Genomic analysis reveals independent evolution of Plasmodium falciparum population in Ethiopia

doi:10.21203/rs.3.rs-75436/v1

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Genomic analysis reveals independent evolution of Plasmodium falciparum population in Ethiopia

https://doi.org/10.21203/rs.3.rs-75436/v1

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published 04 Mar, 2021

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Background

Plasmodium falciparum parasite populations have been experiencing local selective pressures from drugs and immunity, leading to evolutionary adaptation. However, there was paucity of data on the genomic characterization and the evolutionary adaptations of P. falciparum isolates from central area of Ethiopia.

Method

: Whole genome analysis of 25 P. falciparum isolates from central Ethiopia were made to determine their genetic diversity, population structures and signatures of selection in known drug resistance loci against isolates from Cambodia, Thailand, DR Congo and Malawi.

Result

A total of 18,517 high-quality single-nucleotide polymorphisms (SNPs) were identified with average nucleotide diversity (π = 0.00022) across the genome. About 84% of the Ethiopian P. falciparum isolates had F_WS value > 0.95 showing a dominant single genotype infection in most isolates at the time of collection with little potential for out-crossing as expected in areas with low transmission intensity. Within host diversity of Ethiopian infections was significantly different from East African (p < 0.001) but not Southeast Asian infections (P > 0.05). A significant population structure differentiation between Ethiopian parasites and East Africa (Fst < 10%) and Southeast Asia populations (Fst ~ 18%) has been observed, suggesting limited gene flow and the independent evolution of the Ethiopian parasite population. Moreover, a total of 125 genes under balancing selection is identified that included ama1, trap, eba175, and lsa3 previously identified as targets of human host immunity. Recent directional selection analysis using integrated standardized haplotype score (IHS) did not detect any selection signatures in the pfcrt, pfdhfr, pfdhps, pfmdr1, and pfK13 genes. However, mutations analysis showed that at least one SNP marker was fixed in these genes, but not in pfdhps and pfK13.

Conclusion

Plasmodium falciparum population in central region of Ethiopia were structurally diverged from both southeast Asian and other East African populations. A low within host diversity is noted among the Ethiopian parasites. Indeed, the parasites carry fixed chloroquine resistance markers despite the withdrawal of this drug for the treatment of P. falciparum.

General Biochemistry

Plasmodium falciparum

Ethiopia

population structure

drug resistance

admixture

positive selection

Plasmodium falciparum malaria remains one of the major public health problems worldwide accounting for 228 million cases in 2018 compared to 231 million in 2017, while the number of deaths decreased by just 2.5%, from 415, 000 to 405, 000 during the same period [1]. Sub-Saharan Africa (sSA) still accounts for 94% of the global death. In Ethiopia, more than 75% of the total area is malarious and P. falciparum, and P. vivax co-exist [2] making malaria control more complicated than in other African countries.

Across malaria endemic regions, large-scale deployment of antimalarial drugs has led to the emergence of drug resistance to chloroquine (CQ) and sulfadoxine/pyremethamine (SP) drugs [3–5]. Like many other countries, Ethiopia has switched from CQ to SP in 1998 and from SP to AL in 2004 [6] for the treatment of uncomplicated P. falciparum malaria in response to development of parasite resistance. However, CQ remained the first-line drug for P. vivax treatment in the country [7] leading to continued selection of CQ-resistance markers in P. falciparum as the result of indirect pressure from CQ and the presence of mixed infections (P. falciparum and P. vivax). Similar to CQ and SP, P. falciparum developed resistance to aretemether-lumefantrine (AL) first at Thai-Cambodian border [8] and recently in East Africa [9]. The continuous development of resistance in P. falciparum to series of first-line antimalarial hinders malaria prevention, control and elimination efforts.

Of the many pressures known to select for parasite genomics, antimalarial drugs pose tremendous selective pressure on P. falciparum leading to worldwide spread of resistant parasites [10]. It was well noted that P. falciparum resistance has resulted in increased malaria morbidity and mortality across endemic settings. Apart from increased morbidity and mortality, selective sweeps of drug resistance mutations have reduced levels of polymorphism in P. falciparum as these resistant and sensitive strains continue to recombine in mosquitoes [11, 12] with perhaps a reduced diversity around the selected loci. However, the greatly reduced level of diversity across the entire P. falciparum genome most likely resulted from a recent severe population bottleneck, which is most plausibly explained by the gorilla-to-human cross-species transmission event [13].

