Whole-genome sequencing of
Plasmodium
is becoming an increasingly important tool for genomic surveillance of malaria. Due to the predominance of human DNA in a patient blood sample, time-consuming laboratory procedures are required to deplete human DNA or enrich
Plasmodium
DNA. Here, we investigated the potential of nanopore adaptive sampling to enrich
Plasmodium falciparum
reads while sequencing unenriched patient blood samples. To compare adaptive sampling versus regular sequencing on a MinION device, a dilution series consisting of 0%–84%
P
.
falciparum
DNA in human DNA was sequenced. Half of the flow cell channels were run in adaptive sampling mode, enriching for the
P. falciparum
reference genome, resulting in a three- to five-fold enrichment of
P. falciparum
bases in samples containing 0.1%–8.4%
P. falciparum
DNA. This finding was confirmed by sequencing three
P. falciparum
patient blood samples with common levels of parasitemia, that is, 0.1%, 0.2%, and 0.6% in adaptive mode. Their estimated enrichment was 5.8, 3.9, and 2.7, respectively, which was sufficient to cover at least 97% of the
P. falciparum
reference genome at a median depth of 5 (lowest parasitemia) or 355 (highest parasitemia). In all, 38 drug resistance loci were compared to Sanger sequencing results, showing high concordance, which suggests that the obtained sequencing data are of sufficient quality to address common clinical research questions for patients with parasitemias of 0.1% and higher. Overall, our results indicate that adaptive nanopore sequencing has the potential to replace more time-consuming
Plasmodium
enrichment protocols in the future.
IMPORTANCE
Malaria is caused by parasites of the genus
Plasmodium
, and reached a global disease burden of 247 million cases in 2021. To study drug resistance mutations and parasite population dynamics, whole-genome sequencing of patient blood samples is commonly performed. However, the predominance of human DNA in these samples imposes the need for time-consuming laboratory procedures to enrich
Plasmodium
DNA. We used the Oxford Nanopore Technologies’ adaptive sampling feature to circumvent this problem and enrich
Plasmodium
reads directly during the sequencing run. We demonstrate that adaptive nanopore sequencing efficiently enriches
Plasmodium
reads, which simplifies and shortens the timeline from blood collection to parasite sequencing. In addition, we show that the obtained data can be used for monitoring genetic markers, or to generate nearly complete genomes. Finally, owing to its inherent mobility, this technology can be easily applied on-site in endemic areas where patients would benefit the most from genomic surveillance.