Molecular epidemiology of malaria in Yaounde, Cameroon. VI. Sequence variations in the Plasmodium falciparum dihydrofolate reductase-thymidylate synthase gene and in vitro resistance to pyrimethamine and cycloguanil
Lk. Basco et P. Ringwald, Molecular epidemiology of malaria in Yaounde, Cameroon. VI. Sequence variations in the Plasmodium falciparum dihydrofolate reductase-thymidylate synthase gene and in vitro resistance to pyrimethamine and cycloguanil, AM J TROP M, 62(2), 2000, pp. 271-276
Citations number
42
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
Pyrimethamine and cycloguanil, the major human metabolite of proguanil, are
inhibitors of dihydrofolate reductase that play a key role in the treatmen
t and prevention of chloroquine-resistant Plasmodium falciparum infections
in sub-Saharan Africa. Resistance to these antifolate drugs has emerged in
some areas of Africa. Earlier molecular studies have demonstrated that poin
t mutations at key positions of the dihydrofolate reductase-thymidylate syn
thase gene are strongly associated with antifolate resistance. However, whe
ther the same or distinct mutations are involved in the development of resi
stance to both pyrimethamine and cycloguanil has not been well established
in naturally occurring P. falciparum isolates. In this study, the in vitro
responses to both antifolate drugs were measured in 42 Cameroonian isolates
and compared with the complete sequence of the dihydrofolate reductase dom
ain of the gene (from 34 of 42 isolates) to analyze the genotype that may d
istinguish between pyrimethamine and cycloguanil resistance. The wild-type
profile (n = 11 isolates) was associated with low 50% inhibitory concentrat
ions (IC(50)s) ranging from 0.32 to 21.4 nanamole for pyrimethamine and 0.6
0-6.40 nM for cycloguanil. Mutant isolates had at least one amino acid subs
titution, Asn-108. Only three mutant codons were observed among the antifol
ate-resistant isolates: Ile-51, Arg-59, and Asn-108. The increasing number
of point mutations was associated with an increasing level of pyrimethamine
IC50 and, to a much lesser extent, cycloguanil IC50. These results support
a partial cross-resistance between pyrimethamine and cycloguanil that is b
ased on similar amino acid substitutions in dihydrofolate reductase and sug
gest that two or three mutations, including at least Asn-108, may be necess
ary for cycloguanil resistance, whereas a single Asn-108 mutation is suffic
ient for pyrimethamine resistance.