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Oboh MA, Morenikeji OB, Ojurongbe O, Thomas BN. Transcriptomic analyses of differentially expressed human genes, micro RNAs and long-non-coding RNAs in severe, symptomatic and asymptomatic malaria infection. Sci Rep 2024; 14:16901. [PMID: 39043812 PMCID: PMC11266512 DOI: 10.1038/s41598-024-67663-w] [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: 08/16/2023] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
Malaria transmission and endemicity in Africa remains hugely disproportionate compared to the rest of the world. The complex life cycle of P. falciparum (Pf) between the vertebrate human host and the anopheline vector results in differential expression of genes within and between hosts. An in-depth understanding of Pf interaction with various human genes through regulatory elements will pave way for identification of newer tools in the arsenal for malaria control. Therefore, the regulatory elements (REs) involved in the over- or under-expression of various host immune genes hold the key to elucidating alternative control measures that can be applied for disease surveillance, prompt diagnosis and treatment. We carried out an RNAseq analysis to identify differentially expressed genes and network elucidation of non-coding RNAs and target genes associated with immune response in individuals with different clinical outcomes. Raw RNAseq datasets, retrieved for analyses include individuals with severe (Gambia-20), symptomatic (Burkina Faso-15), asymptomatic (Mali-16) malaria as well as uninfected controls (Tanzania-20; Mali-36). Of the total 107 datasets retrieved, we identified 5534 differentially expressed genes (DEGs) among disease and control groups. A peculiar pattern of DEGs was observed, with individuals presenting with severe/symptomatic malaria having the highest and most diverse upregulated genes, while a reverse phenomenon was recorded among asymptomatic and uninfected individuals. In addition, we identified 141 differentially expressed micro RNA (miRNA), of which 78 and 63 were upregulated and downregulated respectively. Interactome analysis revealed a moderate interaction between DEGs and miRNAs. Of all identified miRNA, five were unique (hsa-mir-32, hsa-mir-25, hsa-mir-221, hsa-mir-29 and hsa-mir-148) because of their connectivity to several genes, including hsa-mir-221 connected to 16 genes. Six-hundred and eight differentially expressed long non coding RNA (lncRNA) were also identified, including SLC7A11, LINC01524 among the upregulated ones. Our study provides important insight into host immune genes undergoing differential expression under different malaria conditions. It also identified unique miRNAs and lncRNAs that modify and/or regulate the expression of various immune genes. These regulatory elements we surmise, have the potential to serve a diagnostic purpose in discriminating between individuals with severe/symptomatic malaria and those with asymptomatic infection or uninfected, following further clinical validation from field isolates.
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Affiliation(s)
- Mary A Oboh
- Department of Biomedical Sciences, Rochester Institute of Technology, 153 Lomb Memorial Drive, Rochester, NY, 14623, USA
| | - Olanrewaju B Morenikeji
- Division of Biological and Health Sciences, University of Pittsburgh Bradford, Bradford, PA, USA
| | - Olusola Ojurongbe
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Bolaji N Thomas
- Department of Biomedical Sciences, Rochester Institute of Technology, 153 Lomb Memorial Drive, Rochester, NY, 14623, USA.
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2
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Rosenthal PJ, Asua V, Conrad MD. Emergence, transmission dynamics and mechanisms of artemisinin partial resistance in malaria parasites in Africa. Nat Rev Microbiol 2024; 22:373-384. [PMID: 38321292 DOI: 10.1038/s41579-024-01008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
Malaria, mostly due to Plasmodium falciparum infection in Africa, remains one of the most important infectious diseases in the world. Standard treatment for uncomplicated P. falciparum malaria is artemisinin-based combination therapy (ACT), which includes a rapid-acting artemisinin derivative plus a longer-acting partner drug, and standard therapy for severe P. falciparum malaria is intravenous artesunate. The efficacy of artemisinins and ACT has been threatened by the emergence of artemisinin partial resistance in Southeast Asia, mediated principally by mutations in the P. falciparum Kelch 13 (K13) protein. High ACT treatment failure rates have occurred when resistance to partner drugs is also seen. Recently, artemisinin partial resistance has emerged in Rwanda, Uganda and the Horn of Africa, with independent emergences of different K13 mutants in each region. In this Review, we summarize our current knowledge of artemisinin partial resistance and focus on the emergence of resistance in Africa, including its epidemiology, transmission dynamics and mechanisms. At present, the clinical impact of emerging resistance in Africa is unclear and most available evidence suggests that the efficacies of leading ACTs remain excellent, but there is an urgent need to better appreciate the extent of the problem and its consequences for the treatment and control of malaria.
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Affiliation(s)
| | - Victor Asua
- Infectious Diseases Research Collaboration, Kampala, Uganda
- University of Tübingen, Tübingen, Germany
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3
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Schreidah C, Giesbrecht D, Gashema P, Young NW, Munyaneza T, Muvunyi CM, Thwai K, Mazarati JB, Bailey JA, Juliano JJ, Karema C. Expansion of artemisinin partial resistance mutations and lack of histidine rich protein-2 and -3 deletions in Plasmodium falciparum infections from Rukara, Rwanda. Malar J 2024; 23:150. [PMID: 38755607 PMCID: PMC11100144 DOI: 10.1186/s12936-024-04981-4] [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: 12/17/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Emerging artemisinin partial resistance and diagnostic resistance are a threat to malaria control in Africa. Plasmodium falciparum kelch13 (k13) propeller-domain mutations that confer artemisinin partial resistance have emerged in Africa. k13-561H was initially described at a frequency of 7.4% from Masaka in 2014-2015, but not present in nearby Rukara. By 2018, 19.6% of isolates in Masaka and 22% of isolates in Rukara contained the mutation. Longitudinal monitoring is essential to inform control efforts. In Rukara, an assessment was conducted to evaluate recent k13-561H prevalence changes, as well as other key mutations. Prevalence of hrp2/3 deletions was also assessed. METHODS Samples collected in Rukara in 2021 were genotyped for key artemisinin and partner drug resistance mutations using molecular inversion probe assays and for hrp2/3 deletions using qPCR. RESULTS Clinically validated k13 artemisinin partial resistance mutations continue to increase in prevalence with the overall level of mutant infections reaching 32% in Rwanda. The increase appears to be due to the rapid emergence of k13-675V (6.4%, 6/94 infections), previously not observed, rather than continued expansion of 561H (23.5% 20/85). Mutations to partner drugs and other anti-malarials were variable, with high levels of multidrug resistance 1 (mdr1) N86 (95.5%) associated with lumefantrine decreased susceptibility and dihydrofolate reductase (dhfr) 164L (24.7%) associated with a high level of antifolate resistance, but low levels of amodiaquine resistance polymorphisms with chloroquine resistance transporter (crt) 76T: at 6.1% prevalence. No hrp2 or hrp3 gene deletions associated with diagnostic resistance were found. CONCLUSIONS Increasing prevalence of artemisinin partial resistance due to k13-561H and the rapid expansion of k13-675V is concerning for the longevity of artemisinin effectiveness in the region. False negative RDT results do not appear to be an issue with no hrp2 or hpr3 deletions detected. Continued molecular surveillance in this region and surrounding areas is needed to follow artemisinin partial resistance and provide early detection of partner drug resistance, which would likely compromise control and increase malaria morbidity and mortality in East Africa.
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Affiliation(s)
| | | | | | | | | | | | - Kyaw Thwai
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | | | - Jonathan J Juliano
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Corine Karema
- Quality Equity Health Care, Kigali, Rwanda
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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Laminou IM, Issa I, Adehossi E, Maman K, Jackou H, Coulibaly E, Tohon ZB, Ahmed J, Sanoussi E, Koko D. Therapeutic efficacy and tolerability of artemether-lumefantrine for uncomplicated Plasmodium falciparum malaria in Niger, 2020. Malar J 2024; 23:144. [PMID: 38741101 DOI: 10.1186/s12936-024-04945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Monitoring therapeutic efficacy is important to ensure the efficacy of artemisinin-based combination therapy (ACT) for malaria. The current first-line treatment for uncomplicated malaria recommended by the National Malaria Control Program in Niger is artemether-lumefantrine (AL). In 2020, an in vivo study was carried out to evaluate clinical and parasitological responses to AL as well as the molecular resistance to the drug in three sentinel sites: Agadez, Tessaoua and Gaya, in Niger. METHODS A multi-center, single-arm trial was conducted according to the 28-day World Health Organization (WHO) 2009 therapeutic efficacy study protocol. Children between 6 months and 15 years with confirmed uncomplicated Plasmodium falciparum infection and 1000-200,000 asexual parasites/μL of blood were enrolled and followed up for 28 days. Uncorrected and PCR-corrected efficacy results at day 28 were calculated, and molecular correction was performed by genotyping the msp1, msp2, and glurp genes. The pfk13, pfdhfr, pfdhps, pfcrt and pfmdr genes were analyzed by PCR and Sanger sequencing. The Kaplan-Meier curve assessed parasite clearance. RESULTS A total of 255 patients were enrolled in the study. The adequate clinical and parasitological response after PCR correction was 98.9% (95% CI 96.4-101.0%), 92.2% (85.0-98.5%) and 97.1% (93.1-101.0%) in Gaya, Tessaoua and Agadez, respectively. No adverse events were observed. Ten mutations (SNP) were found, including 7 synonyms (K248K, G690G, E691E, E612E, C469C, G496G, P718P) and 3 non-synonyms (N594K, R255K, V714S). Two mutations emerged: N594K and V714S. The R255K mutation detected in Southeast Asia was also detected. The pfdhpsK540E and pfdhfrI164L mutations associated with high levels of resistance are absent. There is a reversal of chloroquine resistance. CONCLUSION The study findings indicate that AL is effective and well tolerated for the treatment of uncomplicated malaria in three sites in Niger. The emergence of a pfk13 mutation requires additional testing such as the Ring Stage Assay and CRISPR/Cas9 to confirm the role of these emerging mutations. Trial registration NCT05070520, October 7, 2021.
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Affiliation(s)
| | | | - Eric Adehossi
- Abdou Moumouni School of Health Sciences at University of Niamey-Niger , Niamey, Niger
| | | | | | - Eric Coulibaly
- U.S. President's Malaria Initiative, USAID, Niamey, Niger
| | | | - Jehan Ahmed
- U.S. President's Malaria Initiative Impact Malaria, Atlanta, USA
| | - Elisha Sanoussi
- U.S. President's Malaria Initiative Impact Malaria, Niamey, Niger
| | - Daniel Koko
- U.S. President's Malaria Initiative Impact Malaria, Niamey, Niger
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Young NW, Gashema P, Giesbrecht D, Munyaneza T, Maisha F, Mwebembezi F, Budodo R, Leonetti A, Crudale R, Iradukunda V, Bosco NJ, Boyce RM, Mandara CI, Kanyankole GK, Mulogo E, Ishengoma DS, Hangi S, Karema C, Mazarati JB, Juliano JJ, Bailey JA. High frequency of artemisinin partial resistance mutations in the great lake region revealed through rapid pooled deep sequencing. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.29.24306442. [PMID: 38746440 PMCID: PMC11092733 DOI: 10.1101/2024.04.29.24306442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
In Africa, the first Plasmodium falciparum Kelch13 (K13) artemisinin partial resistance mutation 561H was first detected and validated in Rwanda. Surveillance to better define the extent of the emergence in Rwanda and neighboring countries as other mutations arise in East Africa is critical. We employ a novel scheme of liquid blood drop preservation combined with pooled sequencing to provide a cost-effective rapid assessment of resistance mutation frequencies at multiple collection sites across Rwanda and neighboring countries. Malaria-positive samples (n=5,465) were collected from 39 health facilities in Rwanda, Uganda, Tanzania, and the Democratic Republic of the Congo (DRC) between May 2022 and March 2023 and sequenced in 199 pools. In Rwanda, K13 561H and 675V were detected in 90% and 65% of sites with an average frequency of 19.0% (0-54.5%) and 5.0% (0-35.5%), respectively. In Tanzania, 561H had high frequency in multiple sites while it was absent from the DRC although 675V was seen at low frequency. Conceringly candidate mutations were observed: 441L, 449A, and 469F co-occurred with validated mutations suggesting they are arising under the same pressures. Other resistance markers associated with artemether-lumefantrine are common: P. falciparum multidrug resistance protein 1 N86 at 98.0% and 184F at 47.0% (0-94.3%) and P. falciparum chloroquine resistance transporter 76T at 14.7% (0-58.6%). Additionally, sulfadoxine-pyrimethamine-associated mutations show high frequencies. Overall, K13 mutations are rapidly expanding in the region further endangering control efforts with the potential of engendering partner drug resistance.
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Affiliation(s)
| | | | | | | | | | - Fred Mwebembezi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rule Budodo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | | | | | | | | | | | | | - Edgar Mulogo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Deus S. Ishengoma
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Department of Biochemistry, Kampala International University in Tanzania, Dar es Salaam, Tanzania
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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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7
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Schreidah C, Giesbrecht D, Gashema P, Young N, Munyaneza T, Muvunyi CM, Thwai K, Mazarati JB, Bailey J, Juliano JJ, Karema C. Expansion of Artemisinin Partial Resistance Mutations and Lack of Histidine Rich Protein-2 and -3 Deletions in Plasmodium falciparum infections from Rukara, Rwanda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.17.23300081. [PMID: 38196592 PMCID: PMC10775326 DOI: 10.1101/2023.12.17.23300081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Emerging artemisinin resistance and diagnostic resistance are a threat to malaria control in Africa. Plasmodium falciparum kelch13 (K13) propeller-domain mutations that confer artemisinin partial resistance have emerged in Africa. K13-561H was initially described at a frequency of 7.4% from Masaka in 2014-2015 but not present in nearby Rukara. By 2018, 19.6% of isolates in Masaka and 22% of isolates in Rukara contained the mutation. Longitudinal monitoring is essential to inform control efforts. In Rukara, we sought to assess recent K13-561H prevalence changes, as well as for other key mutations. Prevalence of hrp2/3 deletions was also assessed. Methods We genotyped samples collected in Rukara in 2021 for key artemisinin and partner drug resistance mutations using molecular inversion probe assays and for hrp2/3 deletions using qPCR. Results Clinically validated K13 artemisinin partial resistance mutations continue to increase in prevalence with the overall level of artemisinin resistance mutant infections reaching 32% in Rwanda. The increase appears to be due to the rapid emergence of K13-675V (6.4%, 6/94 infections), previously not observed, rather than continued expansion of 561H (23.5% 20/85). Mutations to partner drugs and other antimalarials were variable, with high levels of multidrug resistance 1 (MDR1) N86 (95.5%) associated with lumefantrine resistance and dihydrofolate reductase (DHFR) 164L (24.7%) associated with antifolate resistance, but low levels of amodiaquine resistance polymorphisms with chloroquine resistance transporter (CRT ) 76T: at 6.1% prevalence. No hrp2 or hrp3 gene deletions associated with diagnostic resistance were found. Conclusions Increasing prevalence of artemisinin partial resistance due to K13-561H and the rapid expansion of K13-675V is concerning for the longevity of artemisinin effectiveness in the region. False negative mRDT results do not appear to be an issue with no hrp2 or hpr3 deletions detected. Continued molecular surveillance in this region and surrounding areas is needed to follow artemisinin resistance and provide early detection of partner drug resistance, which would likely compromise control and increase malaria morbidity and mortality in East Africa.
