title: Ex vivo anti-malarial drug susceptibility of Plasmodium falciparum isolates from pregnant women in an area of highly seasonal transmission in Burkina Faso.
abstract: BACKGROUND
  Ex vivo assays are usually carried out on parasite isolates collected from patients with uncomplicated Plasmodium falciparum malaria, from which pregnant women are usually excluded as they are often asymptomatic and with relatively low parasite densities. Nevertheless, P. falciparum parasites infecting pregnant women selectively sequester in the placenta and may have a different drug sensitivity profile compared to those infecting other patients. The drug sensitivity profile of P. falciparum isolates from infected pregnant women recruited in a treatment efficacy trial conducted in Burkina Faso was determined in an ex vivo study.
  
  
  METHODS
  The study was conducted between October 2010 and December 2012. Plasmodium falciparum isolates were collected before treatment and at the time of any recurrent infection whose parasite density was at least 100/µl. A histidine-rich protein-2 assay was used to assess their susceptibility to a panel of seven anti-malarial drugs. The concentration of anti-malarial drug inhibiting 50% of the parasite maturation to schizonts (IC(50)) for each drug was determined with the IC Estimator version 1.2.
  
  
  RESULTS
  The prevalence of resistant isolates was 23.5% for chloroquine, 9.2% for mefloquine, 8.0% for monodesethylamodiaquine, and 4.4% for quinine. Dihydroartemisinin, mefloquine, lumefantrine, and monodesethylamodiaquine had the lowest mean IC(50) ranging between 1.1 and 1.5 nM respectively. The geometric mean IC(50) of the tested drugs did not differ between chloroquine-sensitive and resistant parasites, with the exception of quinine, for which the IC(50) was higher for chloroquine-resistant isolates. The pairwise comparison between the IC(50) of the tested drugs showed a positive and significant correlation between dihydroartemisinin and both mefloquine and chloroquine, between chloroquine and lumefantrine and between monodesethylamodiaquine and mefloquine.
  
  
  CONCLUSIONS
  These ex vivo results suggest that treatment with the currently available artemisinin-based combinations is efficacious for the treatment of malaria in pregnancy in Burkina Faso.
  
  
  BACKGROUND
  ClinicalTrials.gov ID: NCT00852423.
authors.affiliation: Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest (IRSS/DRO), Bobo-Dioulasso, Burkina Faso. marctahita@yahoo.fr.|Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso. marctahita@yahoo.fr.|Malariology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium. marctahita@yahoo.fr.|International Health Unit, University of Antwerp, Antwerp, Belgium. marctahita@yahoo.fr.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Tahita
authors.affiliation: Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest (IRSS/DRO), Bobo-Dioulasso, Burkina Faso. tintohalidou@yahoo.fr.|Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso. tintohalidou@yahoo.fr.|Unité de Recherche sur le Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso. tintohalidou@yahoo.fr.
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.affiliation: Unité de Recherche sur le Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso. yargasibiri@yahoo.fr.
authors.forename: Sibiri
authors.initials: S
authors.lastname: Yarga
authors.affiliation: Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso. kazienga_adama@yahoo.fr.
authors.forename: Adama
authors.initials: A
authors.lastname: Kazienga
authors.affiliation: Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest (IRSS/DRO), Bobo-Dioulasso, Burkina Faso. maminata_traore@yahoo.fr.|Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso. maminata_traore@yahoo.fr.
authors.forename: Maminata
authors.initials: M
authors.lastname: Traore Coulibaly
authors.affiliation: Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso. innocentvalea@yahoo.fr.|Unité de Recherche sur le Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso. innocentvalea@yahoo.fr.
authors.forename: Innocent
authors.initials: I
authors.lastname: Valea
authors.affiliation: Malariology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium. CVOvermeir@itg.be.
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Overmeir
authors.affiliation: Malariology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium. arosanas@itg.be.
authors.forename: Anna
authors.initials: A
authors.lastname: Rosanas-Urgell
authors.affiliation: Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest (IRSS/DRO), Bobo-Dioulasso, Burkina Faso. jbouedraogo@gmail.com.|Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso. jbouedraogo@gmail.com.
authors.forename: Jean-Bosco
authors.initials: JB
authors.lastname: Ouedraogo
authors.affiliation: Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso. rguiguemde@yahoo.fr.|Unité de Recherche sur le Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso. rguiguemde@yahoo.fr.|Institut Supérieur des Sciences de la Santé (INSSA), Bobo-Dioulasso, Burkina Faso. rguiguemde@yahoo.fr.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Guiguemde
authors.affiliation: International Health Unit, University of Antwerp, Antwerp, Belgium. Jean-Pierre.VanGeertruyden@uantwerpen.be.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: van Geertruyden
authors.affiliation: Malariology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium. aerhart@itg.be.
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.affiliation: Malariology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium. udalessandro@mrc.gm.|Medical Research Council Unit, Fajara, The Gambia. udalessandro@mrc.gm.|London School of Hygiene and Tropical Medicine, London, UK. udalessandro@mrc.gm.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000962:Antimalarials / Q000494:pharmacology* / Q000627:therapeutic use*; D002050:Burkina Faso; D004351:Drug Resistance; D005260:Female; D006801:Humans; D020128:Inhibitory Concentration 50; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D021261:Parasitic Sensitivity Tests; D010963:Plasmodium falciparum / Q000187:drug effects*; D011247:Pregnancy; D012621:Seasons
chemical_list: D000962:Antimalarials