About the book
Malaria is a disease that spreads through the bite of anopheles female mosquitoes that carry the infection moieties (sporozoites) of the parasite. The Plasmodium falciparum and Plasmodium Vivex parasites are the most dangerous and lethal to humans in terms of morbidity and mortality. Technological advancements in the field of epidemiology and entomology have supported research efforts that have aided in reducing the burden and allowing scientists to go one step further in malaria parasitology. Two major weapons against malaria are vector control and chemoprophylaxis/chemotherapy. Unfortunately, attempts to eradicate the disease based on these methods have had only limited success, due to the widespread development of drug resistance by the parasites and insecticide resistance by the mosquito vector.
There have been antimalarial drugs available to treat human malaria infection, but continuous drug pressure to clear P. falciparum begets the evolution of tolerance to the therapeutic effects of the drugs. Many mechanisms of action parasites may be employed to escape the drug pressure.
Besides known mechanisms for the evolution of resistance through mutations and/or amplification in drug transporters (quinolines) or drug targets (antifolates), P. falciparum reportedly showed a quiescence mechanism allowing it to survive ART treatment. The emergence of resistance against frontline antimalarials and their combinations by P. falciparum is worrisome as it threatens to make malaria practically untreatable in South-East Asia (SEA). This will have severe implications as it would hinder the global endeavors to eliminate this deadliest human disease. A recent series of clinical trials, in vitro, genomics, and transcriptomic studies in SEA have defined in vivo and in vitro phenotypes of artemisinin resistance; identified its causal genetic determinant; explored its molecular mechanism; and assessed its clinical impact. Artemisinin-based combination therapy (ACT) is the only remaining remedy to clear the parasite infection from the periphery thoroughly. However, tolerance shown by the parasite towards the combination of drugs and co-resistance has prompted researchers to address the question of how parasites escape the therapeutic effect of drugs. Therefore, this book will provide collective information about the drug resistance mechanisms and how currently available and new tools can aid in understanding the drug resistance mechanism.