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As resistance to artemisinin drugs has increased in Southeast Asia, effective therapy for Plasmodium falciparum malaria has relied on partner drugs, such as piperaquine. (NEJM JW Infect Dis Mar 2016 and Lancet 2016; 16:274). Molecular markers are available to track resistance of P. falciparum parasites to mefloquine and artemisinin. Two research teams now report identification of molecular markers for piperaquine resistance in Cambodia.
Witkowski and colleagues used whole-genome sequencing to identify genetic markers of piperaquine resistance in P. falciparum parasites that harbored an artemisinin-resistance mutation. They identified amplification of the plasmepsin 2–3 gene cluster on chromosome 14 that encodes proteases involved in hemoglob…