Expansion of GTP cyclohydrolase I copy number in malaria parasites resistant to a pyrimidine biosynthesis inhibitor.

Changes in the copy number of large genomic regions, termed copy number variations or CNVs, are an important adaptive strategy for malaria parasites. Numerous CNVs across the Plasmodium falciparum genome contribute directly to drug resistance or impact fitness of this protozoan parasite. CNVs that encompass the dihydroorotate dehydrogenase (DHODH) gene confer resistance to antimalarials that target this enzyme in the pyrimidine biosynthesis pathway (i.e. DSM1). During the characterization of DSM1 resistant parasite lines with DHODH CNVs, we detected selection of an additional CNV that encompasses 3 genes (~5 kb) including GTP cyclohydrolase I (GCH1 amplicon). While this locus has been implicated in increased fitness of antifolate resistant parasites, GCH1 CNVs had not previously been reported to contribute to resistance to other antimalarials. Here, we further explored the association between GCH1 and DHODH copy number. We visualized single long reads and directly quantified the number of tandem GCH1 amplicons in a parental line versus a DSM1-selected line. We found that the GCH1 amplicons share a consistent structure in all lines. However, we detected more reads that encompassed a higher number of amplicons in the resistant (up to 7 amplicons) compared to the parental line (3 amplicons). To better understand the implications of this result, we evaluated variation at this locus across multiple short- and long-read data sets collected from various parasite lines. Based on our analysis of parasites resistant to other DHODH inhibitors (DSM265, DSM267, and DSM705), GCH1 is not likely contributing directly to resistance; however, higher numbers of the GCH1 amplicon are associated with increased DHODH copies and may compensate for changes in metabolism of parasites. This is supported by the direct connection between folate and pyrimidine metabolism, which together contribute to nucleic acid biosynthesis. This study highlights the importance of studying clonal variation and potential biochemical connections as novel antimalarials move closer to clinical approval.