PerspectiveInfectious Diseases

Understanding artemisinin resistance

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Science  23 Jan 2015:
Vol. 347, Issue 6220, pp. 373-374
DOI: 10.1126/science.aaa4102

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Summary

The drug resistance specter looms over most infectious diseases. Malaria provides a particularly urgent example of increasing resistance and treatment failure. In the past decade, artemisinin combination therapies (ACTs) have contributed to impressive reductions in malaria morbidity and mortality (1). However, in 2009, Dondorp et al. found that when patients in western Cambodia infected with Plasmodium falciparum (the deadliest form of malaria) were treated with ACTs, they took longer than normal to clear their parasites. It is the artemisinin component that normally clears parasites quickly, and the authors therefore concluded that this component of the ACT was compromised (2). Slow-clearing parasites were also found in western Thailand and other parts of Cambodia (see the first figure) (3, 4). Two reports in this issue, by Mok et al. (page 431) (5) and Straimer et al. (page 428) (6), apply specialized techniques to better understand the mechanisms that underlie this resistance to artemisinins.