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Oduor CI, Cunningham C, Rustamzade N, Zuromski J, Chin DM, Nixon CP, Kurtis JD, Juliano JJ, Bailey JA. Single cell transcriptional changes across the blood stages of artemisinin resistant K13 C580Y mutant Plasmodium falciparum upon dihydroartemisinin exposure. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.06.570387. [PMID: 38105992 PMCID: PMC10723473 DOI: 10.1101/2023.12.06.570387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Artemisinins have been a cornerstone of malaria control, but resistance in Plasmodium falciparum, due to mutations in the Kelch 13 gene, threaten these advances. Artemisinin exposure results in a dynamic transcriptional response across multiple pathways, but most work has focused on ring stages and ex vivo transcriptional analysis, limiting evaluation of all life cycle stages. We applied single cell RNAseq to two unsynchronized isogenic parasite lines (K13C580 and K13580Y) over 6 hrs after a pulse exposure to dihydroartemisinin (DHA). Transcription was altered across all stages, with the greatest occurring at the early trophozoite and mid ring stage in both lines. This response involved the arrest of metabolic processes and the enhancement of protein trafficking and the unfolded protein response. While similar, the response was enhanced in the K13580Y mutant, which may lead to the dormancy phenomenon upon treatment. Increased surface protein expression was seen in mutant parasites at baseline and upon drug exposure, highlighted by the increased expression of PfEMP1 and GARP, a potential therapeutic target. Antibody targeting GARP maintained anti-parasitic efficacy in mutant parasites. This work provides single cell insight of gene transcription across all life cycle stages revealing transcriptional changes that could initiate dormancy state and mediate survival.
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Affiliation(s)
- Cliff I. Oduor
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Clark Cunningham
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Nazrin Rustamzade
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Jenna Zuromski
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Deborah M. Chin
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Christian P. Nixon
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Jonathan D. Kurtis
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Jonathan J. Juliano
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, NC
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
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Dieng CC, Morrison V, Donu D, Cui L, Amoah L, Afrane Y, Lo E. Distribution of Plasmodium falciparum K13 gene polymorphisms across transmission settings in Ghana. BMC Infect Dis 2023; 23:801. [PMID: 37974079 PMCID: PMC10652499 DOI: 10.1186/s12879-023-08812-w] [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: 12/14/2022] [Accepted: 11/12/2023] [Indexed: 11/19/2023] Open
Abstract
Malaria is a significant global health concern, with a majority of cases in Sub-Saharan African nations. Numerous antimalarial drugs have been developed to counter the rampant prevalence of Plasmodium falciparum malaria. Artemisinin-based Combination Therapy (ACT) has served as the primary treatment of uncomplicated malaria in Ghana since 2005. However, a growing concern has emerged due to the escalating reports of ACT resistance, particularly in Southeast Asia, and its encroachment into Africa. Specifically, mutations in the Kelch propeller domain on chromosome 13 (Pfk13) have been linked to ACT resistance. Yet, our understanding of mutation prevalence in Africa remains largely uncharted. In this study, we compared Pfk13 sequences obtained from 172 P. falciparum samples across three ecological and transmission zones in Ghana. We identified 27 non-synonymous mutations among these sequences, of which two of the mutations, C580Y (found in two samples from the central region) and Y493H (found in one sample from the north), had previously been validated for their association with artemisinin resistance, a phenomenon widespread in Southeast Asia. The Pfk13 gene diversity was most pronounced in the northern savannah than the central forest and south coastal regions, where transmission rates are lower. The observed mutations were not significantly associated with geographical regions, suggesting a frequent spread of mutations across the country. The ongoing global surveillance of artemisinin resistance remains pivotal, and our findings provides insights into the potential spread of resistant parasites in West Africa. Furthermore, the identification of novel codon mutations in this study raises their potential association to ACT resistance, warranting further investigation through in vitro assays to ascertain their functional significance.
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Affiliation(s)
- Cheikh Cambel Dieng
- Department of Microbiology and Immunology, College of Medicine, Drexel University, Philadelphia, PA, USA.
| | - Victoria Morrison
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Dickson Donu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Liwang Cui
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Linda Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- West Africa Center for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | - Yaw Afrane
- Department of Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Eugenia Lo
- Department of Microbiology and Immunology, College of Medicine, Drexel University, Philadelphia, PA, USA.
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10
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Kayiba NK, Tshibangu-Kabamba E, Rosas-Aguirre A, Kaku N, Nakagama Y, Kaneko A, Makaba DM, Malekita DY, Devleesschauwer B, Likwela JL, Zakayi PK, DeMol P, Lelo GM, Hayette MP, Dikassa PL, Kido Y, Speybroeck N. The landscape of drug resistance in Plasmodium falciparum malaria in the Democratic Republic of Congo: a mapping systematic review. Trop Med Health 2023; 51:64. [PMID: 37968745 PMCID: PMC10647042 DOI: 10.1186/s41182-023-00551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023] Open
Abstract
CONTEXT The Democratic Republic of Congo (DRC), one of the most malaria-affected countries worldwide, is a potential hub for global drug-resistant malaria. This study aimed at summarizing and mapping surveys of malaria parasites carrying molecular markers of drug-resistance across the country. METHODS A systematic mapping review was carried out before July 2023 by searching for relevant articles through seven databases (PubMed, Embase, Scopus, African Journal Online, African Index Medicus, Bioline and Web of Science). RESULTS We identified 1541 primary studies of which 29 fulfilled inclusion criteria and provided information related to 6385 Plasmodium falciparum clinical isolates (collected from 2000 to 2020). We noted the PfCRT K76T mutation encoding for chloroquine-resistance in median 32.1% [interquartile interval, IQR: 45.2] of analyzed malaria parasites. The proportion of parasites carrying this mutation decreased overtime, but wide geographic variations persisted. A single isolate had encoded the PfK13 R561H substitution that is invoked in artemisinin-resistance emergence in the Great Lakes region of Africa. Parasites carrying various mutations linked to resistance to the sulfadoxine-pyrimethamine combination were widespread and reflected a moderate resistance profile (PfDHPS A437G: 99.5% [IQR: 3.9]; PfDHPS K540E: 38.9% [IQR: 47.7]) with median 13.1% [IQR: 10.3] of them being quintuple IRN-GE mutants (i.e., parasites carrying the PfDHFR N51I-C59R-S108N and PfDHPS A437G-K540E mutations). These quintuple mutants tended to prevail in eastern regions of the country. Among circulating parasites, we did not record any parasites harboring mutations related to mefloquine-resistance, but we could suspect those with decreased susceptibility to quinine, amodiaquine, and lumefantrine based on corresponding molecular surrogates. CONCLUSIONS Drug resistance poses a serious threat to existing malaria therapies and chemoprevention options in the DRC. This review provides a baseline for monitoring public health efforts as well as evidence for decision-making in support of national malaria policies and for implementing regionally tailored control measures across the country.
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Affiliation(s)
- Nadine Kalenda Kayiba
- Research Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health, Faculty of Medicine, University of Mbujimayi, Mbujimayi, Democratic Republic of Congo
- Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Evariste Tshibangu-Kabamba
- Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Internal Medicine, Faculty of Medicine, University of Mbujimayi, Mbujimayi, Democratic Republic of Congo
| | - Angel Rosas-Aguirre
- Research Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Natsuko Kaku
- Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yu Nakagama
- Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Kaneko
- Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Dieudonné Mvumbi Makaba
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Department of Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Doudou Yobi Malekita
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Joris Losimba Likwela
- Department of Public Health, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of Congo
| | - Pius Kabututu Zakayi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Patrick DeMol
- Laboratory of Clinical Microbiology, Center for Interdisciplinary Research on Medicines, University of Liège, Liège, Belgium
| | - Georges Mvumbi Lelo
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie-Pierre Hayette
- Laboratory of Clinical Microbiology, Center for Interdisciplinary Research on Medicines, University of Liège, Liège, Belgium
| | - Paul Lusamba Dikassa
- School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yasutoshi Kido
- Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Niko Speybroeck
- Research Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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Conrad MD, Asua V, Garg S, Giesbrecht D, Niaré K, Smith S, Namuganga JF, Katairo T, Legac J, Crudale RM, Tumwebaze PK, Nsobya SL, Cooper RA, Kamya MR, Dorsey G, Bailey JA, Rosenthal PJ. Evolution of Partial Resistance to Artemisinins in Malaria Parasites in Uganda. N Engl J Med 2023; 389:722-732. [PMID: 37611122 PMCID: PMC10513755 DOI: 10.1056/nejmoa2211803] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Partial resistance of Plasmodium falciparum to the artemisinin component of artemisinin-based combination therapies, the most important malaria drugs, emerged in Southeast Asia and now threatens East Africa. Partial resistance, which manifests as delayed clearance after therapy, is mediated principally by mutations in the kelch protein K13 (PfK13). Limited longitudinal data are available on the emergence and spread of artemisinin resistance in Africa. METHODS We performed annual surveillance among patients who presented with uncomplicated malaria at 10 to 16 sites across Uganda from 2016 through 2022. We sequenced the gene encoding kelch 13 (pfk13) and analyzed relatedness using molecular methods. We assessed malaria metrics longitudinally in eight Ugandan districts from 2014 through 2021. RESULTS By 2021-2022, the prevalence of parasites with validated or candidate resistance markers reached more than 20% in 11 of the 16 districts where surveillance was conducted. The PfK13 469Y and 675V mutations were seen in far northern Uganda in 2016-2017 and increased and spread thereafter, reaching a combined prevalence of 10 to 54% across much of northern Uganda, with spread to other regions. The 469F mutation reached a prevalence of 38 to 40% in one district in southwestern Uganda in 2021-2022. The 561H mutation, previously described in Rwanda, was first seen in southwestern Uganda in 2021, reaching a prevalence of 23% by 2022. The 441L mutation reached a prevalence of 12 to 23% in three districts in western Uganda in 2022. Genetic analysis indicated local emergence of mutant parasites independent of those in Southeast Asia. The emergence of resistance was observed predominantly in areas where effective malaria control had been discontinued or transmission was unstable. CONCLUSIONS Data from Uganda showed the emergence of partial resistance to artemisinins in multiple geographic locations, with increasing prevalence and regional spread over time. (Funded by the National Institutes of Health.).
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Affiliation(s)
- Melissa D Conrad
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Victor Asua
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Shreeya Garg
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - David Giesbrecht
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Karamoko Niaré
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Sawyer Smith
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Jane F Namuganga
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Thomas Katairo
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Jennifer Legac
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Rebecca M Crudale
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Patrick K Tumwebaze
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Samuel L Nsobya
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Roland A Cooper
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Moses R Kamya
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Grant Dorsey
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Jeffrey A Bailey
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
| | - Philip J Rosenthal
- From the University of California, San Francisco, San Francisco (M.D.C., S.G., J.L., G.D., P.J.R.); the Infectious Diseases Research Collaboration (V.A., J.F.N., T.K., P.K.T., S.L.N., M.R.K.) and Makerere University (M.R.K.) - both in Kampala, Uganda; the University of Tübingen, Tübingen, Germany (V.A.); Brown University, Providence, RI (D.G., K.N., S.S., R.M.C., J.A.B.); and Dominican University of California, San Rafael (R.A.C.)
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Azmi WA, Rizki AFM, Djuardi Y, Artika IM, Siregar JE. Molecular insights into artemisinin resistance in Plasmodium falciparum: An updated review. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023:105460. [PMID: 37269964 DOI: 10.1016/j.meegid.2023.105460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/05/2023]
Abstract
Malaria still poses a major burden on human health around the world, especially in endemic areas. Plasmodium resistance to several antimalarial drugs has been one of the major hindrances in control of malaria. Thus, the World Health Organization recommended artemisinin-based combination therapy (ACT) as a front-line treatment for malaria. The emergence of parasites resistant to artemisinin, along with resistant to ACT partner drugs, has led to ACT treatment failure. The artemisinin resistance is mostly related to the mutations in the propeller domain of the kelch13 (k13) gene that encodes protein Kelch13 (K13). The K13 protein has an important role in parasite reaction to oxidative stress. The most widely spread mutation in K13, with the highest degree of resistance, is a C580Y mutation. Other mutations, which are already identified as markers of artemisinin resistance, are R539T, I543T, and Y493H. The objective of this review is to provide current molecular insights into artemisinin resistance in Plasmodium falciparum. The trending use of artemisinin beyond its antimalarial effect is described. Immediate challenges and future research directions are discussed. Better understanding of the molecular mechanisms underlying artemisinin resistance will accelerate implementation of scientific findings to solve problems with malarial infection.
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Affiliation(s)
- Wihda Aisarul Azmi
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency, Cibinong, Bogor 16911, Indonesia; Master's Programme in Biomedical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
| | - Andita Fitri Mutiara Rizki
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency, Cibinong, Bogor 16911, Indonesia; Master's Programme in Biomedical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
| | - Yenny Djuardi
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
| | - I Made Artika
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency, Cibinong, Bogor 16911, Indonesia; Department of Biochemistry, Faculty of Mathematics and Natural Sciences, Bogor Agricultural University, Bogor 16680, Indonesia
| | - Josephine Elizabeth Siregar
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency, Cibinong, Bogor 16911, Indonesia.
