title: Antifolate resistance in Plasmodium falciparum: multiple origins and identification of novel dhfr alleles.
abstract: BACKGROUND
  Sulfadoxine-pyrimethamine has been widely used as first-line therapy for uncomplicated malaria throughout sub-Saharan Africa. Recent studies conducted in Asia and Africa suggest the triple-mutant dhfr genotype (51I/59R/108N) may have been generated as a single event in Southeast Asia, with subsequent spread of the single lineage to the African continent, but this hypothesis needs further validation.
  
  
  METHODS
  Direct sequencing of polymerase chain reaction (PCR) products, pyrosequencing, and cloning of PCR products were utilized to identify mutations in dhfr. To investigate the evolutionary history of dhfr alleles, we assayed microsatellite loci flanking dhfr along chromosome 4.
  
  
  RESULTS
  A total of 15 of 479 samples from western Kenya showed the presence of I164L, in 5 different genotypes. We document C50R in 2 of our samples. Using microsatellite markers, we show 2 haplotypes for both the 51I/108N/164L and 51I/59R/108N/164L genotypes. Our results also show multiple lineages for the triple-mutant dhfr genotype in Africa.
  
  
  CONCLUSIONS
  These findings highlight the importance of local characterization of alleles before molecular surveillance of drug-resistant alleles is considered in different endemic settings and populations.
authors.affiliation: Emory University, Program in Population Biology, Ecology, and Evolution, Atlanta, GA, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: McCollum
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Poe
authors.forename: Mary
authors.initials: M
authors.lastname: Hamel
authors.forename: Curtis
authors.initials: C
authors.lastname: Huber
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Zhou
authors.forename: Ya Ping
authors.initials: YP
authors.lastname: Shi
authors.forename: Peter
authors.initials: P
authors.lastname: Ouma
authors.forename: John
authors.initials: J
authors.lastname: Vulule
authors.forename: Peter
authors.initials: P
authors.lastname: Bloland
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.forename: John W
authors.initials: JW
authors.lastname: Barnwell
authors.forename: Venkatachalam
authors.initials: V
authors.lastname: Udhayakumar
authors.forename: Ananias A
authors.initials: AA
authors.lastname: Escalante
mesh_terms: D000483:Alleles; D000818:Animals; D000962:Antimalarials / Q000494:pharmacology*; D004338:Drug Combinations; D004351:Drug Resistance / Q000235:genetics*; D005493:Folic Acid Antagonists / Q000494:pharmacology*; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016778:Malaria, Falciparum / Q000469:parasitology; D018895:Microsatellite Repeats / Q000235:genetics; D009154:Mutation; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics*; D011739:Pyrimethamine / Q000494:pharmacology; D013413:Sulfadoxine / Q000494:pharmacology; D013762:Tetrahydrofolate Dehydrogenase / Q000235:genetics*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D005493:Folic Acid Antagonists; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D013762:Tetrahydrofolate Dehydrogenase; D011739:Pyrimethamine