Genetic diversity and natural selection in the rhoptry-associated protein 1 (RAP-1) of recent Plasmodium knowlesi clinical isolates from Malaysia
© Rawa et al. 2016
Received: 25 November 2015
Accepted: 25 January 2016
Published: 5 February 2016
The Plasmodium rhoptry-associated protein 1 (RAP-1) plays a role in the formation of the parasitophorous vacuole following the parasite’s invasion of red blood cells. Although there is some evidence that the protein is recognized by the host’s immune system, study of Plasmodium falciparum RAP-1 (PfRAP-1) suggests that it is not under immune pressure. A previous study on five old (1953–1962) P. knowlesi strains suggested that RAP-1 has limited genetic polymorphism and might be under negative selection. In the present study, 30 recent P. knowlesi isolates were studied to obtain a better insight into the polymorphism and natural selection of PkRAP-1.
Blood samples from 30 knowlesi malaria patients were used. These samples were collected between 2010 and 2014. The PkRAP-1 gene, which contains two exons, was amplified by PCR, cloned into Escherichia coli and sequenced. Genetic diversity and phylogenetic analyses were performed using MEGA6 and DnaSP ver. 5.10.00 programs.
Thirty PkRAP-1 sequences were obtained. The nucleotide diversity (π) of exons 1, 2 and the total coding region (0.00915, 0.01353 and 0.01298, respectively) were higher than those of the old strains. Further analysis revealed a lower rate of non-synonymous (dN) than synonymous (dS) mutations, suggesting negative (purifying) selection of PkRAP-1. Tajima’s D test and Fu and Li’s D test values were not significant. At the amino acid level, 22 haplotypes were established with haplotype H7 having the highest frequency (7/34, 20.5 %). In the phylogenetic analysis, two distinct haplotype groups were observed. The first group contained the majority of the haplotypes, whereas the second had fewer haplotypes.
The present study found higher genetic polymorphism in the PkRAP-1 gene than the polymorphism level reported in a previous study. This observation may stem from the difference in sample size between the present (n = 30) and the previous (n = 5) study. Synonymous and non-synonymous mutation analysis indicated purifying (negative) selection of the gene. The separation of PkRAP-1haplotypes into two groups provides further evidence to the postulation of two distinct P. knowlesi types or lineages.
The pathogenesis of malaria parasites incorporates the orchestrated action of various proteins, a few of which are primary targets for anti-malarial vaccines. These proteins frequently exhibit high levels of heterozygosity, and their rapid rates of evolution may be essential for the parasite to escape the host’s immune defence . Highly polymorphic proteins are often favoured by positive selection, in which selective forces, such as immune responses and drugs, drive the genes expressing these antigenic proteins to accumulate mutations and maintain them in the population . This strategy enables the parasite to manifest antigenically different alleles to thwart the host’s immune response. Alternatively, these alleles may be eliminated or negatively selected in the case of less fit genetic variants.
The Plasmodium merozoite invasion of red blood cells involves binding, apical orientation and secretion of apical organelle contents known as rhoptries, micronemes and dense granules [3–5]. Proteins in these organelles have been implicated in key aspects of invasion. These include the formation of moving junctions between the merozoite and erythrocyte surfaces, which subsequently leads to the formation of the parasitophorous vacuole in which the parasite resides. Rhoptry-associated protein 1 (RAP-1) plays a role in the latter process , although its precise function is unknown. RAP-1 forms a complex with smaller proteins, RAP-2 or RAP-3, and deletion of the RAP-1 gene results in mistargeting of RAP-2 to the rhoptries .
Limited polymorphism in the Plasmodium falciparum RAP-1 (PfRAP-1) suggests that it is not under an immune pressure . However, there is some evidence that RAP-1 is recognized by the host’s immune system and that antibodies to this protein inhibit merozoite invasion . For example, monoclonal antibodies against PfRAP-1 hindered erythrocyte invasion in vitro [8, 9] and partial protection against P. falciparum challenge infection was observed in Saimiri sciureus and S. boliviensis monkeys immunized with PfRAP-1 and PfRAP-2 [10, 11]. Although there have been extensive studies of PfRAP-1, studies on the P. knowlesi orthologue are limited.
