Ippolito Matthew M, Moser Kara A, Kabuya Jean-Bertin Bukasa, Cunningham Clark, Juliano Jonathan J
Divisions of Clinical Pharmacology and Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA.
The Johns Hopkins Malaria Research Institute, Johns Hopkins University School of Public Health, Baltimore, MD USA.
Curr Epidemiol Rep. 2021;8(2):46-62. doi: 10.1007/s40471-021-00266-5. Epub 2021 Mar 14.
Five years have passed since the World Health Organization released its Global Technical Strategy for Malaria (GTS). In that time, progress against malaria has plateaued. This review focuses on the implications of antimalarial drug resistance for the GTS and how interim progress in parasite genomics and antimalarial pharmacology offer a bulwark against it.
For the first time, drug resistance-conferring genes have been identified and validated before their global expansion in malaria parasite populations. More efficient methods for their detection and elaboration have been developed, although low-density infections and polyclonality remain a nuisance to be solved. Clinical trials of alternative regimens for multidrug-resistant malaria have delivered promising results. New agents continue down the development pipeline, while a nascent infrastructure in sub-Saharan Africa for conducting phase I trials and trials of transmission-blocking agents has come to fruition after years of preparation.
These and other developments can help inform the GTS as the world looks ahead to the next two decades of its implementation. To remain ahead of the threat that drug resistance poses, wider application of genomic-based surveillance and optimization of existing and forthcoming antimalarial drugs are essential.
自世界卫生组织发布《全球疟疾技术战略》（GTS）至今已有五年。在此期间，疟疾防治工作进展停滞。本综述重点关注抗疟药物耐药性对GTS的影响，以及寄生虫基因组学和抗疟药理学的中期进展如何为其提供抵御。
赋予耐药性的基因首次在疟原虫群体全球传播之前得到鉴定和验证。已开发出更有效的检测和阐释方法，尽管低密度感染和多克隆性仍是有待解决的麻烦。耐多药疟疾替代疗法的临床试验取得了有前景的结果。新药物不断进入研发流程，而撒哈拉以南非洲经过多年筹备，用于开展一期试验和传播阻断剂试验的新生基础设施已初见成效。
随着世界展望GTS未来二十年的实施，这些及其他进展可为其提供参考。为保持领先于耐药性构成的威胁，广泛应用基于基因组的监测以及优化现有和即将推出的抗疟药物至关重要。