Based on analysis made on 12 strains collected from different countries in Africa and Asia, the average diversity of P. falciparum at four-fold degenerate sites was estimated to be 8 × 10^− 4 per site [13]. However, published mutation rates for P. falciparum were in the range 1–10 × 10^− 9 mutations per site per replication cycle [14, 15]. Considering the varying lengths of time that the parasites spend either in the vector or in the mammalian host, P. falciparum parasites are likely to undergo at least 200 replication cycles per year suggesting that the observed level of genetic diversity in P. falciparum could have readily accumulated within the past 10,000 years [10].

In response to exposure to drugs, challenges from host immunity and therapeutic interventions, P. falciparum parasite change and select its new genetic variants [16]. Indeed, high pressure from immunity and drugs are known to select adaptive parasite strains that maintain transmission [17] and therefore many P. falciparum genes encoding immune and drug targets remain under natural selection and show signatures of balancing or directional selection [4, 17–21]. However, the selection may vary due to differences in innate susceptibility of human populations, variations in ecological transmission, resulting in varying degrees of acquired immunity and/or drug pressure. Malaria parasites from low and high endemic regions have distinct opportunity for transmission and host acquired immune responses per se [22]. Balancing selection brings the favored alleles to an intermediate equilibrium while the directional selection forces, on the other hand, cause parasite’s genetic variants to increase in frequency and facilitate the occurrence of selective sweeps around the affected loci [23].

Plasmodium falciparum population genomics has been highly studied in West African populations and showed signatures of balancing selection on multiple candidate vaccine antigens and strong directional selection around known drug resistance genes [19, 24]. In contrast, there is little information about the genomic variations of P. falciparum strains in the horn of Africa, including Ethiopia, where P. falciparum and P. vivax malaria co-exist. A recent study reported P. falciparum populations in the horn of Africa, specifically in Ethiopia are unique and structurally diverged from other West, East, and central African P. falciparum populations [25]. These parasite population share a chunk of genes with other sSA P. falciparum populations across drug and immune targets and facilitate the spread of drug-resistant strains [25].This study calls for in-depth analysis of Ethiopian parasite genomes to deepen understanding of genome diversity and natural selection in Ethiopia’s unique human populations with co-species transmission dynamics.

More importantly, understanding population genetic diversity of P. falciparum strains circulating in the specific region of central Ethiopia is very important to monitor the effectiveness of control schemes and provide baseline information for making informed decisions by the national malaria control programme [26]. This study aimed to characterize P. falciparum strains collected from West Arsi Zone in central Ethiopia, using whole-genome analysis of data generated by Illumina next-generation sequencing.

Study area and population

The study was conducted in West Arsi, Oromia (07′ 17′′ 34.2 S, 038′ 21″ 46.3 W) located about 251 km from Addis Ababa, Ethiopia. This region with distinct wet and dry seasons has an altitude of about 1500 – 2300m above sea level with human population of 176,671. The inhabitants of this malarious region have high levels of poverty worsened by the malaria diseases caused predominantly by P. falciparum and P. vivax with a seasonal and unstable pattern of transmission [7].

Sample collection and processing

About ~5mL venous blood was collected from July 2012 to December 2013 from consented P. falciparum malaria patients following standard procedures. Sequencing of P. falciparum from leukocyte-depleted infected whole blood was done as described in [27] at the Welcome Sanger Institute as part of the MalariaGEN P. falciparum Community Project (www.malariagen.net/projects). Open source sequence data from Cambodia, Thailand, Democratic Republic of Congo (DR Congo), and Malawi were accessed via the Pf3K project (https://www.malariagen.net/data/pf3k-5).

Short sequence reads were generated on the Illumina HiSeq platform and aligned to Pf3D7 reference (version 3) by burrows-wheeler-aligners (BWA). SNP calling was done following a customized genome analysis tool kit (GATK) pipeline. Each sample was genotyped for polymorphic coding SNPs across the genome, ensuring a minimum of 5x paired-end coverage across each variant per sample. Polymorphic sites within hyper-variable, telomeric, and repetitive sequence regions were excluded. Biallelic high-quality SNPs with mapping quality (MQ) > 20 and Variant Quality Score (VQSLOD) >= 3 in the core region loci with a minor allele frequency of at least 2% and individual sample and SNP-site missing less than 10% across the isolates was extracted and used for downstream analysis.

