Background
Malaria is one of the most serious vector-borne diseases. Despite being preventable and treatable, malaria continues to be a major threat to global public health. In 2017, there were an estimated 219 million cases of malaria and 435,000 deaths from malaria globally, with 5% of the cases occurring in the WHO South-East Asia Region [
1]. Guangxi Zhuang Autonomous Region of China was once a malaria-endemic region [
2]. After continued efforts for decades, the malaria burden has been substantially reduced in Guangxi [
2,
3]. However, the risk of malaria re-emergence remains, due to the importation of malaria parasites in thousands of infected travellers from Africa, and Southeast Asia. In neighbouring Vietnam, the malaria incidence declined significantly between 1991 and 2014, but there were 14,941 confirmed cases in 2014, including 473 confirmed cases in the Northern region [
4].
Insecticide-based vector control remains a key preventive strategy in the fight against malaria, credited with the significant reductions in malaria morbidity and mortality since 2000 due to the widespread implementation of insecticidal interventions [
5]. However, the continued effectiveness of this strategy has been challenged by the increasing resistance of vectors to available insecticides. To minimize the risk of control failure caused by insecticide resistance, a better understanding of the status of and the genetic mechanisms underpinning resistance to commonly used insecticide is an urgent need.
In the previous study [
6], the distribution and frequency of genetic mutations in two targets, acetylcholinesterase (AChE) and the voltage-gated sodium channel (VGSC), were investigated. The G119S mutation within AChE was present at high frequencies (0.61–0.85), but the
kdr mutation was rare in the seven Guangxi
An. sinensis populations along the China–Vietnam border, suggesting that pyrethroids remain suitable for use against
An. sinensis [
6]. However, to maintain their effectiveness, the application of pyrethroids should not be taken as the sole measure for vector control, thus insecticides with alternative modes of action should be considered.
The current study was a survey extended to another insecticidal target, gamma-aminobutyric acid (GABA) receptor subunit encoded by the
RDL (Resistant to dieldrin) gene, which is the target of multiple types of insecticides, such as dieldrin (cyclodienes), fipronil (phenylpyrazoles), and fluralaner (isoxazolines) [
7‐
9]. Efforts were given to detect naturally existing genetic mutations, map their distribution and frequency in seven
An. sinensis populations along the China–Vietnam border, and track the origin of the resistance-related mutations. This work focused on amino acid substitutions at three positions (A296G/N/S, V327I and M345M/S) in RDL that are associated with insecticide resistance previously documented in multiple insect species [
8‐
13]. The data obtained in this study are of significance for current and future malaria control programs given that the use of GABA targeting insecticides is on the increase.
Discussion
Point mutations (A to S/G/N) at the site equivalent to 301 in
Drosophila (site 296 of AsRDL) in the second transmembrane domain of RDL have been documented in diverse insecticide-resistant insects [
10‐
12,
17‐
19]. In this study, the resistant mutation 296S was detected and its frequency was very high (79–100%) in the seven examined populations, suggesting a strong risk of resistance to GABA targeting insecticides in these mosquito populations. The prevalence of mutation at 296 was also detected in
An. sinensis collected in other locations of Guangxi [
13], and in
Anopheles funestus in Africa [
12]. Given that the use of cyclodienes has been banned, the high level of 296S in
An. sinensis in Guangxi may be a consequence of the increasing use of insecticides targeting the GABA receptor (e.g. ethiprole, fipronil) in the agriculture [
20], or selection pressures by organochlorine pesticides from unknown origins. Another explanation may be that A296S substitution has no fitness cost under current natural conditions, or the cost mediated by A296S is alleviated by unknown fitness modifiers.
Two mutations (V327I and T345S) previously detected in another nine
An. sinensis populations from Guangxi [
13] were also found in the current study. Interestingly, either 327I or 345S was present together with 296S. The 327I mutation was also previously identified in dieldrin-resistant
An. funestus [
12]. Similarly, a conserved mutation at the equivalent site of RDL was also reported in
Anopheles gambiae (T345M) [
8] and
Drosophila (T350M/S) [
21,
22]. Although the two conserved mutations have been suggested to play a role in insecticide resistance when they occurs together with an amino acid substitution at the site 296 [
12,
22], their impact on the pharmacology of the GABA receptor and contribution to insecticide resistance remains unclear. This would be an interesting question worthy of study.
Network analysis does not support single origin of the resistance-conferring 296S mutation and the related 327I mutation in
AsRDL. The two wild A296 haplotypes (H1 and H4) could be considered as two possible ancestors of resistant 296S haplotypes identified in this study (Fig.
4). Multiple origins of 345S were also inferred in the previous study [
13].
Conclusion
A PCR-RFLP diagnostic assay was developed to genotype the T345S mutation in the AsRDL gene. Three previously reported mutations (A296S, V327I and T345S) were detected in the seven An. sinensis populations in Guangxi along the China–Vietnam border. The prevalence of the resistance-related A296S mutation within An. sinensis populations along the China–Vietnam border indicates a risk of resistance to insecticides targeting the GABA receptor, such as dieldrin and fipronil. The resistance A296S allele may have multiple evolutionary origins, and the double mutations (A296S + V327I) may have evolved from alleles carrying the A296S mutation by scaffolding the additional mutation V327I.
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