First report of glucose-6-phosphate dehydrogenase (G6PD) variants (Mahidol and Acores) from malaria-endemic regions of northeast India and their functional evaluations in-silico.

G6PD deficiency results from numerous mutations in the G6PD gene and can cause alterations in enzyme function up to varying degrees. P. vivax malaria infections require G6PD deficiency screening because of the potential risk of haemolysis by the gametocytocidal drug (primaquine) during the radical treatment. The present study investigated the incidence of G6PD deficiency from northeast India and further, molecular characterization was performed. During 2014-16, a total of 1,015 patients from four north-eastern states of India (Tripura, Mizoram, Meghalaya & Arunachal Pradesh), were screened for G6PD deficiency, using Beutler's fluorescence spot test (FST) and confirmed with SPAN G6PD kit. The deficient individuals (55/1015, 5.4%) were further characterized by PCR-RFLP and DNA sequencing except one case of lost to follow up. As observed by FST, the frequency of G6PD deficient males (42/538, 7.8%) were found to be higher than females (13/477, 2.73%), (p < 0.0001). Two non-synonymous mutations; G6PD-D (Mahidol) (48/54, 88.9%; 36 hemizygous males, 8 homozygous and 4 heterozygous females) and G6PD-D (Acores) (2/54, 3.7%) were identified. Remaining (4/54, 7.4%) individuals could not be characterized. Molecular modeling and dynamic simulations were performed for the G6PD wild-type (G6PD-WT) enzyme and its variants. The in-silico results demonstrated alterations in the secondary structures & crucial loss of ligand-protein interactions, which might result in reduced enzyme function, leading to enzyme deficiency. To the best of our knowledge, this is the first report to document G6PD-Mahidol and G6PD-Acores variants from malaria-endemic regions of northeast India, and provided molecular insights on the varied genetic makeup of the studied population.