In a recent investigation it was demonstrated that negative selection might be acting on the RAP-1 of non-human primate parasites, including P. knowlesi . However, the study used only five old (isolated in 1955–1965) P. knowlesi strains, which may not reflect the true picture of polymorphism in P. knowlesi RAP-1 (PkRAP-1). In the present study, the RAP-1 of 30 recently isolated P. knowlesi was investigated to obtain a better picture of the parasite’s diversity.
Blood sample collection and ethics approval
Between 2010 and 2014, 30 blood samples of patients with P. knowlesi infection were collected from the University of Malaya Medical Centre and several private clinics in Peninsular Malaysia. Ethics approval for the use of the blood samples was granted by the University of Malaya Medical Centre Ethic Committee (MEC No. 817.18). P. knowlesi infection in each patient was confirmed by microscopic examination of Giemsa-stained thin and thick blood smears and polymerase chain reaction (PCR) amplification using diagnostic primers .
Extraction of DNA
Plasmodium knowlesi genomic DNA was extracted from 100 μl of each blood sample using the QIAGEN Blood DNA Extraction Kit (QIAGEN, Hilden, Germany) following the manufacturer’s protocol. Extracted DNA was eluted in 100 μl of elution buffer.
Amplification by PCR of PkRAP-1
Amplification of the PkRAP-1 gene was conducted by PCR using specific oligonucleotide primers PkRAP-1F: 5′-CGT TGA GCA GGA AAT GCC TAC TCC AAT C-3′ and PkRAP-1R: 5′-ATG ATA ACG TAC GCA AGT TCT CTG CTG G-3′. These primers (nucleotide positions 1782248–1782275 and 1784654–1784681) were based on the RAP-1 gene sequence of P. knowlesi strain H (GenBank Accession No. AM910995). The high fidelity DNA polymerase GoTaq® Long PCR Mastermix (Promega, Madison, WI, USA) was used to provide proofreading activity and efficient long DNA amplification. PCR was conducted in a total volume of 25 ml that included a final concentration of 1 × PCR mastermix, 0.4 mM of each primer and 100–500 ng of total genomic DNA. Thermal cycling profile began with an initial denaturation step at 95 °C for 2 min, followed by 35 cycles at 94 °C for 30 s and 63 °C for 2 min and 30 s, with a final extension at 72 °C for 10 min. A PCR product with an expected size of 2433 or 2434 bp was detected following electrophoresis on 1 % agarose gels.
Purification of PCR product and DNA cloning
Purification of PCR products was performed using the QIAquick PCR Purification Kit (QIAGEN) according to the manufacturer’s instructions. The concentration and purity of each product were determined using the NanoDrop 2000 (Thermo Fisher Scientific, Waltham, MA, USA). The purified PCR products were then ligated into the pGEM-T vector (Promega) and transformed into Escherichia coli TOP10F’ competent cells. Recombinant plasmids from the transformants were selected and sent to a commercial laboratory for DNA sequencing. To verify the sequences, the recombinant plasmids of three clones from each isolate were sequenced. In addition, the sequencing was performed in both directions of the inserts in the plasmids.
Sequence and phylogenetic analyses
RAP-1 sequence polymorphism analysis
The number of segregating sites (S), the number of haplotypes (H), haplotype diversity (Hd) and nucleotide diversity (π) were calculated using DnaSP version 5.10.00 . To estimate the step-wise diversity across the PkRAP-1, π was established on a sliding window of 100 bases, with a step size of 25 bp. The Z test (P < 0.05) in MEGA6, employing the Nei and Gojobori method and the Jukes and Cantor correction, was used to estimate and compare the rates of synonymous (dS) and non-synonymous (dN) substitutions. dN will be lower than dS (dN/dS < 1) when a gene is under negative (purifying) selection, while dN will be greater than dS (dN/dS > 1) when the positive selection is more advantageous. Tajima’s D  and Fu and Li’s D  test statistics in the DnaSP version 5.10.00 were used to detect departure from the neutral theory of evolution.