Analysis of population genetic diversity and within host infection diversity

Pairwise nucleotide diversity (π) [28] was used to determine average pairwise nucleotide genetic diversity using a 5-kb sliding window as described [29]. The genome-wide F_WS (inbreeding coefficient within a population) metric was used to calculate within-host diversity as described in [21]. To derive F_WS (=1- H_W/H_S), within isolate expected heterozygosity (H_W) was calculated from the relative allele frequencies for all genic SNPs, averaged across the genome and compared with the heterozygosity of local population (H_S). F_WS value ranged from zero to one, where zero indicates high diversity of infection, and one represents a single infection within the sample as compared to local population diversity. For this analysis, individual alleles with coverage of less than < 5 reads and positions with total coverage of < 20 reads were classified as undermined (missing). Isolates with greater than > 5% missing SNP data and SNPs with > 10% missing isolate data were discarded. Isolates with F_WS scores of > 0.95 were classified as a single predominant genotype infection.

Population structure and admixture analysis

Principal component analysis (PCA) was used to estimate population structure using glPCA function in the open source R statistical software version 3.6.2. The first 10 principal components (PCs) axis were calculated, and the first three PCs which explained majority of the variation in the data were retained. The data was thinned downed by pruning SNPs with pairwise linkage disequilibrium (LD) by r² greater than 0.05 for determining the PCs. The pruned SNP loci employed in glPCA function was used to calculate an allele sharing matrix in custom R scripts. This function use variance between and within groups to determine population genetic structure. A discriminant analysis of principal components (DAPC) [30] was used to transform the PCA data, and perform discriminant analysis on the retained principal components using the adegenet package in the R software version 3.6.2. Population admixture was determined based on spatial modeling of allele sharing among geographical coordinates of sampling sites. DAPC determines ancestry proportions and membership probability modeled on genetic variation across space to determine admixtures as described in [30].

Allele frequency and differentiation analysis

Analyses of allele frequency distributions between-population F_ST values [31] were calculated using Vcftools or hierfstat package from adegenet in R, after excluding SNPs with greater than 10% missing data. For F_ST analysis, missing data were excluded on the SNP basis with the size of each population corrected to account for F_ST value difference due to population size variation.

Detection of signatures of natural selection

Within-population Tajima’s D index [32] was calculated using Vcftools. Tajima D values were determined for each SNP and the average value for each gene was calculated. Genes with at least five SNP and positive TajimaD values > 1 were considered as genes under balancing selection.

The standardized integrated haplotype score (IHS) analysis was used to identify positive directional selection signatures by using phased SNP data with allele frequency > 5%. IHS was determined using the rehh package in R software with default parameters [33] after imputing missing SNP data using Beagle version 5.2. The |IHS| > 2.5 (top 1% of the expected distribution ) was used as cut off value [34] to report genes under recent directional selection as reported for genome analysis of West African P. falciparum [17].

Sequencing of Plasmodium falciparum and analysis of allele frequency

High-quality sequence data obtained from 25 P. falciparum clinical isolates collected from the West Arsi of Ethiopia enabled the identification of 672,956 biallelic SNPs with less than 10% missing SNPs data and < 5% sample missing data in individual isolate. All isolates had 95.95% (645715/672,956) SNPs call. Sequences from the intergenic regions had lower read coverage compared to those sequences in the coding regions, and as a result, 78.92% (531120/672,956) of all SNPs called were located within genes. Of 5,058 genes analyzed, 3,370 genes had at least one SNP (Figure 1A). About 18517 SNPs were polymorphic marker in at least one sample in Ethiopian (n=25) samples of which 43.4 % (8,037/18,517) were non-synonymous coding SNPs, 22.8 % (4,222/18,517) synonymous coding SNPs, 26.6 % (4,932/18,517) in intergenic regions, 3% (587/18,517) intragenic regions and 3.5 % (656/18,517) SNPs in intron region. Similarly, P. falciparum populations from Cambodia (n=46), DR Congo (n=50), Malawi (n=50), and Thailand (n=49) had 32,854, 68,476, 79,250 and 30,427 biallelic polymorphic SNPs marker in at least one sample, respectively (Figure 1B).

In general, all populations had a high percentage of non-synonymous coding SNPs at polymorphic marker consistent with previous findings [17]. SNPs with minor allele frequency (MAF) <5% were common in all analyzed P. falciparum populations following exclusion of monomorphic SNPs in each population. Further, SNPs with minor allele’s frequency of < 5% occurred more frequently in samples from Malawi than in Ethiopian isolates (Figure 2).

