Why work on malaria?
Malaria is a major killer of young children, particularly in sub-Saharan Africa. Tackling this disease saves lives, especially children, and promotes socioeconomic development.
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I studied malaria for my PhD, building a network of colleagues and collaborators based in endemic countries. Although I now spend more of my time focusing on infections in patients with blood cancer, who I see directly as a UK infection doctor, I remain interested in malaria and continue to work with my colleagues in malaria-endemic countries who are leading the charge against this disease.
Why genetic surveillance?
Malaria parasites have a remarkable capacity for evolutionary adaptation; they have repeatedly evolved resistance to the drugs we use to treat the infection. The parasites are also relatively difficult to culture in the lab and directly test how well antimalarial drugs are working. Sequencing parasite DNA collected from patient blood samples can provide proxy information on drug susceptibility, by monitoring the frequency, distribution and trends in genetic markers of drug resistance.
The parasite genome, which is highly complex, also contains valuable information on targets for vaccines and diagnostic tests.
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We are placing parasite populations under immense evolutionary pressure, by driving towards malaria elimination. Vaccine pressure is now being added to antimalarial drug pressure. Genetic surveillance can provide national malaria control programmes with key information about the parasite, such as which drugs are most effective in a given region.
Democratising DNA sequencing
In recent years I have particularly focused on using nanopore technology for rapid, cost-effective DNA sequencing of malaria parasites based in endemic settings. We perform real-time sequencing and run analysis pipelines from high-spec laptops. The goal is to build capacity for genomics across disease-endemic countries without relying on large expensive sequencing centres.
This distributed model of genomics allows researchers on the front line to monitor malaria parasites and other pathogens for drug resistance, to detect new threats and ensure that our interventions remain effective.
Selected publications
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​Girgis, S.T., Adika, E., … Amenga-Etego, L.N., Hamilton, W.L. 2023. Drug resistance and vaccine target surveillance of Plasmodium falciparum using nanopore sequencing in Ghana. Nat Microbiol (2023). https://doi.org/10.1038/s41564-023-01516-6. URL: https://www.nature.com/articles/s41564-023-01516-6
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Hamilton, W.L., et al. 2023. Nanopore sequencing for malaria molecular surveillance: opportunities and challenges. Trends in Parasitology. 2023 Dec;39(12):996-1000. doi: 10.1016/j.pt.2023.09.014. Epub 2023 Oct 19. URL: https://www.cell.com/trends/parasitology/fulltext/S1471-4922(23)00235-0
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Hamilton, W.L., Amato, R., et al. 2019. Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology study. Lancet Infect Dis. 19 (9), 943-951. URL: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30392-5/fulltext
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MalariaGEN Plasmodium falciparum Community Project. 2021. An open dataset of Plasmodium falciparum genome variation in 7,000 worldwide samples. Wellcome Open Res 2021, 6:42. PMID: 33824913. DOI: 10.12688/wellcomeopenres.16168.1. URL: https://wellcomeopenresearch.org/articles/6-42
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Oyola, S.O., Ariani, C.V., et al. 2016. Whole genome sequencing of Plasmodium falciparum from dried blood spots using selective whole genome amplification. Malaria journal 15 (1), 597. URL: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-016-1641-7