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This study examined whether methylene blue, an ancient antimalarial drug with a broad spectrum of activity against\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    blood stages, retains its activity against the young rings of artemisinin-resistant parasites. Clinical isolates carrying\n                    <jats:italic>kelch13<\/jats:italic>\n                    wild type (n\u2009=\u20093), R561H (n\u2009=\u20099), or P441L (n\u2009=\u200910) genotypes were tested with a modified ring survival assay whereby 0- to 3-h post-invasion rings were exposed to a range of methylene blue concentrations. Ring survival was analysed with a Bayesian mixed effects E\n                    <jats:sub>max<\/jats:sub>\n                    model accounting for variability across isolates and experimental replicates. Methylene blue suppressed ring-stage survival at low nanomolar concentrations with no evidence of\n                    <jats:italic>kelch13<\/jats:italic>\n                    -mediated cross-resistance: the mean 50% inhibitory concentration (IC\n                    <jats:sub>50<\/jats:sub>\n                    ) estimates were 23\u00a0nM (95% credible interval [CrI]: 15 to 37) for wild type, 27\u00a0nM (95% CrI: 21 to 36) for R561H and 14\u00a0nM (95% CrI: 10 to 20) for P441L. These findings indicate that methylene blue remains active in vitro against ring-stage artemisinin-resistant parasites.\n                  <\/jats:p>","DOI":"10.1186\/s12936-026-05928-7","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T16:06:53Z","timestamp":1777997213000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Methylene blue retains in vitro activity against early ring-stage artemisinin-resistant Plasmodium falciparum"],"prefix":"10.1186","volume":"25","author":[{"given":"Olivia","family":"Verdier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chalita","family":"Kaewkanya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pachinee","family":"Kobphan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candy","family":"Beau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aung Pyae","family":"Phyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallika","family":"Imwong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesinee","family":"Chotivanich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Nosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Chaumeau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"5928_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00038-8","author":"DJ Weiss","year":"2025","unstructured":"Weiss DJ, Dzianach PA, Saddler A, Lubinda J, Browne A, McPhail M, et al. 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