of sulfadoxine-pyrimethamine for intermittent preventive therapy in pregnant women, and for seasonal chemoprevention in these study sites in Cameroon.
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Affiliation(s)
| | - Julia Kelley
- Atlanta Research and Education Foundation, VAMC, Atlanta, GA, USA.
| | | | - Dhruviben Patel
- Atlanta Research and Education Foundation, VAMC, Atlanta, GA, USA.
| | - Sarah Schmedes
- Association of Public Health Laboratories, Silver Spring, MD, USA.
| | | | - Edvige Perrotti
- Istituto Superiore di Sanità, Department of Infectious Diseases, Rome, Italy.
| | - David Modiano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
| | - Naomi W Lucchi
- Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA, USA.
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
| | - Eldin Talundzic
- Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA, USA.
| | - Carlo Severini
- Istituto Superiore di Sanità, Department of Infectious Diseases, Rome, Italy.
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