A Plasmodium falciparum genetic cross reveals the contributions of pfcrt and plasmepsin II/III to piperaquine drug resistance
Issued Date
2024-07-17
Resource Type
eISSN
21507511
Scopus ID
2-s2.0-85199126051
Pubmed ID
38912775
Journal Title
mBio
Volume
15
Issue
7
Rights Holder(s)
SCOPUS
Bibliographic Citation
mBio Vol.15 No.7 (2024) , e0080524
Suggested Citation
Kane J., Li X., Kumar S., Button-Simons K.A., Brenneman K.M.V., Dahlhoff H., Sievert M.A.C., Checkley L.A., Shoue D.A., Singh P.P., Abatiyow B.A., Haile M.T., Nair S., Reyes A., Tripura R., Peto T.J., Lek D., Mukherjee A., Kappe S.H.I., Dhorda M., Nkhoma S.C., Cheeseman I.H., Vaughan A.M., Anderson T.J.C., Ferdig M.T. A Plasmodium falciparum genetic cross reveals the contributions of pfcrt and plasmepsin II/III to piperaquine drug resistance. mBio Vol.15 No.7 (2024) , e0080524. doi:10.1128/mbio.00805-24 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/100021
Title
A Plasmodium falciparum genetic cross reveals the contributions of pfcrt and plasmepsin II/III to piperaquine drug resistance
Author(s)
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
National Institute of Public Health Cambodia
University of Washington School of Medicine
Texas Biomedical Research Institute
University of Notre Dame
American Type Culture Collection
Nuffield Department of Medicine
Seattle Biomedical Research Institute
National Center for Parasitology
National Institute of Public Health Cambodia
University of Washington School of Medicine
Texas Biomedical Research Institute
University of Notre Dame
American Type Culture Collection
Nuffield Department of Medicine
Seattle Biomedical Research Institute
National Center for Parasitology
Corresponding Author(s)
Other Contributor(s)
Abstract
Piperaquine (PPQ) is widely used in combination with dihydroartemisinin as a first-line treatment against malaria. Multiple genetic drivers of PPQ resistance have been reported, including mutations in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and increased copies of plasmepsin II/III (pm2/3). We generated a cross between a Cambodia-derived multidrug-resistant KEL1/PLA1 lineage isolate (KH004) and a drug-susceptible Malawian parasite (Mal31). Mal31 harbors a wild-type (3D7-like) pfcrt allele and a single copy of pm2/3, while KH004 has a chloroquine-resistant (Dd2-like) pfcrt allele with an additional G367C substitution and multiple copies of pm2/3. We recovered 104 unique recombinant parasites and examined a targeted set of progeny representing all possible combinations of variants at pfcrt and pm2/3. We performed a detailed analysis of competitive fitness and a range of PPQ susceptibility phenotypes with these progenies, including PPQ survival assay, area under the dose response curve, and a limited point IC50. We find that inheritance of the KH004 pfcrt allele is required for reduced PPQ sensitivity, whereas copy number variation in pm2/3 further decreases susceptibility but does not confer resistance in the absence of additional mutations in pfcrt. A deep investigation of genotype-phenotype relationships demonstrates that progeny clones from experimental crosses can be used to understand the relative contributions of pfcrt, pm2/3, and parasite genetic background to a range of PPQ-related traits. Additionally, we find that the resistance phenotype associated with parasites inheriting the G367C substitution in pfcrt is consistent with previously validated PPQ resistance mutations in this transporter.IMPORTANCEResistance to piperaquine, used in combination with dihydroartemisinin, has emerged in Cambodia and threatens to spread to other malaria-endemic regions. Understanding the causal mutations of drug resistance and their impact on parasite fitness is critical for surveillance and intervention and can also reveal new avenues to limiting the evolution and spread of drug resistance. An experimental genetic cross is a powerful tool for pinpointing the genetic determinants of key drug resistance and fitness phenotypes and has the distinct advantage of quantifying the effects of naturally evolved genetic variation. Our study was strengthened since the full range of copies of KH004 pm2/3 was inherited among the progeny clones, allowing us to directly test the role of the pm2/3 copy number on resistance-related phenotypes in the context of a unique pfcrt allele. Our multigene model suggests an important role for both loci in the evolution of this multidrug-resistant parasite lineage.