Nucleotide diversity and genetic differentiation
The in PkRAP-1 contains two exons and one intron (Fig. 1). PCR amplification using the above primers produced a fragment of either 2433 or 2434 bp fragment. The difference in the fragment size was due to the presence of an additional nucleotide in the intron of some of the isolates. After sequencing, the sequences trimmed to obtain the full length PkRAP-1 (2411 or 2412 bp). Thirty sequences of Pk RAP-1 were obtained (GenBank Accession Numbers listed in Additional file 1). These sequences were aligned and analysed for the diversity and natural selection. A comparison was also made between these sequences and the Pk RAP-1 of old strains including Nuri, Hackeri, Malayan and Philippines (isolated in 1953, 1960, 1962, and 1961, respectively).
Estimates of DNA diversity, selection, and neutrality tests of PkRAP-1 in Malaysia
Hd ± SD
π ± SD
dN ± SE
dS ± SE
Fu and Li’s D
0.818 ± 0.054
0.00915 ± 0.00089
0.00574 ± 0.00352
0.02253 ± 0.01104
dN = dS
(P > 0.10)
(P > 0.10)
0.993 ± 0.009
0.01353 ± 0.00102
0.00894 ± 0.00145
0.03274 ± 0.00591
dN < dS
(P < 0.05)
(P > 0.10)
(P > 0.10)
0.995 ± 0.009
0.01298 ± 0.00091
0.00854 ± 0.00126
0.03137 ± 0.00483
dN < dS
(P < 0.05)
(P > 0.10)
(P > 0.10)
Amino acid changes and phylogenetic analysis
RAP-1 haplotypes of Plasmodium knowlesi strains and isolates
Strain/isolate (year isolated)
Malayan (1962), NG (2011)
Hackeri (1960), UM 0004 (2012), UM 0016 (2012), UM 0092 (2013)
UM 0002 (2012), UM 0115 (2014)
MAI (2010), UM 0088 (2013)
AZL (2011), UM 0006 (2012), UM 0018 (2012), UM 0047 (2013), UM 0050 (2013), UM 0058 (2013), UM 0060 (2013)
UM 0001 (2012)
UM 0009 (2012)
UM 0014 (2012)
UM 0015 (2012)
UM 0020 (2012)
UM 0021 (2012)
UM 0029 (2012)
UM 0032 (2012)
UM 0034 (2012)
UM 0063 (2013)
UM 0070 (2013)
UM 0090 (2013)
UM 0105 (2014)
UM 0118 (2014)
Natural selection in the PkRAP-1 gene
A significant excess of synonymous substitutions was seen in the PkRAP-1. The calculated ratios dN/dS for exon 1, exon 2 and total coding region less than 1 (Table 1). This was indicative of negative selection of PkRAP-1. Detailed analysis using the Z test revealed negative selection in exon 2, but neutral selection in exon 1. In the Tajima’s D and Fu and Li’s D tests, all values obtained for PkRAP-1 were negative, but did not differ statistically (P > 0.10) significantly from zero. Therefore, Tajima’s D and related statistics did not detect departure from neutrality.
A study has been carried out previously on the diversity and natural selection of PkRAP-1, albeit using a small sample size (n = 5) of old P. knowlesi strains . The present study was carried out using the same approach, but using a larger sample size (n = 30) consisting of recent isolates. Unlike the findings on the old strains [π: 0.0082 (total coding region), 0.0123 (exon 1), 0.0076 (exon 2)], the present study found relatively higher diversity among the PkRAP-1 of the recent isolates [π: 0.01298 (total coding region)], and diversity was much higher in exon 2 (π: 0.01353) than in exon 1(π: 0.00915). However, both the old strains and recent isolates showed negative selection in exon 2 and neutral selection in exon 1. The PkRAP-1 (π: 0.01298) was observed to be relatively more diverse than PfRAP-1 (π: 0.0041)  and PvRAP-1 (π: 0.00088) . A similar finding was reported for rhoptry bulb proteins . It has been suggested that such contrasting level of polymorphism in rhoptry-related proteins is expected because these proteins are distinct across the Plasmodium species, presumably for adaptation in their respective target host cells .
Merozoite surface protein-8 (MSP-8), MSP-9, apical membrane antigen-1 (AMA-1) and Duffy binding protein (DBPαII) are among the widely studied proteins known to be potential vaccine candidates. For P. knowlesi, the MSP-8 , MSP-9  and AMA-1  expressed lower genetic diversity (π: 0.0008 and 0.00501, respectively) than PkRAP-1. Pk DBPαII (π: 0.013) , however, has almost similar diversity level with PkRAP-1. Similar to PkRAP-1, these proteins also appear to be under negative selection.
