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Figure 1 | Malaria Journal

Figure 1

From: A framework for assessing the risk of resistance for anti-malarials in development

Figure 1

Resistance risk assessment workflow. The resistance risk assessment workflow encompasses three goals: cross-resistance determination (goal I), de novo resistance selection frequency determination (goal II), and resistance mode-of-action determination (goal III). These can be achieved trough a straightforward set of quantitative experiments applied to compounds at the lead and preclinical developmental stages. A resistant IC50 corresponds to a 20-fold increase as compared to a fully sensitive strain (NF54 or HB3 in the case of sulphonamides). C is the theoretical cost of fitness associated with resistance (see main text). C<0 indicates that resistance provides a fitness advantage, which is a major risk factor. Ultimately, the overall risk level can be classified as low, elevated, or major and allows to prioritize the development of robust compounds and to establish risk mitigation strategies for the others.

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