Rare mutations in Pfmdr1 gene of Plasmodium falciparum detected in clinical isolates from patients treated with anti-malarial drug in Nigeria

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Idowu, A.O.
Oyibo, W.A.
Bhattacharyya, S.
Khubbar, M.
Mendie, U.E.
Bumah, V.V.
Black, C.
Igietseme, J.
Azenabor, A.A.
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Malaria Journal
Background: Plasmodium falciparum, the deadliest causative agent of malaria, has a high prevalence in Nigeria. Drug resistance causing failure of previously effective drugs has compromised anti-malarial treatment. On this basis, there is need for a proactive surveillance for resistance markers to the currently recommended artemisinin-based combination therapy (ACT), for early detection of resistance before it becomes widespread. Methods: This study assessed anti-malarial resistance genes polymorphism in patients with uncomplicated P. falciparum malaria in Lagos, Nigeria. Sanger and Next Generation Sequencing (NGS) methods were used to screen for mutations in thirty-seven malaria positive blood samples targeting the P. falciparum chloroquine-resistance transporter (Pfcrt), P. falciparum multidrug-resistance 1 (Pfmdr1), and P. falciparum kelch 13 (Pfk13) genes, which have been previously associated with anti-malarial resistance. Results: Expectedly, the NGS method was more proficient, detecting six Pfmdr1, seven Pfcrt, and three Pfk13 mutations in the studied clinical isolates from Nigeria, a malaria-endemic area. These mutations included rare Pfmdr1 mutations, N504K, N649D, F938Y, and S967N, which were previously unreported. In addition, there was a moderate prevalence of the K76T mutation (34.6%) associated with chloroquine and amodiaquine resistance, and a high prevalence of the N86 wild-type allele (92.3%) associated with lumefantrine resistance. Conclusion: Widespread circulation of mutations associated with resistance to current anti-malarial drugs could potentially limit effective malaria therapy in endemic populations.
Antimalarial gene polymorphism; Infectious disease epidemiology; Malaria; Parasitic disease epidemiology and control; Plasmodium.
Idowu AO, Oyibo WA, Bhattacharyya S, Khubbar M, Mendie UE, Bumah VV, Black C, Igietseme J, Azenabor AA. Rare mutations in Pfmdr1 gene of Plasmodium falciparum detected in clinical isolates from patients treated with anti-malarial drug in Nigeria. Malar J. 2019 Sep 18;18(1):319. doi: 10.1186/s12936-019-2947-z. PMID: 31533729; PMCID: PMC6751857.