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13
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Namayanja C, Eregu EEI, Ongodia P, Okalebo CB, Okiror W, Okello F, Okibure A, Paasi G, Kakungulu H, Grace A, Muhindo R, Banks D, Martin C, Taylor-Robinson S, Olupot-Olupot P. Unusual clinical spectra of childhood severe malaria during malaria epidemic in eastern Uganda: a prospective study. Malar J 2023; 22:169. [PMID: 37259110 DOI: 10.1186/s12936-023-04586-3] [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: 03/22/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), malaria remains a public health problem despite recent reports of declining incidence. Severe malaria is a multiorgan disease with wide-ranging clinical spectra and outcomes that have been reported to vary by age, geographical location, transmission intensity over time. There are reports of recent malaria epidemics or resurgences, but few data, if any, focus on the clinical spectrum of severe malaria during epidemics. This describes the clinical spectrum and outcomes of childhood severe malaria during the disease epidemic in Eastern Uganda. METHODS This prospective cohort study from October 1, 2021, to September 7, 2022, was nested within the 'Malaria Epidemiological, Pathophysiological and Intervention studies in Highly Endemic Eastern Uganda' (TMA2016SF-1514-MEPIE Study) at Mbale Regional Referral Hospital, Uganda. Children aged 60 days to 12 years who at admission tested positive for malaria and fulfilled the clinical WHO criteria for surveillance of severe malaria were enrolled on the study. Follow-up was performed until day 28. Data were collected using a customized proforma on social demographic characteristics, clinical presentation, treatment, and outcomes. Laboratory analyses included complete blood counts, malaria RDT (SD BIOLINE Malaria Ag P.f/Pan, Ref. 05FK60-40-1) and blood slide, lactate, glucose, blood gases and electrolytes. In addition, urinalysis using dipsticks (Multistix® 10 SG, SIEMENS, Ref.2300) at the bedside was done. Data were analysed using STATA V15.0. The study had prior ethical approval. RESULTS A total of 300 participants were recruited. The median age was 4.6 years, mean of 57.2 months and IQR of 44.5 months. Many children, 164/300 (54.7%) were under 5 years, and 171/300 (57.0%) were males. The common clinical features were prostration 236/300 (78.7%), jaundice in 205/300 (68.3%), severe malarial anaemia in 158/300 (52.7%), black water fever 158/300 (52.7%) and multiple convulsions 51/300 (17.0%), impaired consciousness 50/300(16.0%), acidosis 41/300(13.7%), respiratory distress 26/300(6.7%) and coma in 18/300(6.0%). Prolonged hospitalization was found in 56/251 (22.3%) and was associated with acidosis, P = 0.041. The overall mortality was 19/300 (6.3%). Day 28 follow-up was achieved in 247/300 (82.3%). CONCLUSION During the malaria epidemic in Eastern Uganda, severe malaria affected much older children and the spectrum had more of prostration, jaundice severe malarial anaemia, black water fever and multiple convulsions with less of earlier reported respiratory distress and cerebral malaria.
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Affiliation(s)
- Cate Namayanja
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda.
- Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
| | - Egiru Emma Isaiah Eregu
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Paul Ongodia
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Charles Benard Okalebo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - William Okiror
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Francis Okello
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Varimetrics Group Limited, Mbale, Uganda
| | | | - George Paasi
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Hellen Kakungulu
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Varimetrics Group Limited, Mbale, Uganda
| | - Abongo Grace
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Rita Muhindo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Duncan Banks
- Busitema University, TORORO, Uganda
- The Open University, Milton Keynes, UK
| | - Chebet Martin
- Department of Pediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Simon Taylor-Robinson
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Imperial College London, London, UK
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
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14
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Kirby R, Giesbrecht D, Karema C, Watson O, Lewis S, Munyaneza T, Butera JDD, Juliano JJ, Bailey JA, Mazarati JB. Examining the Early Distribution of the Artemisinin-Resistant Plasmodium falciparum kelch13 R561H Mutation in Areas of Higher Transmission in Rwanda. Open Forum Infect Dis 2023; 10:ofad149. [PMID: 37096145 PMCID: PMC10122489 DOI: 10.1093/ofid/ofad149] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023] Open
Abstract
Background Artemisinin resistance mutations in Plasmodium falciparum kelch13 (Pfk13) have begun to emerge in Africa, with Pfk13-R561H being the first reported in Rwanda in 2014, but limited sampling left questions about its early distribution and origin. Methods We genotyped P. falciparum positive dried blood spot (DBS) samples from a nationally representative 2014-2015 Rwanda Demographic Health Surveys (DHS) HIV study. DBS were subsampled from DHS sampling clusters with >15% P. falciparum prevalence, as determined by rapid testing or microscopy done during the DHS study (n clusters = 67, n samples = 1873). Results We detected 476 parasitemias among 1873 residual blood spots from a 2014-2015 Rwanda Demographic Health Survey. We sequenced 351 samples: 341/351 were wild-type (97.03% weighted), and 4 samples (1.34% weighted) harbored R561H that were significantly spatially clustered. Other nonsynonymous mutations found were V555A (3), C532W (1), and G533A (1). Conclusions Our study better defines the early distribution of R561H in Rwanda. Previous studies only observed the mutation in Masaka as of 2014, but our study indicates its presence in higher-transmission regions in the southeast of the country at that time.
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Affiliation(s)
| | | | - Corine Karema
- Quality Equity Health Care, Kigali, Rwanda
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Oliver Watson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Maniga JN, Samuel M, John O, Rael M, Muchiri JN, Bwogo P, Martin O, Sankarapandian V, Wilberforce M, Albert O, Onkoba SK, Adebayo IA, Adeyemo RO, Akinola SA. Novel Plasmodium falciparum k13 gene polymorphisms from Kisii County, Kenya during an era of artemisinin-based combination therapy deployment. Malar J 2023; 22:87. [PMID: 36894982 PMCID: PMC9996564 DOI: 10.1186/s12936-023-04517-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Currently, chemotherapy stands out as the major malaria intervention strategy, however, anti-malarial resistance may hamper global elimination programs. Artemisinin-based combination therapy (ACT) stands as the drug of choice for the treatment of Plasmodium falciparum malaria. Plasmodium falciparum kelch13 gene mutations are associated with artemisinin resistance. Thus, this study was aimed at evaluating the circulation of P. falciparum k13 gene polymorphisms from Kisii County, Kenya during an era of ACT deployment. METHODS Participants suspected to have malaria were recruited. Plasmodium falciparum was confirmed using the microscopy method. Malaria-positive patients were treated with artemether-lumefantrine (AL). Blood from participants who tested positive for parasites after day 3 was kept on filter papers. DNA was extracted using chelex-suspension method. A nested polymerase chain reaction (PCR) was conducted and the second-round products were sequenced using the Sanger method. Sequenced products were analysed using DNAsp 5.10.01 software and then blasted on the NCBI for k13 propeller gene sequence identity using the Basic Local Alignment Search Tool (BLAST). To assess the selection pressure in P. falciparum parasite population, Tajima' D statistic and Fu & Li's D test in DnaSP software 5.10.01 was used. RESULTS Out of 275 enrolled participants, 231 completed the follow-up schedule. 13 (5.6%) had parasites on day 28 hence characterized for recrudescence. Out of the 13 samples suspected of recrudescence, 5 (38%) samples were positively amplified as P. falciparum, with polymorphisms in the k13-propeller gene detected. Polymorphisms detected in this study includes R539T, N458T, R561H, N431S and A671V, respectively. The sequences have been deposited in NCBI with bio-project number PRJNA885380 and accession numbers SAMN31087434, SAMN31087433, SAMN31087432, SAMN31087431 and SAMN31087430 respectively. CONCLUSIONS WHO validated polymorphisms in the k13-propeller gene previously reported to be associated with ACT resistance were not detected in the P. falciparum isolates from Kisii County, Kenya. However, some previously reported un-validated k13 resistant single nucleotide polymorphisms were reported in this study but with limited occurrences. The study has also reported new SNPs. More studies need to be carried out in the entire country to understand the association of reported mutations if any, with ACT resistance.
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Affiliation(s)
- Josephat Nyabayo Maniga
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda.
| | | | - Odda John
- School of Pharmacy, Kampala International University Western Campus, Bushenyi, Uganda.,Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda.,Department of Pharmacology and Toxicology, School of Medicine, King Caesor University, Kampala, Uganda
| | - Masai Rael
- Department of Biological Sciences, Kisii University, Kisii, Kenya
| | | | - Pacifica Bwogo
- Department of Biological Sciences, Kisii University, Kisii, Kenya
| | - Odoki Martin
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda.,Department of Medical Microbiology and Immunology, School of Medicine, King Ceasor University, Kampala, Uganda.,Department of Applied Sciences, School of Sciences, Nkumba University, Entebbe, Uganda
| | - Vidya Sankarapandian
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda
| | - Mfitundinda Wilberforce
- School of Pharmacy, Kampala International University Western Campus, Bushenyi, Uganda.,Department of Pharmacology and Toxicology, School of Medicine, King Caesor University, Kampala, Uganda
| | - Ochweri Albert
- School of Pharmacy, Kampala International University Western Campus, Bushenyi, Uganda
| | - Sarah Kemuma Onkoba
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda
| | - Ismail Abiola Adebayo
- Department of Medical Biochemistry, Molecular Biology and Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Rasheed Omotayo Adeyemo
- Department of Medical Microbiology and Parasitology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Saheed Adekunle Akinola
- Department of Medical Microbiology and Parasitology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
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Duffy S, Avery VM. Naturally Acquired Kelch13 Mutations in Plasmodium falciparum Strains Modulate In Vitro Ring-Stage Artemisinin-Based Drug Tolerance and Parasite Survival in Response to Hyperoxia. Microbiol Spectr 2022; 10:e0128221. [PMID: 36094220 PMCID: PMC9602862 DOI: 10.1128/spectrum.01282-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/25/2022] [Indexed: 12/30/2022] Open
Abstract
The ring-stage survival assay was utilized to assess the impact of physiological hyperoxic stress on dihydroartemisinin (DHA) tolerance for a panel of Plasmodium falciparum strains with and without Kelch13 mutations. Strains without naturally acquired Kelch13 mutations or the postulated genetic background associated with delayed parasite clearance time demonstrated reduced proliferation under hyperoxic conditions in the subsequent proliferation cycle. Dihydroartemisinin tolerance in three isolates with naturally acquired Kelch13 mutations but not two genetically manipulated laboratory strains was modulated by in vitro hyperoxic stress exposure of early-ring-stage parasites in the cycle before drug exposure. Reduced parasite tolerance to additional derivatives, including artemisinin, artesunate, and OZ277, was observed within the second proliferation cycle. OZ439 and epoxomicin completely prevented parasite survival under both hyperoxia and normoxic in vitro culture conditions, highlighting the unique relationship between DHA tolerance and Kelch13 mutation-associated genetic background. IMPORTANCE Artemisinin-based combination therapy (ACT) for treating malaria is under intense scrutiny following treatment failures in the Greater Mekong subregion of Asia. This is further compounded by the potential for extensive loss of life if treatment failures extend to the African continent. Although Plasmodium falciparum has become resistant to all antimalarial drugs, artemisinin "resistance" does not present in the same way as resistance to other antimalarial drugs. Instead, a partial resistance or tolerance is demonstrated, associated with the parasite's genetic profile and linked to a molecular marker referred to as K13. It is suggested that parasites may have adapted to drug treatment, as well as the presence of underlying population health issues such as hemoglobinopathies, and/or environmental pressures, resulting in parasite tolerance to ACT. Understanding parasite evolution and control of artemisinin tolerance will provide innovative approaches to mitigate the development of artemisinin tolerance and thereby artemisinin-based drug treatment failure and loss of life globally to malaria infections.
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Affiliation(s)
- Sandra Duffy
- Discovery Biology, Griffith University, Nathan, Queensland, Australia
| | - Vicky M. Avery
- Discovery Biology, Griffith University, Nathan, Queensland, Australia
- School of Environment and Science, Griffith University, Nathan, Queensland, Australia
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17
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Paton DG, Probst AS, Ma E, Adams KL, Shaw WR, Singh N, Bopp S, Volkman SK, Hien DFS, Paré PSL, Yerbanga RS, Diabaté A, Dabiré RK, Lefèvre T, Wirth DF, Catteruccia F. Using an antimalarial in mosquitoes overcomes Anopheles and Plasmodium resistance to malaria control strategies. PLoS Pathog 2022; 18:e1010609. [PMID: 35687594 PMCID: PMC9223321 DOI: 10.1371/journal.ppat.1010609] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/23/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
The spread of insecticide resistance in Anopheles mosquitoes and drug resistance in Plasmodium parasites is contributing to a global resurgence of malaria, making the generation of control tools that can overcome these roadblocks an urgent public health priority. We recently showed that the transmission of Plasmodium falciparum parasites can be efficiently blocked when exposing Anopheles gambiae females to antimalarials deposited on a treated surface, with no negative consequences on major components of mosquito fitness. Here, we demonstrate this approach can overcome the hurdles of insecticide resistance in mosquitoes and drug resistant in parasites. We show that the transmission-blocking efficacy of mosquito-targeted antimalarials is maintained when field-derived, insecticide resistant Anopheles are exposed to the potent cytochrome b inhibitor atovaquone, demonstrating that this drug escapes insecticide resistance mechanisms that could potentially interfere with its function. Moreover, this approach prevents transmission of field-derived, artemisinin resistant P. falciparum parasites (Kelch13 C580Y mutant), proving that this strategy could be used to prevent the spread of parasite mutations that induce resistance to front-line antimalarials. Atovaquone is also highly effective at limiting parasite development when ingested by mosquitoes in sugar solutions, including in ongoing infections. These data support the use of mosquito-targeted antimalarials as a promising tool to complement and extend the efficacy of current malaria control interventions. Effective control of malaria is hampered by resistance to vector-targeted insecticides and parasite-targeted drugs. This situation is exacerbated by a critical lack of chemical diversity in both interventions and, as such, new interventions are urgently needed. Recent laboratory studies have shown that an alternative approach based on treating Anopheles mosquitoes directly with antimalarial compounds can make mosquitoes incapable of transmitting the Plasmodium parasites that cause malaria. While promising, showing that mosquito-targeted antimalarials remain effective against wild parasites and mosquitoes, including drug- and insecticide-resistant populations in malaria-endemic countries, is crucial to the future viability of this approach. In this study, carried out in the US and Burkina Faso, we show that insecticide-resistance mechanisms found in highly resistant, natural Anopheles mosquito populations do not interfere with the transmission blocking activity of tarsal exposure to the antimalarial atovaquone, and that mosquito-targeted antimalarial exposure can block transmission of parasites resistant to the main therapeutic antimalarial drug artemisinin. By combining lab, and field-based studies in this way we have demonstrated that this novel approach can be effective in areas where conventional control measures are no longer as effective.
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Affiliation(s)
- Douglas G. Paton
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
- * E-mail: (DGP); (FC)
| | - Alexandra S. Probst
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Erica Ma
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Kelsey L. Adams
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - W. Robert Shaw
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Naresh Singh
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Selina Bopp
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Sarah K. Volkman
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Domombele F. S. Hien
- Institut de Recherche en Sciences de la Santé/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Prislaure S. L. Paré
- Institut de Recherche en Sciences de la Santé/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Rakiswendé S. Yerbanga
- Institut de Recherche en Sciences de la Santé/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Abdoullaye Diabaté
- Institut de Recherche en Sciences de la Santé/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Roch K. Dabiré
- Institut de Recherche en Sciences de la Santé/Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Thierry Lefèvre
- MIVEGEC, IRD, CNRS, University of Montpellier, Montpellier, France
- Laboratoire mixte international sur les vecteurs (LAMIVECT), Bobo Dioulasso, Burkina Faso
- Centre de Recherche en Écologie et Évolution de la Santé (CREES), Montpellier, France
| | - Dyann F. Wirth
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Flaminia Catteruccia
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, United States of America
- * E-mail: (DGP); (FC)
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Akoniyon OP, Adewumi TS, Maharaj L, Oyegoke OO, Roux A, Adeleke MA, Maharaj R, Okpeku M. Whole Genome Sequencing Contributions and Challenges in Disease Reduction Focused on Malaria. BIOLOGY 2022; 11:587. [PMID: 35453786 PMCID: PMC9027812 DOI: 10.3390/biology11040587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/11/2022]
Abstract
Malaria elimination remains an important goal that requires the adoption of sophisticated science and management strategies in the era of the COVID-19 pandemic. The advent of next generation sequencing (NGS) is making whole genome sequencing (WGS) a standard today in the field of life sciences, as PCR genotyping and targeted sequencing provide insufficient information compared to the whole genome. Thus, adapting WGS approaches to malaria parasites is pertinent to studying the epidemiology of the disease, as different regions are at different phases in their malaria elimination agenda. Therefore, this review highlights the applications of WGS in disease management, challenges of WGS in controlling malaria parasites, and in furtherance, provides the roles of WGS in pursuit of malaria reduction and elimination. WGS has invaluable impacts in malaria research and has helped countries to reach elimination phase rapidly by providing required information needed to thwart transmission, pathology, and drug resistance. However, to eliminate malaria in sub-Saharan Africa (SSA), with high malaria transmission, we recommend that WGS machines should be readily available and affordable in the region.
