Longitudinal Pooled Deep Sequencing of the Plasmodium vivax K12 Kelch Gene in Cambodia Reveals a Lack of Selection by Artemisinin

Nicholas F. Brazeau Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Doctor of Medicine/Doctor of Philosophy Program, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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Nicholas Hathaway Program in Bioinformatics and Integrative Biology, University of Massachusetts, Worcester, Massachusetts.
School of Medicine, University of Massachusetts, Worcester, Massachusetts.

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Christian M. Parobek Doctor of Medicine/Doctor of Philosophy Program, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Curriculum in Genetics and Molecular Biology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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Jessica T. Lin Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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Jeffrey A. Bailey Program in Bioinformatics and Integrative Biology, University of Massachusetts, Worcester, Massachusetts.
School of Medicine, University of Massachusetts, Worcester, Massachusetts.

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Chanthap Lon Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.

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David L. Saunders Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.

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Jonathan J. Juliano Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Program in Bioinformatics and Integrative Biology, University of Massachusetts, Worcester, Massachusetts.
Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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Abstract

The emergence of artemisinin resistance among Plasmodium falciparum in the Greater Mekong subregion threatens malaria control interventions and is associated with multiple unique mutations in K13 (PF3D7_1343700). The aim of this study was to survey Cambodian Plasmodium vivax for mutations in the K13 ortholog (K12, PVX_083080) that might similarly confer artemisinin resistance. Extracted DNA from Cambodian isolates collected between 2009 and 2012 was pooled by province and year and submitted for next-generation sequencing. Single-nucleotide polymorphisms (SNPs) were identified using a pile-up approach that detected minority SNPs. Among the 14 pools, we found six unique SNPs, including three nonsynonymous SNPs, across six codons in K12. However, none of the SNPs were orthologous to artemisinin resistance–conferring mutations in PF3D7_1343700, and nonsynonymous changes did not persist through time within populations. These results suggest a lack of selection in the P. vivax population in Cambodia due to artemisinin drug pressure.

Author Notes

* Address correspondence to Jonathan J. Juliano, Division of Infectious Diseases, CB#7030, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599. E-mail: jjuliano@med.unc.edu
† These authors contributed equally to this work.

Authors' addresses: Nicholas F. Brazeau, University of North Carolina School of Medicine, Chapel Hill, NC, E-mail: nbrazeau@med.unc.edu. Nicholas Hathaway, School of Medicine, University of Massachusetts Medical School, Worcester, MA, E-mail: nickjhathaway@gmail.com. Christian M. Parobek, Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, E-mail: christian_parobek@med.unc.edu. Jessica T. Lin, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, E-mail: jessica_lin@med.unc.edu. Jeffrey A. Bailey, Division of Transfusion Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, and Program in Bioinformatics and Integrative Biology, University of Massachusetts, Worcester, MA, E-mail: jeffrey.bailey@umassmed.edu. Chanthap Lon and David L. Saunders, Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand, E-mails: chanthapl@afrims.org and david.l.saunders.mil@mail.mil. Jonathan J. Juliano, Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: jonathan_juliano@med.unc.edu.

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