1. Introduction
Highly pathogenic H5N1 avian influenza A (HP A(H5N1)) viruses are fatal to poultry and cause high human fatality after dead-end transmission from infected poultry [
1,
2]. HP A(H5N1) viruses spread from Asia to Africa and Europe by migratory birds, and antigenic evolution has continued under immune pressure by vaccination and natural infection in Asia [
1,
3,
4]. The ancestral HP A(H5N1) virus A/goose/Guangdong/1/96 (clade 0) has evolved into multiple clades from clade 1 to 9 [
5]. Some clade 2.3.2 viruses evolved into clade 2.3.2.1 and further diversified into 2.3.2.1a, b, and c in 2009 [
6,
7]. Clade 2.3.2.1c viruses have spread from Far East and South East Asian countries to Dubai, Bulgaria, Romania, and Nigeria and have become enzootic in Asian countries [
8,
9,
10,
11].
Hemagglutinin (HA) is a surface glycoprotein exposed on the outside of virus particles and it forms a noncovalent homotrimer composed of a distal globular head and proximal stalk [
12]. The receptor binding site (RBS) on the globular head of HA is a shallow pocket-like structure consisting of three secondary structure elements (130-loop, 190-helix, and 220-loop) and a base (Y98, W153, H183, and Y195 in H3 numbering) [
12]. HA binds to cell surface receptors to infect the host cell, and avian and human influenza A viruses (IAVs) preferentially bind to sialic acid α2,3-linked (α2,3 SA) and α2,6-linked (α2,6 SA) to galactose in avian and mammalian receptors, respectively. However, mutations in the RBS of avian IAVs can change receptor affinity from affinity only to α2,3 SA to both α2,3 SA and α2,6 SA or only α2,6 SA to overcome host barriers, resulting in interspecies transmission and adaptation [
13,
14,
15]. Several mutations that increase pathogenicity and affinity to mammalian receptors have been reported in the 220-loop of the H5 subtype HA (Q226L, G228S, etc.) [
16].
The globular head of HA is a major target of humoral immunity and is a hotspot of cumulative missense mutations to escape host immune responses [
17,
18,
19,
20]. Epitope mapping and escape mutant studies with mouse monoclonal antibodies have revealed antigenic variations of H5N1 IAVs [
18,
19]. The evasion mutations identified in H5 were distributed in epitope sites A (140–145 residues, H3 numbering) and B (155–166, H3 numbering) of H3 and Sa of H1 (129–133, H3 numbering) [
18,
19,
21,
22]. Acquisition of an N-glycosylation sequon (NGS) in the epitope not only shields the epitopes from antibody binding but also affects the binding affinity of HA to mammalian receptors [
16,
23].
The HA trimer is stabilized by polar and nonpolar interactions between the three stems and intermolecular salt bridges between the globular heads at low pH [
24,
25,
26]. The H103Y and T318I mutations increase low pH stability and thermostability, as well as droplet transmission of H5N1 viruses between ferrets [
15,
16,
27,
28]. Therefore, multiple mutations of HA acquired in a stepwise manner that play roles in receptor affinity, immunity evasion, and structural/functional stability may cooperatively affect the mammalian pathogenicity of avian IAVs.
Therefore, in this study, we compared the HA amino acid sequences of clade 2.3.2 and clade 2.3.2.1a, b, and c viruses and found two cumulative mutations (S144N and V223I) around the RBS. Most clade 2.3.2.1a and c viruses acquired both mutations. Previously, the PR8-based recombinant virus with HA and Neuraminidase (NA) of a clade 2.3.2.1c HP A(H5N1) virus isolated in Korea, A/mandarin duck/Korea/K10-483/2010 (K10-483), did not replicate well in embryonated chicken eggs (ECEs) and had low pathogenicity in mice [
29,
30]. To understand the effects of the mutations on replication efficiency in ECEs and mammalian cells and on the pathogenicity in mice, we generated PR8-derived mutant viruses and compared their biological characteristics. In addition, we compared the effects of the mutations on egg white resistance and thermostability of HA.
