Abstract

Next-generation sequencing is used here to analyse Plasmodium falciparum genome variation directly from clinical blood samples, as well as cultured isolates, from Africa, Asia and Oceania. Resistance to the major antimalarial drug artemisinin is emerging in the Plasmodium falciparum parasite across Southeast Asia, and there is concern that the increased deployment of antimalarials in pursuit of disease eradication might simply lead to increased drug resistance. To monitor these risks it is important to survey the parasite population for genetic changes. Next-generation sequencing is used here to analyse P. falciparum genome variation directly from nearly 300 clinical blood samples, and from cultured isolates from Africa, Asia and Oceania. The authors use these data to analyse the diversity of the parasite population across different geographical locations, as well as within-host diversity at the level of the whole genome, and they show how this may be used to estimate inbreeding rates, which are important for the evolution of drug resistance. Malaria elimination strategies require surveillance of the parasite population for genetic changes that demand a public health response, such as new forms of drug resistance1,2. Here we describe methods for the large-scale analysis of genetic variation in Plasmodium falciparum by deep sequencing of parasite DNA obtained from the blood of patients with malaria, either directly or after short-term culture. Analysis of 86,158 exonic single nucleotide polymorphisms that passed genotyping quality control in 227 samples from Africa, Asia and Oceania provides genome-wide estimates of allele frequency distribution, population structure and linkage disequilibrium. By comparing the genetic diversity of individual infections with that of the local parasite population, we derive a metric of within-host diversity that is related to the level of inbreeding in the population. An open-access web application has been established for the exploration of regional differences in allele frequency and of highly differentiated loci in the P. falciparum genome.