Detection of the Plasmodium falciparum Kelch-13 gene P553L mutation in sporozoites isolated from mosquito salivary glands in South-Central Vietnam
© The Author(s). 2017
Received: 28 December 2016
Accepted: 15 June 2017
Published: 24 June 2017
Plasmodium falciparum has developed resistance against artemisinin in Southeast Asia. Mutations in the P. falciparum Kelch-13 (Pfk13) gene are associated with artemisinin resistance in vitro and in vivo. We investigated the prevalence of mutations in PfK13 from sporozoite-stage parasites isolated from the salivary glands of Anopheles dirus mosquitoes.
Mosquitoes were caught by human-landing catches at two locations within the Khanh Phu commune, South-Central Vietnam. Identification of Anopheles species was performed based on morphological features and nucleotide sequence analysis. Sporozoite-infected salivary glands were stored on filter paper and at 4–6 °C. A nested-PCR targeting the small subunit ribosomal RNA gene was used for Plasmodium species identification. Pfk13 was amplified by nested PCR, and subjected to nucleotide sequencing.
Five of 33 P. falciparum sporozoite samples carried the P553L mutation at the PfK13 locus. This mutation has been recorded previously in Vietnam, but not in Khanh Hoa province, were surveys of K13 polymorphism have not previously been carried out.
These results demonstrate the utility of mosquito-stage malaria parasite samples for studies on the molecular epidemiology of drug resistance.
Artemisinin-based combination therapy (ACT) against Plasmodium falciparum is currently the most common and effective first-line therapy in most malaria-endemic countries. Recently, however, clinical cases of artemisinin resistance have been reported from various countries in Southeast Asia [1–6] and Africa .
Genome-wide analysis of artemisinin resistance in P. falciparum has demonstrated that mutations in the propeller domain of the gene encoding the Kelch 13 (K13) protein (Pfk13) are associated with delayed parasite clearance in vitro and in vivo [8, 9]. In Southeast Asia, a number of mutations in the Pfk13 gene linked to artemisinin resistance have been identified, including C580Y, Y493H, R539T, I543T and others. In Vietnam, the C580Y, P574L, V568G, P553L, I543T and Y493H mutations have been recorded, all from the Southern part of the country on the border with Cambodia .
In this report, we characterized the polymorphism at the Pfk13 locus using parasite DNA extracted from sporozoites isolated from the salivary glands of human-biting Anopheles dirus mosquitoes in South-central Vietnam.
Collection of mosquitoes was carried out through human-baited landing catches in and around the forest near Nga Hai village in the south of Khanh Phu commune, Khanh Vinh district, Khanh Hoa province, Vietnam. Collection of mosquitoes was carried out as previously described [11, 12] from January 2008 to October 2012. Mosquito collectors provide informed consent and were regularly screened for malaria and treated with ACT if a malaria infection was detected. Identification of Anopheles species was carried out based on morphological characteristics  and through analysis of nucleotide sequences . Female mosquitoes were dissected and examined by microscopy for sporozoites. Sporozoite-infected salivary glands were stored on filter paper kept in closed vials at 4–6 °C until analysis .
Genomic DNA (gDNA) was extracted from preserved filter paper with sporozoite-positive salivary glands [11, 14]. The 18S rRNA gene-based nested PCR was used for the detection of P. falciparum and other Plasmodium species [12, 15]. Amplification of the Pfk13 gene was carried out by nested PCR as previously described , and the products sequenced with BigDye Terminator v3.1 Cycle Sequencing Premix Kit (ABI, Foster city, CA, USA). Sequencing products were run on an ABI/Hitachi 3130x1 Genetic Analyzer (ABI) and nucleotide sequences were analysed using Genetyx (Genetyx Corporation, Tokyo, Japan).
Results and discussion
Results of the collections and dissections of Anopheles dirus mosquitoes caught by human landing catch in the study area
Jan to Dec
Jan to Dec
Jan to Dec
Jan to Dec
Jan to Oct
Prevalence of Plasmodium falciparum and analysis of K13 propeller gene of sporozoites in Anopheles dirus mosquitoes
No. examined samples
K13 gene analyzed
Wild type (%)a
Mutation type (%)a
Mutant alleles of Pfk13 in Plasmodium falciparum sporozoites from Anopheles dirus mosquitoes
Amino acid change and location
CCG → CTG
CCG → CTG
Pf + Pk + Pinu
CCG → CTG
Pf + Pcoat
CCG → CTG
In the forest
Pf + Pv + Pinu
P553L + Wild
CCG → CTG, None
In the forest
The prevalence of malaria in the study area has declined sharply since 1998 and was considered to be ‘residual forest malaria’ during the study period, while the proportion of P. falciparum among infections has remained substantial; densities of An. dirus typically peak in March and April . The sample sizes of P. falciparum infections analyzed for K13 from 2008 to 2012 (Table 2) preclude analysis of prevalence trends through time.
