Summary
Artemisinin and its derivatives (ARTs) are frontline antimalarial drugs.
However, ART monotherapy is associated with a high frequency of recrudescent
infection, resulting in treatment failure. A subset of parasites is thought to
undergo ART-induced latency, but the mechanisms remain unknown. Here we report
that ART treatment results in phosphorylation of the parasite eukaryotic
initiation factor-2α (eIF2α), leading to repression of general
translation and latency induction. Enhanced phosphorylated eIF2α
correlates with high rates of recrudescence following ART, and inhibiting
eIF2α dephosphorylation renders parasites less sensitive to ART
treatment. ART-induced eIF2α phosphorylation is mediated by the
Plasmodium eIF2α kinase, PK4. Overexpression of a
PK4 dominant-negative or pharmacological inhibition of PK4 blocks parasites from
entering latency and abolishes recrudescence after ART treatment of infected
mice. These results show that translational control underlies ART-induced
latency and that interference with this stress response may resolve the clinical
problem of recrudescent infection.