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Repeated Ivermectin Treatment Induces Ivermectin Resistance in Strongyloides ratti by Upregulating the Expression of ATP-Binding Cassette Transporter Genes
ABSTRACT.
Ivermectin (IVM) is a widely used anthelmintic. However, with widespread use comes the risk of the emergence of IVM resistance, particularly in strongyloidiasis. Adenosine triphosphate (ATP)-binding cassette (ABC) transporter genes play an important role in the IVM-resistance mechanism. Here, we aimed to establish an animal experimental model of IVM resistance by frequent treatment of Strongyloides ratti with subtherapeutic doses of IVM, resistance being evaluated by the expression levels of ABC transporter genes. Rats infected with S. ratti were placed in experimental groups as follows: 1) untreated control (control); 2) treated with the mutagen ethyl methanesulfonate (EMS); 3) injected with 100 µg/kg body weight of IVM (IVM); 4) treated with a combination of EMS and IVM (IVM+EMS). Parasites were evaluated after four generations. Extent of IVM resistance was assessed using IVM sensitivity, larval development, and expression of ABC genes. By the F4 generation, S. ratti in the IVM group exhibited significantly higher levels of IVM resistance than did other groups according to in vitro drug-sensitivity tests and inhibition of larval development (IC50 = 36.60 ng/mL; 95% CI: 31.6, 42.01). Expression levels of ABC isoform genes (ABCA, ABCF, and ABCG) were statistically significantly higher in the IVM-resistant line compared with the susceptible line. In conclusion, IVM subtherapeutic doses induced IVM resistance in S. ratti by the F4 generation with corresponding upregulation of some ABC isoform genes. The study provides a model for inducing and assessing drug resistance in Strongyloides.
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Author Notes
Financial support: This study was granted by Faculty of Medicine, Khon Kaen University, Thailand (Grant number IN62135), the project of CKDNET (Grant number CKDNET2559007), and the Postgraduate Scholarship to Mr. Chatchawan Sengthong, Faculty of Medicine, Khon Kaen University, Thailand.
Authors’ addresses: Chatchawan Sengthong, Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, Medical Technology Unit of Bangkatum Hospital, Phitsanulok, Thailand, and Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, E-mail: chachasengthong@gmail.com. Manachai Yingklang, Nuttanan Hongsrichan, Thewarach Laha, and Somchai Pinlaor, Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, and Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, E-mails: manatao@gmail.com, nuttho@kku.ac.th, thewa_la@kku.ac.th, and psomec@kku.ac.th. Kitti Intuyod, Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, and Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mail: kittin@kku.ac.th. Ornuma Haonon, Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, and Faculty of Medical Technology, Nakhonratchasima College, Nakhon Ratchasima, Thailand, E-mail: ornuma.h@nmc.ac.th. Porntip Pinlaor, Chronic Kidney Disease Prevention in The Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, and Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand, E-mail: porawa@kku.ac.th. Chanakan Jantawong, Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, and Science Program in Biomedical Science, Khon Kaen University, Khon Kaen, Thailand, E-mail: chanakan19@hotmail.com. Sirirat Anutrakulchai, Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, and Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mail: sirirt_a@kku.ac.th. Ubon Cha’on, Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET), Faculty of Medicine, Khon Kaen University, Khon Kaen Province, Thailand, and Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mail: ubocha@kku.ac.th. Paiboon Sithithaworn, Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mail: paibsit@gmail.com.