Plasmodium knowlesi can adapt to infect Duffy-negative Erythrocytes

Plasmodium knowlesi, a zoonotic malaria species, has become a significant public health concern in Southeast Asia. In regions such as Malaysia and southern Thailand, P. knowlesi incidence has risen, even as other human malaria parasites are nearing elimination. Like its close relative Plasmodium vivax, P. knowlesi relies on Duffy-Antigen Receptor for Chemokine (DARC) as a key receptor for erythrocyte invasion. Only Duffy-positive individuals are thought to be susceptible to clinical infection. Here, we reveal that P. knowlesi possesses greater invasion plasticity than previously recognized. This parasite can bypass the need for DARC, as shown by its in vitro adaptation to invade and replicate in Duffy-negative (Fy-) erythrocytes. This adaptation is stable and independent of DARC binding, enabling the adapted parasite line to be maintained in Fy-erythrocytes and to resist inhibition by a-DARC antibodies. Genomic analysis identified a genomic recombination event between the parasite's dbpα and dbpγ genes, resulting in a new chimeric gene dbpαγ. Using CRISPR-Cas9 targeted reversion, we were able to demonstrate that dbpαγ is essential for invasion of Fy- erythrocytes. These findings shed new light on the invasion plasticity of P. knowlesi, with implications for its potential spread beyond Southeast Asia and for understanding the complex host-cell specificity and atypical invasion pathways seen in P. vivax.