MOLECULAR EPIDEMIOLOGY OF PLASMODIUM FALCIPARUM RESISTANCE TO ANTIMALARIAL DRUGS IN INDONESIA

DIN SYAFRUDDIN Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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PUJI B. S. ASIH Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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GERARD J. CASEY Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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JASON MAGUIRE Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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J. KEVIN BAIRD Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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HADYA S. NAGESHA Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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ALAN F. COWMAN Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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JOHN C. REEDER Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; United States Naval Medical Research Unit No. 2, Jakarta, Indonesia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea

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The extent of gene polymorphisms associated with resistance to chloroquine and sulfadoxine-pyrimethamine was examined in field isolates of Plasmodium falciparum from Indonesia. Eight malaria-endemic areas, representing a broad region of the western and eastern Indonesian Archipelago were surveyed. Blood from 20–50 patients was collected at each site, DNA was isolated, and the sequences of four different genes (dihydrofolate reductase [dhfr], dihydropteroate synthase [dhps], P. falciparum multidrug resistance 1 [pfmdr1], and P. falciparum chloroquine resistance transporter [pfcrt]) were analyzed using polymerase chain reaction and restriction fragment length polymorphisms to detect polymorphisms previously shown to be associated with resistance. This analysis identified polymorphisms in dhfr at 108-Asn/Thr, 16-Val, and 59-Arg. Polymorphisms in dhps were found less frequently, either 437-Gly alone or paired with 540-Glu. The pfcrt 76-Thr polymorphism was fixed in all parasite populations and pfmdr1 86-Tyr polymorphisms in all populations except in the most eastern regions. The pfmdr1 1042-Asp polymorphism occurred less frequently. These findings indicate that polymorphisms in genes associated with drug resistance in P. falciparum are found across a broad region of Indonesia.

Author Notes

Reprint requests: Din Syafruddin, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia, Telephone: 62-21-3917131, Fax: +62-21-3147982, E-mail: din@eijkman.go.id.
  • 1

    Ebisawa I, Fukuyama T, 1975. Chloroquine-resistant falciparum malaria from west Irian and east Kalimantan. Ann Trop Med Parasitol 69 :275–282.

