Polymorphisms of Molecular Markers of Antimalarial Drug Resistance and Relationship with Artesunate-Mefloquine Combination Therapy in Patients with Uncomplicated Plasmodium falciparum Malaria in Thailand

Poonuch Muhamad Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, Klong Luang District, Pathumtani, Thailand; Mae-Sot General Hospital, Mae-Sot, Tak Province, Thailand

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Papichaya Phompradit Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, Klong Luang District, Pathumtani, Thailand; Mae-Sot General Hospital, Mae-Sot, Tak Province, Thailand

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Wannapa Sornjai Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, Klong Luang District, Pathumtani, Thailand; Mae-Sot General Hospital, Mae-Sot, Tak Province, Thailand

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Thunyaluk Maensathian Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, Klong Luang District, Pathumtani, Thailand; Mae-Sot General Hospital, Mae-Sot, Tak Province, Thailand

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Wanna Chaijaroenkul Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, Klong Luang District, Pathumtani, Thailand; Mae-Sot General Hospital, Mae-Sot, Tak Province, Thailand

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Ronnatrai Rueangweerayut Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, Klong Luang District, Pathumtani, Thailand; Mae-Sot General Hospital, Mae-Sot, Tak Province, Thailand

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Kesara Na-Bangchang Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, Klong Luang District, Pathumtani, Thailand; Mae-Sot General Hospital, Mae-Sot, Tak Province, Thailand

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The aim of this study was to investigate the association between genetic polymorphisms of Plasmodium falciparum chloroquine resistance transporter (pfcrt), P. falciparum multidrug resistance 1 (pfmdr1), and P. falciparum ATPase (pfatp6) and clinical outcome after a three-day mefloquine-artesunate combination therapy in 134 patients with uncomplicated Plasmodium falciparum malaria in an area with multidrug resistance along the Thailand-Myanmar border. Analysis of gene mutation and amplification were performed by nested real-time polymerase chain reaction and SYBR Green I real-time polymerase chain reaction, respectively. The mutation for pfcrt (codons 76, 220, 271, 326, 356, and 371) was found in all isolates (100%), whereas no mutation of pfmdr1 (codon 86) and pfatp6 (codons 37, 693, 769, 898) was found. The Pfmdr1 copy number was significantly higher in isolates with recrudescence (median number = 2.44) compared with a sensitive response (median number = 1.44). The gene copy number was also found to be significantly higher in paired isolates collected before treatment and at the time of recrudescence. All isolates carried one pfatp6 gene copy.

Author Notes

*Address correspondence to Kesara Na-Bangchang, Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, 99 Moo 18 Paholyothin Road, Klongnueng, Klongluang, Pathumthani 12121, Thailand. E-mail: kesaratmu@yahoo.com

Financial support: This study was supported by the Commission on Higher Education, Ministry of Education of Thailand, and the National Research University Project of Thailand, Office of Higher Education Commission. Papichaya Phompradit received a Royal Golden Jubilee Ph.D. scholarship from the Thailand Research Fund.

Authors' addresses: Poonuch Muhamad, Papichaya Phompradit, Wannapa Sornjai, Thunyaluk Maensathian, Wanna Chaijaroenkul, and Kesara Na-Bangchang, Thailand Center of Excellence on Drug Discovery and Development, Thammasat University, Rangsit Campus, 99 Moo 18 Paholyothin Road, Klongnueng, Klongluang, Pathumthani 12121, Thailand, E-mails: nurah_ab@yahoo.com, v_iv_iii_ii_i@hotmail.com, wan_napa_9@hotmail.com, kawaei_sine009@hotmail.com, wn_ap39@yahoo.com, and kesaratmu@yahoo.com. Ronnatrai Rueangweerayut, Mae-Sot General Hospital, Mae-Sot 63110, Tak Province, Thailand, E-mail: ronnatrai@yahoo.com.

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