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Affiliation(s)
- Olusegun Philip Akoniyon
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa; (O.P.A.); (T.S.A.); (L.M.); (O.O.O.); (A.R.); (M.A.A.)
| | - Taiye Samson Adewumi
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa; (O.P.A.); (T.S.A.); (L.M.); (O.O.O.); (A.R.); (M.A.A.)
| | - Leah Maharaj
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa; (O.P.A.); (T.S.A.); (L.M.); (O.O.O.); (A.R.); (M.A.A.)
| | - Olukunle Olugbenle Oyegoke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa; (O.P.A.); (T.S.A.); (L.M.); (O.O.O.); (A.R.); (M.A.A.)
| | - Alexandra Roux
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa; (O.P.A.); (T.S.A.); (L.M.); (O.O.O.); (A.R.); (M.A.A.)
| | - Matthew A. Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa; (O.P.A.); (T.S.A.); (L.M.); (O.O.O.); (A.R.); (M.A.A.)
| | - Rajendra Maharaj
- Office of Malaria Research, South African Medical Research Council, Cape Town 7505, South Africa;
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa; (O.P.A.); (T.S.A.); (L.M.); (O.O.O.); (A.R.); (M.A.A.)
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19
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Yobi DM, Kayiba NK, Mvumbi DM, Boreux R, Kabututu PZ, Akilimali PZ, Situakibanza HNT, De Mol P, Speybroeck N, Mvumbi GL, Hayette MP. Biennial surveillance of Plasmodium falciparum anti-malarial drug resistance markers in Democratic Republic of Congo, 2017 and 2019. BMC Infect Dis 2022; 22:145. [PMID: 35144535 PMCID: PMC8830975 DOI: 10.1186/s12879-022-07112-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Because of the loss of chloroquine (CQ) effectiveness, the Democratic Republic of Congo (DRC)’s malaria treatment policy replaced CQ by sulfadoxine–pyrimethamine (SP) as first-line treatment of uncomplicated malaria in 2003, which in turn was replaced by artemisinin-based combination therapies (ACT) in 2005. The World Health Organization (WHO) recommends monitoring of anti-malarial drug resistance every 2 years. The study aimed to provide baseline data for biennial molecular surveillance of anti-malarial drug resistance by comparing data from a study conducted in 2019 to previously published data from a similar study conducted in 2017 in the DRC. Methods From July to November 2019, a cross-sectional study was conducted in ten sites which were previously selected for a similar study conducted in 2017 across the DRC. P. falciparum malaria was diagnosed by a rapid diagnostic test (RDT) or by microscopy and dried blood samples (DBS) were taken from patients who had a positive test. Segments of interest in pfcrt and pfk13 genes were amplified by conventional PCR before sequencing. Results Out of 1087 enrolled patients, 906 (83.3%) were PCR-confirmed for P. falciparum. Like in the 2017-study, none of the mutations known to be associated with Artemisinine (ART) resistance in Southeast Asia was detected. However, non-synonymous (NS) mutations with unknown functions were observed among which, A578S was detected in both 2017 and 2019-studies. The overall prevalence of pfcrt-K76T mutation that confers CQ-resistance was 22.7% in 2019-study compared to 28.5% in 2017-study (p-value = 0.069), but there was high variability between sites in the two studies. Like in 2017-study, the pfcrt 72–76 SVMNT haplotype associated with resistance to amodiaquine was not detected. Conclusion The study reported, within 2 years, the non-presence of molecular markers currently known to be associated with resistance to ART and to AQ in P. falciparum isolated in the DRC. However, the presence of polymorphisms with as-yet unknown functions was observed, requiring further characterization. Moreover, an overall decrease in the prevalence of CQ-resistance marker was observed in the DRC, but this prevalence remained highly variable from region to region. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07112-z.
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Affiliation(s)
- Doudou M Yobi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Nadine K Kayiba
- School of Public Health & Research Institute of Health and Society, Catholic University of Louvain, 1200, Brussels, Belgium.,School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.,Department of Public Health, Faculty of Medicine, University of Mbujimayi, Mbuji-Mayi, Democratic Republic of Congo
| | - Dieudonné M Mvumbi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Raphael Boreux
- Laboratory of Clinical Microbiology, University of Liège, 4000, Liège, Belgium
| | - Pius Z Kabututu
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pierre Z Akilimali
- School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hippolyte N T Situakibanza
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Patrick De Mol
- Laboratory of Clinical Microbiology, University of Liège, 4000, Liège, Belgium
| | - Niko Speybroeck
- School of Public Health & Research Institute of Health and Society, Catholic University of Louvain, 1200, Brussels, Belgium
| | - Georges L Mvumbi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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20
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Identification of polymorphisms in genes associated with drug resistance in Plasmodium falciparum isolates from school-age children in Kinshasa, Democratic Republic of Congo. Parasitol Int 2022; 88:102541. [PMID: 35051550 DOI: 10.1016/j.parint.2022.102541] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The emergence and spread of Plasmodium falciparum parasites resistant to antimalarial drugs constitutes an obstacle to malaria control and elimination. This study aimed to identify the prevalence of polymorphisms in pfk13, pfmdr1, pfdhfr, pfdhps and pfcrt genes in isolates from asymptomatic and symptomatic school-age children in Kinshasa. METHODS Nested-PCR followed by sequencing was performed for the detection of pfk13, pfmdr1, pfdhfr, pfdhps and pfcrt polymorphisms. RESULTS Two mutations in pfk13, C532S and Q613E were identified in the Democratic Republic of Congo for the first time. The prevalence of the drug-resistance associated mutations pfcrt K76T, pfdhps K540E and pfmdr1 N86Y was low, being 27%, 20% and 9%, respectively. CONCLUSION We found a low prevalence of genetic markers associated with chloroquine and sulfadoxine-pyrimethamine resistance in Kinshasa. Furthermore, no mutations previously associated with resistance against artemisinin and is derivatives were observed in the pfK13 gene. These findings support the continued use of ACTs and IPTp-SP. Continuous molecular monitoring of antimalarial resistance markers is recommended.
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21
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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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22
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Yasri S, Wiwanitkit V. Artemisinin resistance: an important emerging clinical problem in tropical medicine. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2021; 13:152-157. [PMID: 35103097 PMCID: PMC8784654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/06/2021] [Indexed: 06/14/2023]
Abstract
Artemisinin is an important antimalarial drug which is originated and developed from Chinese traditional herbal regimen. At present, artemisinin is used as an antimalarial drug for treatment of drug resistant malarial infection. The effectiveness of artemisinin is clinically accepted. Hence, artemisinin is currently used as main drug for malaria treatment in many tropical countries. Artemisinin resistance is a new emerging clinical problem in tropical medicine. New mutation can result in artemisinin resistance and the resistance becomes important new emerging problem in clinical malariology. It is necessary to control of artemisinin use and searching for new effective drug against artemisinin resistant malaria. In this article, the authors summarizes on important updated information regarding artemisinin resistance.
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Affiliation(s)
- Sora Yasri
- KMT Primary Care CenterBangkok, Thailand
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23
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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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24
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Ghoghari AM, Patel HV, Nayak NN, Mansuri TH, Pillai SM, Jain MR, Patel HB, Kansagra K, Resta ID, Möhrle J, Parmar DV. Simultaneous estimation of ZY-19489 and its active metabolite ZY-20486 in human plasma using LC-MS/MS, a novel antimalarial compound. Bioanalysis 2021; 13:1761-1777. [PMID: 34779650 DOI: 10.4155/bio-2021-0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: ZY-19489 is a new antimalarial drug candidate and selective LC-MS/MS method was established for estimation of ZY-19489 and its metabolite in human plasma. Materials & methods: LLE was employed for extraction, mass spectrometric quantification performed using positive ionization mode and DCP-IMP was used as an internal standard. The chromatographic separation was achieved using mobile phase 5 mM ammonium formate in water and 0.1% v/v ammonia solution in methanol:acetonitrile (90:10% v/v) and column Agilent Zorbex Extended C18, 3.5 μm, 100 × 4.6 mm with a 6-min run time. Results: The calibration curve of ZY-19489 was linear over range 1-500 ng/ml and 2-200 ng/ml for metabolite. Assay was reproducible, selective and devoid of matrix effect. Conclusion: The validated assay was implemented for clinical sample analysis derived from healthy human subjects and parasitemia-induced subjects.
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Affiliation(s)
- Ashok M Ghoghari
- Bioanalytical Laboratory, Zydus Research Centre, Ahmedabad, Gujarat, India
| | - Harilal V Patel
- Bioanalytical Laboratory, Zydus Research Centre, Ahmedabad, Gujarat, India
| | - Nisarg N Nayak
- Bioanalytical Laboratory, Zydus Research Centre, Ahmedabad, Gujarat, India
| | - Tariq H Mansuri
- Bioanalytical Laboratory, Zydus Research Centre, Ahmedabad, Gujarat, India
| | - Soma M Pillai
- Bioanalytical Laboratory, Zydus Research Centre, Ahmedabad, Gujarat, India
| | - Mukul R Jain
- Bioanalytical Laboratory, Zydus Research Centre, Ahmedabad, Gujarat, India
| | - Hardik B Patel
- Clinical Research, Zydus Research Centre, Ahmedabad, Gujarat, India
| | - Kevin Kansagra
- Clinical Research, Zydus Research Centre, Ahmedabad, Gujarat, India
| | | | - Jörg Möhrle
- Medicines for Malaria Venture, Geneva, Switzerland
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25
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Zhao H, Pi L, Zhao L, Qin Y, Zeng W, Xiang Z, Yang Q, Pan M, Li X, Zou C, Chen X, Zhao W, Lu Y, Wu Y, Duan M, Wang X, Li X, Mazier D, Huang Y, Yang Z. First Detection in West Africa of a Mutation That May Contribute to Artemisinin Resistance Plasmodium falciparum. Front Genet 2021; 12:701750. [PMID: 34691144 PMCID: PMC8531651 DOI: 10.3389/fgene.2021.701750] [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: 05/01/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The spread of drug resistance has seriously impacted the effective treatment of infection with the malaria parasite, Plasmodium falciparum. Continuous monitoring of molecular marker polymorphisms associated with drug resistance in parasites is essential for malaria control and elimination efforts. Our study describes mutations observed in the resistance genes Pfkelch13, Pfcrt, and Pfmdr1 in imported malaria and identifies additional potential drug resistance-associated molecular markers. Methods: Chinese patients infected in Africa with P. falciparum were treated with intravenous (IV) injections of artesunate 240–360 mg for 3–5 days while hospitalized and treated with oral dihydroartemisinin-piperaquine (DHP) for 3 days after hospital discharge. Blood samples were collected and PCR sequencing performed on genes Pfkelch13, Pfcrt, and Pfmdr1 from all isolates. Results: We analyzed a total of 225 patients from Guangxi, China with P. falciparum malaria acquired in Africa between 2016 and 2018. All patients were cured completely after treatment. The F446I mutation of the Pfkelch13 gene was detected for the first time from samples of West African P. falciparum, with a frequency of 1.0%. Five haplotypes of Pfcrt that encode residues 72–76 were found, with the wild-type CVMNK sequence predominating (80.8% of samples), suggesting that the parasites might be chloroquine sensitive. For Pfmdr1, N86Y (13.1%) and Y184F (58.8%) were the most prevalent, suggesting that artemether-lumefantrine may not, in general, be a suitable treatment for the group. Conclusions: For the first time, this study detected the F446I mutation of the Pfkelch13 gene from Africa parasites that lacked clinical evidence of resistance. This study provides the latest data for molecular marker surveillance related to antimalarial drug resistance genes Pfkelch13, Pfcrt, and Pfmdr1 imported from Africa, in Guangxi, China from Chinese migrate workers. Clinical Trial Registration: ChiCTROPC17013106.
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Affiliation(s)
- Hui Zhao
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Liang Pi
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Luyi Zhao
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yucheng Qin
- Shanglin County People's Hospital, Guangxi, China
| | - Weilin Zeng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Zheng Xiang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Qi Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Maohua Pan
- Shanglin County People's Hospital, Guangxi, China
| | - Xinxin Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Chunyan Zou
- Guangxi Zhuang Autonomous Region People's Hospital, Nanning, China
| | - Xi Chen
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Wei Zhao
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yuxin Lu
- Shanglin County People's Hospital, Guangxi, China
| | - Yanrui Wu
- Department of Cell Biology & Genetics, Kunming Medical University, Kunming, China
| | - Mengxi Duan
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Xun Wang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Xiaosong Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Dominique Mazier
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses, CIMI, Paris, France
| | - Yaming Huang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.,Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
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Nsanzabana C. Time to scale up molecular surveillance for anti-malarial drug resistance in sub-saharan Africa. Malar J 2021; 20:401. [PMID: 34645475 PMCID: PMC8513315 DOI: 10.1186/s12936-021-03942-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023] Open
Abstract
Artemisinin resistance has emerged and spread in the Greater Mekong Sub-region (GMS), followed by artemisinin-based combination therapy failure, due to both artemisinin and partner drug resistance. More worrying, artemisinin resistance has been recently reported and confirmed in Rwanda. Therefore, there is an urgent need to strengthen surveillance systems beyond the GMS to track the emergence or spread of artemisinin and partner drug resistance in other endemic settings. Currently, anti-malarial drug efficacy is monitored primarily through therapeutic efficacy studies (TES). Even though essential for anti-malarial drug policy change, these studies are difficult to conduct, expensive, and may not detect the early emergence of resistance. Additionally, results from TES may take years to be available to the stakeholders, jeopardizing their usefulness. Molecular markers are additional and useful tools to monitor anti-malarial drug resistance, as samples collected on dried blood spots are sufficient to monitor known and validated molecular markers of resistance, and could help detecting and monitoring the early emergence of resistance. However, molecular markers are not monitored systematically by national malaria control programmes, and are often assessed in research studies, but not in routine surveillance. The implementation of molecular markers as a routine tool for anti-malarial drug resistance surveillance could greatly improve surveillance of anti-malarial drug efficacy, making it possible to detect resistance before it translates to treatment failures. When possible, ex vivo assays should be included as their data could be useful complementary, especially when no molecular markers are validated.
