{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T08:52:36Z","timestamp":1776415956166,"version":"3.51.2"},"reference-count":69,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>The emergence of chloroquine-resistant Plasmodium falciparum in the 1950s posed a global threat to malaria control. Ceasing chloroquine use restored chloroquine-sensitive strains in many African countries. To assess whether chloroquine sensitivity re-emerged in Lambar\u00e9n\u00e9, Gabon, we compiled published and new data on P. falciparum ex vivo chloroquine susceptibility, quantified as half-maximal inhibitory concentration (IC50), from four time points between 2004 and 2024. We then assessed the prevalence of pfcrt and pfmdr1 polymorphisms associated with chloroquine resistance via real-time PCR and Sanger sequencing, respectively, at six different time points between 2009 and 2024. Ex vivo chloroquine susceptibility data revealed a stepwise decrease in the median chloroquine IC50 from 2004 (113.8 nM; IQR: 79.6\u2013163.5 nM, n = 42), 2009 (46.7 nM; IQR: 27.4\u201376.9 nM, n = 26), and 2017\u20132018 (15.6 nM; IQR: 6.1\u201340.9 nM, n = 46) to 2024 (2.1 nM; IQR: 0.8\u20136.1 nM, n = 39). The chloroquine-sensitive pfcrt haplotype CVMNK increased from 3.6% (1\/28) in 2009 to 98.2% (56\/57) in 2024, as well as the wild-type pfmdr1 N86 (23.1% (6\/16), 2009; 100% (19\/19), 2024). Paired molecular and ex vivo analyses revealed an association between IC50 values and CVMNK pfcrt and pfmdr1 N86. Our data provide evidence for the reestablishment of chloroquine-sensitive P. falciparum in Lambar\u00e9n\u00e9, Gabon.<\/jats:p>","DOI":"10.3390\/ijms27083566","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:14:12Z","timestamp":1776352452000},"page":"3566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reversal of Chloroquine Resistance in Plasmodium falciparum in Gabon: A Phenotype-Genotype Relationship over the Last 20 Years"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6786-5509","authenticated-orcid":false,"given":"Juliana","family":"Inoue","sequence":"first","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Rodi","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9740-6872","authenticated-orcid":false,"given":"Francis Emmanuel Towanou","family":"Bohissou","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"},{"name":"Centre de Recherche Entomologique de Cotonou, Cotonou 06 BP 2604, Benin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3857-5462","authenticated-orcid":false,"given":"Lais Pessanha","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Lohse","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9389-6739","authenticated-orcid":false,"given":"Erik","family":"Koehne","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"},{"name":"Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9 (CERMEL), Lambar\u00e9n\u00e9 BP 242, Gabon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selidji T.","family":"Agnandji","sequence":"additional","affiliation":[{"name":"Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9 (CERMEL), Lambar\u00e9n\u00e9 BP 242, Gabon"},{"name":"Institute for Medical Microbiology, University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2658-8706","authenticated-orcid":false,"given":"Ghyslain","family":"Mombo-Ngoma","sequence":"additional","affiliation":[{"name":"Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9 (CERMEL), Lambar\u00e9n\u00e9 BP 242, Gabon"},{"name":"Research Group Drug Implementation, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Kremsner","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"},{"name":"Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9 (CERMEL), Lambar\u00e9n\u00e9 BP 242, Gabon"},{"name":"German Center for Infection Research (DZIF), Partner Site T\u00fcbingen, 72074 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5025-7221","authenticated-orcid":false,"given":"Andrea","family":"Kreidenweiss","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"},{"name":"Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9 (CERMEL), Lambar\u00e9n\u00e9 BP 242, Gabon"},{"name":"German Center for Infection Research (DZIF), Partner Site T\u00fcbingen, 72074 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7970-1429","authenticated-orcid":false,"given":"Jana","family":"Held","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine T\u00fcbingen, University Hospital T\u00fcbingen, Wilhelmstra\u00dfe 27, 72074 T\u00fcbingen, Germany"},{"name":"Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9 (CERMEL), Lambar\u00e9n\u00e9 BP 242, Gabon"},{"name":"German Center for Infection Research (DZIF), Partner Site T\u00fcbingen, 72074 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","unstructured":"WHO (2025). WHO World Malaria Report 2025: Addressing the Threat of Antimalarial Drug Resistance, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240117822."