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在也门塔伊兹省疟疾流行季节,恶性疟原虫分离株中与常用抗疟药物耐药性相关的分子标记物。

Molecular markers associated with resistance to commonly used antimalarial drugs among Plasmodium falciparum isolates from a malaria-endemic area in Taiz governorate-Yemen during the transmission season.

作者信息

Alareqi Lina M Q, Mahdy Mohammed A K, Lau Yee-Ling, Fong Mun-Yik, Abdul-Ghani Rashad, Mahmud Rohela

机构信息

Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen; Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.

出版信息

Acta Trop. 2016 Oct;162:174-179. doi: 10.1016/j.actatropica.2016.06.016. Epub 2016 Jun 22.

Abstract

Since 2005, artesunate (AS) plus sulfadoxine/pyrimethamine (SP) combination has been adopted as the first-line treatment for uncomplicated malaria in Yemen in response to the high level of Plasmodium falciparum resistance to chloroquine (CQ). Therefore, the aim of the present study was to determine the frequency distribution of molecular markers associated with resistance to CQ and AS plus SP combination among P. falciparum isolates from a malaria-endemic area in Taiz governorate, Yemen. Fifty P. falciparum isolates were collected during a cross-sectional study in Mawza district, Taiz, in the period from October 2013 to April 2014. The isolates were investigated for drug resistance-associated molecular markers in five genes, including P. falciparum CQ resistance transporter (pfcrt) 76T and P. falciparum multidrug resistance 1 (pfmdr1) 86Y as markers of resistance to CQ, mutations in the Kelch 13 (K13) propeller domain for resistance to AS, and P. falciparum dihydrofolate reductase (pfdhfr) and P. falciparum dihydropteroate synthase (pfdhps) genes for resistance to SP. Nested polymerase chain reaction was used to amplify target genes in DNA extracts of the isolates followed by restriction fragment length polymorphism for detecting 76T and 86Y mutations in pfcrt and pfmdr1, respectively, and by DNA sequencing for detecting mutations in K13, pfdhfr and pfdhps. All the investigated isolates from Mawza district were harboring the pfcrt 76T mutant and the pfmdr1 N86 wild-type alleles. The pfdhfr 51I/108N double mutant allele was found in 2.2% (1/45) of the isolates; however, no mutations were detected at codons 436, 437, 540, 581 and 613 of pfdhps. All P. falciparum isolates that were successfully sequenced (n=47) showed the K13 Y493, R539, I543 and C580 wild-type alleles. In conclusion, the pfcrt 76T mutant allele is fixed in the study area about six years after the official withdrawal of CQ, possibly indicating its over-the-counter availability and continued use as a self-medication in the study area. However, the almost predominant wild-type alleles of the genes associated with resistance to AS and SP among P. falciparum isolates in the present study indicates the sustained efficacy of the currently adopted first-line treatment of AS plus SP in the study area.

摘要

自2005年以来,鉴于恶性疟原虫对氯喹(CQ)的高度耐药性,青蒿琥酯(AS)加磺胺多辛/乙胺嘧啶(SP)联合用药已被用作也门非复杂性疟疾的一线治疗方法。因此,本研究的目的是确定也门塔伊兹省一个疟疾流行地区的恶性疟原虫分离株中与CQ及AS加SP联合用药耐药性相关分子标记的频率分布。在2013年10月至2014年4月期间,于塔伊兹省马扎区开展的一项横断面研究中收集了50株恶性疟原虫分离株。对这些分离株进行了5个基因中与耐药性相关分子标记的研究,包括作为CQ耐药性标记的恶性疟原虫氯喹耐药转运蛋白(pfcrt)76T和恶性疟原虫多药耐药1(pfmdr1)86Y、作为AS耐药性标记的凯尔希13(K13)螺旋桨结构域突变以及作为SP耐药性标记的恶性疟原虫二氢叶酸还原酶(pfdhfr)和恶性疟原虫二氢蝶酸合酶(pfdhps)基因。采用巢式聚合酶链反应扩增分离株DNA提取物中的目标基因,随后分别采用限制性片段长度多态性检测pfcrt和pfmdr1中的76T和86Y突变,并采用DNA测序检测K13、pfdhfr和pfdhps中的突变。来自马扎区的所有被研究分离株均携带pfcrt 76T突变体和pfmdr1 N86野生型等位基因。在2.2%(1/45)的分离株中发现了pfdhfr 51I/108N双突变等位基因;然而,在pfdhps的436、437、540、581和613密码子处未检测到突变。所有成功测序的恶性疟原虫分离株(n = 47)均显示K13 Y493、R539、I543和C580野生型等位基因。总之,在官方停用CQ约六年后,pfcrt 76T突变等位基因在研究地区固定存在,这可能表明其在研究地区可通过非处方获得并继续被用作自我用药。然而,本研究中恶性疟原虫分离株中与AS和SP耐药性相关基因几乎均为野生型等位基因,这表明目前采用的AS加SP一线治疗方法在研究地区仍具有持续疗效。

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