Abstract
BackgroundArtemisinin and its derivatives have been used for falciparum malaria treatment in China since late 1970s. Monotherapy and uncontrolled use of artemisinin drugs were common practices for a long period of time. In vitro tests showed that the susceptibility of Plasmodium falciparum to artemisinins was declining in China. A concern was raised about the resistance to artemisinins of falciparum malaria in the country. It has been reported that in vitro artemisinin resistance was associated with the S769N mutation in the PfATPase6 gene. The main purpose of this study was to investigate whether that mutation has occurred in field isolates from China.MethodsPlasmodium falciparum field isolates were collected in 2006–2007 from Hainan and Yunnan provinces, China. A nested PCR-sequencing assay was developed to analyse the genotype of the PfATPase6 S769N polymorphism in the P. falciparum field isolates.ResultsThe genotyping results of six samples could not be obtained due to failure of PCR amplification, but no S769N mutation was detected in any of the 95 samples successfully analysed.ConclusionThe results indicate that the S769N mutation in the PfATPase6 gene is not present in China, suggesting that artemisinin resistance has not yet developed, but the situation needs to be watched very attentively.
Highlights
Artemisinin and its derivatives have been used for falciparum malaria treatment in China since late 1970s
Samples Plasmodium falciparum field isolates were collected in 2006–2007 from two provinces. 27 samples were collected from Hainan province and 74 samples were from Yunnan province (Figure 1)
Stable resistance to artemisinins has been induced in the laboratory, and the declining susceptibility of P. falciparum to artemisinin derivatives has been reported in the country [6]
Summary
Artemisinin and its derivatives have been used for falciparum malaria treatment in China since late 1970s. A concern was raised about the resistance to artemisinins of falciparum malaria in the country. Up to the present, falciparum malaria is still an important public health problem in China, especially in Yunnan and Hainan provinces, with 3,240 cases reported from the two provinces in 2006, accounting for 93.4% of the total reported cases in the country [2]. The plant Artemisia annua (Asteraceae) has been used for more than 2,000 years in Chinese traditional medicine for the treatment of febrile illnesses, including malaria. Artemisia annua contains artemisinin, which was isolated in 1972, and since that time its efficacy against malaria has been amply demonstrated [3,4]. Following increased chloroquine (CQ), piperaquine (PQ) and pyrimethamine-sulphadoxine (SP) resistance, artemisinin and its derivatives gradually became the mainstay of falciparum malaria therapy in China. Before the World Health Organization (WHO) urged pharmaceutical companies to end (page number not for citation purposes)
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