Genetic diversity of Ethiopian Plasmodium falciparum population

The overall π value in Ethiopian P. falciparum population was 0.00022 which is relatively lower than the genetic diversity in Malawian P. falciparum [20]. High variability of genetic diversity π values across the chromosomes was observed in Ethiopia with minimum value of 0.00015 in chromosome 12 and maximum value of 0.00045 in chromosome 4 (Figure 3). This was consistent with variable genetic diversity π values observed in different chromosomes of other P. falciparum population [35].

Genomic diversity of Plasmodium falciparum infections

F_WS scores ranged from 0.837 to 0.997 (mean = 0.97, median = 0.99) for Ethiopian P. falciparum infections whereas the F_WS values in Cambodia ranged from 0.702 to 0.999 (mean = 0.962, median = 0.995), from 0.483 to 0.998 (mean = 0.94, median = 0.994) in Thailand, from 0.321 to 0.998 (mean = 0.94, median = 0.994) in DR Congo and from 0.194 to 0.997 (mean = 0.747, median = 0.762) in Malawi (Figure 4; Additional file 2).

The F_WS value of > 0.95 suggests that the individual samples predominantly contained single genotype and could have other additional genotypes in lower proportions. In this study, F_WSvalues of > 0.95 were observed in 84%, 79.6%, 78%, 50% and 36 % of samples from Ethiopia, Thailand, Cambodia, DR Congo, and Malawi, respectively.

The mean F_WS scores of Ethiopian P. falciparum population were not significantly different from Cambodia’s (Welch two Sample t-test, P = 0.42) and Thailand’s (Welch two-sample t-test, p = 0.083) at 95% confidence intervals. However, mean F_WSwas significantly higher in Ethiopia compared to DR Congo (Welch two-sample t-test, p = 5.603e^-06) and Malawi (Welch two-sample t-test, p = 3.242e^-08) at 95% confidence intervals.

Population structure and admixtures

Analysis using PCA revealed the presence of four clear major population groups of isolates, which were coincident with their geographical origins (Figure 5A-C).

Similarly, the findings from admixture analysis were consistent with the PCA clustering. The isolates from the three regions were distinguished. This admixture analysis showed that four major components could be differentiated with a cluster value of K = 5. Multiple parasite subpopulations were observed in Malawi and DR Congo parasite populations suggestive of gene flow between these two populations (Figure 6). There was no detectable gene flow between the isolates from Ethiopia and East African or Southeast Asia.

The clustering of Ethiopian P. falciparum isolates was consistent with the fixation index (F_ST) values with or without correcting for sample size. The F_ST values of Ethiopian isolates versus those from the two other East African regions (DR Congo and Malawi) ranged from 0.08 to 0.09, while F_ST value of Ethiopian P. falciparum versus the two southeast Asian regions (Thailand and Cambodia) was 0.18 (Table 1).

Table 1: Pairwise population Divergence (measured by F_ST) among P. falciparum populations.

Signatures of selection in the Plasmodium falciparum isolates

The Ethiopian isolates had the average Tajima’s D value of 0.18 across the entire genome (One sample t-test, p < 2x10^-16). There were 1,450 genes that had at least one SNP with TajimaD value > 1 of which 125 genes had at least five SNPs with Tajima D values > 1 of which 125 genes had at least five SNPs with Tajima D values >1 (Additional file 3). These genes include apical membrane antigen-1 (ama1), erythrocyte binding antigen-175 (eba175), merozoites surface protein-1 (msp1),thrombospondin related anonymous protein ( trap), duffy binding like merozoites surface protein (dblmsp), and cytoadherence linked asexual protein 2 (clag2), that were previously reported for the balancing selection [24,29].

The standardized integrated haplotype homozygosity score (IHS) was applied to investigate genome-wide evidence for recent positive directional selection due to drug pressure, immune impact, or other mechanisms. Using |IHS| score of > 2.5 (top 1% of the expected distribution) as a threshold for hits, 36 genes with at least one SNP that could be under significant positive selection were identified, and out of these, 15 genes had at least two SNPs (Table 2; Figure 7).

Table 2: Genes under recent positive directional selection in P. falciparum in Ethiopia as identified using the integrated haplotype score at a significance threshold of P< 0.01. SNPs and ID stand for single nucleotide polymorphisms and gene identification number, respectively.

