Mekong Molecular Surveillance Network strengthens efforts to combat drug resistance
The Mekong Molecular Surveillance Network, is a WWARN programme established in 2009 with funding from the United States Agency for International Development (USAID) awarded to the University of Maryland School of Medicine on behalf of the WWARN Molecular Scientific Group. Between 2009 and 2012 the Network worked with the WHO Mekong Malaria Programme to strengthen the capacity of national malaria control program (NMCP) laboratories performing malaria genotyping for therapeutic efficacy surveillance in Cambodia, China, Lao PDR, Myanmar (Burma), Thailand, and Vietnam.
The Project has successfully strengthened partnerships between laboratories and has facilitated a regional approach to antimalarial drug efficacy surveillance. “Parasites do not recognise political boundaries, so countries and institutions must work together to improve ongoing malaria control, elimination, and research efforts,” said Dr. Bouasy Hongvanthong, Director of the Center of Malariology, Parasitology and Entomology in Lao PDR. The Project has brought about significant improvements in the capacity and proficiency of malaria molecular laboratories in the region. Most notably, a series of regional training workshops and staff exchanges strengthened capacity for molecular surveillance of antimalarial drug resistance; and a biannual proficiency testing programme for malaria genotyping, the Malaria Molecular External Quality Assessment Programme, allowed laboratories to differentiate true treatment failure (recrudescence) from re-infection in the absence of a simple molecular method to identify artemisinin drug resistance.
Dr. Ye Htut, Deputy Director General of the Department of Medical Research (Lower Myanmar) in Yangon, stated “Having a molecular marker to quickly identify artemisinin resistant parasites would greatly enhance our malaria control and elimination efforts. Many research groups are working to identify a marker, but it will take a strong partnership among NMCPs and research institutions to validate and implement its widespread use. ”
In a separate but related project, Professor Chris Plowe, head of WWARN’s Molecular Scientific Group, and Shannon Takala Harrison, both of the University of Maryland School of Medicine, led a genome-wide association study designed to help identify the genetic basis of delayed P. falciparum parasite clearance after treatment with artemisinin. The study included over 300 parasite isolates collected from the WHO-led Artemisinin Resistance Confirmation, Characterization and Containment (ARC3) pilot project, a collaborative clinical trial on artemisinin response in Bangladesh, northwestern Thailand, and western Cambodia.
The results, published in Proceedings of the National Academy of Sciences U.S.A., suggest that single nucleoside polymorphisms (SNPs) on chromosomes 10 and 13 may be indicative of artemisinin drug resistance. Members of the Network will now have an opportunity to assist in validating these possible markers.
A genotyping procedure for identifying these SNPs is available on the WWARN website.