1. Introduction
Influenza A virus (IAV) is a major human pathogen that causes 3-5 million cases of severe illness and anywhere from 290 to 650 thousand deaths annually worldwide [
1,
2,
3]. IAV is also zoonotic, permitting interspecies transmission and possible pandemics, as was seen in 2009 with the introduction of a novel H1N1 virus into the human population. This novel virus first emerged from pigs in Mexico spreading into humans in North America and disseminating worldwide, becoming the first influenza pandemic of the 21
st century [
4,
5,
6,
7].
Influenza A virus is an enveloped, negative sense single stranded, segmented RNA virus in the family
Orthomyxoviridae. The RNA genome is comprised of eight segments that code for 10 – 11 proteins. Each segment codes for at least one structural protein and are numbered from largest to smallest: polymerase basic 2 (PB2), polymerase basic 1 (PB1) which codes for the PB1 and PB1-F2 proteins, polymerase acidic (PA), hemagglutinin (HA), nuclear protein (NP), neuraminidase (NA), matrix (M) which codes for both the M1 and M2 proteins, and non-structural (NS) which codes for both the NS1 and NS2 proteins, the latter which is also referred to as the nuclear export protein (NEP) [
2]. Influenza viruses can undergo two different forms of mutation, antigenic drift and shift. Antigenic drift is the gradual accumulation of mutations caused by an error prone RNA dependent RNA polymerase with no proof-reading mechanism. These point mutations can accumulate to allow the virus to escape existing antibodies and cause seasonal outbreaks. Antigenic shift is when two virions infect the same cell, enabling mixing of gene segments, resulting in a new virus. This genetic reassortment can allow for a novel subtype to emerge with the potential of causing a pandemic [
8]. Wild aquatic birds are the reservoir host of IAV, however through adaptation and antigenic shift some subtypes have acquired the ability to infect and transmit among a wide variety of hosts including humans, pigs, horses, cats, dogs, and marine mammals [
9]. One of these essential adaptations is the receptor binding specificity of the HA protein. The first step in virus infection occurs when the HA protein on the surface of the virion binds sialic acids located on glycoproteins on the surface of the target cell. In the avian gastrointestinal and respiratory tracts, the majority of sialic acids are linked to the penultimate galactose via an α-2,3 linkage. In contrast, epithelial cells in the human upper respiratory tract contains glycoproteins with α-2,6 sialic acid linkages, although there are α-2,3 linked sialic acids in the lower respiratory tract. Most avian influenza viruses preferentially bind α-2,3-linked sialic acids while human and other mammalian IAVs bind α-2,6 sialic acids [
10,
11,
12]. Importantly, there are hosts such as swine that possess both α-2,3 and α-2,6 linked sialic acids throughout their respiratory tract and are consequently susceptible to both avian and mammalian influenza viruses [
13]. This mixture of avian and mammalian IAV receptors has led to swine being considered as in influenza mixing vessel as they can be infected with both avian and mammalian IAVs providing the opportunity for gene segment reassortment. The reassortment that occurs in swine plays a central role in emerging human pandemics and the adaptation of avian influenza to mammals as viruses are able to undergo host adaptation by acquiring host-optimized gene segments from circulating endemic viruses. Out of the 144 possible subtypes of influenza only a few are prevalent and currently circulating in humans (H1N1 and H3N2) and pigs (H1N1, H1N2, and H3N2). However, it has recently been shown that a single amino acid change in the HA protein can alter receptor binding from an α-2,3 to an α-2,6 specificity [
14]. Identification of genetic changes that can lead to species adaptation, virulence in hosts, and pandemic potential enhance our understanding of the biology of IAV, aid in surveillance and virus risk assessment, and guide the establishment of counter measures for emerging influenza viruses.
