Abstract
Malaria incidence still is high especially in sub-Saharan Africa. Antimalarial drugs reduce the disease mortality and morbidity but could also impact the parasite's transmission. Current knowledge about the impact of drugs on malaria transmission come mainly from studies quantifying the transmissible blood stages of the parasite (gametocytes) in the vertebrate host. Our knowledge of how these drugs may impact the vector stages of the parasite is still very limited. In this thesis, I investigated the effects of two main antimalarial drugs, artesunate (AS) and sulfadoxine-pyrimethamine (SP), on parasite transmission through a series of laboratory experiments and field studies.Our laboratory experiments (with the avian malaria parasite, Plasmodium relictum) showed that SP decreases drastically sporozoite prevalence and burden and in infected vectors fed on SP-treated birds. We are currently studying the mechanistic underpinnings of these results by exploring the effect of the drug on the mosquito gut microbiome and transcriptome. Our results suggest that SP could exert a selection pressure not only in treated humans (as has been widely reported) but also in the vector feeding on treated humans. Our experiments didn’t show such an effect in mosquitoes fed on an AS-treated bloodmeal. In a separate experiment, where we selected for AS resistance in P. relictum, we were able to establish the existence of fitness costs linked to AS-resistance in the vector (lower intensity of infection) but not in the untreated vertebrate host.We have also compared the prevalence of 3 key drug resistance alleles (in the pfcrt, dhfr and pfmdr loci) between humans and vectors infected with the human malaria parasite Plasmodium falciparum across 4 different sites in West Africa. We show allele-dependent differences in prevalence both between humans and vectors, and between vector species. These differences may not only be indicative of the of costs of drug resistance being different for vectors and humans but also highlight the potential role of the vectors as sentinels for the detection of drug resistant mutations that are rare in humans. In sum, our results show the importance of investigating the effect of drugs on the vector stages of Plasmodium parasites for understanding the emergence and spread of drug resistance mutations on malaria transmission.