The Plasmodium falciparum parasite's ability to adapt to
environmental pressures, such as the human immune system and antimalarial drugs,
makes malaria an enduring burden to public health. Understanding the genetic
basis of these adaptations is critical to intervening successfully against
malaria. To that end, we created a high-density genotyping array that assays
over 17,000 single nucleotide polymorphisms (∼1 SNP/kb), and applied it to
57 culture-adapted parasites from three continents. We characterized genome-wide
genetic diversity within and between populations and identified numerous loci
with signals of natural selection, suggesting their role in recent adaptation.
In addition, we performed a genome-wide association study (GWAS), searching for
loci correlated with resistance to thirteen antimalarials; we detected both
known and novel resistance loci, including a new halofantrine resistance locus,
PF10_0355. Through functional testing we demonstrated that
PF10_0355 overexpression decreases sensitivity to
halofantrine, mefloquine, and lumefantrine, but not to structurally unrelated
antimalarials, and that increased gene copy number mediates resistance. Our GWAS
and follow-on functional validation demonstrate the potential of genome-wide
studies to elucidate functionally important loci in the malaria parasite
genome.
Author Summary
Malaria infection with the human pathogen Plasmodium falciparum
results in almost a million deaths each year, mostly in African children.
Efforts to eliminate malaria are underway, but the parasite is adept at eluding
both the human immune response and antimalarial treatments. Thus, it is
important to understand how the parasite becomes resistant to drugs and to
develop strategies to overcome resistance mechanisms. Toward this end, we used
population genetic strategies to identify genetic loci that contribute to
parasite adaptation and to identify candidate genes involved in drug resistance.
We examined over 17,000 genetic variants across the parasite genome in over 50
strains in which we also measured responses to many known antimalarial
compounds. We found a number of genetic loci showing signs of recent natural
selection and a number of loci potentially involved in modulating the
parasite's response to drugs. We further demonstrated that one of the novel
candidate genes (PF10_0355) modulates resistance to the
antimalarial compounds halofantrine, mefloquine, and lumefantrine. Overall, this
study confirms that we can use genome-wide approaches to identify clinically
relevant genes and demonstrates through functional testing that at least one of
these candidate genes is indeed involved in antimalarial drug resistance.