Parasites resistant to the antimalarial atovaquone fail to transmit by mosquitoes

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Science  15 Apr 2016:
Vol. 352, Issue 6283, pp. 349-353
DOI: 10.1126/science.aad9279

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Transmission blocked by drug resistance

Resistance to the antimalarial drug atovaquone might prove to be this parasite's weak spot. Resistance develops rapidly via mutations in the drug's target: the parasite's mitochondrial cytochrome b complex. Goodman et al. have discovered that although resistant Plasmodium berghei parasites persist in mice, in blood-sucking malarial mosquitoes, the mutations disable female parasites too much for them to reproduce. The human-specific Plasmodium falciparum can only be investigated experimentally in mosquitoes, but a similar effect was seen. Thus, atovaquone-resistant parasites cannot be transmitted to another mammal or person.

Science, this issue p. 349


Drug resistance compromises control of malaria. Here, we show that resistance to a commonly used antimalarial medication, atovaquone, is apparently unable to spread. Atovaquone pressure selects parasites with mutations in cytochrome b, a respiratory protein with low but essential activity in the mammalian blood phase of the parasite life cycle. Resistance mutations rescue parasites from the drug but later prove lethal in the mosquito phase, where parasites require full respiration. Unable to respire efficiently, resistant parasites fail to complete mosquito development, arresting their life cycle. Because cytochrome b is encoded by the maternally inherited parasite mitochondrion, even outcrossing with wild-type strains cannot facilitate spread of resistance. Lack of transmission suggests that resistance will be unable to spread in the field, greatly enhancing the utility of atovaquone in malaria control.

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