Fitness costs and benefits in response to artificial artesunate selection in Plasmodium

Drug resistance is a major issue in the control of malaria. Mutations linked to drug resistance often target key metabolic pathways and are therefore expected to be associated with biological costs. The spread of drug resistance depends on the balance between the benefits that these mutations provide in the drug-treated host and the costs they incur in the untreated host. The latter may therefore be expressed both in the vertebrate host and in the vector. Current information about the costs of drug resistance mutations comes almost exclusively from vertebrate hosts. The potential for these costs to be expressed also in mosquitoes has been given only cursory attention. In this study, we aim to identify the costs and benefits of resistance against artesunate (AS), one of the main artemisinin derivatives used in malaria-endemic countries. For this purpose, we compared different AS-selected lines of the avian malaria parasite Plasmodium relictum to their ancestral (unselected) counterpart. We tested their within host dynamics and virulence both in the vertebrate host and in its natural vector, the mosquito Culex quinquefasciatus. The within-host dynamics of the AS-selected lines in the treated birds was consistent with the phenotype of resistance described in human P. falciparum malaria: a clearance delay during the treatment followed by a recrudescence once the treatment was interrupted. In the absence of treatment, however, we found no significant costs of resistance in the bird. The results of the two experiments to establish the infectivity of the lines to mosquitoes point towards a decreased infectivity of the drug-selected lines as compared to the ancestral, reference one. We discuss the potential implication of these results on the spread of artesunate resistance in the field. ### Competing Interest Statement The authors have declared no competing interest.