Fig. 4

Role of epigenetics in the acquisition of drug resistance, a parallel between resistance to blasticidin S and artemisinin resistance. Upon the exposure of a trophozoite population to Blasticidin S, a majority of them dies because most of them express the CLAG3.2 protein at their cell surface. Only a subset of parasites expresses the CLAG3.1 protein, which allows them to withstand drug exposure at the cost of a slower metabolism. This regulation of CLAG3 genes is epigenetically-mediated, allowing a stochastic number of parasites to survive drug pressure [102, 103]. Following exposure to artemisinins, a subset of ring-stage parasites can enter a quiescent state by slowing down their metabolism. After drug removal, the parasites can resume their life cycle [110]