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Open Access Commentary

Questions over high frequency of mutant PfATP6 haplotypes in traveller isolates

Charles J Woodrow1*, Kate B Gardner1 and Leyla Y Bustamante2

Author Affiliations

1 Mahidol-Oxford University Tropical Medicine Research Unit (MORU), Bangkok, Thailand

2 Sanger Malaria Programme, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK

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Malaria Journal 2012, 11:186  doi:10.1186/1475-2875-11-186

Published: 8 June 2012

Abstract

A recent paper in Malaria Journal suggests that a high proportion of Plasmodium falciparum isolates found in travellers returning from a range of African countries carry the PfATP6 A623E S769N haplotype, and that this genotype is associated with artemether resistance. Such a finding would represent a substantial departure from the extensive literature reporting these individual mutations to be very rare, with the double mutation never documented. The number of isolates screened to obtain these double mutants is unstated, but highly relevant, not least because selection of isolates could have introduced significant confounders, such as timing of in vitro testing. An additional concern relates to the location of sequencing primers used to assess these positions. In the absence of clear information on these fundamental questions it would be appropriate to treat the findings with caution.