2. Materials and Methods
2.1. Viruses, Plasmids, Cells, and Eggs
The attenuated HA (mutation from multi-basic RERRRKR to mono-basic ASGR) and NA genome segments of a clade 2.3.2.1c HP A(H5N1) virus, A/mandarin duck/Korea/K10-483/2010 (K10-483), were previously cloned into a bidirectional reverse genetics vector, pHW2000, and six other internal genomes of A/Puerto Rico/8/34 (H1N1) (PR8) cloned into pHW2000 were used [
29,
31,
32]. The amino acid sequences of HA and NA of K10-483 did not have known mutations affecting the biological traits tested in this study. The 293T, MDCK (Madin-Darby Canine Kidney), and A549 cells were purchased from Korean Collection for Type Cultures (KCTC, Daejeon, Korea). The 293T and MDCK cells were maintained in DMEM supplemented with 10% FBS (Life Technologies Co., Carlsbad, CA, USA), and A549 cells were maintained in DMEM/F12 supplemented with 10% FBS. Virus was propagated with ten-day-old SPF (Specific Pathogen Free) embryonated chicken eggs (ECEs, Charles River Lab., Willimantic, CT, USA).
2.2. Data Mining and Analysis of HA Genes and In Silico Analysis of HA Trimer Structure and N-Glycan Profiles
The HA gene sequences of clade 2.3.2, clade 2.3.2.1, and clades 2.3.2.1a, b, and c HP A(H5N1) viruses were collected from the Influenza Virus Database (
https://www.ncbi.nlm.nih.gov/genomes/FLU/Database/nph-select.cgi?go=database) and Global Initiative on Sharing All Influenza Data (GISAID,
https://www.gisaid.org/) (
n = 647) on April 14, 2018. The collected nucleotide sequences were translated and compared with the BioEdit program (ver. 7.2.5). Additionally, HA sequences of all A(H5) viruses were collected (
n = 4189), and amino acid sequences and frequencies of 144NGS and 158NGS and residue 223 (V or I) were analyzed. In addition, HA genes (
n = 513) of HP A(H5N1) strains from laboratory-confirmed human cases were analyzed as above. Residues 144N and 223V/I were localized and analyzed for intermolecular interactions with other residues in the 3D structure of the H5 trimer (modified 4juk.pdb and 6e7g.pdb) using PyMOL (Molecular Graphis System version 2.3.1, Delano Scientific LLC, South San Francisco, CA, USA). The
N-glycosylation prediction at position 144 was performed by the NetNGlyc program (DTU Bioinformatics, Lyngby, Denmark).
2.3. Site-Directed Mutagenesis and Generation of Viruses by Reverse Genetics
To generate mutated H5N1 recombinant viruses, the cloned HA genome of K10-483 was mutated with a Muta-direct Site Directed Mutagenesis Kit (iNtRON, Gyeonggi, Korea) and specific primer sets (
Table 1). A Hoffmann’s reverse genetics system with a few modifications was used for recombinant virus generation [
32]. Briefly, 300 ng of each of the eight plasmids were transfected together into confluent 293T cells in 6-well plates (10
6 cells/well) with Lipofectamine 2000 and PLUS reagents (Life Technologies Co.). After overnight incubation, 1 mL of Opti-MEM (Life Technologies Co.) and 1 µg/mL of TPCK-treated trypsin (Sigma-Aldrich, St. Louis, MO, USA) were added to transfected cells. The supernatant was harvested after another overnight incubation, and 200 μL of the supernatant was inoculated into ten-day-old ECEs. The presence of the recombinant viruses in allantoic fluids was checked by HA assay according to the World Health Organization (WHO) Manual on Animal Influenza Diagnosis and Surveillance, and the genome segments were confirmed by RT-PCR and sequencing as previously described [
33].
2.4. Comparative Replication Efficiency in ECEs and Growth Kinetics in MDCK and A549 Cells
The generated recombinant viruses (E1) were passaged in ten-day-old SPF ECEs, and the titers of the recombinant viruses (E2) were measured to obtain the 50% chicken embryo infection dose (EID
50). Each virus was diluted 10-fold and inoculated into ECEs. Virus replication was confirmed by a plate hemagglutination test with 1.0% chicken Red Blood Cells (RBCs), and the EID
50 was calculated by the Spearman–Karber method [
34]. To compare the replication efficiency of the recombinant viruses, the same number of viruses were used to infect ECEs and mammalian cells. One hundred EID
50 of recombinant virus (E2) were inoculated into ten-day-old SPF ECEs, and after 3 days, the EID
50 of harvested allantoic fluid was measured as above. In MDCK and A549 cells, 10
5 EID
50 of each virus were used to infect confluent MDCK and A549 cells in 12-well plates. The supernatant of the infected cells was harvested at 0, 12, 24, 48, and 72 h post inoculation (hpi), and 10-fold diluted supernatant was used to inoculate confluent MDCK cells in a a 96-well plate to measure the 50% tissue culture infectious dose (TCID
50) at each time point. Virus replication was confirmed by a hemagglutination assay, and TCID
50 was calculated using the Spearman–Karber method as above.
