Plasmodium falciparum is one of the most lethal parasite responsible for human
malaria. Until now, the only one
solution to counter
malaria is the use of
antimalarial drugs. Unfortunately, the extensively use of drugs, such as
quinolines (i.e.
chloroquine,
quinine or
mefloquine), have led to the emergence of drug resistance.
Chloroquine and probably other
quinolines act in interfering in the detoxification of
hematin in the digestive vacuole.
Quinolines are accumulated in P. falciparum digestive vacuole and the accumulation varies from a susceptible strain to a resistant one. Nevertheless, the mechanisms of
quinoline resistance are still investigating. Genetic polymorphisms in some strains have been linked to drug resistance. The modifications observed are mutations on genes that encode
transport proteins localized in the membrane of digestive vacuole. Three transporters were involved in
quinoline resistance: PfCRT (
Plasmodium falciparum chloroquine resistance transporter), Pgh1 (
P-glycoprotein homologue 1) and PfMRP (Plasmodium falciparum multidrug resistance
protein). They could be involved in accumulation or efflux mechanisms of drugs. In order to understand their role in resistance, localization, encoding gene structure,
protein structure and endogenous function of these three transporters are reported. Some molecules that have no intrinsic
antimalarial effect have been shown to reverse drug resistance when they are combined to
chloroquine,
quinine or
mefloquine. These molecules are a
solution to counter resistance but also they are precious tools to elucidate the resistance mechanisms. The molecules that have already shown a capacity to reverse
chloroquine,
quinine or
mefloquine resistances were reported. Some of them could act on one of the three transporters involved in drug resistance, by confirming their role in
quinoline resistance. Here we summarize the main elements of
quinoline resistance and reversion of
quinoline resistance related to
malaria.