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4269\/ajtmh.1961.10.5","article-title":"Observations on two Plasmodium falciparum infections with an abnormal response to chloroquine","volume":"10","author":"Moore","year":"1961","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4269\/ajtmh.1963.12.305","article-title":"Drug Resistance in Plasmodium Falciparum from Thailand","volume":"12","author":"Young","year":"1963","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1086\/322858","article-title":"Chloroquine-resistant malaria","volume":"184","author":"Wellems","year":"2001","journal-title":"J. Infect. Dis."},{"key":"ref_5","first-page":"1043","article-title":"Chloroquine-resistant falciparum malaria in Benin","volume":"2","author":"Hatin","year":"1986","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/S0140-6736(85)92453-5","article-title":"Chloroquine-resistant Plasmodium falciparum in Cameroon","volume":"1","author":"Sansonetti","year":"1985","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/0035-9203(88)90131-9","article-title":"Chloroquine-resistant Plasmodium falciparum malaria from Ivory Coast","volume":"82","author":"Charmot","year":"1988","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"650","DOI":"10.4269\/ajtmh.1993.49.650","article-title":"Curing of chloroquine-resistant malaria with clindamycin","volume":"49","author":"Kremsner","year":"1993","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1093\/infdis\/169.2.467","article-title":"Clindamycin in combination with chloroquine or quinine is an effective therapy for uncomplicated Plasmodium falciparum malaria in children from Gabon","volume":"169","author":"Kremsner","year":"1994","journal-title":"J. Infect. Dis."},{"key":"ref_10","first-page":"214","article-title":"Drug sensitivity of Plasmodium falciparum in Gabon. Activity correlations between various antimalarials","volume":"45","author":"Winkler","year":"1994","journal-title":"Trop. Med. Parasitol."},{"key":"ref_11","unstructured":"Minist\u00e8re de Sant\u00e9 (2003). Rapport de L\u2019atelier National de Consensus sur les Perspectives Th\u00e9rapeutiques du Paludisme."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/S1097-2765(05)00077-8","article-title":"Mutations in the P. falciparum digestive vacuole transmembrane protein PfCRT and evidence for their role in chloroquine resistance","volume":"6","author":"Fidock","year":"2000","journal-title":"Mol. Cell"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.pt.2012.08.002","article-title":"PfCRT and its role in antimalarial drug resistance","volume":"28","author":"Ecker","year":"2012","journal-title":"Trends Parasitol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18883","DOI":"10.1073\/pnas.0911317106","article-title":"Geographic patterns of Plasmodium falciparum drug resistance distinguished by differential responses to amodiaquine and chloroquine","volume":"106","author":"Sa","year":"2009","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1590\/S0074-02762012000100018","article-title":"Pfcrt haplotypes and the evolutionary history of chloroquine-resistant Plasmodium falciparum","volume":"107","author":"Awasthi","year":"2012","journal-title":"Mem. Inst. Oswaldo Cruz"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12689","DOI":"10.1073\/pnas.221440898","article-title":"Evolution of a unique Plasmodium falciparum chloroquine-resistance phenotype in association with pfcrt polymorphism in Papua New Guinea and South America","volume":"98","author":"Mehlotra","year":"2001","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e02539-19","DOI":"10.1128\/AAC.02539-19","article-title":"Plasmodium falciparum Isolates Carrying pfk13 Polymorphisms Harbor the SVMNT Allele of pfcrt in Northwestern Indonesia","volume":"64","author":"Lubis","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1038\/35002615","article-title":"Pgh1 modulates sensitivity and resistance to multiple antimalarials in Plasmodium falciparum","volume":"403","author":"Reed","year":"2000","journal-title":"Nature"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1086\/320195","article-title":"High-level chloroquine resistance in Sudanese isolates of Plasmodium falciparum is associated with mutations in the chloroquine resistance transporter gene pfcrt and the multidrug resistance Gene pfmdr1","volume":"183","author":"Babiker","year":"2001","journal-title":"J. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11553","DOI":"10.1038\/ncomms11553","article-title":"Globally prevalent PfMDR1 mutations modulate Plasmodium falciparum susceptibility to artemisinin-based combination therapies","volume":"7","author":"Veiga","year":"2016","journal-title":"Nat. Commun."