  • 2

    Clyde DF, McCarthy VC, Miller RM, Hornick RB, 1976. Chloroquine-resistant falciparum malaria from Irian Jaya (Indonesian New Guinea). J Trop Med Hyg 79 :38–41.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Pribadi W, 1992. In vitro sensitivity of Plasmodium falciparum to chloroquine and other antimalarials in east Timor and east Kalimantan, Indonesia. Southeast Asian J Trop Med Public Health 23 (Suppl 4):143–148.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Tjitra E, Gunawan S, Laihad F, HM, Sulaksono S, Arjoso S, Richie TL, Manurung N, 1997. Evaluation of antimalarial drugs in Indonesia 1981–1995. Buletin Penelitian Kesehatan (Indonesian) 25 :27–58.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Fryauff DJ, Baird JK, Candradikusuma D, Masbar S, Sutamihardja MA, Leksana B, Tuti S, Marwoto H, Richie TL, Romzan A, 1997. Survey of in vivo sensitivity to chloroquine by Plasmodium falciparum and P. vivax in Lombok, Indonesia. Am J Trop Med Hyg 56 :241–244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Tjitra E, Suprianto S, Currie BJ, Morris PS, Saunders JR, Anstey NM, 2001. Therapy of uncomplicated falciparum malaria: a randomized trial comparing artesunate plus sulfadoxine-pyrimethamine versus sulfadoxine-pyrimethamine alone in Irian Jaya, Indonesia. Am J Trop Med Hyg 65 :309–317.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Maguire JD, Susanti AI, Krisin, Sismadi P, Fryauff DJ, Baird JK, 2001. The T76 mutation in the pfcrt gene of Plasmodium falciparum and clinical chloroquine resistance phenotypes in Papua, Indonesia. Ann Trop Med Parasitol 95 :559–572.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Nagesha HS, Din S, Casey GJ, Susanti AI, Fryauff DJ, Reeder JC, Cowman AF, 2001. Mutations in the pfmdr1, dhfr and dhps genes of Plasmodium falciparum are associated with in-vivo drug resistance in west Papua, Indonesia. Trans R Soc Trop Med Hyg 95 :43–49.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Baird JK, Wiady I, Sutanihardja A, Suradi, Purnomo, Basri H, Sekartuti, Ayomi E, Fryauff DJ, Hoffman SL, 2002. Short report: therapeutic efficacy of chloroquine combined with primaquine against Plasmodium falciparum in northeastern Papua, Indonesia. Am J Trop Med Hyg 66 :659–660.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Maguire JD, Lacy MD, Sururi, Sismadi P, Krisin, Wiady I, Laksana B, Bangs MJ, Masbar S, Susanti I, Basuki W, Barcus MJ, Marwoto H, Edstein MD, Tjokrosonto S, Baird JK, 2002. Chloroquine or sulfadoxine-pyrimethamine for the treatment of uncomplicated, Plasmodium falciparum malaria during an epidemic in central Java, Indonesia. Ann Trop Med Parasitol 96 :655–668.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Sumawinata IW, Bernadeta, Leksana B, Sutamihardja A, Purnomo, Subianto B, Sekartuti, Fryauff DJ, Baird JK, 2003. Very high risk of therapeutic failure with chloroquine for uncomplicated Plasmodium falciparum and P. vivax malaria in Indonesian Papua. Am J Trop Med Hyg 68 :416–420.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Syafruddin D, Asih PBS, Aggarwal SL, Shankar AH, 2003. Frequency distribution of antimalarial drug-resistant alleles among isolates of Plasmodium falciparum in Purworejo district, Central Java Province, Indonesia. Am J Trop Med Hyg 69 :614–620.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Chulay JD, Watkins WM, Sixsmith DG, 1984. Synergistic anti-malarial activity of pyrimethamine and sulfadoxine against Plasmodium falciparum in vitro. Am J Trop Med Hyg 33 :325– 330.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Sirawaraporn W, Yuthavong Y, 1986. Potentiating effect of pyrimethamine and sulfadoxine against dihydrofolate reductase from pyrimethamine-sensitive and pyrimethamine-resistant Plasmodium chabaudi. Antimicrob Agents Chemother 29 :899– 905.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Hoffman SL, Rustama D, Dimpudus AJ, Punjabi NH, Campbell JR, Oetomo HS, Marwoto HA, Harun S, Sukri N, Heizmann P, 1985. RII and RIII type resistance of Plasmodium falciparum to combination of mefloquine and sulfadoxine/pyrimethamine in Indonesia. Lancet 2 :1038–1040.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Baird JK, Basri H, Jones TR, Purnomo, Bangs MJ, Ritonga A, 1991. Resistance to antimalarials by Plasmodium falciparum in Arso PIR, Irian Jaya, Indonesia. Am J Trop Med Hyg 44 :640–644.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Fryauff DJ, Leksana B, Masbar S, Wiady I, Sismadi P, Susanti AI, Nagesha HS, Syafruddin D, Atmosoedjono S, Bangs MJ, Baird JK, 2002. The drug sensitivity and transmission dynamics of human malaria on Nias Island, north Sumatra, Indonesia. Ann Trop Med Parasitol 96 :447–462.