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Affiliation(s)
- Christian Nsanzabana
- Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. .,University of Basel, P.O. Box, 4003, Basel, Switzerland.
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Discrete Survival Model Analysis of Plasmodium falciparum Response to Artemisinin-Based Combination Therapies among Children in Regions of Varying Malaria Transmission in Cameroon. Pathogens 2021; 10:pathogens10091106. [PMID: 34578139 PMCID: PMC8465257 DOI: 10.3390/pathogens10091106] [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: 07/09/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
The need to monitor changes in parasite clearance following treatment with artemisinin-based combination therapies (ACTs) is important in the containment of drug resistance. This study aimed to model Plasmodium falciparum response to ACTs among children in two different transmission settings (Mutengene and Garoua) in Cameroon. Using the step function, a discrete-time survival model was fitted with all the covariates included that might play a role in parasite clearance. The probability of clearing parasites within 24 h following treatment was 21.6% and 70.3% for younger children aged 6 to 59 months and 29.3% and 59.8% for older children aged 60 to 120 months in Mutengene and Garoua, respectively. After two days of treatment, the conditional probability of clearing parasites given that they were not cleared on day 1 was 76.7% and 96.6% for children aged 6–59 months and 83.1% and 93.5% for children aged 60–120 months in Mutengene and Garoua, respectively. The model demonstrated that the ecological setting, age group and pretreatment serum levels of creatinine and alanine aminotransferase were the main factors that significantly influenced parasite clearance in vivo after administration of ACTs (p < 0.05). The findings highlight the need for further investigations on host differential response to ACTs in current practice.
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Wicht KJ, Mok S, Fidock DA. Molecular Mechanisms of Drug Resistance in Plasmodium falciparum Malaria. Annu Rev Microbiol 2021; 74:431-454. [PMID: 32905757 DOI: 10.1146/annurev-micro-020518-115546] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Understanding and controlling the spread of antimalarial resistance, particularly to artemisinin and its partner drugs, is a top priority. Plasmodium falciparum parasites resistant to chloroquine, amodiaquine, or piperaquine harbor mutations in the P. falciparum chloroquine resistance transporter (PfCRT), a transporter resident on the digestive vacuole membrane that in its variant forms can transport these weak-base 4-aminoquinoline drugs out of this acidic organelle, thus preventing these drugs from binding heme and inhibiting its detoxification. The structure of PfCRT, solved by cryogenic electron microscopy, shows mutations surrounding an electronegative central drug-binding cavity where they presumably interact with drugs and natural substrates to control transport. P. falciparum susceptibility to heme-binding antimalarials is also modulated by overexpression or mutations in the digestive vacuole membrane-bound ABC transporter PfMDR1 (P. falciparum multidrug resistance 1 transporter). Artemisinin resistance is primarily mediated by mutations in P. falciparum Kelch13 protein (K13), a protein involved in multiple intracellular processes including endocytosis of hemoglobin, which is required for parasite growth and artemisinin activation. Combating drug-resistant malaria urgently requires the development of new antimalarial drugs with novel modes of action.
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Affiliation(s)
- Kathryn J Wicht
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, New York 10032, USA; , ,
| | - Sachel Mok
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, New York 10032, USA; , ,
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University Irving Medical Center, New York, New York 10032, USA; , , .,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York 10032, USA
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Das S, Kar A, Manna S, Mandal S, Mandal S, Das S, Saha B, Hati AK. Artemisinin combination therapy fails even in the absence of Plasmodium falciparum kelch13 gene polymorphism in Central India. Sci Rep 2021; 11:9946. [PMID: 33976269 PMCID: PMC8113598 DOI: 10.1038/s41598-021-89295-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022] Open
Abstract
Artemisinin is the frontline fast-acting anti-malarial against P. falciparum. Emergence and spread of resistant parasite in eastern-India poses a threat to national malaria control programs. Therefore, the objective of our study is to evaluate the artesunate-sulfadoxine-pyrimethamine efficacy in Central India. 180 monoclonal P. falciparum-infected patients received standard ASSP therapy during August 2015–January 2017, soon after diagnosis and monitored over next 42-days. Artemisinin-resistance was assessed through in-vivo parasite clearance half-life (PC1/2), ex-vivo ring-stage survivability (RSA), and genome analysis of kelch13 and other candidate gene (pfcrt, pfmdr1, pfatpase 6, pfdhfr and pfdhps). Of 180 P. falciparum positive patients, 9.5% showed increased PC1/2 (> 5.5 h), among them eleven isolates (6.1%) showed reduced sensitivity to RSA. In 4.4% of cases, parasites were not cleared by 72 h and showed prolonged PC1/2(5.6 h) (P < 0.005) along with significantly higher RSA (2.2%) than cured patients (0.4%). None of day-3 positive isolates contained the pfkelch13 mutation implicated in artemisinin resistance. Parasite recrudescence was observed in 5.6% patients, which was associated with triple dhfr–dhps (A16I51R59N108I164–S436G437K540G581T613) combination mutation. Emergence of reduced sensitivity to artesunate-sulfadoxine-pyrimethamine, in central India highlighted the risk toward spread of resistant parasite across different parts of India. Day-3 positive parasite, featuring the phenotype of artemisinin-resistance without pfkelch13 mutation, suggested kelch13-independent artemisinin-resistance.
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Affiliation(s)
- Sabyasachi Das
- Department of Physiology, Faculty of Medicine, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, 75150, Melaka, Malaysia. .,Department of Physiology, Faculty of Medicine, Lincoln University College, Petaling Jaya, Selangor, Malaysia. .,Department of Human Physiology, Vidyasagar University, Midnapore, West Bengal, India.
| | - Amrita Kar
- Department of Biotechnology, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, Sastra University, Thanjavur, Tamil Nadu, India
| | - Subhankar Manna
- Department of Human Physiology, Vidyasagar University, Midnapore, West Bengal, India
| | - Samaresh Mandal
- Department of Human Physiology, Vidyasagar University, Midnapore, West Bengal, India
| | | | | | - Bhaskar Saha
- Lab 5, National Centre for Cell Science, Ganeshkhind, Pune, India
| | - Amiya Kumar Hati
- Department of Medical Entomology and Parasitology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
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30
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Uwimana A, Umulisa N, Venkatesan M, Svigel SS, Zhou Z, Munyaneza T, Habimana RM, Rucogoza A, Moriarty LF, Sandford R, Piercefield E, Goldman I, Ezema B, Talundzic E, Pacheco MA, Escalante AA, Ngamije D, Mangala JLN, Kabera M, Munguti K, Murindahabi M, Brieger W, Musanabaganwa C, Mutesa L, Udhayakumar V, Mbituyumuremyi A, Halsey ES, Lucchi NW. Association of Plasmodium falciparum kelch13 R561H genotypes with delayed parasite clearance in Rwanda: an open-label, single-arm, multicentre, therapeutic efficacy study. THE LANCET. INFECTIOUS DISEASES 2021; 21:1120-1128. [PMID: 33864801 DOI: 10.1016/s1473-3099(21)00142-0] [Citation(s) in RCA: 215] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Partial artemisinin resistance is suspected if delayed parasite clearance (ie, persistence of parasitaemia on day 3 after treatment initiation) is observed. Validated markers of artemisinin partial resistance in southeast Asia, Plasmodium falciparum kelch13 (Pfkelch13) R561H and P574L, have been reported in Rwanda but no association with parasite clearance has been observed. We aimed to establish the efficacy of artemether-lumefantrine and genetic characterisation of Pfkelch13 alleles and their association with treatment outcomes. METHODS This open-label, single-arm, multicentre, therapeutic efficacy study was done in 2018 in three Rwandan sites: Masaka, Rukara, and Bugarama. Children aged 6-59 months with P falciparum monoinfection and fever were eligible and treated with a 3-day course of artemether-lumefantrine. Treatment response was monitored for 28 days using weekly microscopy screenings of blood samples for P falciparum. Mutations in Pfkelch13 and P falciparum multidrug resistance-1 (Pfmdr1) genes were characterised in parasites collected from enrolled participants. Analysis of flanking microsatellites surrounding Pfkelch13 was done to define the origins of the R561H mutations. The primary endpoint was PCR-corrected parasitological cure on day 28, as per WHO protocol. FINDINGS 228 participants were enrolled and 224 (98·2%) reached the study endpoint. PCR-corrected efficacies were 97·0% (95% CI 88-100) in Masaka, 93·8% (85-98) in Rukara, and 97·2% (91-100) in Bugarama. Pfkelch13 R561H mutations were present in 28 (13%) of 218 pre-treatment samples and P574L mutations were present in two (1%) pre-treatment samples. 217 (90%) of the 240 Pfmdr1 haplotypes observed in the pretreatment samples, had either the NFD (N86Y, Y184F, D1246Y) or NYD haplotype. Eight (16%) of 51 participants in Masaka and 12 (15%) of 82 participants in Rukara were microscopically positive 3 days after treatment initiation, which was associated with pre-treatment presence of Pfkelch13 R561H in Masaka (p=0·0005). Genetic analysis of Pfkelch13 R561H mutations suggest their common ancestry and local origin in Rwanda. INTERPRETATION We confirm evidence of emerging artemisinin partial resistance in Rwanda. Although artemether-lumefantrine remains efficacious, vigilance for decreasing efficacy, further characterisation of artemisinin partial resistance, and evaluation of additional antimalarials in Rwanda should be considered. FUNDING The US President's Malaria Initiative. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Aline Uwimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Noella Umulisa
- Maternal and Child Survival Program, Jhpiego, Kigali, Rwanda; PMI Impact Malaria, Kigali, Rwanda
| | - Meera Venkatesan
- US President's Malaria Initiative, US Agency for International Development, Washington, DC, USA
| | - Samaly S Svigel
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Zhiyong Zhou
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Rafiki M Habimana
- National Reference Laboratory, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Anicet Rucogoza
- National Reference Laboratory, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Leah F Moriarty
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States; US President's Malaria Initiative, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Emily Piercefield
- US President's Malaria Initiative, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Ira Goldman
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Bryan Ezema
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eldin Talundzic
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - M Andreína Pacheco
- Biology Department, Institute of Genomics and Evolutionary Medicine, Temple University Philadelphia, PA, USA
| | - Ananias A Escalante
- Biology Department, Institute of Genomics and Evolutionary Medicine, Temple University Philadelphia, PA, USA
| | | | - Jean-Louis N Mangala
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Michee Kabera
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Kaendi Munguti
- US President's Malaria Initiative, US Agency for International Development, Kigali, Rwanda
| | - Monique Murindahabi
- Roll Back Malaria, West and Central Africa National Malaria Control Programme, Bobo-Dioulasso, Burkina Faso
| | - William Brieger
- Bloomberg School of Public Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Leon Mutesa
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Eric S Halsey
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States; US President's Malaria Initiative, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Naomi W Lucchi
- Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States; US President's Malaria Initiative, US Centers for Disease Control and Prevention, Kigali, Rwanda.
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Da Veiga Leal S, Ward D, Campino S, Benavente ED, Ibrahim A, Claret T, Isaías V, Monteiro D, Clark TG, Gonçalves L, Valdez T, da Luz Lima Mendonça M, Silveira H, Nogueira F. Drug resistance profile and clonality of Plasmodium falciparum parasites in Cape Verde: the 2017 malaria outbreak. Malar J 2021; 20:172. [PMID: 33789667 PMCID: PMC8011132 DOI: 10.1186/s12936-021-03708-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cape Verde is an archipelago located off the West African coast and is in a pre-elimination phase of malaria control. Since 2010, fewer than 20 Plasmodium falciparum malaria cases have been reported annually, except in 2017, when an outbreak in Praia before the rainy season led to 423 autochthonous cases. It is important to understand the genetic diversity of circulating P. falciparum to inform on drug resistance, potential transmission networks and sources of infection, including parasite importation. METHODS Enrolled subjects involved malaria patients admitted to Dr Agostinho Neto Hospital at Praia city, Santiago island, Cape Verde, between July and October 2017. Neighbours and family members of enrolled cases were assessed for the presence of anti-P. falciparum antibodies. Sanger sequencing and real-time PCR was used to identify SNPs in genes associated with drug resistance (e.g., pfdhfr, pfdhps, pfmdr1, pfk13, pfcrt), and whole genome sequencing data were generated to investigate the population structure of P. falciparum parasites. RESULTS The study analysed 190 parasite samples, 187 indigenous and 3 from imported infections. Malaria cases were distributed throughout Praia city. There were no cases of severe malaria and all patients had an adequate clinical and parasitological response after treatment. Anti-P. falciparum antibodies were not detected in the 137 neighbours and family members tested. No mutations were detected in pfdhps. The triple mutation S108N/N51I/C59R in pfdhfr and the chloroquine-resistant CVIET haplotype in the pfcrt gene were detected in almost all samples. Variations in pfk13 were identified in only one sample (R645T, E668K). The haplotype NFD for pfmdr1 was detected in the majority of samples (89.7%). CONCLUSIONS Polymorphisms in pfk13 associated with artemisinin-based combination therapy (ACT) tolerance in Southeast Asia were not detected, but the majority of the tested samples carried the pfmdr1 haplotype NFD and anti-malarial-associated mutations in the the pfcrt and pfdhfr genes. The first whole genome sequencing (WGS) was performed for Cape Verdean parasites that showed that the samples cluster together, have a very high level of similarity and are close to other parasites populations from West Africa.