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1128\/AAC.00012-07","article-title":"Resistance-mediating Plasmodium falciparum pfcrt and pfmdr1 alleles after treatment with artesunate-amodiaquine in Uganda","volume":"51","author":"Nsobya","year":"2007","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1086\/522154","article-title":"Seasonal carriage of pfcrt and pfmdr1 alleles in Gambian Plasmodium falciparum imply reduced fitness of chloroquine-resistant parasites","volume":"196","author":"Ord","year":"2007","journal-title":"J. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1086\/655659","article-title":"Return of chloroquine-susceptible falciparum malaria in Malawi was a reexpansion of diverse susceptible parasites","volume":"202","author":"Laufer","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1086\/375419","article-title":"Reemergence of chloroquine-sensitive Plasmodium falciparum malaria after cessation of chloroquine use in Malawi","volume":"187","author":"Kublin","year":"2003","journal-title":"J. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7540","DOI":"10.1128\/AAC.01894-15","article-title":"In Vitro and Molecular Surveillance for Antimalarial Drug Resistance in Plasmodium falciparum Parasites in Western Kenya Reveals Sustained Artemisinin Sensitivity and Increased Chloroquine Sensitivity","volume":"59","author":"Lucchi","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1186\/s12936-016-1637-3","article-title":"The return of chloroquine-susceptible Plasmodium falciparum malaria in Zambia","volume":"15","author":"Mwanza","year":"2016","journal-title":"Malar. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12936-020-03157-0","article-title":"Recovery and stable persistence of chloroquine sensitivity in Plasmodium falciparum parasites after its discontinued use in Northern Uganda","volume":"19","author":"Balikagala","year":"2020","journal-title":"Malar. J."},{"key":"ref_28","first-page":"1","article-title":"Plasmodium falciparum-malaria: Resistance to chloroquine, but sensitivity to mefloquine in the Gabon. A prospective in-vitro study","volume":"35","author":"Burchard","year":"1984","journal-title":"Tropenmed. Parasitol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"612","DOI":"10.4269\/ajtmh.1998.58.612","article-title":"Follow-up of the susceptibility of Plasmodium falciparum to antimalarials in Gabon","volume":"58","author":"Philipps","year":"1998","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1017\/S0031182097002266","article-title":"Plasmodium falciparum: In vitro chloroquine susceptibility and allele-specific PCR detection of Pfmdr1 Asn86Tyr polymorphism in Lambarene, Gabon","volume":"116","author":"Grobusch","year":"1998","journal-title":"Parasitology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/S0035-9203(00)90084-1","article-title":"Decreasing chloroquine resistance in Plasmodium falciparum isolates from Gabon","volume":"94","author":"Brandts","year":"2000","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_32","first-page":"63","article-title":"Declining chloroquine resistance of Plasmodium falciparum in Lambarene, Gabon from 1992 to 1998","volume":"113","author":"Schwenke","year":"2001","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00436-006-0287-8","article-title":"No variation in the prevalence of point mutations in the Pfcrt and Pfmdr1 genes in isolates from Gabonese patients with uncomplicated or severe Plasmodium falciparum malaria","volume":"100","author":"Mayengue","year":"2007","journal-title":"Parasitol. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/S0035-9203(02)90345-7","article-title":"Reassessment of the resistance of Plasmodium falciparum to chloroquine in Gabon: Implications for the validity of tests in vitro vs. in vivo","volume":"96","author":"Borrmann","year":"2002","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00436-001-0546-7","article-title":"Polymorphisms in the parasite genes for pfcrt and pfmdr-1 as molecular markers for chloroquine resistance in Plasmodium falciparum in Lambar\u00e9n\u00e9, Gabon","volume":"88","author":"Binder","year":"2002","journal-title":"Parasitol. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1186\/1475-2875-10-304","article-title":"A thirteen-year analysis of Plasmodium falciparum populations reveals high conservation of the mutant pfcrt haplotype despite the withdrawal of chloroquine from national treatment guidelines in Gabon","volume":"10","author":"Frank","year":"2011","journal-title":"Malar. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9784","DOI":"10.1038\/s41598-019-46194-9","article-title":"Characterization of Plasmodium infections among inhabitants of rural areas in Gabon","volume":"9","author":"Woldearegai","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1186\/s12936-019-2972-y","article-title":"DNA recovery from archived RDTs for genetic characterization of Plasmodium falciparum in a routine setting in Lambarene, Gabon","volume":"18","author":"Nguyen","year":"2019","journal-title":"Malar. