Expression of Plasmodium vivaxcrt-oIs Related to Parasite Stage but NotEx VivoChloroquine Susceptibility
ABSTRACTChloroquine (CQ)-resistantPlasmodium vivaxis present in most countries whereP. vivaxinfection is endemic, but the underlying molecular mechanisms responsible remain unknown. Increased expression ofP. vivaxcrt-o(pvcrt-o) has been correlated within vivoCQ resistance in an area with low-grade resistance. We assessedpvcrt-oexpression in isolates from Papua (Indonesia), whereP. vivaxis highly CQ resistant.Ex vivodrug susceptibilities to CQ, amodiaquine, piperaquine, mefloquine, and artesunate were determined using a modified schizont maturation assay. Expression levels ofpvcrt-owere measured using a novel real-time quantitative reverse transcription-PCR method. Large variations inpvcrt-oexpression were observed across the 51 isolates evaluated, with the fold change in expression level ranging from 0.01 to 59 relative to that seen with theP. vivaxβ-tubulin gene and from 0.01 to 24 relative to that seen with theP. vivaxaldolase gene. Expression was significantly higher in isolates with the majority of parasites at the ring stage of development (median fold change, 1.7) compared to those at the trophozoite stage (median fold change, 0.5;P< 0.001). Twenty-nine isolates fulfilled the criteria forex vivodrug susceptibility testing and showed high variability in CQ responses (median, 107.9 [range, 6.5 to 345.7] nM). After controlling for the parasite stage, we found thatpvcrt-oexpression levels did not correlate with theex vivoresponse to CQ or with that to any of the other antimalarials tested. Our results highlight the importance of development-stage composition for measuringpvcrt-oexpression and suggest thatpvcrt-otranscription is not a primary determinant ofex vivodrug susceptibility. A comprehensive transcriptomic approach is warranted for an in-depth investigation of the role of gene expression levels andP. vivaxdrug resistance.