Influenza A virus was first isolated from swine in 1930 by Richard Shope. This H1N1 IAV remained the dominant strain circulating in North American swine for more than 60 years and so is referred to as classical swine influenza virus (classical swine) [
15,
16]. In 1998 a human-origin H3N2 triple reassortment virus became endemic in swine, adding to the subtype diversity circulating in North American swine. The H3N2 virus contained the NP, M, and NS gene segments from the classical swine H1N1 virus, the PB1, HA, and NA gene segments from a human seasonal H3N2 virus, and the PB2 and PA gene segments of an avian influenza virus [
17,
18]. This combination of six internal gene segments: NP, M, NS, PB1, PB2, and PA was referred to as the triple reassortment internal gene cassette (TRIG) and supported a variety of HA and NA combinations, greatly expanding the diversity of IAVs circulating in swine [
19]. The classical H1N1 and recent H3N2 viruses continued to co-circulate and reassort, producing an H1N2 virus that became endemic. Moreover, human IAVs continued to spill back into swine populations, adding to the genetic diversity of HA and NA gene segments. While the surface glycoproteins continued to diversify, the TRIG cassette became the dominant gene constellation circulating in North American swine and was observed in most fully characterized swine influenza viruses since 2000 [
17,
20,
21,
22,
23].
The pandemic H1N1 of 2009 (pdmH1N1) emerged from multiple reassortment events. The virus that caused the pandemic contained gene segments from three distinct swine influenza lineages: five of the six gene segments (PB2, PB1, PA, NP and NS) from the triple-reassortment North American swine lineage, the HA from a classical H1N1 swine lineage, and the M and NA segments from a Eurasian avian-like H1N1 swine influenza lineage [
24,
25,
26]. This virus rapidly spread across the globe, infecting an estimated 25% of the population, but fortunately caused only limited mortality [
27]. However, the virus also quickly crossed back into swine in multiple reverse zoonotic spillovers and while the full pdmH1N1 virus itself has not persisted in swine, several of its gene segments have been maintained in swine through reassortment and in some cases have become dominant in in current circulating swine influenza viruses [
28,
29,
30,
31,
32,
33,
34]. Specifically, the PA, NP, and M gene segments from the pdmH1N1 have gradually replaced the corresponding gene segments in the TRIG cassette [
35,
36]. While the 2009 pandemic was considered to have high morbidity and low mortality, studies have linked the pdmH1N1 virus and its gene segments to increased disease in humans and animal models [
4,
37,
38,
39,
40]. While pdmH1N1 replaced the H1N1 viruses circulating in humans and is now effectively a seasonal human IAV, H1N1, H1N2, and H3N2 viruses continue to co-circulate and reassort in endemically-infected swine and represent a public health threat. This is evidenced by the regular detection of variant swine influenza virus infections of humans associated with state fairs and other intersections of humans and pigs [
41,
42].
Understanding the genetic determinants affecting virus fitness, virulence, and transmission as well as the mutations that may enhance or attenuate these features is critical for risk assessment of zoonotic influenza viruses. Mutations that attenuate IAVs may also be used to develop live attenuated influenza virus vaccines. Here, we discuss the determinants that have been mapped to specific phenotypes in influenza viruses. Mutations in avian influenza viruses that are important for virulence or transmission in mammals have been robustly reviewed by Lloren et al. [
43], so we will focus on the fitness, transmission, and virulence determinants identified in swine influenza A viruses and/or in relation to the 2009 pdmH1N1 virus.
Table 1 summarizes the determinants and mutations to be discussed.
3. Conclusion
Due to its extensive host range allowing for antigenic shift as well as the error-prone polymerase enabling antigenic drift mutations, IAV has the potential to cross species barriers and rapidly escape existing immunity, enabling the emergence of novel potentially pandemic subtypes and viruses. Thus, mutations acquired through both drift and shift allow for changes in host tropism, transmission, and pathogenesis. There are a multitude of mutation sites across the IAV genome where amino acid changes can have a measurable effect and, in some cases, lead to co-mutations, amplifying the phenotype.
