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Emergence and clonal expansion of in vitro artemisinin-resistant Plasmodium falciparum kelch13 R561H mutant parasites in Rwanda

Open access
Uwimana, Aline, Legrand, Eric, Stokes, Barbara H., Ndikumana, Jean-Louis Mangala, Warsame, Marian, Umulisa, Noella, Ngamije, Daniel, Munyaneza, Tharcisse, Mazarati, Jean-Baptiste, Munguti, Kaendi, Campagne, Pascal, Criscuolo, Alexis, Ariey, Frédéric, Murindahabi, Monique, Ringwald, Pascal, Fidock, David A., Mbituyumuremyi, Aimable, Menard, Didier·2020·Nature Medicine

Abstract

Artemisinin resistance (delayed P. falciparum clearance following artemisinin-based combination therapy), is widespread across Southeast Asia but to date has not been reported in Africa 1–4. Here we genotyped the P. falciparum K13 (Pfkelch13) propeller domain, mutations in which can mediate artemisinin resistance 5,6, in pretreatment samples collected from recent dihydroarteminisin-piperaquine and artemether-lumefantrine efficacy trials in Rwanda 7. While cure rates were >95% in both treatment arms, the Pfkelch13 R561H mutation was identified in 19 of 257 (7.4%) patients at Masaka. Phylogenetic analysis revealed the expansion of an indigenous R561H lineage. Gene editing confirmed that this mutation can drive artemisinin resistance in vitro. This study provides evidence for the de novo emergence of Pfkelch13-mediated artemisinin resistance in Rwanda, potentially compromising the continued success of antimalarial chemotherapy in Africa.

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Metadata

Authors
Uwimana, A., Legrand, E., Stokes, B. H., Ndikumana, J.-L. M., Warsame, M., Umulisa, N., Ngamije, D., Munyaneza, T., Mazarati, J.-B., Munguti, K., Campagne, P., Criscuolo, A., Ariey, F., Murindahabi, M., Ringwald, P., Fidock, D. A., Mbituyumuremyi, A., & Menard, D.
Venue
Nature Medicine
Published
2020-08-03
Volume
26
Issue
10
Pages
1602-1608
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W3046809066
Cited by
831
References
36
FWCI
85.02
Type
journal article
Language
en
Open access
hybrid

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CoChat. (2026). Citation check: Emergence and clonal expansion of in vitro artemisinin-resistant Plasmodium falciparum kelch13 R561H mutant parasites in Rwanda. https://app.cochat.ai/papers/10.1038/s41591-020-1005-2
The paper
Uwimana, A., Legrand, E., Stokes, B. H., Ndikumana, J.-L. M., Warsame, M., Umulisa, N., Ngamije, D., Munyaneza, T., Mazarati, J.-B., Munguti, K., Campagne, P., Criscuolo, A., Ariey, F., Murindahabi, M., Ringwald, P., Fidock, D. A., Mbituyumuremyi, A., & Menard, D. (2020). Emergence and clonal expansion of in vitro artemisinin-resistant Plasmodium falciparum kelch13 R561H mutant parasites in Rwanda. Nature Medicine. https://doi.org/10.1038/s41591-020-1005-2

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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.