Serology and Amplicon Deep Sequencing of MSP1-Block 2 Haplotypes as New Tools for Plasmodium Vivax Infections

Background: Relapses of Plasmodium vivax (P. vivax) infections are major causes of malaria morbidity, and tools for distinguishing relapses from reinfections are needed in malaria endemic areas. Methods: Herein, a panel of plasmas of 72 P. vivax-infected pregnant women, of whom 31 had had at least a recurrence of P. vivax infection, was used in a serology for IgM and IgG against 6 P. vivax-merozoite surface protein-1 (P. vivax-MSP1-Block 2) haplotype-specific peptides, in order to identify re-expositions to same haplotypes in the recurrences during the pregnancy. In parallel, we used the amplicon deep sequencing (ADS) with P. vivax-MSP1-Block 2 amplicons of the in eight blood samples of non-pregnant P. vivax-infected patients to identify multi or monoclonal infections based on MSP1-Block-2 haplotypes, and to quantify the reads of different haplotypes between those with multiclonal infections. We synthetized a new panel of overlapping peptides mapping each one of the six P. vivax-MSP1-Block 2 haplotypes and we validated with new IgM and IgG serology. Results: Most pregnant women presented IgM that recognized more than one peptide, thus indicating multiple infections by P. vivax-MSP1-Block 2 haplotypes. The same IgM anti-peptides remained in several women in the recurrent episodes most likely indicates re-exposure to the same haplotype of MSP1 Block 2. The IgG reactivity the IgM to IgG switch were low. The ADS using next-generation sequencing (NGS) identified multi- and monoinfection by P. vivax-MSP1-Block 2 haplotypes. Of eight patients, two of them had had the first P. vivax-infection. Monoinfections with P. vivax-MSP1-Block 2 haplotypes were observed in two prime-infected patients and three of patients with previous malaria. In all P. vivax-MSP1-Block 2 haplotype-monoinfected patients, the reactivity of IgM was observed only against overlapped peptides of the same haplotype detected in ADS, while for IgG, no reactivity was observed for any of the peptides of the same haplotype or the others.We were able to identify multiclonal infections through three haplotypes of P. vivax MSP1 Block 2 in three remaining patients, among which, there was always one majority haplotype that predominated with more of 95% of high-quality reads. The levels of haplotype-specific IgM in the serology correlated with the read ratios of each haplotype, but IgG levels not, including in one of the multiclonal infections, a minority haplotype was recognized with higher levels of IgG than that of the majority one. Conclusion: Our findings suggest that the combination of ADS and serology for P. vivax-MSP1-Block 2 haplotypes may be used as a new tool for distinguishing reinfections from relapses in malaria.