Monitoring Plasmodium vivax resistance to antimalarials: Persisting challenges and future directions

Autor(es)

Ferreira, Marcelo U. ^{[1, 2]} ; de Sousa, Tais Nobrega ^[3] ; Rangel, Gabriel W. ^[4] ; Johansen, Igor C. ^[1] ; Corder, Rodrigo M. ^[1] ; Ladeia-Andrade, Simone ^[5] ; Gil, Jose Pedro ^[6]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Inst Biomed Sci, Dept Parasitol, Ave Prof Lineu Prestes 1374, BR-05508900 Sao Paulo, SP - Brazil

^[2] Nova Univ Lisbon, Inst Hyg & Trop Med, Global Hlth & Trop Med, Lisbon - Portugal

^[3] Fiocruz MS, Rene Rachou Inst, Mol Biol & Malaria Immunol Res Grp, Belo Horizonte, MG - Brazil

^[4] Penn State Univ, Dept Biochem & Mol Biol, University Pk, PA 16802 - USA

^[5] Fiocruz MS, Inst Oswaldo Cruz, Parasit Dis Lab, Rio De Janeiro - Brazil

^[6] Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Solna - Sweden

• Tipo de documento: Artigo Científico
• Fonte: INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE; v. 15, p. 9-24, APR 2021.
• Citações Web of Science: 2

Resumo

Emerging antimalarial drug resistance may undermine current efforts to control and eliminate Plasmodium vivax, the most geographically widespread yet neglected human malaria parasite. Endemic countries are expected to assess regularly the therapeutic efficacy of antimalarial drugs in use in order to adjust their malaria treatment policies, but proper funding and trained human resources are often lacking to execute relatively complex and expensive clinical studies, ideally complemented by ex vivo assays of drug resistance. Here we review the challenges for assessing in vivo P. vivax responses to commonly used antimalarials, especially chloroquine and primaquine, in the presence of confounding factors such as variable drug absorption, metabolism and interaction, and the risk of new infections following successful radical cure. We introduce a simple modeling approach to quantify the relative contribution of relapses and new infections to recurring parasitemias in clinical studies of hypnozoitocides. Finally, we examine recent methodological advances that may render ex vivo assays more practical and widely used to confirm P. vivax drug resistance phenotypes in endemic settings and review current approaches to the development of robust genetic markers for monitoring chloroquine resistance in P. vivax populations. (AU)

• Processo FAPESP: 20/00433-8 - Além de pvmdr1 e pvcrt: busca de diversidade em novos genes de Plasmodium vivax potencialmente associados resistência aos antimaláricos
• Beneficiário: Marcelo Urbano Ferreira
• Modalidade de apoio: Auxílio à Pesquisa - Regular