Tu Youyou’s Team Announces Major Breakthrough in Artemisinin Resistance For Treating Malaria

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Chinese Nobel Prize winner Tu Youyou’s team announced major scientific breakthroughs in the treatment of artemisinin resistance.

According to Xinhua News, Nobel laureate Tu Youyou and her team have proposed solutions to the problem of artemisinin resistance, providing new evidence that artemisinin is still “the best weapon” against malaria, which remains the world’s most widespread insect-borne infectious disease.

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Artemisinin Combination Treatments (ACTs) were recommended by the World Health Organization in 2005 as the most effective malaria treatment available. However, following its World Malaria Report published in 2018, WHO indicated that after an unprecedented period of success in global malaria control, progress had stalled and malaria remains one of the leading causes of death in the world.

The stagnating progress was largely due to artemisinin resistance and partner drugs resistance, which was reported in malaria-endemic countries in Asian territories, including Myanmar, Thailand, Laos, and China. These areas are collectively referred to as the Greater Mekong Subregion. In response to this problem, Tu told reporters on Monday that after three years of research, her team identified treatment to artemisinin resistance.

“Prolonging the period of taking the medicine, or replacing the partner drug, could solve the problem of resistance,” Tu said. She explained that to approach the problem, it was important to first understand how artemisinin works as a treatment solution.

Tu’s team explained that by prolonging the treatment course and using artemisinin in combination with other partner drugs, the new ACT would be able to provide a solution to the drug resistance. The team published their findings in an article in the New England Journal of Medicine titled, “A Temporizing Solution to Artemisinin Resistance.”

The article explained that relatively minor adjustments such as extended treatment durations can effectively overcome the current “artemisinin-resistance” problem.

The article states that, “It remains entirely possible to rely on artemisinin and its partner drugs to eliminate malaria in the Greater Mekong Subregion by modifying the current standard regimens and accounting for partner-drug resistance. Interventions involving existing combinations (optimized to maintain high cure rates) should be taken soon after infections are diagnosed in regions and before any new complications emerge.”

Phenotypically, “artemisinin resistance” is defined as a delay in parasite clearance. It was determined that parasites that were cleared more slowly after artemisinin treatment carried gene mutations called kelch13 (K13). Parasites bearing these mutations are called “artemisinin-resistant.”

The recommended standard procedure for treating malaria used to entail a 3-day therapeutic course with ACTs. However, the short period does not contain the full treatment doses of artemisinin needed to cure infections, which last 7 to 10 days, according clinical studies conducted in China.

Tu’s team has explained that a 7-day treatment course is effective even when early parasite clearance is delayed. The same is not true of resistance to other classes of antimalarials, which results in a failure to cure the infection after a full treatment course.

The article also concludes that a next-generation antimalarial that compares favorably with artemisinin in potency, safety, and risk of resistance seems unlikely to emerge soon. Most ACTs are inexpensive, costing roughly less than $10.

Four decades after their development, artemisinin remains the antimalarial class of choice when used in combination therapy.

Featured photo credit to Internet