Single Nucleotide Polymorphism Analysis of Pvmdr-1 in Plasmodium Vivax Isolated from Military Personnel of Republic of Korea in 2016 and 2017
Abstract Background: Malaria chemoprophylaxis using chloroquine (CQ) and primaquine (PQ) has been administered to resident soldiers in the 3rd Army of Republic of Korea (ROK) to prevent malaria infection since the year 1997. Due to mass chemoprophylaxis against malaria, concern exists about occurrence of chloroquine resistance (CQR). Herein, we investigated the single nucleotide polymorphisms (SNPs) of the Plasmodium vivax multi-drug resistance protein-1 (pvmdr-1) gene to monitor the risk of CQR. Methods: SNPs of the pvmdr-1 gene were analyzed in 73 soldiers of the 3rd Army of ROK diagnosed with infection by Plasmodium vivax (P. vivax). Results: Quintuple mutations (G698S, L845F, M908L, T958M, and F1076L) were detected in 73 soldiers. Mutation in the Y541C position was firstly detected in soldiers at a frequency of 1.3% (1/73). In addition, synonymous mutations were detected at positions K44, L493, T529, and E1233. Based on these SNPs, pvmdr-1 sequences of ROK were classified into 6 haplotypes. The phylogenetic analysis closed to Type of North Korean showed that P. vivax malaria of ROK could be a reason of influx from North Korea. In this study, there was no therapeutic resistance (CQ-mediated parasite clearance within 72 hours) for clinical samples that possessed various SNPs of pvmdr-1. Various SNPs including a newly identified non-synonymous mutation (Y541C) had been introduced into P. vivax malaria-endemic areas in ROK. Conclusions: Our study showed that synonymous and non-synonymous mutations of pvmdr-1 were introduced to the malaria chemoprophylaxis-executed regions of ROK from 2016 to 2017. Thus, to prevent the emergence of CQR, continuous surveillance for SNPs of pvmdr-1 related with CQR in the malaria-endemic regions of ROK is essential.