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"6378","DOI":"10.1128\/AAC.03326-14","article-title":"Antimalarial activity of the myxobacterial macrolide chlorotonil a","volume":"58","author":"Held","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"17336","DOI":"10.1038\/s41598-019-53912-w","article-title":"Histone deacetylase inhibitors with high in vitro activities against Plasmodium falciparum isolates collected from Gabonese children and adults","volume":"9","author":"Koehne","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.4269\/ajtmh.2006.75.1178","article-title":"In vitro activity of ferroquine (SAR97193) is independent of chloroquine resistance in Plasmodium falciparum","volume":"75","author":"Kreidenweiss","year":"2006","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4245","DOI":"10.1128\/AAC.00161-13","article-title":"Fitness Consequences of Plasmodium falciparum pfmdr1 Polymorphisms Inferred from Ex Vivo Culture of Ugandan Parasites","volume":"57","author":"Ochong","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.actatropica.2006.03.002","article-title":"Role of pfmdr1 mutations on chloroquine resistance in Plasmodium falciparum isolates with pfcrt K76T from Papua New Guinea","volume":"98","author":"Mita","year":"2006","journal-title":"Acta Trop."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Maiga, H., Grivoyannis, A., Sagara, I., Traore, K., Traore, O.B., Tolo, Y., Traore, A., Bamadio, A., Traore, Z.I., and Sanogo, K. (2021). Selection of pfcrt K76 and pfmdr1 N86 Coding Alleles after Uncomplicated Malaria Treatment by Artemether-Lumefantrine in Mali. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22116057"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1128\/AAC.00875-06","article-title":"Amodiaquine and artemether-lumefantrine select distinct alleles of the Plasmodium falciparum mdr1 gene in Tanzanian children treated for uncomplicated malaria","volume":"51","author":"Humphreys","year":"2007","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"833","DOI":"10.4269\/ajtmh.14-0031","article-title":"Polymorphisms in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance 1 genes: Parasite risk factors that affect treatment outcomes for P. falciparum malaria after artemether-lumefantrine and artesunate-amodiaquine","volume":"91","author":"Venkatesan","year":"2014","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1086\/596738","article-title":"In vivo selection of Plasmodium falciparum parasites carrying the chloroquine-susceptible pfcrt K76 allele after treatment with artemether-lumefantrine in Africa","volume":"199","author":"Sisowath","year":"2009","journal-title":"J. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"105835","DOI":"10.1016\/j.ebiom.2025.105835","article-title":"Assessment of ex vivo antimalarial drug efficacy in African Plasmodium falciparum parasite isolates, 2016\u20132023: A genotype-phenotype association study","volume":"118","author":"Rosado","year":"2025","journal-title":"eBioMedicine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"7353","DOI":"10.1038\/s41467-025-62810-x","article-title":"Changes in susceptibility of Plasmodium falciparum to antimalarial drugs in Uganda over time: 2019\u20132024","volume":"16","author":"Okitwi","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/jac\/dkt388","article-title":"Occurrence of multiple chloroquine-resistant Pfcrt haplotypes and emergence of the S(agt)VMNT type in Cameroonian Plasmodium falciparum","volume":"69","author":"Das","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"106975","DOI":"10.1016\/j.actatropica.2023.106975","article-title":"Polymorphism analysis of drug resistance markers in Plasmodium falciparum isolates from Benin","volume":"245","author":"Perrotti","year":"2023","journal-title":"Acta Trop."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S1473-3099(22)00593-X","article-title":"Prevalence of Plasmodium falciparum haplotypes associated with resistance to sulfadoxine-pyrimethamine and amodiaquine before and after upscaling of seasonal malaria chemoprevention in seven African countries: A genomic surveillance study","volume":"23","author":"Beshir","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1186\/s12936-021-04000-w","article-title":"Temporal evolution of the resistance genotypes of Plasmodium falciparum in isolates from Equatorial Guinea during 20 years (1999 to 2019)","volume":"20","author":"Berzosa","year":"2021","journal-title":"Malar. J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12936-016-1672-0","article-title":"Profile of molecular mutations in pfdhfr, pfdhps, pfmdr1, and pfcrt genes of Plasmodium falciparum related to resistance to different anti-malarial drugs in the Bata District (Equatorial Guinea)","volume":"16","author":"Berzosa","year":"2017","journal-title":"Malar. J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.meegid.2015.08.039","article-title":"Molecular mutation