Bites of Anopheles mosquitoes transmit Plasmodium falciparum parasites that cause malaria, which kills hundreds of thousands of people every year. Since the turn of this century, efforts to prevent the transmission of these parasites via the mass distribution of insecticide-treated bed nets have been extremely successful, and have led to an unprecedented reduction in deaths from malaria1. However, resistance to insecticides has become widespread in Anopheles populations2,3,4, which has led to the threat of a global resurgence of malaria and makes the generation of effective tools for controlling this disease an urgent public health priority. Here we show that the development of P. falciparum can be rapidly and completely blocked when female Anopheles gambiae mosquitoes take up low concentrations of specific antimalarials from treated surfaces—conditions that simulate contact with a bed net. Mosquito exposure to atovaquone before, or shortly after, P. falciparum infection causes full parasite arrest in the midgut, and prevents transmission of infection. Similar transmission-blocking effects are achieved using other cytochrome b inhibitors, which demonstrates that parasite mitochondrial function is a suitable target for killing parasites. Incorporating these effects into a model of malaria transmission dynamics predicts that impregnating mosquito nets with Plasmodium inhibitors would substantially mitigate the global health effects of insecticide resistance. This study identifies a powerful strategy for blocking Plasmodium transmission by female Anopheles mosquitoes, which has promising implications for efforts to eradicate malaria.
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Raw data for infection experiments are available as Supplementary Data. All further data are available upon request.
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We thank N. Singh, E. Lund and K. Thornburg for Plasmodium and Anopheles culture; M. Bernardi for help with graphics; D. Wirth, S. Bopp, H. Ranson, and the members of the Catteruccia laboratories for comments and suggestions on the manuscript. Malaria prevalence and LLIN coverage map data were retrieved from the Malaria Atlas Project (www.map.ox.ac.uk). Insecticide resistance data were retrieved from the IR Mapper database (www.irmapper.com). F.C. is funded by a Faculty Research Scholar Award by the Howard Hughes Medical Institute (HHMI) and the Bill & Melinda Gates Foundation (BMGF) (Grant ID: OPP1158190), and by the National Institutes of Health (NIH) (R01 AI124165, R01 AI104956). L.M.C. is supported by Simons Foundation Collaboration Grant 524390. C.O.B. is supported by NIGMS Maximizing Investigator's Research Award (MIRA) R35GM124715-02. The findings and conclusions within this publication are those of the authors and do not necessarily reflect positions or policies of the HHMI, the BMGF, Simons Foundation or the NIH.
Nature thanks Jaline Gerardin, Janet Hemingway, Elizabeth Winzeler and the other anonymous reviewer(s) for their contribution to the peer review of this work.