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Bustos DG, Canfield CJ, Canete-Miguel E, Hutchinson DB, 1999. Atovaquone-proguanil compared with chloroquine and chloroquine-sulfadoxine-pyrimethamine for treatment of acute Plasmodium falciparum malaria in the Philippines. J Infect Dis 179 :1587–1590.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Cox-Singh J, Zakaria R, Abdullah MS, Rahman HA, Nagappan S, Singh B, 2001. Short report: differences in dihydrofolate reductase but not dihydropteroate synthase alleles in Plasmodium falciparum isolates from geographically distinct areas in Malaysia. Am J Trop Med Hyg 64 :28–31.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Wongsrichanalai C, Sirichaisinthop J, Karwacki JJ, Congpuong K, Miller RS, Pang L, Thimasarn K, 2001. Drug resistant malaria on the Thai-Myanmar and Thai-Cambodian borders. Southeast Asian J Trop Med Public Health 32 :41–49.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Schwobel B, Jordan S, Vanisaveth V, Phetsouvanh R, Christophel EM, Phompida S, von Sonnenburg F, Jelinek T, 2003. Therapeutic efficacy of chloroquine plus sulphadoxine/pyrimethamine compared with monotherapy with either chloroquine or sulphadoxine/pyrimethamine in uncomplicated Plasmodium falciparum malaria in Laos. Trop Med Int Health 8 :19–24.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Mohapatra PK, Namchoom NS, Prakash A, Bhattacharya DR, Goswami BK, Mahanta J, 2003. Therapeutic efficacy of anti-malarials in Plasmodium falciparum malaria in an Indo-Myanmar border area of Arunachal Pradesh. Indian J Med Res 118 :71–76.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Fidock DA, Nomura T, Talley AK, Cooper RA, Dzekunov SM, Ferdig MT, Ursos LM, Sidhu AB, Naude B, Deitsch KW, Su XZ, Wootton JC, Roepe PD, Wellems TE, 2000. Mutations in the P. falciparum digestive vacuole transmembrane protein PfCRT and evidence for their role in chloroquine resistance. Mol Cell 6 :861–871.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Djimde A, Doumbo OK, Cortese JF, Kayentao K, Doumbo S, Diourte Y, Dicko A, Su XZ, Nomura T, Fidock DA, Wellems TE, Plowe CV, 2001. A molecular marker for chloroquine-resistant falciparum malaria. N Engl J Med 344 :257–263.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Djimde A, Doumbo OK, Steketee RW, Plowe CV, 2001b. Application of a molecular marker for surveillance of chloroquine-resistant falciparum malaria. Lancet 358 :890–891.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Sidhu AB, Verdier-Pinard D, Fidock DA, 2002. Chloroquine resistance in Plasmodium falciparum malaria parasites conferred by pfcrt mutations. Science 298 :210–213.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Foote SJ, Thompson JK, Cowman AF, Kemp DJ, 1989. Amplification of the multidrug resistance gene in some chloroquine-resistant isolates of P. falciparum. Cell 57 :921–930.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Reed MB, Saliba KJ, Caruana SR, Kirk K, Cowman AF, 2000. Pgh1 modulates sensitivity and resistance to multiple antimalarials in Plasmodium falciparum. Nature 403 :906–909.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Cowman AF, Morry MJ, Biggs BA, Cross GA, Foote SJ, 1988. Amino acid changes linked to pyrimethamine resistance in the dihydrofolate reductase-thymidylate synthase gene of Plasmodium falciparum. Proc Natl Acad Sci U S A 85 :9109–9113.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Peterson DS, Walliker D, Wellems TE, 1988. Evidence that a point mutation in dihydrofolate reductase-thymidylate synthase confers resistance to pyrimethamine in falciparum malaria. Proc Natl Acad Sci U S A 85 :9114–9118.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Foote SJ, Galatis D, Cowman AF, 1990. Amino acids in the dihydrofolate reductase-thymidylate synthase gene of Plasmodium falciparum involved in cycloguanil resistance differ from those involved in pyrimethamine resistance. Proc Natl Acad Sci U S A 87 :3014–3017.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Peterson DS, Milhous WK, Wellems TE, 1990. Molecular basis of differential resistance to cycloguanil and pyrimethamine in Plasmodium falciparum malaria. Proc Natl Acad Sci U S A 87 :3018–3022.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Triglia T, Wang P, Sims PF, Hyde JE, Cowman AF, 1998. Allelic exchange at the endogenous genomic locus in Plasmodium falciparum proves the role of dihydropteroate synthase in sulfadoxine-resistant malaria. EMBO J 17 :3807–3815.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Triglia T, Cowman AF, 1999. The mechanism of resistance to sulfa drugs in Plasmodium falciparum. Drug Resist Update 2 :15–19.