Thirteen (13) out of above 15 genes under positive directional selection showed both positive balancing and directional selections (Table 3) and these genes includes the vaccine candidate gene SURF4.2 on chromosome 4 and CLAG8 (cytoadherence linked asexual protein 8) on chromosome 8 [36].

Table 3: Genes under both recent positive directional selection and balancing selection in Ethiopian P. falciparum populations.

Interestingly, our analysis failed to detect selection signals in drug-resistance genes such as pfcrt, pfmdr1, pfdhfr, and pfdhps. The reason could be that IHS may not be suitable for detecting positive selection for those SNPs that have reached or are near fixation in the local P. falciparum population [34].

Prevalence of mutations conferring antimalarial drug resistance in Plasmodium falciparum

Table 4 shows inter-population differences in the prevalence of drug resistance genes observed among the P. falciparum global datasets analyzed. In tandem with previous studies [20,37] that suggest temporal differences in the geographical distribution of antimalarial drug resistance mutations, we observed that CQ-resistance alleles (pfcrt-K76T, pfcrt-A220S and pfcrt-Q271E) were fixed in Ethiopia, Cambodia, and Thailand, regions where malaria transmission rates are comparably low; however, the prevalence of these same alleles were 0% in Malawi and ranged from 66% to 72% in DR Congo.

Similarly, drug resistance mutations in pfmdr1 (pfmdr1-N86Y and pfmdr1-Y184F) were also variable among populations. For instance, the Ethiopian parasite population showed presence of 14% pfmdr1-N86Y and 100% pfmdr1-Y184F gene mutations, whereas pfmdr1-N86Y detected in 48% of DR Congo isolates and in 3% of Malawi’s. In addition, pfmdr1-Y184F drug resistance marker was detected in 58% of P. falciparum population in Cambodia, 32% in DR Congo, 35% in Malawi, and 6% in Thailand’s parasite isolates.

Sulfadoxine/pyrimethamine drug resistance mutations were also present in pfdhfr and pfdhps genes in all analyzed P. falciparum populations. The major pyrimethamine resistance-conferring alleles such as pfdhfr-N51I and pfdhfr-C59R were also identified in all parasite populations with fixed or near fixation in frequency. pfdhfr-S108N was fixed in other P. falciparum populations, except in Ethiopia’s. Variable prevalence of drug resistance-conferring alleles was also observed in pfdhps (pfdhps-S436A, pfdhps-G437A, pfdhps-K540N, and pfdhps-A581G), for the parent drug sulfadoxine resistance.

Table 4: Drug resistance conferring allele’s frequency across the 5 P. falciparum populations

In terms of artemisinin resistance, the African population-specific Pfk13-K189T mutation was observed in Ethiopia (in 20% of the samples), DR Congo (17%), and Malawi (13%). This mutation was previously identified in African P. falciparum populations [20,37]. As previously reported [8] the validated and most characterized artemisinin resistance-conferring mutation pfK13-C580Y was identified in Cambodia (36% of the samples) as well as in Thailand (26%), but not in Africa.

The transmission dynamic coupled with the unique history, ecology and demography of Ethiopia raises interest in the genetics of its parasite population. High resolution whole genome SNP data was used to analyze P. falciparum parasite genetic diversity in central region of Ethiopia and compared with similar parasite data from mainland Africa (DR Congo and Malawi) and Southeast Asian parasites from Cambodia and Thailand. We observe similar MAF across all five parasite populations with over representation of low frequency (< 5%) variants as previously reported [19, 21]. Interestingly, mean F_ws values were significantly higher in the Ethiopian parasite isolates compared to the other African populations but not the Southeast Asian parasite populations. F_ws is genome-wide metric that averages heterozygosity across the genome in comparison with heterozygosity within the local parasite population [21]. Hence it is a measure of within-host diversity of infections that allows us to gauge the potential for inbreeding (or outcrossing). The higher F_ws values (> 0.95) in Ethiopia (P. falciparum prevalence of 0.02) [38] and east Asian infections is underscored by the low malaria transmission rates in these settings which supports a higher inbreeding and clonal propagation of infections (Fig. 4; Additional file 2). Unlike the other East African countries (DR Congo and Malawi) where transmission intensities are higher [20, 37], and there was a good distribution of F_ws values with majority of infections being polyclonal with high potential for outcrossing (Fig. 4). These findings are supported by a similar studies that link lower F_WS values to in west African where transmission is high [18]. However, of note, is possibility for high F_WS values to occur in areas of high transmission intensity if P. falciparum circulates in a geographically isolated community which limits the chance of outcrossing with other genetically distinct P. falciparum parasites as observed in the previous study [21].

