title: The T76 mutation in the pfcrt gene of Plasmodium falciparum and clinical chloroquine resistance phenotypes in Papua, Indonesia.
abstract: The T76 mutation in the pfcrt gene has been linked to chloroquine (CQ) resistance in Plasmodium falciparum. PCR-based analysis of pfcrt alleles was performed on pre-treatment samples from 107 individuals who had P. falciparum infections and lived in Papua, Indonesia. The results of a 28-day, in-vivo test revealed clinical resistance to CQ in 79 (74%) of the samples. The crude sensitivity of the pfcrt T76 assay for detecting the CQ-resistant infections in the samples was 96% and the crude specificity 52%. Discordance between pfcrt genotype and in-vivo phenotype was analysed either by genotyping of the merozoite surface protein-2 (to distinguish re-infection from recrudescence) or by amplification of the P. falciparum-specific small-subunit ribosomal RNA (ssrRNA) gene, using nested PCR (to detect any sub-patent but resistant parasites in infections misclassified as sensitive by the in-vivo test). When adjusting for the results of these analyses, the sensitivity and specificity of the pfcrt T76 assay for detecting the CQ-resistant infections became 93% and 82%, respectively. Overall, the present results indicate that the pfcrt T76 assay may be used to forecast therapeutic failure caused by CQ resistance. Validation requires exploration of the phenotype classifications based on the results of in-vivo tests, using genetic analyses that distinguish re-infection from recrudescence and detect microscopically subpatent parasitaemias.
authors.affiliation: United States Naval Medical Research Unit No. 2, U.S. Embassy Jakarta, Unit 8132, NAMRU-TWO, FPO AP 96520-8132, USA. maguirejd@namru2.med.navy.mil
authors.forename: J D
authors.initials: JD
authors.lastname: Maguire
authors.forename: A I
authors.initials: AI
authors.lastname: Susanti
authors.lastname: Krisin
authors.forename: P
authors.initials: P
authors.lastname: Sismadi
authors.forename: D J
authors.initials: DJ
authors.lastname: Fryauff
authors.forename: J K
authors.initials: JK
authors.lastname: Baird
mesh_terms: D000328:Adult; D000483:Alleles; D000818:Animals; D000953:Antigens, Protozoan / Q000235:genetics; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002738:Chloroquine / Q000627:therapeutic use*; D004351:Drug Resistance / Q000235:genetics*; D017125:Genes, Protozoan / Q000235:genetics*; D005838:Genotype; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy; D008565:Membrane Proteins / Q000235:genetics*; D026901:Membrane Transport Proteins; D009154:Mutation / Q000235:genetics*; D010641:Phenotype; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics*; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015800:Protozoan Proteins / Q000235:genetics; D012335:RNA, Ribosomal / Q000235:genetics; D012680:Sensitivity and Specificity
chemical_list: D000953:Antigens, Protozoan; D000962:Antimalarials; D008565:Membrane Proteins; D026901:Membrane Transport Proteins; C416369:PfCRT protein, Plasmodium falciparum; D015800:Protozoan Proteins; D012335:RNA, Ribosomal; C065974:merozoite surface protein 2, Plasmodium; D002738:Chloroquine