Intrinsic multiplication rate variation and plasticity of human blood stage malaria parasites

Pathogen multiplication rate is theoretically an important determinant of virulence, although often poorly understood. We show intrinsic multiplication rate variation of the major human malaria parasite Plasmodium falciparum to be associated with blood-stage infection intensity. A panel of clinical isolates from a highly endemic West African population was analysed repeatedly during five months of continuous culture, showing a range of exponential multiplication rates at all timepoints tested, mean rates increasing over time. All isolates had different genome sequences, many containing within-isolate diversity that decreased over time, but increases in multiplication rates were not primarily attributable to genomic selection. New mutants, including premature stop codons emerging in a few isolates, did not attain sufficiently high frequencies to substantially affect overall multiplication rates. Significantly, multiplication rate variation at each of the cultured timepoints robustly correlated with parasite levels in patients at clinical presentation, indicating parasite control of multiplication that contributes to virulence.