Further, we found that overall, genetic diversity (π) in the Ethiopian P. falciparum population was relatively lower than that in the Malawian P. falciparum population. This observation is probably because of the higher potential for outcrossing in Malawi as compared to Ethiopia due to differences in parasites transmission intensity. P. falciparum malaria transmission occurs throughout the year in Malawi [20], unlike Ethiopia where transmission is low and fragmented especially in the region where these samples were collected [38]. Our observed variance in pairwise genetic Diversity (π) across the 14 chromosomes of P. falciparum parasites in Ethiopia with a tendency for higher genetic diversity in the smaller chromosomes, notably 1 and 4, and lowest values in chromosome 12 (Fig. 3), may be explained by differences in recombination activities at chromosomal level as observed in the previous studies [20, 35].

An analysis of parasite population structure within and between continents revealed a higher degree of population structure between Ethiopian parasites and other east African parasites and between Southeast Asia and East Africa. However, neither PCA (Fig. 5) nor admixture analysis (Fig. 6) could resolve parasite populations in DR Congo and Malawi. These observations are corroborated by several studies that report regional and inter-continental level structure in global P. falciparum parasite populations [21]. However, the separation of Ethiopian parasites from the two east African populations is worth noting. Notwithstanding the increased human mobility between Addis Ababa and the rest of Africa, particularly east Africa, there remain important barriers to gene flow between parasite populations in central Ethiopia and the rest of the sub-region. We believe one of the factors that severely limit gene flow between Ethiopia and its neighbors is the local malaria transmission intensity as a function of poor vectoral capacity determined by the ecological landscape (highlands).

Against the backdrop of this unique eco-epidemiology of P. falciparum malaria in Ethiopia, TajimaD and HIS identified many antigenic genes to be under balancing selection with TajimaD value greater than one. These genes included known vaccine candidates such as ama1, trap, msp1, eba175, and clag2 (Additional file 3) which were previously identified in different populations that vary in transmission intensity [24, 29, 39], to be under balancing selection. Besides, we identified 15 genes under positive directional selection by IHS, which includes SURFIN and PHIST families previously suggested to be targets of immunity [24]. We believe the low seasonal transmission in Ethiopia maintains significant immune selection pressure on the infection reservoir than drug pressure due to clinical malaria. Therefore, the candidate vaccine antigen loci under balancing selection may be largely due to immune modulation and not positive adaptive selection influenced by drug pressure. This is supported by a failure to detect selection signatures in known drug target genes such as pfcrt, pfmdr1, pfdhfr, pfdhps, and pfkelch-13. In this study, the ability of IHS to detect selection in these drug resistance genes in Ethiopia may be because the frequency of polymorphisms in these loci are either fixed or near fixation in the Ethiopian population (Table 4). These findings are supported by a previous study in Ethiopia which showed that the CQ-resistant haplotype (CVIET) was fixed [7]. The continued use of CQ in Ethiopia for the treatment of P. vivax malaria may account for the high prevalence of CQ resistant markers through indirect pressure. Also, pfmdr 1 mutations have been demonstrated to mediate AL resistance and therefore, the high prevalence of pfmdr 1 mutations may signal poor efficacy of AL as first treatment for P. falciparum malaria in Ethiopia. Variable prevalence of CQ-resistant polymorphisms were observed only in DR Congo and not in Malawi, evidence that support the complete reversal of CQ susceptibility in Malawi as reported by Ochola etal [20]

Undoubtedly, artemisinin resistance has taken root in Southeast Asia. Although no validated pfKelch13 mutation was found in the African samples, 36% and 26% prevalence of pfKelch13-C580Y mutations were reported in Cambodia and Thailand, respectively. However, an uncharacterized pfkelch13 mutation (pfK13-K189T) found at prevalence > 10% in all the African datasets was previously reported in other studies [37] although its role in artemisinin resistance is yet to be determined. Indeed, a study reported mutation in pfkelch13 at amino acid positions less than 441that may not play any role in mediating artemisinin resistance [8]. But, validated pfkelch13- R561H mutation for artemisinin resistance was recently reported in other East African P. falciparum populations [9].

