Usui, M.Prajapati, S.K.Ayanful-Torgby, R.Acquah, F.K.Cudjoe, E.Kakaney, C.Amponsah, J.A.Obboh, E.K.Reddy, D.K.Barbeau, M.C.Simons, L.M.Czesny, B.Raiciulescu, S.Olsen, C.Abuaku, B.K.Amoah, L.E.Williamson, K.C.2019-08-192019-08-192019vol.10:214010.1038/s41467-019-10172-6http://ugspace.ug.edu.gh/handle/123456789/32032Plasmodium sexual differentiation is required for malaria transmission, yet much remains unknown about its regulation. Here, we quantify early gametocyte-committed ring (gc-ring) stage, P. falciparum parasites in 260 uncomplicated malaria patient blood samples 10 days before maturation to transmissible stage V gametocytes using a gametocyte conversion assay (GCA). Seventy six percent of the samples have gc-rings, but the ratio of gametocyte to asexual-committed rings (GCR) varies widely (0–78%). GCR correlates positively with parasitemia and is negatively influenced by fever, not hematocrit, age or leukocyte counts. Higher expression levels of GDV1-dependent genes, ap2-g, msrp1 and gexp5, as well as a gdv1 allele encoding H217 are associated with high GCR, while high plasma lysophosphatidylcholine levels are associated with low GCR in the second study year. The results provide a view of sexual differentiation in the field and suggest key regulatory roles for clinical factors and gdv1 in gametocytogenesis in vivo. © 2019, The Author(s).enArticle