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Multidrug-resistant Plasmodium falciparum in the Greater Mekong Subregion of Southeast Asia is a major threat to malaria elimination and requires close surveillance. In this study, we collected 107 longitudinal clinical samples of P. falciparum in 2007-2012 from the malaria hypoendemic region of the China-Myanmar border and measured their in vitro susceptibilities to 10 antimalarial drugs. Overall, parasites had significantly different IC 50 values to all the drugs tested as compared to the reference 3D7 strain. Parasites were also genotyped in seven genes that were associated with drug resistance including pfcrt, pfmdr1, pfmrp1, pfdhfr, pfdhps, pfnhe1, and PfK13 genes. Despite withdrawal of chloroquine and antifolates from treating P. falciparum, parasites remained highly resistant to these drugs and mutations in pfcrt, pfdhfr, and pfdhps genes were highly prevalent and almost reached fixation in the study parasite population. Except for pyronaridine, quinine and lumefantrine, all other tested drugs exhibited significant temporal variations at least between some years, but only chloroquine and piperaquine had a clear temporal trend of continuous increase of IC 50 s. For the pfmrp1 gene, several mutations were associated with altered sensitivity to a number of drugs tested including chloroquine, piperaquine, lumefantrine and dihydroartemisinin. The association of PfK13 mutations with resistance to multiple drugs suggests potential evolution of PfK13 mutations amid multidrug resistance genetic background. Furthermore, network analysis of drug resistance genes indicated that certain haplotypes associated multidrug resistance persisted in these years, albeit there were year-to-year fluctuations of the predominant haplotypes., (Copyright © 2018. Published by Elsevier Ltd.)

Understanding the population genetics of genes which shape resistance to antimalarial drugs can help in devising novel control strategies. The high spread of the resistant strains of the malaria parasite Plasmodium falciparum pose a greater challenge than before to the control programs across the world. Specific mutations in the P. falciparum chloroquine resistant transporter gene "Pfcrt" have been associated with resistance to not only chloroquine, but also to amodiaquine, one of the artemisinin partners used in Cameroon for the treatment of uncomplicated malaria. We here present data on genetic variation at the Single Nucleotide Polymorphisms (SNPs) level in the Pfcrt gene in five distinct geographical settings of the Southern-Cameroon (the most malaria endemic part), i.e. Ebolowa, Yaounde, Bertoua, Douala and Kye-ossi (a city bordering Cameroon and two others African countries). Two novel mutations, hitherto unreported (in Cameroon) were found in the Pfcrt gene and variable genetic diversity was observed across the populations. High linkage disequilibrium was found between few SNPs including one of the novel mutations suggesting a synergistic work for conferring/maintaining a higher level of resistance. The inference of evolutionary pattern of this gene in Cameroon based on the genetic diversity data depicts a signature of Darwinian positive natural selection on these loci. Observation of novel mutations might traduce new variants in chloroquine/or amodiaquine resistance (proposal awaiting an experimental verification) and signal of positive selection can be the result of drug pressure exerted by misuse of chloroquine (though officially banned from the country) and/or amodiaquine. Our findings thus, provide a baseline understanding of the evolution of a malaria drug resistant gene in Cameroon and suggest a successful establishment of chloroquine-resistant strains which requires urgent attention of the malaria control program in Cameroon., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objectives: The main objective of this study was to unravel the distribution of different Pfcrt genotypes in the central, littoral, eastern and southern regions of Cameroon and also in locations bordering Gabon and Equatorial Guinea. This is because (i) the chloroquine-resistant malaria parasite Plasmodium falciparum shows a wide occurrence in Cameroon, (ii) mutations in the 72nd to 76th amino acid positions of the Pfcrt gene are known to confer resistance to chloroquine, and (iii) only a single chloroquine-resistant haplotype (C72V73I74E75T76) has so far been reported in Cameroon., Methods: We followed a molecular approach with DNA sequencing of the second exon of the Pfcrt gene to identify single nucleotide polymorphisms in 180 P. falciparum field isolates sampled in five different locations in Cameroon., Results: The chloroquine-resistant Pfcrt CVIET haplotype was most abundant, followed by the wild-type CVMNK haplotype. Five hitherto unreported chloroquine-resistant Pfcrt haplotypes were detected for the first time in Cameroonian P. falciparum, including the surprise appearance of the S(agt)VMNT haplotype., Conclusions: The high observed haplotype diversity of the chloroquine-resistant Pfcrt gene and the appearance of the S(agt)VMNT haplotype are daunting and can be attributed to drug pressure and/or the misuse of chloroquine and/or amodiaquine in Cameroon.