Surveillance to track and characterize antimalarial resistance trends in Ugandan Plasmodium falciparum parasites (STARTUP)

项目总结/摘要： 乌干达和卢旺达的新研究报告了pfkelch 13（K13）突变的流行率增加 与青蒿素临床或体外治疗后寄生虫清除延迟相关，表明 担心非洲会出现恶性疟原虫对青蒿素的抗药性， 疟疾病例和死亡的发生，已经实现。然而，对组分的抗性程度 基于青蒿素的联合疗法（ACT）尚未得到很好的理解。我们正在进行的研究活动和 乌干达完善的基础设施使我们处于独特的地位，能够迅速满足 改进对乌干达青蒿素和伙伴药物耐药性的监测和定性。 得益于全国80个监测点网络和坎帕拉的现代化实验室， 托罗罗，我们将使用分子，寄生虫学和流行病学方法a）评估起源， 青蒿素和青蒿素综合疗法伙伴药物耐药性的已知标志物的流行率和分布情况， 表征促进抗性表型建立和传播的遗传背景， B）评估基因型和药物敏感性/适合性表型之间的关联，和 生态和流行病学因素，促进耐药性的演变。对重要的 毒品仍然是地理上的焦点，我们的目标是确定其出现和传播的关键驱动因素，然后 及时向公共卫生领导人通报遏制耐药性在非洲蔓延的最佳方法。

PROJECT SUMMARY/ABSTRACT: New studies in Uganda and Rwanda have reported increasing prevalence of mutations in pfkelch13 (K13) associated with delayed parasite clearance following clinical or in vitro treatment with artemisinins, suggesting that fears that resistance of Plasmodium falciparum to artemisinins will emerge in Africa, where >90% of malaria cases and deaths occur, have been realized. However, the extent of resistance to components of artemisinin-based combination therapies (ACTs) is not well understood. Our ongoing research activities and well-established infrastructure in Uganda put us in a unique position to rapidly address urgent needs for improved surveillance and characterization of resistance to artemisinins and partner drugs in Uganda. Benefitting from a network of 80 surveillance sites across the country and modern laboratories in Kampala and Tororo, we will use molecular, parasitological and epidemiological approaches a) to evaluate the origins, prevalence and distribution of known markers of artemisinin and ACT partner drug resistance and to characterize the genetic background(s) that facilitate the establishment and spread of resistance phenotypes, b) assess associations between genotypes and drug susceptibility/fitness phenotypes, and c) assess ecological and epidemiological factors that facilitate the evolution of resistance. With resistance to important drugs still geographically focal, our goal is to identify key drivers of its emergence and spread, and then to promptly inform public health leaders on the best means of blunting the spread of resistance across Africa.