Department of Chemistry, University of Washington, Seattle, Washington, USA.
Department of Global Health, University of Washington, Seattle, Washington, USA.
Antimicrob Agents Chemother. 2019 Sep 23;63(10). doi: 10.1128/AAC.00101-19. Print 2019 Oct.
Artemisinin-based combination therapy (ACT) has been used to treat uncomplicated infections in India since 2004. Since 2008, a decrease in artemisinin effectiveness has been seen throughout the Greater Mekong Subregion. The geographic proximity and ecological similarities of northeastern India to Southeast Asia may differentially affect the long-term management and sustainability of ACT in India. In order to collect baseline data on variations in ACT sensitivity in Indian parasites, 12 isolates from northeast India and 10 isolates from southwest India were studied Ring-stage survival assay (RSA) showed reduced sensitivity to dihydroartemisinin in 50% of the samples collected in northeast India in 2014 and 2015. Two of the 10 assayed samples from the southwest region of India from as far back as 2012 also showed decreased sensitivity to artemisinin. In both these regions, gene sequences were not predictive of reduced artemisinin sensitivity, as measured by RSA. The present data justify future investments in integrated approaches involving clinical follow-up studies, survival assays, and molecular markers for tracking potential changes in the effectiveness of artemisinin against throughout India.
自 2004 年以来，青蒿素复方疗法（ACT）已在印度用于治疗非复杂性感染。自 2008 年以来，大湄公河次区域的青蒿素疗效一直在下降。印度东北部与东南亚地理位置接近，生态相似，这可能会对 ACT 在印度的长期管理和可持续性产生不同的影响。为了收集印度寄生虫对 ACT 敏感性变化的基线数据，研究了来自印度东北部的 12 个分离株和来自印度西南部的 10 个分离株。环早期存活测定（RSA）显示，2014 年和 2015 年在印度东北部采集的 50%样本对双氢青蒿素的敏感性降低。来自印度西南部的两个样本可追溯到 2012 年，对青蒿素的敏感性也有所降低。在这两个地区，基因序列并不能预测 RSA 测定的青蒿素敏感性降低。目前的数据证明，未来需要对涉及临床随访研究、存活测定和分子标记的综合方法进行投资，以跟踪印度各地青蒿素有效性的潜在变化。
