The evolutionary arms race: mass drug use and malaria parasites - BugBitten

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The evolutionary arms race: mass drug use and malaria parasites - BugBitten
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In a BugBitten blog post sophie_jm4 discusses the findings of a systematic review on the impact of mass drug administration on evolving resistance in malaria parasites.

The evolution of resistance to antimalarial drugs, taken from Moss et al., 2022.Antimalarial drug use on a mass scale In June 2022, the WHO released new guidelines for the treatment and prevention of malaria. These updated guidelines are less restrictive on drug use, suggesting that antimalarial drugs will be used more often on a ‘mass scale’. A summary of these changes can be found here.

How does DHA-PPQ work? Dihydroartemisinin-piperaquine is drug with two components: fast-acting dihydroartemisinin, and slow acting piperaquine. The fast-acting dihydroartemisinin has a short half-life and kills parasites quickly. This is paired with slow acting piperaquine, which ‘mops up’ by killing any parasites that are still remaining. The images below show how each of these components is hypothesised to work.

To supplement these therapeutic efficacy studies, researchers can monitor genomic changes in the parasite DNA, termed ‘molecular markers’. These markers are genomic mutations which have previously been associated with resistance to antimalarial drugs. Monitoring molecular markers is particularly useful on a population-based level. For example, blood samples or finger-prick dried blood spots can be sampled from people living in malaria endemic areas.

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