Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Emergence of artemisinin-resistance on Thai-Myanmar border raises spectre of untreatable malaria

10.04.2012
Evidence that the most deadly species of malaria parasite, Plasmodium falciparum, is becoming resistant to the front line treatment for malaria on the border of Thailand and Myanmar is reported in The Lancet today. This increases concern that resistance could now spread to India and then Africa. Eliminating malaria might then prove impossible.
Evidence that the most deadly species of malaria parasite, Plasmodium falciparum, is becoming resistant to the front line treatment for malaria on the border of Thailand and Myanmar (Burma) is reported in The Lancet today. This increases concern that resistance could now spread to India and then Africa as resistance to other antimalarial drugs has done before. Eliminating malaria might then prove impossible.

The study coincides with research published today in Science in which researchers in south east Asia and the USA identify a major region of the malaria parasite genome associated with artemisinin resistance. This region, which includes several potential candidate genes for resistance, may provide researchers with a tool for mapping resistance.

Both studies, funded by the Wellcome Trust and the National Institutes of Health, follow reports in 2009 of the emergence of artemisinin-resistant malaria parasites in western Cambodia, 800km away from the Thailand-Myanmar border where the new cases of resistance have been observed. Resistance to artemisinin makes the drugs less effective and could eventually render them obsolete, putting millions of lives at risk.

According to the World Malaria Report 2011, malaria killed an estimated 655,000 people in 2010, mainly young children and pregnant women. It is caused by parasites that are injected into the bloodstream by infected mosquitoes. Plasmodium falciparum is responsible for nine out of ten deaths from malaria.

The most effective antimalarial drug is artemisinin; the artemisinin derivatives, most commonly artesunate, have the advantage over other antimalarial drugs such as chloroquine and mefloquine, of acting more rapidly and having fewer side-effects and, until recently, malaria parasites have shown no resistance against them. Although the drugs can be used on their own as a monotherapy, and these can still be obtained, fears over the possible development of resistance led to recommendations that they should only be used in conjunction with one or more other drugs as artemisinin-based combination therapies (ACTs). These are now recommended by the World Health Organization as the first-line treatment for uncomplicated falciparum malaria in all endemic countries. ACTs have contributed substantially to the recent decline in malaria cases in most tropical endemic regions.

In the Lancet study, researchers at the Shoklo Malaria Research Unit on the border of Thailand and Myanmar, part of the Wellcome Trust-Mahidol University-Oxford University Tropical Medicine Research Programme, measured the time taken to clear parasites from the blood stream in 3,202 patients with falciparum malaria using oral artesunate-containing medications over a ten year period between 2001 and 2010.

Over this period, the average time taken to reduce the number of parasites in the blood by a half – known as the ‘parasite clearance half-life’ – increased from 2.6 hours in 2001 to 3.7 hours in 2010, a clear sign that the drugs were becoming less effective. The proportion of slow-clearing infections – defined as a half-life of over 6.2 hours – increased over this same period from six to 200 out of every 1000 infections.

By examining the genetic make-up of the parasites, the researchers were able to provide compelling evidence that the decline in the parasite clearance rates was due to genetic changes in the parasites which had made them resistant to the drugs.

This finding is supported by the evidence reported in Science, in which the same researchers, together with an international team led by scientists at the Texas Biomedical Research Institute, San Antonio, identified a region on chromosome 13 of genome of the P. falciparum parasite that shows a strong association with slow parasite clearance rates. Whilst the actual mechanism involved is not clear, the region contains several candidate genes that may confer artemisinin resistance to the parasite.

Professor François Nosten, Director of the Shoklo Malaria Research Unit, said: “We have now seen the emergence of malaria resistant to our best drugs, and these resistant parasites are not confined to western Cambodia. This is very worrying indeed and suggests that we are in a race against time to control malaria in these regions before drug resistance worsens and develops and spreads further. The effect of that happening could be devastating. Malaria already kills hundreds of thousands of people a year – if our drugs become ineffective, this figure will rise dramatically.”
Professor Nick White, Chairman of the Wellcome Trust’s South-East Asia Major Overseas Programmes and Chair of the WorldWide Antimalarial Resistance Network (WWARN), added: “Initially we hoped we might prevent this serious problem spreading by trying to eliminate all P. falciparum from western Cambodia. Whilst this could still be beneficial, this new study suggests that containing the spread of resistance is going to be even more challenging and difficult than we had first feared.”

Dr Tim Anderson from the Texas Biomedical Research Institute, who led the genetics studies in both papers, commented: “Mapping the geographical spread of resistance can be particularly challenging using existing clinical and parasitology tools. If we can identify the genetic determinants of artemisinin resistance, we should be able to confirm potential cases of resistance more rapidly. This could be critically important for limiting further spread of resistance.

“We know that the genome region identified harbours a number of potential genes to explore further to see which ones drive artemisinin resistance. If we can pinpoint the precise gene or genes, we can begin to understand how resistance occurs.”

The Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme is one of the Wellcome Trust’s major overseas programmes, working to achieve the Trust’s strategic priorities, which include combating infectious diseases.

Dr Jimmy Whitworth, Head of International Activities at the Wellcome Trust, said: “These two studies highlight the importance of being vigilant against the emergence of drug resistance. Researchers will need to monitor these outbreaks and follow them closely to make sure they are not spreading. Preventing the spread of artemisinin resistance to other regions is imperative, but as we can see here, it is going to be increasingly difficult. It will require the full force of the scientific and clinical communities, working together with health policymakers.”

Craig Brierley | Research asia research news
Further information:
http://www.wellcome.ac.uk
http://www.researchsea.com

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>