Spatial distribution of G6PD deficiency variants across malaria-endemic regions

Malaria Journal

Research

Ari W Satyagraha¹  Mewahyu Dewi²  J Kevin Baird³  Frédéric B Piel⁴  Anavaj Sakuntabhai⁵  Thomas N Williams⁶  Katherine E Battle⁷  Rosalind E Howes⁷  Jane P Messina⁷  Simon I Hay⁷  Wuelton M Monteiro⁸ 

[1] Eijkman Institute for Molecular Biology, Jakarta, Indonesia;Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, Indonesia;Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, Indonesia;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK;Evolutionary Ecology of Infectious Disease Group, Department of Zoology, University of Oxford, South Parks Road, Oxford, UK;Institut Pasteur, Unité de Génétique Fonctionnelle des Maladies Infectieuses, Paris, France;Kenya Medical Research Institute/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, Kilifi District Hospital, Kilifi, Kenya;Department of Medicine, Imperial College, St Mary’s Hospital, London, UK;Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, South Parks Road, Oxford, UK;Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil;University of the State of Amazonas, Manaus, Amazonas, Brazil;

关键词: Glucose-6-phosphate dehydrogenase deficiency;    G6PD;    Genetic variants;    Spatial distribution;    Primaquine;    Plasmodium vivax;    Malaria elimination;    Haemolysis;   

DOI  :  10.1186/1475-2875-12-418

 received in 2013-09-05, accepted in 2013-10-28,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundPrimaquine is essential for malaria control and elimination since it is the only available drug preventing multiple clinical attacks by relapses of Plasmodium vivax. It is also the only therapy against the sexual stages of Plasmodium falciparum infectious to mosquitoes, and is thus useful in preventing malaria transmission. However, the difficulties of diagnosing glucose-6-phosphate dehydrogenase deficiency (G6PDd) greatly hinder primaquine’s widespread use, as this common genetic disorder makes patients susceptible to potentially severe and fatal primaquine-induced haemolysis. The risk of such an outcome varies widely among G6PD gene variants.MethodsA literature review was conducted to identify surveys of G6PD variant frequencies among representative population groups. Informative surveys were assembled into two map series: (1) those showing the relative proportions of the different variants among G6PDd individuals; and (2) those showing allele frequencies of G6PD variants based on population surveys without prior G6PDd screening.ResultsVariants showed conspicuous geographic patterns. A limited repertoire of variants was tested for across sub-Saharan Africa, which nevertheless indicated low genetic heterogeneity predominated by the G6PD A-202A mutation, though other mutations were common in western Africa. The severe G6PD Mediterranean variant was widespread across western Asia. Further east, a sharp shift in variants was identified, with high variant heterogeneity in the populations of China and the Asia-Pacific where no single variant dominated.ConclusionsG6PD variants exhibited distinctive region-specific distributions with important primaquine policy implications. Relative homogeneity in the Americas, Africa, and western Asia contrasted sharply with the heterogeneity of variants in China, Southeast Asia and Oceania. These findings will inform rational risk assessments for primaquine in developing public health strategies for malaria control and elimination, and support the future development of regionally targeted policies. The major knowledge gaps highlighted here strongly advocate for further investigation of G6PD variant diversity and their primaquine-sensitivity phenotypes.

【 授权许可】

CC BY   
© Howes et al.; licensee BioMed Central Ltd. 2013