  • 35

    Plowe CV, Cortese JF, Djimde A, Nwanyanwu OC, Watkins WM, Winstanley PA, Estrada-Franco JG, Mollinedo RE, Avila JC, Cespedes JL, Carter D, Doumbo OK, 1997. Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase and epidemiologic patterns of pyrimethamine- sulfadoxine use and resistance. J Infect Dis 176 :1590–1596.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Vasconcelos KF, Plowe CV, Fontes CJ, Kyle D, Wirth DF, Pereira da Silva LH, Zalis MG, 2000. Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase of isolates from the Amazon region of Brazil. Mem Inst Oswaldo Cruz 95 :721–728.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Basco LK, Ndounga M, Ngane VF, Soula G, 2002. Molecular epidemiology of malaria in Cameroon. XIV. Plasmodium falciparum chloroquine resistance transporter (PFCRT) gene sequences of isolates before and after chloroquine treatment. Am J Trop Med Hyg 67 :392–395.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Wooden J, Kyes S, Sibley CH, 1993. PCR and strain identification in Plasmodium falciparum. Parasitol Today 9 :303–305.

  • 39

    Duraisingh MT, Drakeley CJ, Muller O, Bailey R, Snounou G, Targett GA, Greenwood BM, Warhurst DC, 1997. Evidence for selection for the tyrosine-86 allele of the pfmdr 1 gene of Plasmodium falciparum by chloroquine and amodiaquine. Parasitology 114 :205–211.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Duraisingh MT, Curtis J, Warhurst DC, 1998. Plasmodium falciparum: detection of polymorphisms in the dihydrofolate reductase and dihydropteroate synthetase genes by PCR and restriction digestion. Exp Parasitol 89 :1–8.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Gomez-Saladin E, Fryauff D, Taylor W, Laksana B, Susanti A, Purnomo, Subianto B, Richie T, 1999. Plasmodium falciparum mdr1 mutations and in vivo chloroquine resistance in Indonesia. Am J Trop Med Hyg 61 :240–244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Nagesha HS, Casey GJ, Riekmann KH, Fryauff DJ, Laksana BS, Reeder JC, Maguire JD, Baird JK, 2003. New haplotypes of the Plasmodium falciparum chloroquine resistance transporter (pfcrt) gene among chloroquine-resistant parasite isolates. Am J Trop Med Hyg 68 :398–402.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Mehlotra RK, Fujioka H, Roepe PD, Janneh O, Ursos LM, Jacobs-Lorena V, McNamara DT, Bockarie MJ, Kazura JW, Kyle DE, Fidock DA, Zimmerman PA, 2001. Evolution of a unique Plasmodium falciparum chloroquine-resistance phenotype in association with pfcrt polymorphism in Papua New Guinea and South America. Proc Natl Acad Sci U S A 98 :12689–12694.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Fryauff DJ, Sumawinata I, Purnomo, Richie TL, Tjitra E, Bangs MJ, Kadir A, Ingkokusumo G, 1999. In vivo responses to antimalarials by Plasmodium falciparum and Plasmodium vivax from isolated Gag Island off northwest Irian Jaya, Indonesia. Am J Trop Med Hyg 60 :542–546.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Sirawaraporn W, Sathitkul T, Sirawaraporn R, Yuthavong Y, Santi DV, 1997. Antifolate-resistant mutants of Plasmodium falciparum dihydrofolate reductase. Proc Natl Acad Sci U S A 94 :1124–1129.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Reeder JC, Rieckmann KH, Genton B, Lorry K, Wines B, Cowman AF, 1996. Point mutations in the dihydrofolate reductase and dihydropteroate synthetase genes and in vitro susceptibility to pyrimethamine and cycloguanil of Plasmodium falciparum isolates from Papua New Guinea. Am J Trop Med Hyg 55 :209–213.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Syafruddin D, Asih PB, Siregar JE, Tjitra E, 2003. Molecular basis of antimalarial drug resistance in Indonesia. Adv Exp Med Biol 531 :103–115.

  • 48

    Casey GJ, Ginny M, Uranoli M, Mueller I, Reeder JC, Genton B, Cowman AF, 2004. Molecular analysis of Plasmodium falciparum from drug treatment failure patients in Papua New Guinea. Am J Trop Med Hyg 70 :251–255.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Plowe CV, Kublin JG, Dzinjalamala FK, Kamwendo DS, Mukadam RAG, Chimpeni P, Molyneux ME, Taylor TE, 2004. Sustained clinical efficacy of sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Malawi after 10 years as first line treatment: five year prospective study. BMJ 328 :545.

    • PubMed
    • Search Google Scholar
    • Export Citation
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