Malaria parasite evolution in a test tube

Experimental evolution studies reveal drug targets and resistance mechanisms Malaria is an infectious disease caused by the Plasmodium parasite, and transmitted by Anopheles mosquitoes. In 2016, a staggering 216 million cases of malaria and 445,000 deaths were recorded, mostly in Africa, although half of the world's population in 91 countries is at risk of the disease ( 1 ). Malaria prevention methods include control of the mosquito with insecticide-treated bed nets and indoor residual spraying of insecticides. Prompt diagnosis through the use of rapid diagnostic tests is also key. Although there is a malaria vaccine, RTS,S/AS01, it shows limited efficacy and has yet to be used widely. However, the frontline against malaria is antimalarial drugs, in particular artemisinin-based combination therapies (ACTs), which are mixtures of artemisinin and its derivatives from the Chinese sweet wormwood herb, with drugs such as piperaquine. Alarmingly, the parasite is now resistant to most drugs that have been developed (see the figure). It is imperative that we identify new inhibitors if progress in reducing malaria is to be sustained. On page 191 of this issue, Cowell et al. ( 2 ) present a major step forward, revealing new antimalarial drug targets and their possible resistance mechanisms.