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Antimicrobial Agents and Chemotherapy, August 2003, p. 2418-2423, Vol. 47, No. 8
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.8.2418-2423.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Resistance to Antimalarials in Southeast Asia and Genetic Polymorphisms in pfmdr1

Amy L. Pickard,1 Chansuda Wongsrichanalai,2 Anne Purfield,3 Deborah Kamwendo,4 Kathryn Emery,4 Christy Zalewski,4 Fumihiko Kawamoto,5 R. Scott Miller,2 and Steven R. Meshnick1,3*

Department of Epidemiology, University of North Carolina School of Public Health,1 Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina,3 Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand,2 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan,4 Department of International Health, Nagoya University School of Medicine, Nagoya, Japan5

Received 10 January 2003/ Returned for modification 7 March 2003/ Accepted 15 May 2003

Resistance to antimalarial drugs is a public health problem worldwide. Molecular markers for drug-resistant malaria, such as pfcrt and pfmdr1 polymorphisms, could serve as useful surveillance tools. To evaluate this possibility, sequence polymorphisms in pfcrt (position 76) and pfmdr1 (positions 86, 184, 1034, 1042, and 1246) and in vitro drug sensitivities were measured for 65 Plasmodium falciparum isolates from Thailand, Myanmar, Vietnam, and Bangladesh. The pfcrt Thr76 polymorphism was present in 97% of samples, consistent with observations that chloroquine resistance is well established in this region. Polymorphisms in pfmdr1 clustered into four specific patterns: the wild type (category I), a Tyr86 polymorphism only (category II), a Phe184 polymorphism only (category III), and Phe184 in combination with Cys1034 and/or Asp1042 (category IV). Isolates in categories I and III were more sensitive to chloroquine and more resistant to mefloquine, artesunate, and artemisinin than isolates in categories II and IV (P <= 0.01). Mefloquine resistance was significantly more common in category I and III isolates than in category II and IV isolates, with a prevalence ratio of 14.95 (95% confidence interval, 3.88 to 57.56). These categories identified mefloquine resistance with a sensitivity and a specificity of 94 and 91%, respectively. The pfmdr1 gene copy number was measured by real-time PCR as a ratio of the amount of pfmdr1 DNA to the amount of lactate dehydrogenase (ldh) DNA. Eight samples had pfmdr1 DNA/ldh DNA ratios >=3. The isolates in all 8 samples fell into categories I and III and were significantly more resistant to mefloquine, quinine, artemisinin, and artesunate and more sensitive to chloroquine than the isolates in the 57 samples with <3 copies of the gene (P <= 0.001). Thus, measurement of pfmdr1 mutations and gene copy number may be useful for surveillance of mefloquine-resistant malaria in Southeast Asia.

* Corresponding author. Mailing address: Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC 27599-7435. Phone: (919) 966-7414. Fax: (919) 966-2089. E-mail: meshnick{at}unc.edu.

Antimicrobial Agents and Chemotherapy, August 2003, p. 2418-2423, Vol. 47, No. 8
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.8.2418-2423.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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