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Background  Artemisinin-based combination therapy is the first-line anti-malarial treatment for uncomplicated  Plasmodium falciparum  infection in Angola. To date, the prevalence of polymorphisms in the  pfk13  gene, associated with artemisinin resistance, and  pfmdr1 , associated with lumefantrine resistance, have not been systematically studied in Angola.    Methods  DNA was isolated from pretreatment and late treatment failure dried blood spots collected during the 2015 round of therapeutic efficacy studies in Benguela, Lunda Sul, and Zaire Provinces in Angola. The  pfk13  propeller domain and  pfmdr1  gene were sequenced and analysed for polymorphisms.  Pfmdr1  copy number variation was assessed using a real-time PCR method. The association between  pfmdr1  and  pfk13  mutations and treatment failure was investigated.    Results  The majority of pretreatment (99%, 466/469) and all late treatment failure (100%, 50/50) samples were wild type for  pfk13 . Three of the pretreatment samples (1%) carried the A578 S  mutation commonly observed in Africa and not associated with artemisinin resistance. All 543 pretreatment and day of late treatment failure samples successfully analysed for  pfmdr1  copy number variation carried one copy of  pfmdr1.  The NYD haplotype was the predominant  pfmdr1  haplotype, present in 63% (308/491) of pretreatment samples, followed by N F D, which was present in 32% (157/491) of pretreatment samples. The  pfmdr1  N86 allele was overrepresented in day of late treatment failure samples from participants receiving artemether–lumefantrine (p value 0.03).    Conclusions  The pretreatment parasites in patients participating in therapeutic efficacy studies in 2015 in Angola’s three sentinel sites showed genetic evidence of susceptibility to artemisinins, consistent with clinical outcome data showing greater than 99% day 3 clearance rates. The lack of increased  pfmdr1  copy number is consistent with previous reports from sub-Saharan Africa. Although  pfmdr1  NYD and N F D haplotypes were overrepresented in artemether–lumefantrine late treatment failure samples, their role as markers of resistance was unclear given that these haplotypes were also present in the majority of successfully treated patients in the artemether–lumefantrine treatment arms.    Electronic supplementary material  The online version of this article (10.1186/s12936-018-2233-5) contains supplementary material, which is available to authorized users.

malaria journal

Prevalence of molecular markers of artemisinin and lumefantrine resistance among patients with uncomplicated Plasmodium falciparum malaria in three provinces in Angola, 2015