Abstract
It is rare to come across an Aesop’s fable in respectable journals. It might catch scientists outside the malaria field by surprise to learn that the famous story of “The Boy Who Cried Wolf” has been repeatedly compared to the threat from artemisinin-resistant malaria parasites, including the two latest reports on the rise of a specific haplotype in Cambodia and Thailand, sensationally dubbed “Super Malaria” by the media [1, 2]. The comparison to a children’s tale should not negate the fact that malaria drug resistance is one of the most pressing threats to the global public health community. Here, the findings leading to this contentious discourse will be delineated in order to provide a perspective. Possible solutions will be presented to stimulate further research and discussion to solve one of the greatest public health challenges of our lifetime.
Highlights
If malaria drug resistance is compared to a wolf, the area at the border between Cambodia and Thailand could be considered a wolf’s lair packed with the parasites conferring resistance to almost every clinically implemented antimalarial drug
Parasite populations in this location have a strong propensity to develop resistance, and complete artemisinin resistance will be a deadly addition to their ability to withstand several antimalarial drug regimens
Two reports identified copy number polymorphism of a gene encoding one of the hemoglobin protease enzymes as a genetic marker for piperaquine resistance [33, 34]. Since these findings were published, it has been observed that parasites containing a unique combination of the molecular marker alleles for artemisinin and piperaquine resistance have spread at the border areas between Cambodia and Thailand [2, 35]
Summary
The fast parasite clearance action of artemisinin is unparalleled since it is the only drug that can kill every asexual red blood cell stage [14]. Based on the history and the known origin of malaria drug resistance, Cambodia has become a sentinel site for monitoring emerging artemisinin resistance [16, 17]. The malaria research community has sought potential molecular markers to monitor the artemisinin resistance situation.
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