Distribution and Temporal Dynamics of Plasmodium falciparum Chloroquine Resistance Transporter Mutations Associated with Piperaquine Resistance in Northern Cambodia

Biraj Shrestha, Zalak Shah, Andrew P. Morgan, Piyaporn Saingam, Chaiyaporn Chaisatit, Suwanna Chaorattanakawee, Chantida Praditpol, Nonlawat Boonyalai, Paphavee Lertsethtakarn, Mariusz Wojnarski, Molly Deutsch-Feldman, Matthew Adams, Darapiseth Sea, Soklyda Chann, Stuart D. Tyner, Charlotte A. Lanteri, Michele D. Spring, David L. Saunders, Philip L. Smith, Chanthap LonPanita Gosi, Somethy Sok, Prom Satharath, Huy Rekol, Dysoley Lek, Brian A. Vesely, Jessica T. Lin, Norman C. Waters, Shannon Takala-Harrison*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Newly emerged mutations within the Plasmodium falciparum chloroquine resistance transporter (PfCRT) can confer piperaquine resistance in the absence of amplified plasmepsin II (pfpm2). In this study, we estimated the prevalence of co-circulating piperaquine resistance mutations in P. falciparum isolates collected in northern Cambodia from 2009 to 2017. Methods: The sequence of pfcrt was determined for 410 P. falciparum isolates using PacBio amplicon sequencing or whole genome sequencing. Quantitative polymerase chain reaction was used to estimate pfpm2 and pfmdr1 copy number. Results: Newly emerged PfCRT mutations increased in prevalence after the change to dihydroartemisinin-piperaquine in 2010, with >98% of parasites harboring these mutations by 2017. After 2014, the prevalence of PfCRT F145I declined, being outcompeted by parasites with less resistant, but more fit PfCRT alleles. After the change to artesunate-mefloquine, the prevalence of parasites with amplified pfpm2 decreased, with nearly half of piperaquine-resistant PfCRT mutants having single-copy pfpm2. Conclusions: The large proportion of PfCRT mutants that lack pfpm2 amplification emphasizes the importance of including PfCRT mutations as part of molecular surveillance for piperaquine resistance in this region. Likewise, it is critical to monitor for amplified pfmdr1 in these PfCRT mutants, as increased mefloquine pressure could lead to mutants resistant to both drugs.

Original languageEnglish
Pages (from-to)1077-1085
Number of pages9
JournalJournal of Infectious Diseases
Volume224
Issue number6
DOIs
StatePublished - 15 Sep 2021
Externally publishedYes

Keywords

  • Cambodia
  • Plasmodium falciparum
  • chloroquine resistance transporter
  • malaria
  • piperaquine resistance

Fingerprint

Dive into the research topics of 'Distribution and Temporal Dynamics of Plasmodium falciparum Chloroquine Resistance Transporter Mutations Associated with Piperaquine Resistance in Northern Cambodia'. Together they form a unique fingerprint.

Cite this