Identification of hookworm anthelmintic resistance genes to ameliorate maternal and infant anemia

Nearly 740 million people are infected by hookworms, including one-third of pregnant women in developing countries. These parasitic nematodes cause anemia and protein malnutrition, as they are voracious consumers of blood. In pregnant women, anemia caused by hookworms leads to poor outcomes for the mother and her infant, including an increased risk of death, premature delivery, low birth weight, and impaired milk production. Hookworm infections are treated with anti-nematode drugs, but rare cases of resistance to these drugs have been observed in patients. These same drugs are administered on a massive scale to treat hookworm infections of livestock, where resistance develops rapidly. Drug resistance is less prevalent in human patients than in livestock because administration in humans is not yet as pervasive. Therefore, resistance in human hookworms is predicted to increase as administration increases, prompting an urgent need to identify the resistance genes. I propose to identify the genes that cause resistance to these anti-nematode drugs in human hookworm populations. These discoveries will allow physicians to tailor dosages and combinations of existing drugs to exploit the weaknesses found in parasites to more effectively treat infected mothers and infants.