A Single Mutation in K13 Predominates in Southern China and Is Associated with Delayed Clearance of Plasmodium falciparum Following Artemisinin Treatment

Fang Huang, Shannon Takala-Harrison, Christopher G. Jacob, Hui Liu, Xiaodong Sun, Henglin Yang, Myaing M. Nyunt, Matthew Adams, Shuisen Zhou, Zhigui Xia, Pascal Ringwald, Maria Dorina Bustos, Linhua Tang, Christopher V. Plowe

Research output: Contribution to journalArticle


Background. Artemisinin resistance in Plasmodium falciparum has emerged in Southeast Asia and poses a threat to malaria control and elimination. Mutations in a P. falciparum gene encoding a kelch protein on chromosome 13 have been associated with delayed parasite clearance following artemisinin treatment elsewhere in the region, but not yet in China. Methods. Therapeutic efficacy studies of artesunate and dihydroartemisinin-piperaquine were conducted from 2009 to 2012 in the Yunnan Province of China near the border with Myanmar. K13 mutations were genotyped by capillary sequencing of DNA extracted from dried blood spots collected in these clinical trials and in routine surveillance. Associations between K13 mutations and delayed parasite clearance were tested using regression models. Results. Parasite clearance half-lives were prolonged after artemisinin treatment, with 44% of infections having half-lives > 5 hours (n = 109). Fourteen mutations in K13 were observed, with an overall prevalence of 47.7% (n = 329). A single mutation, F446I, predominated, with a prevalence of 36.5%. Infections with F446I were significantly associated with parasitemia on day 3 following artemisinin treatment and with longer clearance half-lives. Conclusions. Plasmodiumfalciparuminfections in southern China displayedmarkedly delayed clearance following artemisinin treatment. F446I was the predominant K13 mutation and was associated with delayed parasite clearance.

Original languageEnglish (US)
Pages (from-to)1629-1635
Number of pages7
JournalJournal of Infectious Diseases
Issue number10
Publication statusPublished - 2015
Externally publishedYes



  • Artemisinin resistance
  • China
  • Kelch 13
  • Malaria
  • Plasmodium falciparum

ASJC Scopus subject areas

  • Immunology and Allergy
  • Medicine(all)
  • Infectious Diseases

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