Plasmodium falciparum sexual conversion rates can be affected by artemisinin-based treatment in naturally infected malaria patients
Harvie P. Portugaliza,
H. Magloire Natama,
Pieter Guetens,
Eduard Rovira-Vallbona,
Athanase M. Somé,
Aida Millogo,
D. Florence Ouédraogo,
Innocent Valéa,
Hermann Sorgho,
Halidou Tinto,
Nguyen van Hong,
Antonio Sitoe,
Rosauro Varo,
Quique Bassat,
Alfred Cortés,
Anna Rosanas-Urgell
Affiliations
Harvie P. Portugaliza
ISGlobal, Hospital Clinic – Universitat de Barcelona, Barcelona, Catalonia, Spain; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
H. Magloire Natama
Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
Pieter Guetens
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
Eduard Rovira-Vallbona
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
Athanase M. Somé
Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
Aida Millogo
Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
D. Florence Ouédraogo
Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
Innocent Valéa
Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
Hermann Sorgho
Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
Halidou Tinto
Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
Nguyen van Hong
National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
Antonio Sitoe
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
Rosauro Varo
ISGlobal, Hospital Clinic – Universitat de Barcelona, Barcelona, Catalonia, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
Quique Bassat
ISGlobal, Hospital Clinic – Universitat de Barcelona, Barcelona, Catalonia, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Barcelona, Catalonia, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Catalonia, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Summary: Background: Artemisinins (ART) are the key component of the frontline antimalarial treatment, but their impact on Plasmodium falciparum sexual conversion rates in natural malaria infections remains unknown. This is an important knowledge gap because sexual conversion rates determine the relative parasite investment between maintaining infection in the same human host and transmission to mosquitoes. Methods: The primary outcome of this study was to assess the impact of ART-based treatment on sexual conversion rates by comparing the relative transcript levels of pfap2-g and other sexual ring biomarkers (SRBs) before and after treatment. We analysed samples from previously existing cohorts in Vietnam, Burkina Faso and Mozambique (in total, n=109) collected before treatment and at 12 h intervals after treatment. As a secondary objective, we investigated factors that may influence the effect of treatment on sexual conversion rates. Findings: In the majority of infections from the African cohorts, but not from Vietnam, we observed increased expression of pfap2-g and other SRBs after treatment. Estimated parasite age at the time of treatment was negatively correlated with the increase in pfap2-g transcript levels, suggesting that younger parasites are less susceptible to stimulation of sexual conversion. Interpretation: We observed enhanced expression of SRBs after ART-based treatment in many patients, which suggests that in natural malaria infections sexual conversion rates can be altered by treatment. ART-based treatment reduces the potential of a treated individual to transmit the disease, but we hypothesise that under some circumstances this reduction may be attenuated by ART-enhanced sexual conversion. Funding: Spanish Agencia Estatal de Investigación (AEI), European Regional Development Fund (ERDF, European Union), Belgium Development Cooperation (DGD), Canadian University Health Network (UHN), TransGlobalHealth–Erasmus Mundus (European Union).