The sliding window plot analysis showed that Pk RAP-1 was more conserved at the C-terminal region. This is most likely due to the role of this region in a key binding activity. The RAP-1 is known to bind to RAP-2 or RAP-3 via its C-terminal region . Furthermore, deletion of the RAP-1 C-terminus leads to RAP-1 mislocalization to the rhoptry neck instead of the bulb , suggesting the importance of this region in protein targeting. In contrast, the N-terminal of PkRAP-1 exhibited genetic diversity and this may be due to the presence of T cell epitopes. It has been observed that lymphocytes gave response to the N-terminus of PfRAP-1 [23, 24].
Many of the malaria parasite blood stage antigens, such as the merozoite surface proteins, display polymorhism as a result of positive selection . This is said to be an escape mechanism for the parasite to evade the immune responses of the host. Antigenic polymorphism involving the expression of different alleles of the gene would hamper the host’s immune system to recognize the protein . Immune defences, such as antibodies and T cells, will not be able to identify antigenically different epitopes, and these mutated alleles will then be selectively expanded. Negative selection usually minimizes genetic variants, therefore leading to low frequency rare alleles in the population. Low frequency rare haplotypes were evident among the PkRAP-1 in the present study (Fig. 3).
Interestingly, negative selection is also seen in the RAP-1 gene of several non-human primate malarial parasites such as P. cynomolgi, P. inui and P. fieldi but not in human malaria parasites, such as P. falciparum and P. vivax . For P. knowlesi, this negative selection may be due to a bottleneck event that drives population expansion or growth. Mitochodrial DNA analysis have shown that P. knowlesi in Southeast Asia underwent significant population expansion approximately 30,000–40,000 years ago . An alternative explanation for the negative selection is that PkRAP-1, being an important protein in erythrocyte invasion, has functional constraints that limit polymorphism, and any variant form of PkRAP-1 will be disadvantageous to the parasite.
The phylogenetic tree in this present study also showed separation of the PkRAP-1 haplotypes into two groups (Fig. 4). This separation of PkRAP-1 haplotypes groups may indicate dimorphism of the gene. Similar observations have been reported in P. knowlesi genes such as PkDBPαII , Pknbpxa , PkAMA-1 domain I  and PkMSP-1 . These findings provide support to the postulation of the existence of two distinct P. knowlesi types or lineages in Southeast Asia . Microsatellite genotyping data revealed admixture of two highly divergent P. knowlesi populations, and each population is associated with different forest-dwelling macaque reservoir host species . Recently, a whole-genome population study showed two major sub-groups of P. knowlesi clinical isolates .
The present study found higher genetic polymorphism in the PkRAP-1 gene than the polymorphism level reported in a previous study. This observation may stem from the difference in sample size between the present (n = 30) and the previous (n = 5) study. Synonymous and nonsynonymous mutation analysis indicated purifying (negative) selection of the gene. The separation of PkRAP-1 haplotypes into two groups is further evidence to the existence of two distinct P. knowlesi types or lineages.
MYF and YLL designed the study and supervised the study process. MSAR performed all the experiments. MSAR and MYF performed sequence and phylogenetic analyses. MSAR, MYF and YLL wrote the manuscript. All authors read and approved the final manuscript.
This study was supported by the UM High Impact Research Grant UM-MOHE UM.C/625/1/HIR/MOHE/MED/09 from the Ministry of Education, Malaysia. We thank the Department of Parasitology Diagnostic Laboratory, Faculty of Medicine, University of Malaya and University of Malaya Medical Centre for providing the patient blood samples.
