Conference abstract
Independent origin and spread of Artemisinin-resistant Plasmodium falciparum
Pan African Medical Journal - Conference Proceedings. 2017:4(46).27
Nov 2017.
doi: 10.11604/pamj-cp.2017.4.46.417
Archived on: 27 Nov 2017
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Keywords: Malaria, Plasmodium falciparum, resistance, artemisinin
Abstract
Independent origin and spread of Artemisinin-resistant Plasmodium falciparum
Dongmei Zhang1,&
1Department of Tropical Infectious Diseases, Second Military Medical University, Department of Craniofacial Trauma and Plastic Surgery, School of Stomatology, the Key State Laboratory of Military Stomatology, Fourth Military Medical University, China
&Corresponding author
Dongmei Zhang, Department of Tropical Infectious Diseases, Second Military Medical University, Department of Craniofacial Trauma and Plastic Surgery, School of Stomatology, the Key State Laboratory of Military Stomatology, Fourth Military Medical University, China
Introduction: Artemisinin (ART) is a novel antimalarial drug discovered in China that is quick and effective. The World Health Organization (WHO) has recommended ART-based combination therapies (ACT) as first-line drugs for the treatment of Plasmodium falciparum malaria in all malaria endemic countries. This has contributed to the recent significant decline in the global malaria burden. ART resistance was first detected along the Thai-Cambodian border and has been detected across mainland Southeast Asia. The continued spread of ART resistance will threaten malaria control programs.
Methods: in this study, we collected over 600 samples of Plasmodium falciparum from different areas in China. We detected 111 isolates of P. falciparum for their susceptibility to dihydroartemisinin using the ring stage survival assay (RSA0-3h).
Results: overall, 24% of 111 isolates had a resistant phenotype with higher ring-stage survival rates. Those isolates with the R539T and C580Y mutant alleles exhibited extremely increased RSA0-3h rates with mean survival rate greater than 10%. In addition, we genotyped the K13 gene of 602 P. falciparum isolates collected from Southern China and showed that 39.2% of 602 isolates had single mutations in the propeller domain of the K13 gene marker with 31 different mutations including 13 novel mutations.
Conclusion: importantly, we demonstrated that the R539T mutant allele that was strongly associated with ART resistance emerged independently. The multiple indigenous origins of the ART resistance-associated mutations suggest that efforts should focus on preventing the spread of resistance from all emergent areas, in addition to the epicenter for the resistance, and highlight the importance of surveillance of the resistance in all malaria endemic areas including Africa where artemisinin has been introduced.
