Emergence, transmission dynamics and mechanisms of artemisinin partial resistance in malaria parasites in Africa

Malaria, mostly due to Plasmodium falciparum infection in Africa, remains one of the most important infectious diseases in the world. Standard treatment for uncomplicated P. falciparum malaria is artemisinin-based combination therapy (ACT), which includes a rapid-acting artemisinin derivative plus a...

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Bibliographic Details
Published in:Nature reviews. Microbiology 2024-06, Vol.22 (6), p.373-384
Main Authors: Rosenthal, Philip J., Asua, Victor, Conrad, Melissa D.
Format: Article
Language:English
Subjects:
631/154
631/326/22/1434
631/326/417
692/420/254
Artemisinin
Artesunate
Biomedical and Life Sciences
Drug resistance
Epidemiology
Health services
Infectious Diseases
Life Sciences
Malaria
Medical Microbiology
Microbiology
Parasite resistance
Parasites
Parasitology
Plasmodium falciparum
Review Article
Vector-borne diseases
Virology
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Summary:Malaria, mostly due to Plasmodium falciparum infection in Africa, remains one of the most important infectious diseases in the world. Standard treatment for uncomplicated P. falciparum malaria is artemisinin-based combination therapy (ACT), which includes a rapid-acting artemisinin derivative plus a longer-acting partner drug, and standard therapy for severe P. falciparum malaria is intravenous artesunate. The efficacy of artemisinins and ACT has been threatened by the emergence of artemisinin partial resistance in Southeast Asia, mediated principally by mutations in the P. falciparum Kelch 13 (K13) protein. High ACT treatment failure rates have occurred when resistance to partner drugs is also seen. Recently, artemisinin partial resistance has emerged in Rwanda, Uganda and the Horn of Africa, with independent emergences of different K13 mutants in each region. In this Review, we summarize our current knowledge of artemisinin partial resistance and focus on the emergence of resistance in Africa, including its epidemiology, transmission dynamics and mechanisms. At present, the clinical impact of emerging resistance in Africa is unclear and most available evidence suggests that the efficacies of leading ACTs remain excellent, but there is an urgent need to better appreciate the extent of the problem and its consequences for the treatment and control of malaria. In this Review, Rosenthal, Asua and Conrad summarize our current knowledge of artemisinin partial resistance and focus on the emergence of resistance in Africa, including its epidemiology and transmission dynamics, and mechanisms of resistance.
ISSN:1740-1526
1740-1534
1740-1534
DOI:10.1038/s41579-024-01008-2