Emergence and Clonal Expansion of in Vitro Artemisinin-resistant Plasmodium Falciparum Kelch13 R561H Mutant Parasites in Rwanda

Overview

Journal Nat Med

Specialties General Medicine
Molecular Biology

Date 2020 Aug 5

PMID 32747827

Citations 339

Authors

Aline Uwimana

Eric Legrand

Barbara H Stokes

Jean-Louis Mangala Ndikumana

Marian Warsame

Noella Umulisa

Daniel Ngamije

Tharcisse Munyaneza

Jean-Baptiste Mazarati

Kaendi Munguti

Pascal Campagne

Alexis Criscuolo

Frederic Ariey

Monique Murindahabi

Pascal Ringwald

David A Fidock

Aimable Mbituyumuremyi

Didier Menard

Affiliations

Soon will be listed here.

Abstract

Artemisinin resistance (delayed P. falciparum clearance following artemisinin-based combination therapy), is widespread across Southeast Asia but to date has not been reported in Africa. Here we genotyped the P. falciparum K13 (Pfkelch13) propeller domain, mutations in which can mediate artemisinin resistance, in pretreatment samples collected from recent dihydroarteminisin-piperaquine and artemether-lumefantrine efficacy trials in Rwanda. While cure rates were >95% in both treatment arms, the Pfkelch13 R561H mutation was identified in 19 of 257 (7.4%) patients at Masaka. Phylogenetic analysis revealed the expansion of an indigenous R561H lineage. Gene editing confirmed that this mutation can drive artemisinin resistance in vitro. This study provides evidence for the de novo emergence of Pfkelch13-mediated artemisinin resistance in Rwanda, potentially compromising the continued success of antimalarial chemotherapy in Africa.

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