profile of Pfcrt and Pfmdr1 in Plasmodium falciparum isolates from Bioko Island, Equatorial Guinea","volume":"36","author":"Li","year":"2015","journal-title":"Infect. Genet. Evol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e0041322","DOI":"10.1128\/spectrum.00413-22","article-title":"Molecular Surveillance of Artemisinin-Based Combination Therapies Resistance in Plasmodium falciparum Parasites from Bioko Island, Equatorial Guinea","volume":"10","author":"Liu","year":"2022","journal-title":"Microbiol. Spectr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1093\/trstmh\/traf069","article-title":"Genetic epidemiology of Plasmodium falciparum chloroquine resistance in coastal, North and Far North areas of Cameroon","volume":"119","author":"Narang","year":"2025","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"27988","DOI":"10.1038\/s41598-024-78670-2","article-title":"Polymorphisms in the Pfcrt, Pfmdr1, and Pfk13 genes of Plasmodium falciparum isolates from southern Brazzaville, Republic of Congo","volume":"14","author":"Baina","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Djontu, J.C., Baina, M.T., Ntabi, J.D.M., Mapanguy, C.C.M., Batchi-Bouyou, A.L., Elenga, V.A., Kouikani, F.Y., Ndala, A.C.M., Mouanga, A.M., and Ntoumi, F. (2025). Characterization of Plasmodium falciparum infections among people living with HIV under antiretroviral and co-trimoxazole chemoprophylaxis in Brazzaville, Republic of Congo. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-12000-3"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e0018822","DOI":"10.1128\/aac.00188-22","article-title":"Genetic Diversity of Plasmodium falciparum and Distribution of Antimalarial Drug Resistance Mutations in Symptomatic and Asymptomatic Infections","volume":"66","author":"Guillochon","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"104814","DOI":"10.1016\/j.ebiom.2023.104814","article-title":"Efficacy and safety of ivermectin for the treatment of Plasmodium falciparum infections in asymptomatic male and female Gabonese adults\u2014A pilot randomized, double-blind, placebo-controlled single-centre phase Ib\/IIa clinical trial","volume":"97","author":"Held","year":"2023","journal-title":"eBioMedicine"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1128\/AAC.46.6.1658-1664.2002","article-title":"Histidine-rich protein II: A novel approach to malaria drug sensitivity testing","volume":"46","author":"Noedl","year":"2002","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1038\/nature21060","article-title":"Sterile protection against human malaria by chemoattenuated PfSPZ vaccine","volume":"542","author":"Surat","year":"2017","journal-title":"Nature"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1093\/cid\/ciz131","article-title":"Prospective Clinical and Molecular Evaluation of Potential Plasmodium ovale curtisi and wallikeri Relapses in a High-transmission Setting","volume":"69","author":"Groger","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_65","first-page":"20153038","article-title":"Within-host competition and drug resistance in the human malaria parasite Plasmodium falciparum","volume":"283","author":"Bushman","year":"2016","journal-title":"Proc. Biol. Sci."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1179\/2047773214Y.0000000158","article-title":"High prevalence of pfmdr1 N86Y and Y184F mutations in Plasmodium falciparum isolates from Bioko Island, Equatorial Guinea","volume":"108","author":"Li","year":"2014","journal-title":"Pathog. Glob. Health"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Kamau, E., Alemayehu, S., Feghali, K.C., Saunders, D., and Ockenhouse, C.F. (2013). Multiplex qPCR for detection and absolute quantification of malaria. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0071539"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/0166-6851(93)90077-B","article-title":"High sensitivity of detection of human malaria parasites by the use of nested polymerase chain reaction","volume":"61","author":"Snounou","year":"1993","journal-title":"Mol. Biochem. Parasitol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e01758-17","DOI":"10.1128\/AAC.01758-17","article-title":"Prospective Clinical Trial Assessing Species-Specific Efficacy of Artemether-Lumefantrine for the Treatment of Plasmodium malariae, Plasmodium ovale, and Mixed Plasmodium Malaria in Gabon","volume":"62","author":"Groger","year":"2018","journal-title":"Antimicrob. Agents Chemother."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/8\/3566\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T07:50:19Z","timestamp":1776412219000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/8\/3566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":69,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijms27083566"],"URL":"https:\/\/doi.org\/10.3390\/ijms27083566","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}