Overall, our study revealed comparably low genetic diversity of P. falciparum parasites in Ethiopia. The majority of infections were of low complexity, demonstrated significant population structure with Ethiopian parasites diverged from parasite populations within the sub-region. We highlight limited gene flow between parasite populations in the east African sub-region and Ethiopia. We also reported balancing selection in antigenic loci known to be targets of immunity and adaptive positive selection in SURFIN and PHIST gene families that are potential vaccine antigens. Though selection analysis did not pick up any adaptive mutations in known drug resistant genes, we reported fixation of the CQ-resistance pfcrt-K76T genotype and others in Ethiopia and the wild-type genotype (K) in Malawi. We reported no pfKelch13 validated mutations in Ethiopia, DR Congo and Malawi except a PfK13-K189TAfrican specific uncharacterized mutation. Further molecular studies involving deeper sampling of Ethiopian parasite populations are essential to understand the genetic diversity, gene flow and temporal evolution of drug resistance loci within Ethiopia. Our findings can be used to support national malaria control decision making for optimal impact in further reducing malaria transmission in Ethiopia.

ACT: Artemisinin Combined therapy; AL:Artemether-Lumefantrine; ART:Artemisinin; CQ:Chloroquine; FWS:Within infection diversity fixation index; FST:Population differentiation fixation index; HW:Heterozygosity within infection; HS:Heterozygosity within local population; IHS:Standardized Integrated haplotype Score; IRS:Indoor Residual Spray; ITN:Insecticide treated Nets; P. falciparum:plasmodium falciparum; Pfcrt:Plasmodium falciparum chloroquine; Pfdhfr:Plasmodium falciparum dihydrofolate reductase; Pfdhps:Plasmodium falciparum pteroate synthase; PfK13:Plasmodium falciparum kelch-13; P. vivax:Plasmodium vivax; SNP:Single Nucleotide Polymorphisms; SP:Sulfadoxine/Pyrimethamine

Ethics approval and consent to participate

The use of human subjects and scientific merit for this study was approved by the institutional Ethical Review Board (IRB) and scientific committee of Addis Ababa University and AHRI-ALERT (Armauer Hansen Research Institute and the Africa Leprosy Rehabilitation and Training Hospital). Written informed consent was obtained from all adult subjects and from the parent or legal guardians of minors.

Consent for publication

Not applicable

Availability of data and materials

Datasets generated and/or analyzed during the study are available through the MalariaGEN Pf3K Project. The P. falciparum genome sequences used in this study are available in the ENA and SRA databases (see Additional file 1 for accession numbers)

Competing interests

The authors declare that they have no competing interests.

Funding

This project was funded by the Developing Excellence in Leadership and Genetics Training for Malaria Elimination in sub-Saharan Africa (DELGEME). DELGEME is a training programme sponsored by the Welcome Trust Developing Excellence in Leadership, Training and Science Africa (DELTAS Africa) initiative in partnership with the Department of International Development (DFID) and the Alliance for Accelerating Excellence in Science in Africa (AESA).

Authors' contributions

DA participated in study design, data analysis, interpretation and writing manuscript, CK, TD, LAE and JLB reviewed the manuscript, and LG participated in data collection, DNA extraction, genome sequencing, manuscript review.

Acknowledgements

Plasmodium falciparum genome sequencing was done at the Wellcome Sanger Institute as part of the MalariaGEN P. falciparum Community Project (www.malariagen.net/projects). We thank the MalariaGEN P. falciparum Community Project and Pf3K Project for allowing access to sequence data.

JLB is supported by DELTAS Africa Initiative grant # DEL-15-011 to THRiVE-2. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust grant # 107742/Z/15/Z and the UK government. The views expressed herein do not necessarily reflect the official opinion of the donors.

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Table 1: Pairwise population Divergence (measured by FST) among P. falciparum populations. Ethiopian P. falciparum highly diverged from both Southeast Asian and East African P. falciparum population.

Country	Cambodia	DR Congo	Ethiopia	Malawi	Thailand
Cambodia	0	0.16	0.18	0.17	0.06
DR Congo	0.16	0	0.08	0.02	0.16
Ethiopia	0.18	0.08	0	0.09	0.18
Malawi	0.17	0.02	0.09	0	0.17
Thailand	0.06	0.16	0.18	0.17	0

Table 2: Genes with at least two SNPs that had a recent positive directional selection in P. falciparum of Ethiopia, identified using the integrated haplotype score at a significance threshold of P< 0.01. SNPs and ID stand for single nucleotide polymorphisms and gene identification number, respectively.