The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Hughes MK, Hughes AL. Natural selection on Plasmodium surface proteins. Mol Biochem Parasitol. 1995;71:99–113.View ArticlePubMedGoogle Scholar
- Escalante AA, Cornejo OE, Rojas A, Udhayakumar V, Lal AA. Assessing the effect of natural selection in malaria parasites. Trends Parasitol. 2004;20:388–95.View ArticlePubMedGoogle Scholar
- Counihan NA, Kalanon M, Coppel RL, de Koning-Ward TF. Plasmodium rhoptry proteins: why order is important. Trends Parasitol. 2013;29:228–36.View ArticlePubMedGoogle Scholar
- Baum J, Gilberger TW, Frischknecht F, Meissner M. Host-cell invasion by malaria parasites: insights from Plasmodium and Toxoplasma. Trends Parasitol. 2008;24:557–63.View ArticlePubMedGoogle Scholar
- Kats LM, Cooke BM, Coppel RL, Black CG. Protein trafficking to apical organelles of malaria parasites– building an invasion machine. Traffic. 2008;9:176–86.View ArticlePubMedGoogle Scholar
- Baldi DL, Andrews KT, Waller RF, Roos DS, Howard RF, Crabb BS, Cowman AF. RAP1 controls rhoptry targeting of RAP2 in the malaria parasite Plasmodium falciparum. EMBO J. 2000;19:2435–43.PubMed CentralView ArticlePubMedGoogle Scholar
- Pacheco MA, Ryan EM, Poe AC, Basco L, Udhayakumar V, Collins WE, et al. Evidence for negative selection on the gene encoding rhoptry-associated protein 1 (RAP-1) in Plasmodium spp. Infect Genet Evol. 2010;10:655–61.View ArticlePubMedGoogle Scholar
- Harnyuttanakorn P, McBride JS, Donachie S, Heidrich HG, Ridley RG. Inhibitory monoclonal antibodies recognise epitopes adjacent to a proteolytic cleavage site on the RAP-1 protein of Plasmodium falciparum. Mol Biochem Parasitol. 1992;55:177–86.View ArticlePubMedGoogle Scholar
- Schofield L, Bushell GR, Cooper JA, Saul AJ, Upcroft JA, Kidson C. A rhoptry antigen of Plasmodium falciparum contains conserved and variable epitopes recognized by inhibitory monoclonal antibodies. Mol Biochem Parasitol. 1986;18:183–95.View ArticlePubMedGoogle Scholar
- Perrin LH, Merkli B, Gabra MS, Stocker JW, Chizzolini C, Richle R. Immunization with a Plasmodium falciparum merozoite surface antigen induces a partial immunity in monkeys. J Clin Invest. 1985;75:1718–21.PubMed CentralView ArticlePubMedGoogle Scholar
- Collins WE, Walduck A, Sullivan JS, Andrews K, Stowers A, Morris CL, et al. Efficacy of vaccines containing rhoptry-associated proteins RAP1 and RAP2 of Plasmodium falciparum in Saimiri boliviensis monkeys. Am J Trop Med Hyg. 2000;62:466–79.PubMedGoogle Scholar
- Singh B, Kim Sung L, Matusop A, Radhakrishnan A, Shamsul SS, Cox-Singh J, et al. A large focus of naturally acquired Plasmodium knowlesi infections in human beings. Lancet. 2004;363:1017–24.View ArticlePubMedGoogle Scholar
- Clustal Omega, a multiple sequence alignment program available online at http://www.ebi.ac.uk/Tools/msa/clustalo.