2.5. Mouse Pathogenicity Test
The mouse pathogenicity test was approved on January 10, 2019 by the Institutional Animal Care and Use Committee (IACUC) of Seoul National University (IACUC-SNU-171214-1-1). The approved experiment was performed in a biosafety level 2 facility at the Animal Center for Pharmaceutical Research of Seoul National University (Seoul, Korea) according to the national guidelines for the care and use of laboratory animals. Six-week-old female BALB/c mice (
n = 8) (KOATEC, Pyeongtaek, Korea) were anesthetized by Zoletil 50 (15 mg/kg, IP) (Virbac, Carros, France), and 10
6 EID
50/50 μL of each recombinant virus was inoculated intranasally. Five mice from each group were weighed for 2 weeks, and three mice were euthanized to obtain lung samples at 3 days post inoculation (dpi). During the experiment, mice with 20% or more body weight loss were euthanized. The sampled lungs were ground with TissueLyzer 2 and 5 mm stainless steel beads (Qiagen, Valencia, CA, USA) and suspended in PBS. The virus titer (EID
50) was measured as previously described [
35].
2.6. Solid-Phase Receptor Binding Assays
To evaluate the receptor binding affinity of recombinant viruses, a solid-phase assay was used as previously described with some modifications [
36,
37]. In short, 96-well enzyme-linked immunosorbent assay plates (SPL, Gyeonggi, Korea) coated with 10 µg/mL fetuin (Sigma-Aldrich) were bound with the recombinant viruses overnight. After washing the virus-bound plates three times with PBS + 0.05% Tween 20 (PBST), the plates were blocked with 0.1% desialylated BSA + 10 µM oseltamivir (Sigma-Aldrich) for 1 h at 4 °C. The blocked plates were washed three more times with PBST, and the biotinylated sialylglycopolymers (Neu5Acα2-3Galb1-4GlcNAcb-PAA-biotin, 3′SLN-PAA, and Neu5Acα2-6GalNAca-PAA-biotin, 6′SLN-PAA) (Glycotech Corporation, Gaithersburg, MD, USA) were serially diluted and added to the plates for 1 h at 4 °C. Then, the plates were washed three times with PBST and incubated with horseradish peroxidase (HRP)-conjugated streptavidin (Thermo Fisher Scientific, Waltham, MA, USA) for 1 h at 4 °C. Finally, HRP was developed with 3,3’5,5’-Tetramethylbenzidine (TMB) substrate (SurModics, Eden Prairie, MN, USA), and the chromogenic reaction was stopped by adding 0.1 M sulfuric acid. The absorbance at 450 nm was measured by a microplate reader (TECAN, Männedorf, Switzerland).
2.7. HA and Hemagglutination Inhibition (HI) Tests
The HA test and HI test with chicken RBCs and guinea-pig RBCs were performed according to the WHO manual for the laboratory diagnosis and virological surveillance of influenza. The recombinant virus was serially diluted 2-fold in 96-well plates, and chicken RBCs (1%) or guinea-pig RBCs (1%) were added. After 40 min of incubation at 4 °C, the hemagglutination unit (HAU) of each virus was recorded. Chicken RBCs have similar amounts of sialic acids bound to galactose by α2,3 linkage (SAα2,3Gal) and sialic acid linked to galactose by α2,6 linkage (SAα2,6Gal), and guinea pig RBCs have more SAα2,6Gal than SAα2,3Gal [
38]. The HI test of recombinant viruses was conducted with chicken egg white to compare the resistance of the recombinant viruses against egg white. Chicken egg white was serially diluted as in the HA test, and 4 HAU of each virus were added to each well and incubated for 30 min at 4 °C. Then, chicken RBCs or guinea pig RBCs were added, and the HI titer was recorded after 40 min of incubation at 4 °C. All experiments were repeated three times independently.
2.8. Heat Stability Test
Recombinant viruses were diluted to the same HA titer (24) and aliquoted for heat treatment. Each aliquot was incubated at 60 °C for 0, 5, 15, and 30 min, and the HA titer was measured.
