Artemisinin Partial Resistance in Ugandan Children

To the Editor The article by Dr Henrici and colleagues notes an urgent problem of artemisinin combination therapies that induced artemisinin partial resistance in 110 Ugandan children. Resistance was promoted by Pfkelch13 gene variations in Plasmodium falciparum. Even before the 2015 Nobel Prize for artemisinin’s discovery and isolation from the plant Artemisia annua, reports of resistance arose in Cambodia and Thailand. It was inevitable that resistance to a single compound would develop in a highly mutable parasite. Centuries before artemisinin’s discovery, the A annua plant itself was used as a therapy and may constitute a natural combination therapy more robust than monotherapy or artemisinin combination therapies against the inexorable evolutionary pressure toward drug resistance.