Chromosomes	Number of SNPs	Genes Name or ID.	Product description
1	9	PF3D7_0104100	Conserved Plasmodium membrane protein, unknown function
1	3	PF3D7_0113600	Surface-associated interspersed protein 1.2 (SURFIN 1.2)
4	2	PF3D7_0424300	Erythrocyte binding antigen-165
4	14	SURF4.2	Surface-associated interspersed protein 4.2 (SURFIN 4.2)
4	5	PF3D7_0425200	Plasmodium exported protein (hyp15), unknown function
4	4	PF3D7_0425250	Plasmodium exported protein (PHIST), unknown function
7	5	PF3D7_0713900	Conserved Plasmodium protein, unknown function
7	3	CRMP2	Cysteine repeat modular protein 2
8	3	CLAG8	Cytoadherence linked asexual protein 8
10	2	PF3D7_1004800	ADP/ATP carrier protein, putative
12	2	PF3D7_1201400	Plasmodium exported protein, unknown function
13	7	PF3D7_1301800	Surface-associated interspersed protein 13.1 (SURFIN 13.1)
13	3	PF3D7_1308400	Conserved Plasmodium protein, unknown function
14	2	PF3D7_1434500	Dynein-related AAA-type ATPase, putative
14	2	PF3D7_1477500	Plasmodium exported protein (PHISTb), unknown function

Table 3: Genes under both recent positive directional Selection and positive balancing selections in Ethiopian P. falciparum populations. ID stands for a gene identification number.

Chromosomes	Gene Name/ID.	Product Description
1	PF3D7_0104100	Conserved Plasmodium membrane protein, unknown function
1	PF3D7_0113600	Surface-associated interspersed protein 1.2 (SURFIN 1.2)
4	PF3D7_0424300	Erythrocyte binding antigen-165, pseudogene
4	SURF4.2	Surface-associated interspersed protein 4.2 (SURFIN 4.2)
4	PF3D7_0425200	Plasmodium exported protein (hyp15), unknown function
4	PF3D7_0425250	Plasmodium exported protein (PHIST), unknown function
7	PF3D7_0713900	Conserved Plasmodium protein, unknown function
8	CLAG8	Cytoadherence linked asexual protein 8
10	PF3D7_1004800	ADP/ATP carrier protein, putative
12	PF3D7_1201400	Plasmodium exported protein, unknown function
13	PF3D7_1301800	Surface-associated interspersed protein 13.1 (SURFIN 13.1)
13	PF3D7_1308400	Conserved Plasmodium protein, unknown function
14	PF3D7_1434500	Dynein-related AAA-type ATPase, putative

Table 4: Drug resistance conferring alleles frequency across the 5 P. falciparum populations

Genes	Chromosome	Position	mutation site	Ethiopia	Cambodia	DR Congo	Malawi	Thailand
DHFR	4	748577	I164L	0	0.5	0	0	0.84
DHFR	4	748410	S108N	0	1	1	1	1
DHFR	4	748262	C59R	0.86	1	0.86	0.99	1
DHFR	4	748239	N51I	1	0.95	1	1	0.95
MDR1	5	961625	D1246Y	0	0	0.17	0	0
MDR1	5	958145	N86Y	0.14	0	0.48	0.03	0
MDR1	5	961566	F1226Y	0	0.04	0	0	0.59
MDR1	5	958440	Y184F	1	0.58	0.32	0.35	0.06
CRT	7	405600	I356T	0	0.52	0.27	0	1
CRT	7	405362	N326S	0.98	0.51	0	0	1
CRT	7	405838	R371I	0	0.8	0.71	0	1
CRT	7	404407	A220S	1	1	0.663	0	1
CRT	7	403625	K76T	1	1	0.66	0	1
CRT	7	404836	Q271E	1	1	0.7143	0	1
DHPS	8	549685	G437A	0.08	0.13	0.08	0.01	0
DHPS	8	549995	K540N	0	0.4	0	0	0.03
DHPS	8	549681	S436A	0	0.2	0.11	0.02	0.17
DHPS	8	550117	A581G	0.02	0.4	0.03	0.02	0.82
K13	13	1726432	K189T	0.2	0	0.17	0.13	0
K13	13	1725259	C580Y	0	0.36	0	0	0.26

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Genomic analysis reveals independent evolution of Plasmodium falciparum population in Ethiopia

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