Drug resistance in vectorborne parasites: multiple actors and scenarios for an evolutionary arms race

Authors

  • Manu Vanaerschot,

    Corresponding author
    1. Unit of Molecular Parasitology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
    • Correspondence: Manu Vanaerschot, Unit of Molecular Parasitology, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerpen 2000, Belguim. Tel.: +(32) 3 2476 586;

      fax: +(32) 3 2476 359;

      e-mail: mvanaerschot@itg.be

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  • Silvie Huijben,

    1. Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
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  • Frederik Van den Broeck,

    1. Unit of Medical Helminthology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
    2. Laboratory of Biodiversity and Evolutionary Genomics, Department of Biology, University of Leuven, Leuven, Belgium
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  • Jean-Claude Dujardin

    1. Unit of Molecular Parasitology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
    2. Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Abstract

Drug-resistant pathogens emerge faster than new drugs come out of drug discovery pipelines. Current and future drug options should therefore be better protected, requiring a clear understanding of the factors that contribute to the natural history of drug resistance. Although many of these factors are relatively well understood for most bacteria, this proves to be more complex for vectorborne parasites. In this review, we discuss considering three key models (Plasmodium, Leishmania and Schistosoma) how drug resistance can emerge, spread and persist. We demonstrate a multiplicity of scenarios, clearly resulting from the biological diversity of the different organisms, but also from the different modes of action of the drugs used, the specific within- and between-host ecology of the parasites, and environmental factors that may have direct or indirect effects. We conclude that integrated control of drug-resistant vectorborne parasites is not dependent upon chemotherapy only, but also requires a better insight into the ecology of these parasites and how their transmission can be impaired.

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