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Affiliation(s)
- Silvania Da Veiga Leal
- Laboratório de Entomologia Médica, Largo Do Desastre da Assistência, Instituto Nacional de Saúde Pública, Chã de Areia, Praia 719, Cape Verde.
| | - Daniel Ward
- Department of Infection and Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Susana Campino
- Department of Infection and Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ernest Diez Benavente
- Department of Infection and Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Ibrahim
- Department of Infection and Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Tânia Claret
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Varela Isaías
- Laboratório de Entomologia Médica, Largo Do Desastre da Assistência, Instituto Nacional de Saúde Pública, Chã de Areia, Praia 719, Cape Verde
| | - Davidson Monteiro
- Laboratório de Entomologia Médica, Largo Do Desastre da Assistência, Instituto Nacional de Saúde Pública, Chã de Areia, Praia 719, Cape Verde
| | - Taane G Clark
- Department of Infection and Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
| | - Luzia Gonçalves
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
- Centro de Estatística E Aplicações da Universidade de Lisboa (CEAUL), Campo Grande, Bloco C6, Piso 4, 1749-016, Lisbon, Portugal
| | - Tomas Valdez
- Ministério da Saúde E da Segurança, Palácio Do Governo, nº47, Praia, Cape Verde
| | - Maria da Luz Lima Mendonça
- Laboratório de Entomologia Médica, Largo Do Desastre da Assistência, Instituto Nacional de Saúde Pública, Chã de Areia, Praia 719, Cape Verde
| | - Henrique Silveira
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
| | - Fatima Nogueira
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisbon, Portugal
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32
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Sibley CH. Prevalence of Antimalarial Resistance Mediators. J Infect Dis 2021; 223:927-929. [PMID: 33146721 DOI: 10.1093/infdis/jiaa688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carol Hopkins Sibley
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
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Asua V, Conrad MD, Aydemir O, Duvalsaint M, Legac J, Duarte E, Tumwebaze P, Chin DM, Cooper RA, Yeka A, Kamya MR, Dorsey G, Nsobya SL, Bailey J, Rosenthal PJ. Changing Prevalence of Potential Mediators of Aminoquinoline, Antifolate, and Artemisinin Resistance Across Uganda. J Infect Dis 2021; 223:985-994. [PMID: 33146722 PMCID: PMC8006419 DOI: 10.1093/infdis/jiaa687] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In Uganda, artemether-lumefantrine is recommended for malaria treatment and sulfadoxine-pyrimethamine for chemoprevention during pregnancy, but drug resistance may limit efficacies. METHODS Genetic polymorphisms associated with sensitivities to key drugs were characterized in samples collected from 16 sites across Uganda in 2018 and 2019 by ligase detection reaction fluorescent microsphere, molecular inversion probe, dideoxy sequencing, and quantitative polymerase chain reaction assays. RESULTS Considering transporter polymorphisms associated with resistance to aminoquinolines, the prevalence of Plasmodium falciparum chloroquine resistance transporter (PfCRT) 76T decreased, but varied markedly between sites (0-46% in 2018; 0-23% in 2019); additional PfCRT polymorphisms and plasmepsin-2/3 amplifications associated elsewhere with resistance to piperaquine were not seen. For P. falciparum multidrug resistance protein 1, in 2019 the 86Y mutation was absent at all sites, the 1246Y mutation had prevalence ≤20% at 14 of 16 sites, and gene amplification was not seen. Considering mutations associated with high-level sulfadoxine-pyrimethamine resistance, prevalences of P. falciparum dihydrofolate reductase 164L (up to 80%) and dihydropteroate synthase 581G (up to 67%) were high at multiple sites. Considering P. falciparum kelch protein propeller domain mutations associated with artemisinin delayed clearance, prevalence of the 469Y and 675V mutations has increased at multiple sites in northern Uganda (up to 23% and 41%, respectively). CONCLUSIONS We demonstrate concerning spread of mutations that may limit efficacies of key antimalarial drugs.
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Affiliation(s)
- Victor Asua
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Melissa D Conrad
- University of California, San Francisco, San Francisco, California, USA
| | | | - Marvin Duvalsaint
- University of California, San Francisco, San Francisco, California, USA
| | - Jennifer Legac
- University of California, San Francisco, San Francisco, California, USA
| | - Elias Duarte
- University of California, San Francisco, San Francisco, California, USA
| | | | | | - Roland A Cooper
- Dominican University of California, San Rafael, California, USA
| | - Adoke Yeka
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grant Dorsey
- University of California, San Francisco, San Francisco, California, USA
| | - Sam L Nsobya
- Infectious Diseases Research Collaboration, Kampala, Uganda
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Ippolito MM, Moser KA, Kabuya JBB, Cunningham C, Juliano JJ. Antimalarial Drug Resistance and Implications for the WHO Global Technical Strategy. CURR EPIDEMIOL REP 2021; 8:46-62. [PMID: 33747712 PMCID: PMC7955901 DOI: 10.1007/s40471-021-00266-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Five years have passed since the World Health Organization released its Global Technical Strategy for Malaria (GTS). In that time, progress against malaria has plateaued. This review focuses on the implications of antimalarial drug resistance for the GTS and how interim progress in parasite genomics and antimalarial pharmacology offer a bulwark against it. RECENT FINDINGS For the first time, drug resistance-conferring genes have been identified and validated before their global expansion in malaria parasite populations. More efficient methods for their detection and elaboration have been developed, although low-density infections and polyclonality remain a nuisance to be solved. Clinical trials of alternative regimens for multidrug-resistant malaria have delivered promising results. New agents continue down the development pipeline, while a nascent infrastructure in sub-Saharan Africa for conducting phase I trials and trials of transmission-blocking agents has come to fruition after years of preparation. SUMMARY These and other developments can help inform the GTS as the world looks ahead to the next two decades of its implementation. To remain ahead of the threat that drug resistance poses, wider application of genomic-based surveillance and optimization of existing and forthcoming antimalarial drugs are essential.
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Affiliation(s)
- Matthew M. Ippolito
- Divisions of Clinical Pharmacology and Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Johns Hopkins Malaria Research Institute, Johns Hopkins University School of Public Health, Baltimore, MD USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Kara A. Moser
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC USA
| | | | - Clark Cunningham
- School of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Jonathan J. Juliano
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, CB#7030, 130 Mason Farm Rd, Chapel Hill, NC 27599 USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, NC USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
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Yobi DM, Kayiba NK, Mvumbi DM, Boreux R, Kabututu PZ, Situakibanza HNT, Umesumbu SE, De Mol P, Speybroeck N, Mvumbi GL, Hayette MP. Assessment of Plasmodium falciparum anti-malarial drug resistance markers in pfk13-propeller, pfcrt and pfmdr1 genes in isolates from treatment failure patients in Democratic Republic of Congo, 2018-2019. Malar J 2021; 20:144. [PMID: 33706773 PMCID: PMC7953712 DOI: 10.1186/s12936-021-03636-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background The national policy for malaria treatment of the Democratic Republic of Congo recommends two first-line artemisinin-based combinations for the treatment of uncomplicated malaria: artesunate-amodiaquine and artemether-lumefantrine. This study investigated the presence of markers associated with resistance to the current first-line artemisinin-based combination therapy (ACT) in isolates of Plasmodium falciparum from treatment failure patients in the Democratic Republic of Congo. Methods From November 2018 to November 2019, dried blood spots were taken from patients returning to health centres for fever within 28 days after an initial malaria treatment in six sentinel sites of the National Malaria Control Programme across Democratic Republic of Congo. The new episode of malaria was first detected by a rapid diagnostic test and then confirmed by a real-time PCR assay to define treatment failure. Fragments of interest in pfk13 and pfcrt genes were amplified by conventional PCR before sequencing and the Pfmdr1 gene copy number was determined by a TaqMan real-time PCR assay. Results Out of 474 enrolled patients, 364 (76.8%) were confirmed positive by PCR for a new episode of P. falciparum malaria, thus considered as treatment failure. Of the 325 P. falciparum isolates obtained from 364 P. falciparum-positive patients and successfully sequenced in the pfk13-propeller gene, 7 (2.2%) isolates carried non-synonymous mutations, among which 3 have been previously reported (N498I, N554K and A557S) and 4 had not yet been reported (F506L, E507V, D516E and G538S). Of the 335 isolates successfully sequenced in the pfcrt gene, 139 (41.5%) harboured the K76T mutation known to be associated with chloroquine resistance. The SVMNT haplotype associated with resistance to amodiaquine was not found. None of the isolates carried an increased copy number of the pfmdr1 gene among the 322 P. falciparum isolates successfully analysed. Conclusion No molecular markers currently known to be associated with resistance to the first-line ACT in use were detected in isolates of P. falciparum from treatment failure patients. Regular monitoring through in vivo drug efficacy and molecular studies must continue to ensure the effectiveness of malaria treatment in Democratic Republic of Congo.
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Affiliation(s)
- Doudou M Yobi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Nadine K Kayiba
- School of Public Health and Research Institute of Health and Society, Catholic University of Louvain, 1200, Brussels, Belgium.,School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.,Department of Public Health, Faculty of Medicine, University of Mbujimayi, Mbujimayi, Democratic Republic of Congo
| | - Dieudonné M Mvumbi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Raphael Boreux
- Laboratory of Clinical Microbiology, University of Liège, 4000, Liège, Belgium
| | - Pius Z Kabututu
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hippolyte N T Situakibanza
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Solange E Umesumbu
- National Malaria Control Programme, Kinshasa, Democratic Republic of Congo
| | - Patrick De Mol
- Laboratory of Clinical Microbiology, University of Liège, 4000, Liège, Belgium
| | - Niko Speybroeck
- School of Public Health and Research Institute of Health and Society, Catholic University of Louvain, 1200, Brussels, Belgium
| | - Georges L Mvumbi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Kayode AT, Akano K, Ajogbasile FV, Uwanibe JN, Oluniyi PE, Bankole BE, Eromon PJ, Sowunmi A, Folarin OA, Volkman SK, McInnis B, Sabeti P, Wirth DF, Happi CT. Polymorphisms in Plasmodium falciparum chloroquine resistance transporter (Pfcrt) and multidrug-resistant gene 1 (Pfmdr-1) in Nigerian children 10 years post-adoption of artemisinin-based combination treatments. Int J Parasitol 2021; 51:301-310. [PMID: 33359205 PMCID: PMC7940560 DOI: 10.1016/j.ijpara.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
The emergence and spread of Plasmodium falciparum parasites resistant to artemisinin derivatives and their partners in southeastern Asia threatens malaria control and elimination efforts, and heightens the need for an alternative therapy. We have explored the distribution of P. falciparum chloroquine resistance transporter (Pfcrt) and multidrug-resistant gene 1 (Pfmdr-1) haplotypes 10 years following adoption of artemisinin-based combination therapies in a bid to investigate the possible re-emergence of Chloroquine-sensitive parasites in Nigeria, and investigated the effect of these P. falciparum haplotypes on treatment outcomes of patients treated with artemisinin-based combination therapies. A total of 271 children aged <5 years with uncomplicated falciparum malaria were included in this study. Polymorphisms on codons 72-76 of the Pfcrt gene and codon 86 and 184 of Pfmdr-1 were determined using the high resolution melting assay. Of 240 (88.6%) samples successfully genotyped with HRM for Pfcrt, wildtype C72M74N75K76 (42.9%) and mutant C72I74E75T76 (53.8%) were observed. Also, wildtype N86Y184 (62.9%) and mutant N86F184 (21.1%), Y86Y184 (6.4%), and Y86F184 (0.4%) haplotypes of Pfmdr-1 were observed. Measures of responsiveness to ACTs were similar in children infected with P. falciparum crt haplotypes (C72I74E75T76 and C72M74N75K76) and major mdr-1 haplotypes (N86Y184, N86F184 and Y86Y184). Despite a 10 year gap since the malaria treatment policy changed to ACTs, over 50% of the P. falciparum parasites investigated in this study harboured the Chloroquine-resistant C72I74E75T76 haplotype, however this did not compromise the efficacy of artemisinin-based combination therapies. Should complete artemisinin resistance emerge from or spread to Nigeria, chloroquine might not be a good alternative therapy.
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Affiliation(s)
- Adeyemi T Kayode
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Kazeem Akano
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Fehintola V Ajogbasile
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Jessica N Uwanibe
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Paul E Oluniyi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Bolajoko E Bankole
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Philomena J Eromon
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Akintunde Sowunmi
- Institute of Medical Research and Training, College of Medicine, University of Ibadan; Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Onikepe A Folarin
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Sarah K Volkman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Pardis Sabeti
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Dyann F Wirth
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Christian T Happi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Bergmann C, van Loon W, Habarugira F, Tacoli C, Jäger JC, Savelsberg D, Nshimiyimana F, Rwamugema E, Mbarushimana D, Ndoli J, Sendegeya A, Bayingana C, Mockenhaupt FP. Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda. Emerg Infect Dis 2021; 27:294-296. [PMID: 33350925 PMCID: PMC7774571 DOI: 10.3201/eid2701.203527] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Artemisinin resistance in Plasmodium falciparum is associated with nonsynonymous mutations in the Kelch 13 (K13) propeller domain. We found that 12.1% (8/66) of clinical P. falciparum isolates from Huye district, Rwanda, exhibited K13 mutations, including R561H, a validated resistance marker. K13 mutations appear to be increasing in this region.
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Sharma AI, Shin SH, Bopp S, Volkman SK, Hartl DL, Wirth DF. Genetic background and PfKelch13 affect artemisinin susceptibility of PfCoronin mutants in Plasmodium falciparum. PLoS Genet 2020; 16:e1009266. [PMID: 33370279 PMCID: PMC7793257 DOI: 10.1371/journal.pgen.1009266] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/08/2021] [Accepted: 11/10/2020] [Indexed: 11/21/2022] Open
Abstract
Malaria continues to impose a significant health burden in the continent of Africa with 213 million cases in 2018 alone, representing 93% of cases worldwide. Because of high transmission of malaria within the continent, the selection pressures to develop drug resistance in African parasites are distinct compared to the rest of the world. In light of the spread of resistance to artemisinin conferred by the C580Y mutation in the PfKelch13 propeller domain in Southeast Asia, and its independent emergence in South America, it is important to study genetic determinants of resistance in the African context using African parasites. Through in vitro evolution of Senegalese parasites, we had previously generated the artemisinin-resistant parasites Pikine_R and Thiès_R and established pfcoronin mutations to be sufficient to confer artemisinin resistance in the standard ring-stage survival assay (RSA). In the current study, we used genetic analysis of revertants to demonstrate pfcoronin to be the major driver of elevated RSA in the artemisinin-resistant parasites Pikine_R and Thiès_R evolved in vitro. We interrogated the role of a second gene PF3D7_1433800, which also had mutations in both the Pikine_R and Thiès_R selected lines, but found no evidence of a contribution to reduced susceptibility in the RSA survival assay. Nevertheless, our genetic analysis demonstrates that parasite genetic background is important in the level of pfcoronin mediated RSA survival, and therefore we cannot rule out a role for PF3D7_1433800 in other genetic backgrounds. Finally, we tested the potential synergy between the mutations of pfcoronin and pfkelch13 through the generation of single and double mutants in the Pikine genetic background and found that the contribution of pfcoronin to reduced susceptibility is masked by the presence of pfkelch13. This phenomenon was also observed in the 3D7 background, suggesting that pfcoronin may mediate its effects via the same pathway as pfkelch13. Investigating the biology of proteins containing the beta-propeller domain could further elucidate the different pathways that the parasite could use to attain resistance.