2.9. SDS-PAGE and Western Blotting
To confirm the 144N glycosylation, 4 µL of each recombinant virus (CE3) treated or untreated with PNGase F enzyme (New England Biolabs, Ipswich, MA, USA) was mixed with Protein 5X Sample Buffer (ELPIS BIOTECH, Daejeon, Korea) to denature it for 5 min at 95 °C, and SDS-PAGE was performed using NuPAGE 4–12% Bis-Tris Protein Gels (Life Technologies Co.). The proteins were transferred to a nitrocellulose membrane (Life Technologies Co.), and the membrane was incubated with anti-H5N1 virus (A/Vietnam/1194/2004), HA rabbit IgG (Sino Biological Inc., Beijing, China), followed by incubation with horseradish peroxidase conjugated-goat anti-rabbit IgG (Bethyl Laboratories Inc., Montgomery, AL, USA). Then, HA proteins were visualized with BioFX TMB One Component HRP Membrane Substrate (SurModics IVD, INC., Eden Prairie, MN, USA) and sulfuric acid stop solution (Sigma-Aldrich).
2.10. Statistical Analysis
All data were analyzed with IBM SPSS Statistics version 23 (IBM., Armonk, NY, USA). The statistical significance of viral titers in ECEs, growth kinetics in cells, and receptor binding affinity were evaluated by one-way analysis of variance (p < 0.05). Survival rates were compared by Kaplan–Meier survival analysis, and the differences in frequency were assessed by chi-square test (p < 0.05).
4. Discussion
Clade 2.3.2 viruses were isolated from ducks and wild birds in mainland China and Hong Kong in 2004, but they might have been already present in mainland China in 2003 due to virus isolation from Muscovy ducks smuggled from China to Taiwan [
6,
39,
45]. New clade 2.3.2.1 viruses derived from clade 2.3.2 viruses appeared in 2007, and clades 2.3.2.1a, b, and c viruses appeared in 2009 [
7,
45]. In Viet Nam, clades 2.3.2.1a, b, and c viruses used to cocirculate, but clade 2.3.2.1b viruses have disappeared [
10]. Clade 2.3.2.1 viruses acquired 144NGS, and this mutation was conserved in most of the clade 2.3.2.1a, b, and c viruses. Considering the significantly higher frequency of 158NGS than 144NGS among A(H5) viruses, given the same possibility of acquiring either 144NGS or 158NGS (
Table S1), the acquisition of 144NGS may reflect the presence of certain selection pressure or other circumstances.
HA glycosylation to evade humoral immunity may be the most effective but final choice because it reduces viral fitness [
46]. The variability of NGS precursors and their higher frequencies than NGS at 144–146 (86.5% vs. 13.5%) and 158–160 (71.9% vs. 28.1%) may be in line with the above notion (
Table S1). The 144N-glycan reduced the replication efficiency in ECEs and the a2,3 SA affinity of rH5N1-I223V in comparison with rH5N1-N144S-I223V. Therefore, 144N-glycan in H5 reduced viral fitness, similar to the findings in a previous report in H1 [
46]. However, circumstantial evidence explaining why clade 2.3.2.1 viruses chose 144NGS instead of the more prevalent and preferable 158NGS needs to be discussed further.
Humoral immunity induced by vaccination may facilitate the appearance of mutants evading vaccine immunity [
47]. The vaccine program was implemented with A/chicken/Mexico/232-CPA/1994 (H5N2) in Hong Kong (HK) from 2002 to 2003 and with A/turkey/England/N28/1973 (H5N2) from 2004 to 2006 in mainland China. Monovalent (Re-1 (clade 1) from 2004 to 2008, Re-4 (clade 7.2) from 2006 to 2012, Re-5 (clade 2.3.4) from 2008 to 2012, Re-6 (clade 2.3.2) in 2012) and bivalent (Re-1/Re-4 from 2007 to 2008, Re-4/Re-5 from 2008 to 2012 and Re-4/Re-6 in 2012) inactivated PR8-derived recombinant vaccines have been used [
48,
49]. Among them, Re-1, Re-4, and Re-5 were the major vaccines in mainland China during the evolution period (2005–2009) of clade 2.3.2 to clades 2.3.2.1a, b, and c, and Re-4 and Re-5 contained only 158NGS, and other viruses, except Re-6 (only 144NGS), contained neither 144NGS nor 158NGS [
50]. Therefore, vaccine-induced antibodies might have targeted the shielded epitope site B (group 2, 155–166) rather than epitope site A (group 1, 140–145), and mutant viruses acquiring 144NGS to shield epitope site B might have been selected [
44]. Re-6 with 144NGS might have been effective against clade 2.3.2.1a, b, and c viruses not only due to antigenic similarity but also due to the restricted acquisition of additional 158NGS. The very low frequency of A(H5) viruses possessing both 144NGS and 158NGS (0.1%) may reflect the inferior competitiveness of such HAs in nature (
Table 3). In Viet Nam, where clade 2.3.4 and clade 2.3.2.1a, b, and c viruses had cocirculated, Re-1, from 2005 to 2010, and Re-5, (clade 2.3.4) since 2011, had been used for vaccinations [
51]. Clade 2.3.4 viruses declined after vaccination, but clade 2.3.2.1c viruses became enzootic, possibly due to antigenic mismatch and the shielding effect of 144N-glycan [
10,
52,
53].
