Absence of kelch13 artemisinin resistance markers but strong selection for lumefantrine-tolerance molecular markers following 18 years of artemisinin-based combination therapy use in Mpumalanga Province, South Africa (2001–2018)
Identifieur interne : 000B21 ( Main/Exploration ); précédent : 000B20; suivant : 000B22Absence of kelch13 artemisinin resistance markers but strong selection for lumefantrine-tolerance molecular markers following 18 years of artemisinin-based combination therapy use in Mpumalanga Province, South Africa (2001–2018)
Auteurs : Jaishree Raman [Afrique du Sud] ; Frank M. Kagoro [Afrique du Sud, Thaïlande] ; Aaron Mabuza [Afrique du Sud] ; Gillian Malatje ; Anthony Reid [Luxembourg (pays)] ; John Frean [Afrique du Sud] ; Karen I. Barnes [Afrique du Sud]Source :
- Malaria Journal [ 1475-2875 ] ; 2019.
Abstract
The ability of
Molecular analyses to determine the prevalence of alleles associated with resistance to lumefantrine (
Parasite DNA was successfully amplified from 1667/2393 (70%) of malaria-positive rapid diagnostic tests routinely collected at primary health care facilities. No artemisinin resistance-associated
No
Url:
DOI: 10.1186/s12936-019-2911-y
PubMed: 31438951
PubMed Central: 6704579
Affiliations:
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Le document en format XML
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Absence of <italic>kelch13</italic>
artemisinin resistance markers but strong selection for lumefantrine-tolerance molecular markers following 18 years of artemisinin-based combination therapy use in Mpumalanga Province, South Africa (2001–2018)</title>
<author><name sortKey="Raman, Jaishree" sort="Raman, Jaishree" uniqKey="Raman J" first="Jaishree" last="Raman">Jaishree Raman</name>
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<institution>A Division of the National Health Laboratory Service,</institution>
</institution-wrap>
Sandringham, Johannesburg, Gauteng South Africa</nlm:aff>
<wicri:noCountry code="subfield">Gauteng South Africa</wicri:noCountry>
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Cape Town, South Africa</nlm:aff>
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<wicri:regionArea>Bangkok</wicri:regionArea>
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Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Cape Town</wicri:regionArea>
</affiliation>
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<author><name sortKey="Malatje, Gillian" sort="Malatje, Gillian" uniqKey="Malatje G" first="Gillian" last="Malatje">Gillian Malatje</name>
<affiliation><nlm:aff id="Aff6">Mpumalanga Provincial Malaria Elimination Programme, Nelspruit, Mpumalanga South Africa</nlm:aff>
<wicri:noCountry code="subfield">Mpumalanga South Africa</wicri:noCountry>
</affiliation>
</author>
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<institution>Médecins Sans Frontières, Operational Centre,</institution>
</institution-wrap>
Brussels, Luxembourg</nlm:aff>
<country xml:lang="fr">Luxembourg (pays)</country>
<wicri:regionArea>Brussels</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Frean, John" sort="Frean, John" uniqKey="Frean J" first="John" last="Frean">John Frean</name>
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<institution-id institution-id-type="GRID">grid.416657.7</institution-id>
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<institution>A Division of the National Health Laboratory Service,</institution>
</institution-wrap>
Sandringham, Johannesburg, Gauteng South Africa</nlm:aff>
<wicri:noCountry code="subfield">Gauteng South Africa</wicri:noCountry>
</affiliation>
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<institution>Wits Research Institute for Malaria,</institution>
<institution>Faculty of Health Sciences, University of Witwatersrand,</institution>
</institution-wrap>
Johannesburg, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Johannesburg</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Barnes, Karen I" sort="Barnes, Karen I" uniqKey="Barnes K" first="Karen I." last="Barnes">Karen I. Barnes</name>
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<institution-id institution-id-type="GRID">grid.7836.a</institution-id>
<institution>Division of Clinical Pharmacology, Department of Medicine,</institution>
<institution>University of Cape Town,</institution>
</institution-wrap>
Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Cape Town</wicri:regionArea>
</affiliation>
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<series><title level="j">Malaria Journal</title>
