Multiple adaptive trajectories shape antimalarial resistance evolution in Ethiopian Plasmodium falciparum

Multiple adaptive trajectories shape antimalarial resistance evolution in Ethiopian Plasmodium falciparum, including selection around PfK13 R622I and emergence of the PfPX1 D384A-PIN haplotype.

• Why it matters: Ethiopia’s 2024 resurgence and sub-Saharan transmission diversity create uncertainty about how resistance evolves—whether via one dominant lineage or several adaptive routes.
• What they did: Whole-genome data from 120 Ethiopian isolates collected in 2024 were analyzed across five transmission settings and compared with 1,220 public genomes to detect selection, co-occurring mutations, and identity-by-descent links.
• The result: Evidence of recent positive selection around PfK13 R622I co-occurred with Pfcrt mutations and recurrent signals in PfK13-associated haemoglobin endocytosis genes, while PfPX1 D384A-PIN linked Ethiopian and Ugandan carriers and suggests recent introduction plus local selection.

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