There have been no previous reports of ART-resistance associated mutations in the Pfk13 gene from this region of Vietnam. We observed only an azygous non-synonymous mutation in Pfk13, P553L, and this was present at low frequencies. This mutant allele has been identified previously, in samples collected from the Vietnam-Cambodia border, Southern China and Kenya [10, 16–19]. It is not currently known whether it is linked resistance to ART .
The Vietnamese national malaria treatment guidelines proscribe that patients are treated with 2.4 mg/kg of body weight dihydroartemisinin and 18 mg/kg piperaquine once a day for 3 days, and these guidelines were in effect in Khanh Hoa province during this study. The first record of the protracted parasite clearance after treatment with artesunate monotherapy or dihydroartemisinin-piperaruine was from the Bu Dang district of Binh Phuoc province in 2009 . In that area, five types of mutant allele, including P553L, have been found Pfk13 . Our study demonstrates the presence of the Pfk13 P553L SNP in 2009 and 2010 in Khanh Hoa province, some 200 km distant from Binh Phuoc. This result could suggest that the parasite populations of Southcentral Vietnam are contiguous over large distances, and that mutant allele gene flow is possible between relatively distant regions, although more evidence is required to support this hypothesis.
In conclusion, this study demonstrates the presence of mono non-synonymous nucleotide mutations in the Pfk13 gene in P. falciparum sporozoites isolated from the salivary glands of from An. dirus. The observed mutant allele, P553L, has previously been reported in a different region of Vietnam. No other mutant alleles, including those previously recorded in Vietnam were found in this study area.
Our results show that mosquito stage malaria parasites are a useful source of parasite DNA for drug-resistance associated molecular epidemiological studies.
Phan Chau Do, Nguyen Son Hai, Dang Duy Vu and Nguyen Le Dung are thanked for their technical support. The Provincial Health Service and Malaria Control Centre of Khanh Hoa Province and the authorities of Khanh Vinh district and Khanh Phu municipality provided administrative support.
This study was supported in part by the following three grants: (i) JSPS KAKENHI Grant Number 26360029 and 17H04513, (ii) a Grant-in-Aid for Scientific Research from Fujita Health University, (iii) the Cooperative Research Grants from Joint Usage / Research Center on Tropical Disease, Institute of Tropical Medicine, Nagasaki University (2015-Ippan-14, 2016-Ippan-9). The Khanh Phu Malaria Research team and the field research costs were financially supported through private donations to the Medical Committee Netherlands-Vietnam.
Availability of data and materials
The data supporting the conclusions of this article are included within the article. Nucleotide sequences generated in this work have been deposited at GenBank, accession numbers MF326505–MF326508.
Conceived and designed the study: YM, SN, NTQ and RPM. Field work and data collection performed by: GM, NTQ and RPM. Experiments performed by: YM, KH, RC, SK and SN. Wrote the paper: YM, SN, SK, RC, RPM, NTQ, KH and GM. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Ethics approval and consent to participate
This study was certified as permitted standard procedures by the National Institute of Malariology, Parasitology and Entomology in Hanoi, and was reviewed and approved by the ethics committees of Institute of Tropical Medicine, Nagasaki University (permit number: 10121662-5). Mosquito collectors provide informed consent.
