Acknowledgment We thank Alexandre Chau for assistance with figure formatting. Footnotes Supported by the Belgian National Fund for Scientific Research (FNRS). R.O. is an FNRS research fellow, A.L. is an FNRS postdoctoral researcher, and D.D. is an FNRS M.D. and Ph.D. student. selleckchem KPT-330 A grant from E. Jacobs contributed to the project.
Shrinking the malaria map is now proposed as a realistic goal in many countries [1,2]. The Solomon Islands (SI) are one of the so defined “elimination countries”. Being an insular nation with varying levels of endemicity and transmission on most populated islands [3], and located at the margins of the endemic zones makes it feasible to embark upon malaria elimination. However, to reach this target, it is of crucial importance to gather information about the local malaria epidemiology.
Limited information is available on the prevalence of mutations associated with drug resistance or on the population structure of malaria parasites in the SI. The present study provides baseline data on Plasmodium falciparum malaria gathered in the Guadalcanal Province in 2004, with focus on anti-malarial resistance. In vivo studies are still considered the gold standard for the assessment of anti-malarial drug efficacy. The analysis of parasite molecular markers has been proposed as an alternative approach for the estimation of resistance to treatment. It has been shown that chloroquine (CQ) resistance is associated with mutations in pfmdr1 (P. falciparum multidrug resistance gene, coding for P-glycoprotein homologue-1, pgh1) and pfcrt (P.
falciparum chloroquine resistance transporter gene) [4-9]. Similarly, it is known that sulphadoxine-pyrimethamine (SP) resistance is associated with mutations in the genes pfdhfr (dihydrofolate reductase) and pfdhps (dihydropteroate synthase) [10-14]. Mutations in pfATPase6 have been described as potential molecular markers involved in resistance to artemisinin derivatives [15]. However, solid evidence for their association with artemisinin resistance is lacking to date. The analysis of such parasite mutations has the advantage over classical in vivo studies that it can be conducted on samples collected on the first day of health centre attendance. It is therefore independent of compliance and circumvents the need for time- and resource-consuming follow-up, which often leads to significant patient loss.
Most of the previous studies on parasite mutations were based on samples obtained from patients prior to treatment. However, there is evidence that the molecular profile of parasites circulating in the community matches the one observed among patients attending health Dacomitinib centres. Talisuna et al [16] showed that the presence of pfdhfr mutations in the community was independently correlated with the clinical treatment outcome.