Plasmodium falciparum: multifaceted resistance to artemisinins

Malar J. 2016 Mar 9:15:149. doi: 10.1186/s12936-016-1206-9.

Abstract

Plasmodium falciparum resistance to artemisinins, the most potent and fastest acting anti-malarials, threatens malaria elimination strategies. Artemisinin resistance is due to mutation of the PfK13 propeller domain and involves an unconventional mechanism based on a quiescence state leading to parasite recrudescence as soon as drug pressure is removed. The enhanced P. falciparum quiescence capacity of artemisinin-resistant parasites results from an increased ability to manage oxidative damage and an altered cell cycle gene regulation within a complex network involving the unfolded protein response, the PI3K/PI3P/AKT pathway, the PfPK4/eIF2α cascade and yet unidentified transcription factor(s), with minimal energetic requirements and fatty acid metabolism maintained in the mitochondrion and apicoplast. The detailed study of these mechanisms offers a way forward for identifying future intervention targets to fend off established artemisinin resistance.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antimalarials / pharmacology*
  • Artemisinins / pharmacology*
  • Drug Resistance* / drug effects
  • Drug Resistance* / genetics
  • Humans
  • Malaria, Falciparum / parasitology*
  • Models, Biological
  • Plasmodium falciparum* / drug effects
  • Plasmodium falciparum* / genetics

Substances

  • Antimalarials
  • Artemisinins