Growing resistance to malaria drugs in Southeast Asia is caused by a single mutated gene inside the disease-causing Plasmodium falciparum parasite, according to a study led by David Fidock, Ph.D., professor of microbiology & immunology and of medical sciences (in medicine) at Columbia University Medical Center. This finding provides public health officials around the world with a way to look for pockets of emerging resistance and potentially eliminate them before they spread. Though malaria deaths have dropped by 30 percent worldwide since the introduction of artemisinin-based combination therapies (ACTs) in the late 1990s, these gains are now threatened by the emergence of resistance to the core artemisinin component of ACTs in Southeast Asia. No alternative therapy is currently available to replace ACTs should resistance spread to other parts of the world. The current study, published online on December 11, 2014 in Science, builds on a recent report that mutations in the gene--K13--are frequently found in drug-resistant parasites in Southeast Asia. Dr. Fidock, working with scientists at the Pasteur Institutes in Paris and Cambodia, the University of Toulouse III, Sangamo Biosciences, Inc., and the National Institutes of Health (NIH), showed definitively that K13 mutations directly cause drug resistance. "The bad news about our finding is that it shows that resistance can arise through single mutations in one gene and pop up anywhere, at any time," Dr. Fidock says. "That's quite different from past instances with former first-line drugs, when complex sets of multiple mutations were required and resistance spread only as the mutated parasites spread."
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