Changes in malaria parasite drug resistance in an endemic population over a 25-year period with resulting genomic evidence of selection

J Infect Dis. 2014 Apr 1;209(7):1126-35. doi: 10.1093/infdis/jit618. Epub 2013 Nov 21.

Abstract

Background: Analysis of genome-wide polymorphism in many organisms has potential to identify genes under recent selection. However, data on historical allele frequency changes are rarely available for direct confirmation.

Methods: We genotyped single nucleotide polymorphisms (SNPs) in 4 Plasmodium falciparum drug resistance genes in 668 archived parasite-positive blood samples of a Gambian population between 1984 and 2008. This covered a period before antimalarial resistance was detected locally, through subsequent failure of multiple drugs until introduction of artemisinin combination therapy. We separately performed genome-wide sequence analysis of 52 clinical isolates from 2008 to prospect for loci under recent directional selection.

Results: Resistance alleles increased from very low frequencies, peaking in 2000 for chloroquine resistance-associated crt and mdr1 genes and at the end of the survey period for dhfr and dhps genes respectively associated with pyrimethamine and sulfadoxine resistance. Temporal changes fit a model incorporating likely selection coefficients over the period. Three of the drug resistance loci were in the top 4 regions under strong selection implicated by the genome-wide analysis.

Conclusions: Genome-wide polymorphism analysis of an endemic population sample robustly identifies loci with detailed documentation of recent selection, demonstrating power to prospectively detect emerging drug resistance genes.

Keywords: archival analysis; genomic surveillance; policy and practice; population genetics; resistance monitoring.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alleles
  • Antimalarials / therapeutic use
  • DNA, Protozoan / chemistry
  • DNA, Protozoan / genetics
  • Drug Resistance*
  • Gambia / epidemiology
  • Genome, Protozoan
  • Genotype
  • Humans
  • Malaria, Falciparum / drug therapy
  • Malaria, Falciparum / epidemiology*
  • Malaria, Falciparum / parasitology*
  • Plasmodium falciparum / drug effects*
  • Plasmodium falciparum / genetics*
  • Plasmodium falciparum / isolation & purification
  • Polymorphism, Single Nucleotide
  • Selection, Genetic*
  • Sequence Analysis, DNA

Substances

  • Antimalarials
  • DNA, Protozoan