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<imprint><date when="2019">2019</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p id="Par1">The ability of <italic>Plasmodium falciparum</italic>
parasites to develop resistance to widely used anti-malarials threatens malaria control and elimination efforts. Regular drug efficacy monitoring is essential for ensuring effective treatment policies. In low transmission settings where therapeutic efficacy studies are often not feasible, routine surveillance for molecular markers associated with anti-malarial resistance provides an alternative for the early detection of emerging resistance. Such a longitudinal survey of changes in the prevalence of selected molecular markers of resistance was conducted in the malaria-endemic regions of Mpumalanga Province, South Africa, where malaria elimination at a district-level is being pursued.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">Molecular analyses to determine the prevalence of alleles associated with resistance to lumefantrine (<italic>mdr</italic>
86N, <italic>crt</italic>
76K and <italic>mdr1</italic>
copy number variation) and sulfadoxine–pyrimethamine (<italic>dhfr</italic>
triple, <italic>dhps</italic>
double, SP quintuple) were conducted between 2001 and 2018, while artemisinin resistance markers (<italic>kelch13</italic>
mutations) were assessed only in 2018.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">Parasite DNA was successfully amplified from 1667/2393 (70%) of malaria-positive rapid diagnostic tests routinely collected at primary health care facilities. No artemisinin resistance-associated <italic>kelch13</italic>
mutations nor amplification of the <italic>mdr1</italic>
gene copy number associated with lumefantrine resistance were observed. However, prevalence of both the <italic>mdr</italic>
86N and <italic>crt</italic>
76K alleles increased markedly over the study period, with all isolates collected in 2018 carrying these markers. SP quintuple mutation prevalence increased steadily from 14% in 2001 to 96% in 2018. Mixed alleles at any of the codons assessed were rare by 2018.</p>
</sec>
<sec><title>Conclusion</title>
<p id="Par4">No <italic>kelch13</italic>
mutations confirmed or suspected to be associated with artemisinin resistance were identified in 2018. Although parasites carrying the <italic>mdr</italic>
86N and <italic>crt</italic>
76K alleles associated with reduced lumefantrine susceptibility were strongly selected for over the study period, nearing fixation by 2018, the marker for lumefantrine resistance, namely increased <italic>mdr1</italic>
copy number, was not observed in this study. The increase in <italic>mdr</italic>
86N and <italic>crt</italic>
76K allele prevalence together with intense regional artemether–lumefantrine drug pressure, raises concern regarding the sustained artemether–lumefantrine efficacy. Regular, rigorous anti-malarial resistance marker surveillance across all three South African malaria-endemic provinces to inform case management is recommended.</p>
</sec>
</div>
</front>
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<author><name sortKey="Sow, D" uniqKey="Sow D">D Sow</name>
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<author><name sortKey="Nag, S" uniqKey="Nag S">S Nag</name>
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<author><name sortKey="Sylla, K" uniqKey="Sylla K">K Sylla</name>
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<author><name sortKey="Tine, Rc" uniqKey="Tine R">RC Tine</name>
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<author><name sortKey="Ndiaye, Jl" uniqKey="Ndiaye J">JL Ndiaye</name>
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<name sortKey="Barnes, Karen I" sort="Barnes, Karen I" uniqKey="Barnes K" first="Karen I." last="Barnes">Karen I. Barnes</name>
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<name sortKey="Mabuza, Aaron" sort="Mabuza, Aaron" uniqKey="Mabuza A" first="Aaron" last="Mabuza">Aaron Mabuza</name>
<name sortKey="Raman, Jaishree" sort="Raman, Jaishree" uniqKey="Raman J" first="Jaishree" last="Raman">Jaishree Raman</name>
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<country name="Thaïlande"><noRegion><name sortKey="Kagoro, Frank M" sort="Kagoro, Frank M" uniqKey="Kagoro F" first="Frank M." last="Kagoro">Frank M. Kagoro</name>
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<country name="Luxembourg (pays)"><noRegion><name sortKey="Reid, Anthony" sort="Reid, Anthony" uniqKey="Reid A" first="Anthony" last="Reid">Anthony Reid</name>
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