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- Noedl H, Se Y, Schaecher K, Smith BL, Socheat D, Fukuda MM. Artemisinin resistance in Cambodia 1 (ARC1) study consortium. Evidence of artemisinin-resistant malaria in western Cambodia. N Engl J Med. 2008;359(24):2619–20. doi:10.1056/NEJMc0805011.View ArticlePubMedGoogle Scholar
- Dondorp AM, Nosten F, Yi P, Das D, Phyo AP, Tarning J, et al. Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med. 2009;361(5):455–67. doi:10.1056/NEJMoa0808859. Erratum in: N Engl J Med. 2009;361(17):1714View ArticlePubMedPubMed CentralGoogle Scholar
- Amaratunga C, Sreng S, Suon S, Phelps ES, Stepniewska K, Lim P, et al. Artemisinin-resistant Plasmodium falciparum in Pursat province, western Cambodia: a parasite clearance rate study. Lancet Infect Dis. 2012;12(11):851–8.Google Scholar
- Phyo AP, Nkhoma S, Stepniewska K, Ashley EA, Nair S, McGready R, et al. Emergence of artemisinin-resistant malaria on the western border of Thailand: a longitudinal study. Lancet. 2012;379(9830):1960–6.View ArticlePubMedPubMed CentralGoogle Scholar
- Kyaw MP, Nyunt MH, Chit K, Aye MM, Aye KH, Aye MM, et al. Reduced susceptibility of Plasmodium falciparum to artesunate in southern Myanmar. PLoS One. 2013;8(3):e57689. Google Scholar
- Ashley EA, Dhorda M, Fairhurst RM, Amaratunga C, Lim P, Suon S, et al. Tracking resistance to artemisinin collaboration (TRAC). Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med. 2014;371(5):411–23. Erratum in: N Engl J Med. 2014;371(8):786.Google Scholar
- Lu F, Culleton R, Zhang M, Ramaprasad A, von Seidlein L, Zhou H, et al. Emergence of indigenous artemisinin-resistant Plasmodium falciparum in Africa. N Engl J Med. 2017;376(10):991–3. Google Scholar
- Takala-Harrison S, Clark TG, Jacob CG, Cummings MP, Miotto O, Dondorp AM, et al. Genetic loci associated with delayed clearance of Plasmodium falciparum following artemisinin treatment in Southeast Asia. Proc Natl Acad Sci USA. 2013;110(1):240–5. Google Scholar
- Ariey F, Witkowski B, Amaratunga C, Beghain J, Langlois AC, Khim N, et al. A molecular marker of artemisinin-resistant Plasmodium falciparum malaria. Nature. 2014;505(7481):50–5. Google Scholar
- Takala-Harrison S, Jacob CG, Arze C, Cummings MP, Silva JC, Dondorp AM, et al. Independent emergence of artemisinin resistance mutations among Plasmodium falciparum in Southeast Asia. J Infect Dis. 2015;211(5):670–9. Google Scholar
- Marchand RP, Culleton R, Maeno Y, Quang NT, Nakazawa S. Co-infections of Plasmodium knowlesi, P. falciparum, and P. vivax among humans and Anopheles dirus mosquitoes, Southern Vietnam. Emerg Infect Dis. 2011;17(7):1232–9. Google Scholar
- Maeno Y, Quang NT, Culleton R, Kawai S, Masuda G, Nakazawa S, et al. Humans frequently exposed to a range of non-human primate malaria parasite species through the bites of Anopheles dirus mosquitoes in South-central Vietnam. Parasit Vectors. 2015;8:376.Google Scholar
- Vietnam National Institute of Malariology, Parasitology and Entomology. Identification key for Anophelinae in Vietnam. Hanoi: Medical Publishing House; 2008.Google Scholar
- Nakazawa S, Marchand RP, Quang NT, Culleton R, Manh ND, Maeno Y. Anopheles dirus co-infection with human and monkey malaria parasites in Vietnam. Int J Parasitol. 2009;39(14):1533–7. Google Scholar
- Singh B, Bobogare A, Cox-Singh J, Snounou G, Abdullah MS, Rahman HA. A genus- and species-specific nested polymerase chain reaction malaria detection assay for epidemiologic studies. Am J Trop Med Hyg. 1999;60:687–92.View ArticlePubMedGoogle Scholar
- Boussaroque A, Fall B, Madamet M, Camara C, Benoit N, Fall M, et al. Emergence of mutations in the K13 propeller gene of Plasmodium falciparum isolates from Dakar, Senegal, in 2013-2014. Antimicrob Agents Chemother. Google Scholar
- Huang F, Takala-Harrison S, Jacob CG, Liu H, Sun X, Yang H, et al. A single mutation in K13 predominates in southern China and is associated with delayed clearance of Plasmodium falciparum following artemisinin treatment. J Infect Dis. 2015;212(10):1629–35.Google Scholar
- Leang R, Taylor WR, Bouth DM, Song L, Tarning J, Char MC, et al. Evidence of Plasmodium falciparum malaria multidrug resistance to artemisinin and piperaquine in Western Cambodia: dihydroartemisinin-piperaquine open-label multicenter clinical assessment. Antimicrob Agents Chemother. 2015;59(8):4719–26. Google Scholar
- Taylor SM, Parobek CM, DeConti DK, Kayentao K, Coulibaly SO, Greenwood BM, et al. Absence of putative artemisinin resistance mutations among Plasmodium falciparum in sub-Saharan Africa: a molecular epidemiologic study. J Infect Dis. 2015;211(5):680–8.Google Scholar
- Update on artemisinin and ACT resistance-September 2015. Geneva: World Health Organization, September; 2015. http://www.who.int/malaria/publications/atoz/status-rep-artemisinin-act-resistance-sept2015.pdf?ua=1 WHO/HTM/GMP/2015.4. Accessed 15 Nov 2016.