Tu youyou and others put forward a reasonable plan to cope with "artemisinin resistance"

According to the World Health Organization, malaria kills one person every two minutes At present, malaria is still one of the most important causes of death in the world April 25, 2019 is the 12th World Malaria Day Scientists from artemisinin research center and Institute of traditional Chinese medicine of Chinese Academy of traditional Chinese medicine put forward a reasonable response plan for artemisinin resistance in the international authoritative journal New England Medical Journal Researcher Wang Jigang, a distinguished expert of artemisinin research center and Institute of traditional Chinese medicine of Chinese Academy of Sciences, as the main writer, worked with five experts including Tu Youyou, director of artemisinin research center of Chinese Academy of Sciences, and based on the mechanism of artemisinin, the existing treatment plan, the special situation and reason of drug resistance and the drug price and many other factors, from the overall situation, put forward the practical Line of response to "artemisinin resistance" reasonable program Artemisia annua was first recorded in Shennong Materia Medica, and its therapeutic effect on malaria was clearly defined in elbow reserve emergency prescription It has been used in malaria treatment by our ancestors since ancient times In the 1970s, Tu Youyou, a researcher at the Institute of traditional Chinese medicine, Chinese Academy of traditional Chinese medicine, and his research team were inspired by the ancient book "Artemisia annua in one hand, two stains in water, juice in wring, and all you have to take" Artemisinin was successfully discovered Since then, artemisinin, as a first-line antimalarial drug, has successfully cured countless malaria patients This is the great contribution of traditional Chinese medicine and the older generation of scientific researchers to the whole mankind However, it is worrisome that artemisinin resistance has been shown in malaria endemic areas The problem of artemisinin resistance is a public health problem faced by the Greater Mekong Subregion and parts of Africa Researcher Tu youyou paid special attention to it In his Nobel Prize winning speech, he emphasized the importance and urgency of relevant research It should be emphasized that in order to correctly understand the phenomenon of artemisinin resistance, we must first understand the mechanism of artemisinin Unlike other drugs, artemisinin needs to be activated to work The research shows that heme in red blood cells is an efficient and specific activator of artemisinin When Plasmodium destroys a large number of red blood cells in the human body, it will release a very high concentration of heme In this way, artemisinin will be activated in the place where the metabolism of Plasmodium is strong, and it will combine with hundreds of proteins in the body of Plasmodium, causing it to lose activity, and then kill Plasmodium In contrast, heme in normal red blood cells cannot activate artemisinin because it is firmly bound to hemoglobin Therefore, artemisinin has little side effects on normal cells In other words, the nature of Plasmodium's phagocytosis makes it an inevitable target of artemisinin attack Such a pattern makes it very difficult for Plasmodium to produce drug resistance by mutating individual target proteins, which is also the reason why artemisinin is not completely resistant after being widely used for many years However, it should be pointed out that the half-life of artemisinin in human body is short, only 1-2 hours, while the recommended treatment course of artemisinin combination therapy is only 3 days, so the truly effective window of artemisinin insecticidal is only 4-8 hours The existing resistant strains make full use of the short half-life of artemisinin, which may reduce the drug pressure by reducing the degree of artemisinin activation First, change the life cycle, further shorten the sensitive insecticidal period (trophozoite period); second, temporarily enter a quasi dormant state, slow down the metabolic rate, hemoglobin degradation speed and heme release Once the resistant strain enters the trophozoite stage, it can be quickly and efficiently killed by artemisinin This explains why the 3-day artemisinin combination therapy is not effective on drug-resistant strains Once the treatment time is extended, malaria patients can still be cured In addition, the existing phenomenon of "artemisinin resistance", in many cases, is actually the resistance of adjuvant drugs in artemisinin combination therapy In view of this situation, replacing the auxiliary drugs in the combination therapy will achieve immediate results Tu youyou's team believes that by simply adjusting the existing treatment plan, such as specifically replacing the auxiliary drugs in artemisinin combination therapy or appropriately extending the medication time, the existing problem of artemisinin resistance can be effectively solved This paper also discusses a problem that is often ignored by researchers, that is, the price of antimalarial drugs Any good drug, if it can't be taken by the people who need it, will lose the value of the drug itself Artemisinin is cheap and costs only a few dollars a course of treatment The malaria epidemic areas are mainly concentrated in developing countries and Africa Therefore, the development of efficient and cheap drugs is the key to effectively curb the spread of malaria and eradicate malaria Looking at the existing research and development of new antimalarial drugs, no potential drug can be as efficient and safe as artemisinin Even if there is a successful development of new drugs, the cost of drug development will inevitably be reflected in the drug price Whether these drugs can really serve the people who need them, there are many difficulties to overcome It can be seen that good use of artemisinin is still the necessary choice for human beings to cure malaria at present It is hopeful to overcome the existing phenomenon of "artemisinin resistance" by optimizing the drug use scheme in clinical practice.