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Affiliation(s)
- Aabha I. Sharma
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Sara H. Shin
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Selina Bopp
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Sarah K. Volkman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States of America
- Infectious Disease and Microbiome Program, Broad Institute, Cambridge, United States of America
- College of Natural, Behavioral and Health Sciences, Simmons University, Boston, United States of America
| | - Daniel L. Hartl
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States of America
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, United States of America
| | - Dyann F. Wirth
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States of America
- Infectious Disease and Microbiome Program, Broad Institute, Cambridge, United States of America
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Kayiba NK, Yobi DM, Tshibangu-Kabamba E, Tuan VP, Yamaoka Y, Devleesschauwer B, Mvumbi DM, Okitolonda Wemakoy E, De Mol P, Mvumbi GL, Hayette MP, Rosas-Aguirre A, Speybroeck N. Spatial and molecular mapping of Pfkelch13 gene polymorphism in Africa in the era of emerging Plasmodium falciparum resistance to artemisinin: a systematic review. THE LANCET. INFECTIOUS DISEASES 2020; 21:e82-e92. [PMID: 33125913 DOI: 10.1016/s1473-3099(20)30493-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 03/29/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
The spread of Plasmodium falciparum isolates carrying mutations in the kelch13 (Pfkelch13) gene associated with artemisinin resistance (PfART-R) in southeast Asia threatens malaria control and elimination efforts. Emergence of PfART-R in Africa would result in a major public health problem. In this systematic review, we investigate the frequency and spatial distribution of Pfkelch13 mutants in Africa, including mutants linked to PfART-R in southeast Asia. Seven databases were searched (PubMed, Embase, Scopus, African Journal Online, African Index Medicus, Bioline, and Web of Science) for relevant articles about polymorphisms of the Pfkelch13 gene in Africa before January, 2019. Following PRISMA guidelines, 53 studies that sequenced the Pfkelch13 gene of 23 100 sample isolates in 41 sub-Saharan African countries were included. The Pfkelch13 sequence was highly polymorphic (292 alleles, including 255 in the Pfkelch13-propeller domain) but with mutations occurring at very low relative frequencies. Non-synonymous mutations were found in only 626 isolates (2·7%) from west, central, and east Africa. According to WHO, nine different mutations linked to PfART-R in southeast Asia (Phe446Ile, Cys469Tyr, Met476Ile, Arg515Lys, Ser522Cys, Pro553Leu, Val568Gly, Pro574Leu, and Ala675Val) were detected, mainly in east Africa. Several other Pfkelch13 mutations, such as those structurally similar to southeast Asia PfART-R mutations, were also identified, but their relevance for drug resistance is still unknown. This systematic review shows that Africa, thought to not have established PfART-R, reported resistance-related mutants in the past 5 years. Surveillance using PfART-R molecular markers can provide valuable decision-making information to sustain the effectiveness of artemisinin in Africa.
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Affiliation(s)
- Nadine K Kayiba
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium; Department of Public Health, University of Mbujimayi, Mbujimayi, DR Congo; Department of Epidemiology and Biostatistics, University of Kinshasa, Kinshasa, DR Congo
| | - Doudou M Yobi
- Department of Basic Sciences, University of Kinshasa, Kinshasa, DR Congo
| | - Evariste Tshibangu-Kabamba
- Department of Basic Sciences, University of Mbujimayi, Mbujimayi, DR Congo; Department of Environmental and Preventive Medicine, Oita University, Yufu, Japan
| | - Vo P Tuan
- Department of Endoscopy, Cho Ray Hospital, Ho Chi Minh, Vietnam; Department of Environmental and Preventive Medicine, Oita University, Yufu, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University, Yufu, Japan
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Dieudonné M Mvumbi
- Department of Basic Sciences, University of Kinshasa, Kinshasa, DR Congo
| | | | - Patrick De Mol
- Department of Parasitology and Mycology, University Hospital of Liège, Liège, Belgium
| | - Georges L Mvumbi
- Department of Basic Sciences, University of Kinshasa, Kinshasa, DR Congo
| | - Marie-Pierre Hayette
- Department of Parasitology and Mycology, University Hospital of Liège, Liège, Belgium
| | - Angel Rosas-Aguirre
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Niko Speybroeck
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.
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Karema C, Wen S, Sidibe A, Smith JL, Gosling R, Hakizimana E, Tanner M, Noor AM, Tatarsky A. History of malaria control in Rwanda: implications for future elimination in Rwanda and other malaria-endemic countries. Malar J 2020; 19:356. [PMID: 33028337 PMCID: PMC7539391 DOI: 10.1186/s12936-020-03407-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria was first reported in Rwanda in the early 1900s with significant heterogeneity and volatility in transmission over subsequent decades. Here, a comprehensive literature review of malaria transmission patterns and control strategies in Rwanda between 1900 and 2018 is presented to provide insight into successes and challenges in the country and to inform the future of malaria control in Rwanda. METHODS A systematic literature search of peer-reviewed publications (Web of Knowledge, PubMed, Google Scholar, and the World Health Organization Library (WHOLIS) and grey literature on malaria control in Rwanda between 1900 and 2019 was conducted with the following search terms: "malaria"", "Rwanda", "epidemiology", "control", "treatment", and/or "prevention." Reports and other relevant documents were also obtained from the Rwanda National Malaria Control Programme (NMCP). To inform this literature review and evidence synthesis, epidemiologic and intervention data were collated from NMCP and partner reports, the national routine surveillance system, and population surveys. RESULTS Two hundred sixty-eight peer-reviewed publications and 56 grey literature items were reviewed, and information was extracted. The history of malaria control in Rwanda is thematically described here according to five phases: 1900 to 1954 before the launch of the Global Malaria Eradication Programme (GMEP); (2) Implementation of the GMEP from 1955 to 1969; (3) Post- GMEP to 1994 Genocide; (4) the re-establishment of malaria control from 1995 to 2005, and (5) current malaria control efforts from 2006 to 2018. The review shows that Rwanda was an early adopter of tools and approaches in the early 2000s, putting the country ahead of the curve and health systems reforms created an enabling environment for an effective malaria control programme. The last two decades have seen unprecedented investments in malaria in Rwanda, resulting in significant declines in disease burden from 2000 to 2011. However, in recent years, these gains appear to have reversed with increasing cases since 2012 although the country is starting to make progress again. CONCLUSION The review shows the impact and fragility of gains against malaria, even in the context of sustained health system development. Also, as shown in Rwanda, country malaria control programmes should be dynamic and adaptive to respond and address changing settings.
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Affiliation(s)
- Corine Karema
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Quality and Equity Health Care, Kigali, Rwanda.
| | - Shawn Wen
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Abigail Sidibe
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
| | - Emmanuel Hakizimana
- Malaria and Other Parasitic Diseases Division, RBC-Ministry of Health, Kigali, Rwanda
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Abdisalan M Noor
- Strategic Information for Response, Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Allison Tatarsky
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, USA
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Yobi DM, Kayiba NK, Mvumbi DM, Boreux R, Bontems S, Kabututu PZ, De Mol P, Speybroeck N, Mvumbi GL, Hayette MP. The lack of K13-propeller mutations associated with artemisinin resistance in Plasmodium falciparum in Democratic Republic of Congo (DRC). PLoS One 2020; 15:e0237791. [PMID: 32822392 PMCID: PMC7446852 DOI: 10.1371/journal.pone.0237791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/02/2020] [Indexed: 11/20/2022] Open
Abstract
Artemisinin-based combination therapies (ACTs) have been recommended by the World Health Organization (WHO) as first-line treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria since 2005 in Democratic Republic of Congo (DRC) and a regular surveillance of the ACT efficacy is required to ensure the treatment effectiveness. Mutations in the propeller domain of the pfk13 gene were identified as molecular markers of artemisinin resistance (ART-R). This study investigated the pfk13-propeller gene polymorphism in clinical isolates of P. falciparum collected in the DRC. In 2017, ten geographical sites across DRC were selected for a cross-sectional study that was conducted first in Kinshasa from January to March, then in the nine other sites from September to December. Dried blood samples were collected from patients attending health centers for fever where diagnosis of Malaria was first made by rapid diagnostic test (RDT) available on site (SD Bioline malaria Ag Pf or CareStart Malaria Pf) or by thick blood smear and then confirmed by a P. falciparum real-time PCR assay. A pfk13-propeller segment containing a fragment that codes for amino acids at positions 427–595 was amplified by conventional PCR before sequencing. In total, 1070 patients were enrolled in the study. Real-time PCR performed confirmed the initial diagnosis of P. falciparum infection in 806 samples (75.3%; 95% CI: 72.6%– 77.9%). Of the 717 successfully sequenced P. falciparum isolates, 710 (99.0%; 95% CI: 97.9% - 99.6) were wild-type genotypes and 7 (1.0%; 95% CI: 0.4% - 2.1%) carried non-synonymous (NS) mutations in pfk13-propeller including 2 mutations (A578S and V534A) previously detected and 2 other (M472I and A569T) not yet detected in the DRC. Mutations associated with ART-R in Southeast Asia were not observed in DRC. However, the presence of other mutations in pfk13-propeller gene calls for further investigations to assess their implication in drug resistance.
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Affiliation(s)
- Doudou Malekita Yobi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- * E-mail:
| | - Nadine Kalenda Kayiba
- School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- School of Public Health & Research Institute of Health and Society, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Dieudonné Makaba Mvumbi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Raphael Boreux
- Laboratory of Clinical Microbiology, University of Liège, Liège, Belgium
| | - Sebastien Bontems
- Laboratory of Clinical Microbiology, University of Liège, Liège, Belgium
| | - Pius Zakayi Kabututu
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Patrick De Mol
- Laboratory of Clinical Microbiology, University of Liège, Liège, Belgium
| | - Niko Speybroeck
- School of Public Health & Research Institute of Health and Society, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Georges Lelo Mvumbi
- Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Hanboonkunupakarn B, White NJ. Advances and roadblocks in the treatment of malaria. Br J Clin Pharmacol 2020; 88:374-382. [PMID: 32656850 PMCID: PMC9437935 DOI: 10.1111/bcp.14474] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
The deployment of artesunate for severe malaria and the artemisinin combination therapies (ACTs) for uncomplicated malaria has been a major advance in antimalarial therapeutics. These drugs have reduced treated mortality, accelerated recovery and reduced treatment failure rates and transmission from the treated infection. Artemisinin derivatives remain highly effective against falciparum malaria in most malaria endemic areas, but significant resistance has emerged in the Greater Mekong subregion of Southeast Asia. Resistance to artemisinins was followed by resistance to the ACT partner drugs, and fit multidrug resistant parasite lineages have now spread widely across the region. ACTs remain highly effective against P. vivax and the other malaria species. Recent studies have shown that radical curative regimens of primaquine (to prevent relapse) can be shortened to 7 days, and that the newly introduced single dose tafenoquine is an alternative, although the currently recommended dose is insufficient in Southeast Asia and Oceania. Targeted malaria elimination using focal mass treatments with dihydroartemisinin-piperaquine have proved safe and effective malaria elimination accelerators, but progress overall towards malaria elimination is slow. Indeed since 2015 overall malaria case numbers globally have risen. As new drugs will not become widely available in the near future, active measures to preserve the current antimalarials should be given the highest priority.
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Affiliation(s)
| | - Nicholas J White
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, UK
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Traoré K, Diakité SAS, Bah S, Konaté DS, Dabitao D, Sanogo I, Sangaré M, Dama S, Keita B, Doumbouya M, Guindo MA, Doumbia S, Diakité M. Ex-vivo Sensitivity of Plasmodium falciparum to Common Anti-malarial Drugs: The Case of Kéniéroba, a Malaria Endemic Village in Mali. Drugs R D 2020; 20:249-255. [PMID: 32557086 PMCID: PMC7419409 DOI: 10.1007/s40268-020-00313-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In 2006, the National Malaria Control Program in Mali recommended artemisinin-based combination therapy as the first-line treatment for uncomplicated malaria. Since the introduction of artemisinin-based combination therapy, few reports are available on the level of resistance of Plasmodium falciparum to the most common anti-malarial drugs in Mali. METHODS From 2016 to 2017, we assessed the ex-vivo drug sensitivity of P. falciparum isolates in Kéniéroba, a village located in a rural area of southern Mali. We collected P. falciparum isolates from malaria-infected children living in Kéniéroba. The isolates were tested for ex-vivo sensitivity to commonly used anti-malarial drugs, namely chloroquine, quinine, amodiaquine, mefloquine, lumefantrine, dihydroartermisinin, and piperaquine. We used the 50% inhibitory concentration determination method, which is based on the incorporation of SYBR® Green into the parasite's genetic material. RESULTS Plasmodium falciparum isolates were found to have a reduced ex-vivo sensitivity to quinine (25.7%), chloroquine (12.2%), amodiaquine (2.7%), and mefloquine (1.3%). In contrast, the isolates were 100% sensitive to lumefantrine, dihydroartermisinin, and piperaquine. A statistically significant correlation was found between 50% inhibitory concentration values of quinine and amodiaquine (r = 0.80; p < 0.0001). CONCLUSIONS Plasmodium falciparum isolates were highly sensitive to dihydroartermisinin, lumefantrine, and piperaquine and less sensitive to amodiaquine (n = 2), mefloquine (n = 1), and quinine (n = 19). Therefore, our data support the previously reported increasing trend in chloroquine sensitivity in Mali.
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Affiliation(s)
- Karim Traoré
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali.
| | - Seidina A S Diakité
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Sekou Bah
- Hospital of Point-G/University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Drissa S Konaté
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Djeneba Dabitao
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Ibrahim Sanogo
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Modibo Sangaré
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Souleymane Dama
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Bourama Keita
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Mory Doumbouya
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Merepen A Guindo
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Seydou Doumbia
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
| | - Mahamadou Diakité
- Malaria Research and Training Center, Mali International Center for Excellence in Research (Mali-ICER), University of Sciences, Techniques and Technologies of Bamako (USTTB), BP 1805, Bamako, Mali
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Khan AQ, Pernaute-Lau L, Khattak AA, Luijcx S, Aydin-Schmidt B, Hussain M, Khan TA, Mufti FU, Morris U. Surveillance of genetic markers associated with Plasmodium falciparum resistance to artemisinin-based combination therapy in Pakistan, 2018-2019. Malar J 2020; 19:206. [PMID: 32513171 PMCID: PMC7282094 DOI: 10.1186/s12936-020-03276-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/29/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The spread of artemisinin resistance in the Greater Mekong Subregion of Southeast Asia poses a significant threat for current anti-malarial treatment guidelines globally. The aim of this study was to assess the current prevalence of molecular markers of drug resistance in Plasmodium falciparum in the four provinces with the highest malaria burden in Pakistan, after introducing artemether-lumefantrine as first-line treatment in 2017. METHODS Samples were collected during routine malaria surveillance in Punjab, Sindh, Baluchistan, and Khyber Pakhtunkhwa provinces of Pakistan between January 2018 and February 2019. Plasmodium falciparum infections were confirmed by rapid diagnostic test or microscopy. Plasmodium falciparum positive isolates (n = 179) were screened by Sanger sequencing for single nucleotide polymorphisms (SNPs) in the P. falciparum kelch 13 (pfk13) propeller domain and in P. falciparum coronin (pfcoronin). SNPs in P. falciparum multidrug resistance 1 (pfmdr1) N86Y, Y184F, D1246Y and P. falciparum chloroquine resistance transporter (pfcrt) K76T were genotyped by PCR-restriction fragment length polymorphism. RESULTS No artemisinin resistance associated SNPs were identified in the pfk13 propeller domain or in pfcoronin. The pfmdr1 N86, 184F, D1246 and pfcrt K76 alleles associated with reduced lumefantrine sensitivity were present in 83.8% (150/179), 16.9% (29/172), 100.0% (173/173), and 8.4% (15/179) of all infections, respectively. The chloroquine resistance associated pfcrt 76T allele was present in 98.3% (176/179) of infections. CONCLUSION This study provides an update on the current prevalence of molecular markers associated with reduced P. falciparum sensitivity to artemether and/or lumefantrine in Pakistan, including a first baseline assessment of polymorphisms in pfcoronin. No mutations associated with artemisinin resistance were observed in pfk13 or pfcoronin. However, the prevalence of the pfmdr1 N86 and D1246 alleles, that have been associated with decreased susceptibility to lumefantrine, remain high. Although clinical and molecular data suggest that the current malaria treatment guidelines for P. falciparum are presently effective in Pakistan, close monitoring for artemisinin and lumefantrine resistance will be critical to ensure early detection and enhanced containment of emerging ACT resistance spreading across from Southeast Asia.
