Genome-Wide Linkage Analysis of Malaria Infection Intensity and Mild Disease

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Abstract
Although balancing selection with the sickle-cell trait and other red blood cell disorders has emphasized the interaction between malaria and human genetics, no systematic approach has so far been undertaken towards a comprehensive search for human genome variants influencing malaria. By screening 2,551 families in rural Ghana, West Africa, 108 nuclear families were identified who were exposed to hyperendemic malaria transmission and were homozygous wild-type for the established malaria resistance factors of hemoglobin (Hb)S, HbC, alpha+ thalassemia, and glucose-6-phosphate-dehydrogenase deficiency. Of these families, 392 siblings aged 0.5–11 y were characterized for malaria susceptibility by closely monitoring parasite counts, malaria fever episodes, and anemia over 8 mo. An autosome-wide linkage analysis based on 10,000 single-nucleotide polymorphisms was conducted in 68 selected families including 241 siblings forming 330 sib pairs. Several regions were identified which showed evidence for linkage to the parasitological and clinical phenotypes studied, among them a prominent signal on Chromosome 10p15 obtained with malaria fever episodes (asymptotic z score = 4.37, empirical p-value = 4.0 × 10−5, locus-specific heritability of 37.7%; 95% confidence interval, 15.7%–59.7%). The identification of genetic variants underlying the linkage signals may reveal as yet unrecognized pathways influencing human resistance to malaria. In tropical Africa, virtually all children become infected with malaria parasites. Most of them experience several malaria attacks per year, and over a million die from disease complications. Sickle-cell anemia, thalassemias, and other inherited red blood cell disorders indicate that malaria has selected for human genetic variants, but no attempts have so far been reported to systematically screen the human genome for malaria-resistance factors. We describe a genome-wide linkage analysis performed in children living in rural Ghana, West Africa, including approaches to select an informative study cohort and to assess, over a period of 8 mo, individual disposition to malaria parasitemia, fever episodes, and anemia. Families carrying the known malaria-protective red blood cell disorders were excluded, infection intensities were adjusted to the use of mosquito-protection devices, and parasitological and clinical findings were corrected according to the state of partial malaria immunity, which, under constant exposure, gradually develops over the first 10 y of life. The study revealed several genomic regions showing evidence for linkage to the various malaria phenotypes recorded, among them a prominent signal on Chromosome 10 correlated to the frequency of fever episodes. Future identification of genes involved is expected to reveal previously unrecognized pathways that may protect children against malaria.