Resistance to malaria through structural variation of red blood cell invasion receptors

The malaria parasite <i>Plasmodium falciparum</i> invades human red blood cells by a series of interactions between host and parasite surface proteins. By analyzing genome sequence data from human populations, including 1269 individuals from sub-Saharan Africa, we identify a diverse array of large copy-number variants affecting the host invasion receptor genes <i>GYPA</i> and <i>GYPB</i> We find that a nearby association with severe malaria is explained by a complex structural rearrangement involving the loss of <i>GYPB</i> and gain of two <i>GYPB-A</i> hybrid genes, which encode a serologically distinct blood group antigen known as Dantu. This variant reduces the risk of severe malaria by 40% and has recently increased in frequency in parts of Kenya, yet it appears to be absent from west Africa. These findings link structural variation of red blood cell invasion receptors with natural resistance to severe malaria.