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Ménard D, Khim N, Beghain J, Adegnika AA, Shafiul-Alam M, Amodu O, Rahim-Awab G, Barnadas C, Berry A, Boum Y, Bustos MD, Cao J, Chen JH, Collet L, Cui L, Thakur GD, Dieye A, Djallé D, Dorkenoo MA, Eboumbou-Moukoko CE, Espino FECJ, Fandeur T, Ferreira-da-Cruz MF, Fola AA, Fuehrer HP, Hassan AM, Herrera S, Hongvanthong B, Houzé S, Ibrahim ML, Jahirul-Karim M, Jiang L, Kano S, Ali-Khan W, Khanthavong M, Kremsner PG, Lacerda M, Leang R, Leelawong M, Li M, Lin K, Mazarati JB, Ménard S, Morlais I, Muhindo-Mavoko H, Musset L, Na-Bangchang K, Nambozi M, Niaré K, Noedl H, Ouédraogo JB, Pillai DR, Pradines B, Quang-Phuc B, Ramharter M, Randrianarivelojosia M, Sattabongkot J, Sheikh-Omar A, Silué KD, Sirima SB, Sutherland C, Syafruddin D, Tahar R, Tang LH, Touré OA, Tshibangu-wa-Tshibangu P, Vigan-Womas I, Warsame M, Wini L, Zakeri S, Kim S, Eam R, Berne L, Khean C, Chy S, Ken M, Loch K, Canier L, Duru V, Legrand E, Barale JC, Stokes B, Straimer J, Witkowski B, Fidock DA, Rogier C, Ringwald P, Ariey F, Mercereau-Puijalon O. A Worldwide Map of Plasmodium falciparum K13-Propeller Polymorphisms. N Engl J Med 2016; 374:2453-64. [PMID: 27332904 PMCID: PMC4955562 DOI: 10.1056/nejmoa1513137] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent gains in reducing the global burden of malaria are threatened by the emergence of Plasmodium falciparum resistance to artemisinins. The discovery that mutations in portions of a P. falciparum gene encoding kelch (K13)-propeller domains are the major determinant of resistance has provided opportunities for monitoring such resistance on a global scale. METHODS We analyzed the K13-propeller sequence polymorphism in 14,037 samples collected in 59 countries in which malaria is endemic. Most of the samples (84.5%) were obtained from patients who were treated at sentinel sites used for nationwide surveillance of antimalarial resistance. We evaluated the emergence and dissemination of mutations by haplotyping neighboring loci. RESULTS We identified 108 nonsynonymous K13 mutations, which showed marked geographic disparity in their frequency and distribution. In Asia, 36.5% of the K13 mutations were distributed within two areas--one in Cambodia, Vietnam, and Laos and the other in western Thailand, Myanmar, and China--with no overlap. In Africa, we observed a broad array of rare nonsynonymous mutations that were not associated with delayed parasite clearance. The gene-edited Dd2 transgenic line with the A578S mutation, which expresses the most frequently observed African allele, was found to be susceptible to artemisinin in vitro on a ring-stage survival assay. CONCLUSIONS No evidence of artemisinin resistance was found outside Southeast Asia and China, where resistance-associated K13 mutations were confined. The common African A578S allele was not associated with clinical or in vitro resistance to artemisinin, and many African mutations appear to be neutral. (Funded by Institut Pasteur Paris and others.).
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Affiliation(s)
- Didier Ménard
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Nimol Khim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Johann Beghain
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Ayola A Adegnika
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mohammad Shafiul-Alam
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Olukemi Amodu
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Ghulam Rahim-Awab
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Céline Barnadas
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Antoine Berry
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Yap Boum
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Maria D Bustos
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jun Cao
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jun-Hu Chen
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Louis Collet
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Liwang Cui
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Garib-Das Thakur
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Alioune Dieye
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Djibrine Djallé
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Monique A Dorkenoo
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | | | - Thierry Fandeur
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Abebe A Fola
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Hans-Peter Fuehrer
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Abdillahi M Hassan
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Socrates Herrera
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Bouasy Hongvanthong
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sandrine Houzé
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Maman L Ibrahim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mohammad Jahirul-Karim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lubin Jiang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Shigeyuki Kano
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Wasif Ali-Khan
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Maniphone Khanthavong
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Peter G Kremsner
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Marcus Lacerda
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Rithea Leang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mindy Leelawong
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Mei Li
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Khin Lin
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jean-Baptiste Mazarati
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sandie Ménard
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Isabelle Morlais
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Lise Musset
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Kesara Na-Bangchang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Michael Nambozi
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Karamoko Niaré
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Harald Noedl
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jean-Bosco Ouédraogo
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Dylan R Pillai
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Bruno Pradines
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Bui Quang-Phuc
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Michael Ramharter
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Jetsumon Sattabongkot
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Abdiqani Sheikh-Omar
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Kigbafori D Silué
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sodiomon B Sirima
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Colin Sutherland
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Din Syafruddin
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Rachida Tahar
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lin-Hua Tang
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Offianan A Touré
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | | | - Inès Vigan-Womas
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Marian Warsame
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lyndes Wini
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sedigheh Zakeri
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Saorin Kim
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Rotha Eam
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Laura Berne
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Chanra Khean
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Sophy Chy
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Malen Ken
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Kaknika Loch
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Lydie Canier
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Valentine Duru
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Eric Legrand
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Jean-Christophe Barale
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Barbara Stokes
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Judith Straimer
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Benoit Witkowski
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - David A Fidock
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Christophe Rogier
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Pascal Ringwald
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
| | - Frederic Ariey
- The authors' affiliations are listed in the Supplementary Appendix , available at NEJM.org
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