The V223I mutation is unlikely to stand alone without 144NGS due to its very low frequency in nature, and stepwise acquisitions of 144NGS and V223I mutations during clade 2.3.2.1a, b, and c diversification from clade 2.3.2.1 are noteworthy (
Table 3). Similarly, cooperating mutations with N-glycans, K147 with 144NGS, and N227S with 158NGS have been reported [
23,
54]. The biological effects and roles of the V223I mutation are unclear, but a single V223I mutation decreased the virus replication efficiency of rH5N1-N144S in ECEs. Additionally, rH5N1-N144S showed resistance to egg white due to a relatively steep decrease in HI titer and significantly lower a2,3 SA affinity than those of the other viruses in this study (
Table 6,
Figure 3). Ovomucin in egg white is an effector molecule of innate immunity present on the surface of the mucous membrane, and a different mutation reducing the inhibition has been reported [
36,
55]. Therefore, characterization of egg white resistance may be useful to understand the evolutionary status of IAVs. Mutations such as S223N (S224N according to our H3 numbering), N224K, G225D, Q226L, G228S, and S227N directly or indirectly increase a2,6 SA affinity, and their side chains are located in or near the RBS. However, the side chain of residue 223 is located at the interface of the globular heads of the HA trimer (
Figure 5). The amino acid residues located between the interfaces of the HA trimer affect structure and pH stability, and the electrostatic intermolecular interaction between T212 and N216 and the increased rigidity of the S221P mutation stabilized the HA trimer to increase pH stability [
25,
26]. The lower thermostability of rH5N1-N144S than rH5N1 and rH5N1-I223V may imply a negative effect of the intermolecular interaction between 223I and 207S on HA thermostability (
Figure 5). V/I223 did not interact with S207 via hydrogen bonding, and the bulkier side chain of I may cause steric hindrance at the interface. Although we did not test pH stability, a pH stability-related mutation (H103Y) showed increased thermostability by stabilizing the HA trimer in previous reports [
56,
57]. Therefore, the V223I mutation acquired in addition to S144N during adaptation in vaccinated poultry might have improved viral fitness in terms of a2,3 SA receptor affinity at the cost of decreased HA trimer stability.
The mammalian pathogenicity of HP A(H5N1) viruses is a multigenic trait, and the human pathogenicity of clade 2.3.2.1 viruses has been regarded as lower than that of other clades [
58]. In our previous studies, a PR8-derived clade 2.3.2.1c recombinant vaccine strain showed less pathogenicity in mice than another PR8-derived recombinant virus containing HA and NA genes from a low pathogenic (LP) A(H5N1) virus [
29,
59]. Although the amino acid sequences of the two HA proteins are only 89% identical, the HA of the LP A(H5N1) virus has V223 and neither 144NGS nor 158NGS. The higher mouse pathogenicity and replication efficiency of rH5N1-N144S-V223I than other H5N1 recombinant viruses in MDCK and A549 cells may indicate a reduction in mammalian pathogenicity during poultry adaptation to evade immune responses. Poorly glycosylated HA was recognized by an ER stress pathway and induced strong lung injury [
60]. The relatively high mammalian pathogenicity of viruses without 144NGS and 158NGS has been verified [
23]. As we did not directly compare the pathogenicity of 144NGS- or 158NGS-bearing recombinant viruses, we cannot conclude which virus is more pathogenic in humans. However, a significantly higher frequency of 158NGS- (70.0%) than 144NGS-bearing (1.6%) HA in human cases compared with the frequencies of single 158NGS- (27.2%) or 144NGS-bearing (13.1%) HA in nature may reflect a higher risk of 158NGS than 144NGS in human infection (
Table S2).
In conclusion, intensive inoculation of certain types of vaccines may distort natural evolutionary pathways, and the acquired novel adaptive mutations may reduce viral fitness by destabilizing the HA trimer as well as affecting mammalian pathogenicity. Our results may provide clues for future studies to develop more effective vaccine strains and programs that reduce the appearance of antigenic or more human-pathogenic variants.