Resistance develops in low-risk regions

The more we understand the evolution of drug resistance, the better equipped we are to stop it.

Dogs were able to correctly identify 70 percent of the malaria-infected samples. PHOTO| FILE | NATION MEDIA GROUP 
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New drug-resistant strains of the parasite that causes malaria tend to evolve in regions with a lower risk of malaria.

In hard-hit areas with high transmission rates like sub-Saharan Africa, they get outcompeted by the more common drug-sensitive strains inside the human host. In such high-transmission settings, it takes a long time for drug-resistant strains to take hold, but once they do, they can spread very rapidly.

Since the 1950s, the malaria parasite has repeatedly become resistant to new anti-malaria drugs, making it difficult to control the spread of the disease and creating the threat of a future public health crisis.

In a new study, researchers used mathematical modelling to investigate the historical observation that resistant strains of the parasite evolve first in regions with lower infection rates like Southeast Asia and South America.

“The early stages of drug resistance evolution are crucial because by the time resistance is identified, it is often too late to control it effectively. Mathematical modelling can be incredibly helpful to understand what's going on beneath the surface and identify drivers of resistance evolution that we can target to try and disrupt the process," said researcher Dr Mary Bushman.

The researchers used a model that simulates the infection and transmission dynamics of drug-sensitive and resistant strains in a population of humans and mosquitoes.

The model indicated that emerging drug-resistant strains are more likely to go extinct within a host in regions with high malaria transmission rates. But once the new strains finally become established, they spread more rapidly in areas that are heavily burdened with the parasite, than in countries with lower transmission rates.

The findings offer a novel explanation for the observed global patterns of drug resistance in malaria. A better understanding of the relationship between transmission rates and the rise of drug-resistant strains could help public health workers tailor malaria response for local conditions and lead to improved strategies for slowing future drug resistance.

"The more we understand the evolution of drug resistance, the better equipped we are to stop it. If within-host competition inhibits the spread of resistant parasites, then we can try to leverage that as a tool to stop resistance from spreading," explained Dr Bushman. The findings were published in the journal PLOS Biology.- Science Daily

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