Discovery and Development of Artemisinin
The article recounts the history of artemisinin, a crucial antimalarial drug discovered as part of China's Project 523 during the Vietnam War. Vietnam faced a crisis where more soldiers were dying from malaria than combat due to chloroquine-resistant strains of Plasmodium falciparum.
Project 523 and Tu Youyou's Contribution
- China's Project 523 aimed to find new antimalarial compounds.
- Hundreds of scientists screened thousands of substances, including traditional medicinal plants.
- Tu Youyou's Innovation: She identified a low-temperature extraction method from Artemisia annua leading to the isolation of artemisinin.
- Artemisinin's potency quickly cleared malaria parasites, even the chloroquine-resistant strains.
Resistance Development and Global Spread
Despite its success, artemisinin faced resistance issues similar to chloroquine. Overuse in low-transmission areas led to resistant parasite strains.
Resistance in Southeast Asia
- By 2007-2010, artemisinin-based therapies were failing in western Cambodia, Thailand, Laos, Vietnam, and Myanmar.
- Resistance was linked to genetic mutations in the parasite, especially the kelch13 gene.
Africa's Emerging Resistance
A recent study in eLife highlights artemisinin resistance in Africa, showing patterns similar to Southeast Asia from 10-15 years ago.
Challenges and Recommendations
The rise in resistance is alarming, and there are gaps in data and surveillance that need addressing.
Challenges
- The COVID-19 pandemic reduced malaria funding and sample collection.
- Variability in testing methods across laboratories might miss rare mutations.
Urgent Priorities
- Improve genetic surveillance and data sharing in Africa.
- Monitor resistance to partner drugs and prepare for policy changes.
- Invest in malaria control for timely interventions.
The Call for Coordinated Action
There is need for urgent, coordinated efforts to combat resistance, recommending diversified drug use and improved surveillance. Drawing lessons from the past, it warns against complacency in dealing with resistance.
