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ART derivatives remain the key frontline treatment, while sulfadoxine-pyrimethamine is used for prevention. Recent detection in Africa of\n                      <jats:italic>P. falciparum kelch 13<\/jats:italic>\n                      (\n                      <jats:italic>k13<\/jats:italic>\n                      ) substitutions associated with ART resistance (ART-R), distinct from Southeast Asian\n                      <jats:italic>k13<\/jats:italic>\n                      ART-R alleles, suggests local emergence. Together with widespread pyrimethamine resistance, ART-R poses a major public health concern. In the Democratic Republic of the Congo (DRC), however, data on resistance markers beyond conventional loci remain limited.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      From June 2022 to February 2023, 303 malaria rapid diagnostic test-positive patients with uncomplicated malaria were enrolled at three clinics in Kinshasa, the Democratic Republic of the Congo (DRC). Day 1 parasitemia reduction rate (PRR) after artemether-lumefantrine treatment was assessed by microscopy. The gene region encoding the K13 propeller domain was sequenced from 171 microscopy-confirmed\n                      <jats:italic>P. falciparum<\/jats:italic>\n                      cases. Whole-genome sequencing data from 31 culture-adapted isolates were used to examine polymorphisms and copy number in 13 resistance-associated genes:\n                      <jats:italic>k13<\/jats:italic>\n                      ,\n                      <jats:italic>coronin, kic4, kic5, kic7, px1<\/jats:italic>\n                      ,\n                      <jats:italic>ap2-mu<\/jats:italic>\n                      ,\n                      <jats:italic>ubp1<\/jats:italic>\n                      ,\n                      <jats:italic>mdr1<\/jats:italic>\n                      ,\n                      <jats:italic>mdr2<\/jats:italic>\n                      ,\n                      <jats:italic>crt<\/jats:italic>\n                      ,\n                      <jats:italic>dhfr<\/jats:italic>\n                      , and\n                      <jats:italic>dhps.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No validated or candidate K13 propeller mutation associated with ART partial resistance was detected, including in samples from patients with\u2009&lt;\u200980% PRR. One isolate carried K13 A578S, a variant previously shown not to confer ART resistance. Whole-genome sequencing showed that all 13 genes were single copy and revealed diverse known and novel polymorphisms. K13 Asn-repeat variants and non-\n                      <jats:italic>k13<\/jats:italic>\n                      candidate variants, including PX1 M1701I\/D1705N, AP2-Mu S160N, and UBP1 E1528D, were detected. Partner-drug and antifolate markers included MDR1 Y184F, the CRT chloroquine-resistant IET haplotype, the DHFR N51I\/C59R\/S108N triple-mutant haplotype, and DHPS K540E. Among variants compared between PRR groups, the synonymous\n                      <jats:italic>ap2-mu<\/jats:italic>\n                      a300c substitution remained significant after false discovery rate correction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Established K13 propeller-mediated ART partial resistance was not evident in Kinshasa at the time of sampling. However, diverse non-\n                      <jats:italic>k13<\/jats:italic>\n                      candidate variants and persistent partner-drug and antifolate resistance markers support expanded molecular surveillance combined with clinical and ex vivo phenotypic monitoring.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41182-026-01022-5","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:32:49Z","timestamp":1783445569000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug resistance gene polymorphisms of Plasmodium falciparum clinical isolates from Kinshasa, Democratic Republic of the Congo"],"prefix":"10.1186","volume":"54","author":[{"given":"Mimie","family":"Bitshi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeko K.","family":"Naruse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyo","family":"Sakata-Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ritier Nzuau","family":"Mabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prince","family":"Kassanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria Kangite","family":"Yakenvu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evariste","family":"Tshibangu-Kabamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Papy Mandoko","family":"Nkoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natsuko","family":"Kaku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Nakagama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutoshi","family":"Kido","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieudonn\u00e9 Mumba","family":"Ngoyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0675-8296","authenticated-orcid":false,"given":"Osamu","family":"Kaneko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"1022_CR1","doi-asserted-by":"publisher","DOI":"10.30875\/9789287074560","volume-title":"World malaria report 2025","author":"World Health Organization","year":"2025","unstructured":"World Health Organization. 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