Mitochondrial Membrane Potential in a Small Subset of Artemisinin-Induced Dormant Plasmodium falciparum Parasites In Vitro

J Infect Dis. 2015 Aug 1;212(3):426-34. doi: 10.1093/infdis/jiv048. Epub 2015 Jan 29.


Artemisinin-induced dormancy is a proposed mechanism for failures of monotherapy and is linked with artemisinin resistance in Plasmodium falciparum. The biological characterization and dynamics of dormant parasites are not well understood. Here we report that after dihydroartemisinin treatment in vitro, a small subset of morphologically dormant parasites was stained with rhodamine 123 (RH), a mitochondrial membrane potential marker, and persisted to recovery. RH-positive parasites sorted with fluorescence-activated cell sorting resumed growth at 10,000/well whereas RH-negative parasites failed to recover at 5 million/well. Furthermore, transcriptional activity for mitochondrial enzymes was detected only in RH-positive dormant parasites. Importantly, after treatment of dormant parasites with different concentrations of atovaquone, a mitochondrial inhibitor, the recovery of dormant parasites was delayed or stopped. This demonstrates that mitochondrial activity is critical for survival and regrowth of dormant parasites and that RH staining provides a means of identifying these parasites. These findings provide novel paths for studying and eradicating this dormant stage.

Keywords: P. falciparum; artemisinin; dihydroartemisinin (DHA); dormancy; mitochondrial membrane potential.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antimalarials / pharmacology*
  • Artemisinins / pharmacology*
  • Atovaquone / pharmacology
  • Fluorescent Dyes / analysis
  • Genes, Mitochondrial
  • Humans
  • Membrane Potential, Mitochondrial / drug effects*
  • Membrane Potential, Mitochondrial / physiology*
  • Plasmodium falciparum / drug effects*
  • Plasmodium falciparum / physiology*
  • Rhodamine 123 / analysis


  • Antimalarials
  • Artemisinins
  • Fluorescent Dyes
  • Rhodamine 123
  • dihydroartemisinin
  • Atovaquone