Duru Valentine, Witkowski Benoit, Ménard Didier
Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
Am J Trop Med Hyg. 2016 Dec 7;95(6):1228-1238. doi: 10.4269/ajtmh.16-0234. Epub 2016 Oct 17.
Artemisinin-based combination therapies (ACTs) are the cornerstone of current strategies for fighting malaria. Over the last decade, ACTs have played a major role in decreasing malaria burden. However, this progress is being jeopardized by the emergence of artemisinin-resistant Plasmodium falciparum parasites. Artemisinin resistance was first detected in western Cambodia in 2008 and has since been observed in neighboring countries in southeast Asia. The problem of antimalarial drug resistance has recently worsened in Cambodia, with reports of parasites resistant to piperaquine, the latest generation of partner drug used in combination with dihydroartemisinin, leading to worrying rates of clinical treatment failure. The monitoring and the comprehension of both types of resistance are crucial to prevent the spread of multidrug-resistant parasites outside southeast Asia, and particularly to Africa, where the public health consequences would be catastrophic. To this end, new tools are required for studying the biological and molecular mechanisms underlying resistance to antimalarial drugs and for monitoring the geographic distribution of the resistant parasites. In this review, we detail the major advances in our understanding of resistance to artemisinin and piperaquine and define the challenges that the malaria community will have to face in the coming years.
以青蒿素为基础的联合疗法（ACTs）是当前抗击疟疾策略的基石。在过去十年中，ACTs在减轻疟疾负担方面发挥了重要作用。然而，对青蒿素耐药的恶性疟原虫的出现正危及这一进展。青蒿素耐药性于2008年首次在柬埔寨西部被发现，此后在东南亚周边国家也有观察到。柬埔寨的抗疟药物耐药问题最近有所恶化，有报告称出现了对双氢青蒿素联合使用的最新一代辅助药物哌喹耐药的寄生虫，导致临床治疗失败率令人担忧。监测和理解这两种耐药性对于防止多重耐药寄生虫在东南亚以外地区传播，尤其是传播到非洲至关重要，因为在非洲，其对公共卫生的影响将是灾难性的。为此，需要新的工具来研究抗疟药物耐药性的生物学和分子机制，并监测耐药寄生虫的地理分布。在这篇综述中，我们详细阐述了我们在理解青蒿素和哌喹耐药性方面取得的主要进展，并确定了疟疾研究界在未来几年将面临的挑战。