- Tamura K, Stecher G, Peterson D, Filipski A, Kumar S. MEGA6: molecular Evolutionary Genetics Analysis version 6.0. Mol Biol Evol. 2013;30:2725–9.PubMed CentralView ArticlePubMedGoogle Scholar
- Librado P, Rozas J. DnaSP v5: a software for comprehensive analysis of DNA polymorphism data. Bioinformatics. 2009;25:1451–2.View ArticlePubMedGoogle Scholar
- Tajima F. Statistical method for testing the neutral mutation hypothesis by DNA polymorphism. Genetics. 1989;123:585–95.PubMed CentralPubMedGoogle Scholar
- Fu YX, Li WH. Statistical tests of neutrality of mutations. Genetics. 1993;133:693–709.PubMed CentralPubMedGoogle Scholar
- Garzon-Ospina D, Romero-Murillo L, Patarroyo MA. Limited genetic polymorphism of the Plasmodium vivax low molecular weight rhoptry protein complex in the Colombian population. Infect Genet Evol. 2010;10:261–7.View ArticlePubMedGoogle Scholar
- Pacheco MA, Elango AP, Rahman AA, Fisher D, Collins WE, Barnwell JW, et al. Evidence of purifying selection on merozoite surface protein 8 (MSP8) and 10 (MSP10) in Plasmodium spp. Infect Genet Evol. 2012;12:978–86.PubMed CentralView ArticlePubMedGoogle Scholar
- Chenet SM, Pacheco MA, Bacon DJ, Collins WE, Barnwell JW, Escalante AA. The evolution and diversity of a low complexity vaccine candidate, merozoite surface protein 9 (MSP-9), in Plasmodium vivax and closely related species. Infect Genet Evol. 2013;20:239–48.PubMed CentralView ArticlePubMedGoogle Scholar
- Faber BW, Kadir KA, Rodriguez-Garcia R, Remarque EJ, Saul FA, Vulliez-Le Normand B, et al. Low levels of polymorphisms and no evidence for diversifying selection on the Plasmodium knowlesi apical membrane antigen 1 gene. PLoS One. 2015;10:e0124400.PubMed CentralView ArticlePubMedGoogle Scholar
- Fong MY, Lau YL, Chang PY, Anthony CN. Genetic diversity, haplotypes and allele groups of Duffy binding protein (PkDBPαII) of Plasmodium knowlesi clinical isolates from Peninsular Malaysia. Parasit Vectors. 2014;7:161.PubMed CentralView ArticlePubMedGoogle Scholar
- Stowers A, Taylor D, Prescott N, Cheng Q, Cooper J, Saul A. Assessment of the humoral immune response against Plasmodium falciparum rhoptry-associated proteins 1 and 2. Infect Immun. 1997;65:2329–38.PubMed CentralPubMedGoogle Scholar
- Fonjungo PN, Stuber D, McBride JS. Antigenicity of recombinant proteins derived from rhoptry-associated protein 1 of Plasmodium falciparum. Infect Immun. 1998;66:1037–44.PubMed CentralPubMedGoogle Scholar
- Weedall GD, Conway DJ. Detecting signatures of balancing selection to identify targets of anti-parasite immunity. Trends Parasitol. 2010;26:363–9.View ArticlePubMedGoogle Scholar
- Lee KS, Divis PC, Zakaria SK, Matusop A, Julin RA, Conway DJ, et al. Plasmodium knowlesi: reservoir hosts and tracking the emergence in humans and macaques. PLoS Pathog. 2011;7:e1002015.PubMed CentralView ArticlePubMedGoogle Scholar
- Pinheiro MM, Ahmed MA, Millar SB, Sanderson T, Otto TD, Lu WC, et al. Plasmodium knowlesi genome sequencesfrom clinical isolates reveal extensive genomic dimorphism. PLoS One. 2015;10:e0121303.PubMed CentralView ArticlePubMedGoogle Scholar
- Fong MY, Wong SS, De Silva JR, Lau YL. Genetic polymorphism in domain I of the apical membrane antigen-1among Plasmodium knowlesi clinical isolates from Peninsular Malaysia. Acta Trop. 2015;152:145–50.View ArticlePubMedGoogle Scholar
- Putaporntip C, Thongaree S, Jongwutiwes S. Differential sequence diversity at merozoite surface protein-1 locus of Plasmodium knowlesi from humans and macaques in Thailand. Infect Genet Evol. 2013;18:213–9.View ArticlePubMedGoogle Scholar
- Muehlenbein MP, Pacheco MA, Taylor JE, Prall SP, Ambu L, Nathan S, et al. Accelerated diversification of nonhuman primate malarias in Southeast Asia: adaptive radiation or geographic speciation? Mol Biol Evol. 2015;32:422–39.PubMed CentralView ArticlePubMedGoogle Scholar
- Divis PC, Singh B, Anderios F, Hisam S, Matusop A, Kocken CH, et al. Admixture in humans of two divergent Plasmodium knowlesi populations associated with different macaque host species. PLoS Pathog. 2015;11:e1004888.PubMed CentralView ArticlePubMedGoogle Scholar
- Assefa S, Lim C, Preston MD, Duffy CW, Nair MB, Adroub SA, et al. Population genomic structure and adaptation in the zoonotic malaria parasite Plasmodium knowlesi. Proc Natl Acad Sci USA. 2015;112:13027–32.PubMed CentralView ArticlePubMedGoogle Scholar