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Affiliation(s)
- Abdul Qader Khan
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Leyre Pernaute-Lau
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Biosystems and Integrative Science Institute, Faculty of Sciences of the University of Lisbon, Lisbon, Portugal
| | - Aamer Ali Khattak
- Department of Medical Lab Technology, The University of Haripur, Haripur, Pakistan
| | - Sanna Luijcx
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Berit Aydin-Schmidt
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Mubashir Hussain
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
| | - Taj Ali Khan
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
| | - Farees Uddin Mufti
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Ulrika Morris
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
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Different Plasmodium falciparum clearance times in two Malian villages following artesunate monotherapy. Int J Infect Dis 2020; 95:399-405. [PMID: 32320811 PMCID: PMC7294218 DOI: 10.1016/j.ijid.2020.03.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022] Open
Abstract
High prevalence of residual parasitemia at day 3 post-artesunate monotherapy treatment using qPCR while no parasites were detected by microscopy at the same timepoint. A longer parasite clearance time observed in a Malian village. Artesunate treatment is still efficacious on Plasmodium falciparum in Mali.
Background Artemisinin resistance described as increased parasite clearance time (PCT) is rare in Africa. More sensitive methods such as qPCR might better characterize the clearance phenotype in sub-Saharan Africa. Methods PCT is explored in Mali using light microscopy and qPCR after artesunate for uncomplicated malaria. In two villages, patients were followed for 28 days. Blood smears and spots were collected respectively for microscopy and qPCR. Parasitemia slope half-life was calculated after microscopy. Patient residual parasitemia were measured by qPCR. Results Uncorrected adequate clinical and parasitological responses (ACPR) observed in Faladje and Bougoula-Hameau were 78% and 92%, respectively (p = 0.01). This reached 100% for both after molecular correction. Proportions of 24H microscopy positive patients in Faladje and Bougoula-Hameau were 97.2% and 72%, respectively (p < 0.0001). Slope half-life was 2.8 h in Faladje vs 2H in Bougoula-Hameau (p < 0.001) and Proportions of 72H patients with residual parasitemia were 68.5% and 40% in Faladje and Bougoula-Hameau, respectively (p = 0.003). The mean residual parasitemia was 2.9 in Faladje vs. 0.008 in Bougoula-Hameau (p = 0.002). Although artesunate is efficacious in Mali, the longer parasite clearance time with submicroscopic parasitemia observed may represent early signs of developing P. falciparum resistance to artemisinins.
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Bwire GM, Ngasala B, Mikomangwa WP, Kilonzi M, Kamuhabwa AAR. Detection of mutations associated with artemisinin resistance at k13-propeller gene and a near complete return of chloroquine susceptible falciparum malaria in Southeast of Tanzania. Sci Rep 2020; 10:3500. [PMID: 32103124 PMCID: PMC7044163 DOI: 10.1038/s41598-020-60549-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 02/12/2020] [Indexed: 11/09/2022] Open
Abstract
In Tanzania, chloroquine was replaced by sulphadoxine- pyrimethamine (SP) as a first-line for treatment of uncomplicated malaria. Due to high resistance in malaria parasites, SP lasted for only 5 years and by the end of 2006 it was replaced with the current artemisinin combination therapy. We therefore, set a study to determine the current genotypic mutations associated with Plasmodium falciparum resistance to artemisinin, partner drugs and chloroquine. Parasites DNA were extracted from dried blood spots collected by finger-prick from Tanzanian malaria infected patients. DNA were sequenced using MiSeq then genotypes were translated into drug resistance haplotypes at Wellcome Sanger Institute, UK. About 422 samples were successful sequenced for K13 gene (marker for artemisinin resistance), the wild type (WT) was found in 391 samples (92.7%) whereby 31 samples (7.3%) had mutations in K13 gene. Of 31 samples with mutations, one sample had R561H, a mutation that has been associated with delayed parasite clearance in Southeast Asia, another sample had A578S, a mutation not associated with artemisinin whilst 29 samples had K13 novel mutations. There were no mutations in PGB, EXO, P23_BP and PfMDR1 at position 86 and 1246 (markers for resistance in artemisinin partner drugs) but 270 samples (60.4%) had mutations at PfMDR1 Y184F. Additionally, genotyped PfCRT at positions 72-76 (major predictors for chroquine resistance), found WT gene in 443 out of 444 samples (99.8%). In conclusion, this study found mutations in K13-propeller gene and high prevalence of chloroquine susceptible P. falciparum in Southeast of Tanzania.
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Affiliation(s)
- George M Bwire
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania.
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Appolinary A R Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
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Wang X, Ruan W, Zhou S, Huang F, Lu Q, Feng X, Yan H. Molecular surveillance of Pfcrt and k13 propeller polymorphisms of imported Plasmodium falciparum cases to Zhejiang Province, China between 2016 and 2018. Malar J 2020; 19:59. [PMID: 32019571 PMCID: PMC7001319 DOI: 10.1186/s12936-020-3140-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Resistance to anti-malarial drugs hinders malaria elimination. Monitoring the molecular markers of drug resistance helps improve malaria treatment policies. This study aimed to assess the distribution of molecular markers of imported Plasmodium falciparum infections. METHODS In total, 485 P. falciparum cases imported from Africa, Southeast Asia, and Oceania into Zhejiang province, China, from 2016 to 2018 were investigated. Most were imported from Africa, and only a few cases originated in Asia and Oceania. Blood samples were collected from each patient. Plasmodium falciparum chloroquine resistance transporter (Pfcrt) at residues 72-76 and Kelch13-propeller (k13) were determined by nested PCR and DNA sequence. RESULTS Wild-type Pfcrt at residues 72-76 was predominant (72.61%), but mutant and mixed alleles were also detected, of which CVIET (22.72%) was the most common. Mutant Pfcrt haplotypes were more frequent in patients from West Africa (26.92%), North Africa (25%), and Central Africa (21.93%). The number of cases of P. falciparum infections was small in Southeast Asia and Oceania, and these cases involved Pfcrt mutant type. For the k13 propeller gene, 26 samples presented 19 different point mutations, including eight nonsynonymous mutations (P441S, D464E, K503E, R561H, A578S, R622I, V650F, N694K). In addition, R561H, one of the validated SNPs in k13, was detected in one patient from Myanmar and one patient from Rwanda. A578S, although common in Africa, was found in only one patient from Cameroon. R622I was detected in one sample from Mozambique and one sample from Somalia. The genetic diversity of k13 was low in most regions of Africa and purifying selection was suggested by Tajima's D test. CONCLUSIONS The frequency and spatial distributions of Pfcrt and k13 mutations associated with drug resistance were determined. Wild-type Pfcrt was dominant in Africa. Among k13 mutations correlated with delayed parasite clearance, only the R561H mutation was found in one case from Rwanda in Africa. Both Pfcrt and k13 mutations were detected in patients from Southeast Asia and Oceania. These findings provide insights into the molecular epidemiological profile of drug resistance markers in the study region.
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Affiliation(s)
- Xiaoxiao Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Schistosomiasis and Filariasis, MOH, and WHO Collaborating Centre for Malaria, Shanghai, People's Republic of China
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People's Republic of China
| | - Wei Ruan
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People's Republic of China
| | - Shuisen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Schistosomiasis and Filariasis, MOH, and WHO Collaborating Centre for Malaria, Shanghai, People's Republic of China.
| | - Fang Huang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Schistosomiasis and Filariasis, MOH, and WHO Collaborating Centre for Malaria, Shanghai, People's Republic of China.
| | - Qiaoyi Lu
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People's Republic of China
| | - Xinyu Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Schistosomiasis and Filariasis, MOH, and WHO Collaborating Centre for Malaria, Shanghai, People's Republic of China
| | - He Yan
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Schistosomiasis and Filariasis, MOH, and WHO Collaborating Centre for Malaria, Shanghai, People's Republic of China
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Smith-Aguasca R, Gupta H, Uberegui E, Maquina M, Saute F, Paaijmans KP, Mayor A, Huijben S. Mosquitoes as a feasible sentinel group for anti-malarial resistance surveillance by Next Generation Sequencing of Plasmodium falciparum. Malar J 2019; 18:351. [PMID: 31623623 PMCID: PMC6796398 DOI: 10.1186/s12936-019-2946-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/03/2019] [Indexed: 12/19/2022] Open
Abstract
Background Plasmodium falciparum drug resistance surveillance is key to successful disease control and eradication. Contemporary methods that only allow determination of prevalence of resistance are expensive, time consuming and require ethical considerations. A newer method involving Next Generation Sequencing (NGS) permits obtaining frequency of resistance while allowing to detect minority variants in mixed infections. Here, NGS was tested for P. falciparum resistance marker detection in mosquito samples as a feasible and suitable alternative for molecular resistance surveillance. Anopheles funestus were collected in southern Mozambique using CDC light traps and manual collections. DNA was extracted from either whole mosquito, head-thorax and abdomen separately or pools of five mosquitoes. These samples were screened for P. falciparum and if positive for k13, pfcrt, pfmdr1, pfdhps and pfdhfr mutations related to anti-malarial drug resistance with Sanger sequencing and NGS. Results Among the 846 samples screened for P. falciparum, 122 were positive by 18S ssrDNA qPCR with an infection rate of 23.6%. No mutations were observed for k13 and pfcrt72-76 and almost zero for pfmdr86, but quintuple pfdhfr/pfdhps mutations were near fixation and about half of the isolates contained the pfmdr184F polymorphism. Similar allele frequencies of resistance markers were estimated with NGS in comparison with the prevalence of markers obtained with the gold standard Sanger sequencing. Conclusions Pooled deep sequencing of P. falciparum isolates extracted from mosquitoes is a promising, efficient and cost-effective method to quantify allele frequencies at population level which allows to detect known and unknown markers of resistance in single and mixed infections in a timelier manner. Using mosquitoes as sentinel group and focusing on allele frequency opposed to prevalence, permits active surveillance across a more homogeneous geographical range.
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Affiliation(s)
- Rebecca Smith-Aguasca
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain.,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, AZ, 85287-1701, USA
| | - Himanshu Gupta
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain
| | - Estefania Uberegui
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain
| | - Mara Maquina
- Centro de Investigação em Saúde da Manhiça (CISM), 1929, Manhiça, Mozambique
| | - Francisco Saute
- Centro de Investigação em Saúde da Manhiça (CISM), 1929, Manhiça, Mozambique
| | - Krijn P Paaijmans
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain.,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, AZ, 85287-1701, USA.,Centro de Investigação em Saúde da Manhiça (CISM), 1929, Manhiça, Mozambique.,The Biodesign Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, AZ, 85287-1701, USA
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain.,Centro de Investigação em Saúde da Manhiça (CISM), 1929, Manhiça, Mozambique
| | - Silvie Huijben
- ISGlobal, Hospital Clínic - Universitat de Barcelona, 08036, Barcelona, Spain. .,Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe, AZ, 85287-1701, USA.
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Decreased In Vitro Artemisinin Sensitivity of Plasmodium falciparum across India. Antimicrob Agents Chemother 2019; 63:AAC.00101-19. [PMID: 31332065 PMCID: PMC6761557 DOI: 10.1128/aac.00101-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/07/2019] [Indexed: 01/14/2023] Open
Abstract
Artemisinin-based combination therapy (ACT) has been used to treat uncomplicated Plasmodium falciparum infections in India since 2004. Since 2008, a decrease in artemisinin effectiveness has been seen throughout the Greater Mekong Subregion. The geographic proximity and ecological similarities of northeastern India to Southeast Asia may differentially affect the long-term management and sustainability of ACT in India. Artemisinin-based combination therapy (ACT) has been used to treat uncomplicated Plasmodium falciparum infections in India since 2004. Since 2008, a decrease in artemisinin effectiveness has been seen throughout the Greater Mekong Subregion. The geographic proximity and ecological similarities of northeastern India to Southeast Asia may differentially affect the long-term management and sustainability of ACT in India. In order to collect baseline data on variations in ACT sensitivity in Indian parasites, 12 P. falciparum isolates from northeast India and 10 isolates from southwest India were studied in vitro. Ring-stage survival assay (RSA) showed reduced sensitivity to dihydroartemisinin in 50% of the samples collected in northeast India in 2014 and 2015. Two of the 10 assayed samples from the southwest region of India from as far back as 2012 also showed decreased sensitivity to artemisinin. In both these regions, kelch gene sequences were not predictive of reduced artemisinin sensitivity, as measured by RSA. The present data justify future investments in integrated approaches involving clinical follow-up studies, in vitro survival assays, and molecular markers for tracking potential changes in the effectiveness of artemisinin against P. falciparum throughout India.
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The Diversity of the Plasmodium falciparum K13 Propeller Domain Did Not Increase after Implementation of Artemisinin-Based Combination Therapy in Uganda. Antimicrob Agents Chemother 2019; 63:AAC.01234-19. [PMID: 31358588 DOI: 10.1128/aac.01234-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022] Open
Abstract
Artemisinin-based combination therapies (ACTs) are the standard of care to treat uncomplicated falciparum malaria. However, resistance to artemisinins, defined as delayed parasite clearance after therapy, has emerged in Southeast Asia, and the spread of resistance to sub-Saharan Africa could have devastating consequences. Artemisinin resistance has been associated in Southeast Asia with multiple nonsynonymous single nucleotide polymorphisms (NS-SNPs) in the propeller domain of the gene encoding the Plasmodium falciparum K13 protein (K13PD). Some K13PD NS-SNPs have been seen in Africa, but the relevance of these mutations is unclear. To assess whether ACT use has selected for specific K13PD mutations, we compared the K13PD genetic diversity in clinical isolates collected before and after the implementation of ACT use from seven sites across Uganda. We detected K13PD NS-SNPs in 16 of 683 (2.3%) clinical isolates collected between 1999 and 2004 and in 26 of 716 (3.6%) isolates collected between 2012 and 2016 (P = 0.16), representing a total of 29 different polymorphisms at 27 codons. Individual NS-SNPs were usually detected only once, and none were found in more than 0.7% of the isolates. Three SNPs (C469F, P574L, and A675V) associated with delayed clearance in Southeast Asia were seen in samples collected between 2012 and 2016, each in a single isolate. No differences in diversity following implementation of ACT use were found at any of the seven sites, nor was there evidence of selective pressures acting on the locus. Our results suggest that selection by ACTs is not impacting on K13PD diversity in Uganda.
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