Following the 2009 influenza pandemic, the pdmH1N1 replaced the previously circulating H1N1 virus and now circulates as a seasonal influenza virus. Repeated introductions of human seasonal influenza viruses into swine have led to the incorporation of human influenza gene segments into circulating swine influenza viruses. This was also seen with the pdmH1N1 virus. While the full pdmH1N1 virus does not circulate in the swine population, certain gene segments have been maintained and, in some cases, have become dominant in current circulating swine viruses, suggesting a fitness benefit. The 2009 H1N1 pandemic was not the most lethal influenza pandemic, however studies of the pdmH1N1 gene segments demonstrate that components of this virus can lead to increased disease in humans and animal models. Many of these segments or mutations are found in circulating swine influenza viruses.
The regular emergence of pandemic influenza viruses demonstrates the critical need for surveillance and risk assessment of zoonotic influenza viruses. Understanding genetic determinants that affect fitness, virulence, transmission, and host tropism, as well as the mutations that alter these features provides a reference for pandemic potential genetic screening tools. Knowledge of these mutation sites and attenuating residues may also be used in the development of attenuated influenza virus vaccines and the formulation of new anti-viral drugs. Influenza virus genetic mutation and evolution is inevitable. It is through the utilization of surveillance for known genetic determinants as well as continuing research defining novel mutations that we can continue to be prepared for novel, potentially pandemic influenza viruses. Further, use of these findings to develop new vaccines and treatments better prepare us for the next influenza pandemic.
Table 1.
Fitness determinants of influenza A viruses.
Table 1.
Fitness determinants of influenza A viruses.
Segment |
Amino Acid Position |
Subtypes |
Remarks |
References |
PB2 |
E627K |
H1N1, H3N2, H5N1 |
Did not lead to enhanced virulence or transmission in pdm2009 H1N1, replicates more efficiently in mammalian cells before 2009, increased lethality in mice before 2009, increased H5N1 virulence in mice, increased H5N1 transmissibility in ferrets, determinant of cold sensitivity |
[45,46,51,53,54,56,57,58,119] |
T271A, 590S, 591R |
H1N1 |
Critical for viral replication and virulence of swine viruses in vitro and in vivo, associated with mammalian adaptation |
[47,48,59] |
E667G |
H1N1, H5N1 |
Associated with mammalian adaptation, did not lead to enhanced virulence or transmission |
[45,49] |
T588I |
H1N1 |
Increased polymerase activity and viral replication in mammalian cells, increased pathogenicity in mice, regulate host antiviral innate immune response in vitro and in vivo
|
[50] |
D701N |
H1N1, H3N2, H5N1 |
Did not lead to enhanced virulence or transmission in pdm2009 H1N, associated with mammalian adaptation, improved viral growth in mammalian cells and enhanced aerosol transmission in guinea pigs of H3N2 and H5N1 |
[45,46,59,60,61,62] |
526R |
H3N2, H5N1, H7N9 |
Increased polymerase activity, in concert with 627K enhanced replication and virulence in mice, associated with mammalian adaptation |
[63] |
E158G |
H1N1 |
Increased virulence in mice, increased polymerase activity in human cells |
[64] |
147T, 339T, 558T |
H1N1, H5N1 |
Increased replication in mammalian cells, enhance virulence in mice |
[65,66] |
PB1 |
V336I |
H1N1 |
Associated with mammalian adaptation |
[70] |
S216G |
H1N1 |
Associated with mammalian adaptation, attenuated virulence in mice, reduced RdRp fidelity |
[44,70] |
473V |
H5N1, H1N1 |
Maintaining efficient viral replication |
[67] |
13P; 678N |
H1N1 |
Enhanced polymerase activity |
[73] |
G622D |
H5N1 |
Decreased in polymerase activity, attenuation in mice |
[68] |
K577E |
H9N2 |
Increased pathogenicity in mice, associated with mammalian adaptation |
[75] |
M317I |
H5N1 |
Increased pathogenicity in mice |
[76] |
N375S |
H1N1, H2N2, H3N2 |
Associated with mammalian adaptation |
[77] |
K/I340; K/I649, T667 |
H1N1 |
Increased virulence in mice |
[73,78] |
A469T |
H1N1 |
Enhanced polymerase activity, transmissibility in guinea pigs, potential pathogenicity determinant |
[79] |
N66S |
H1N1, H5N1 |
Increased pathogenicity in mice |
[82] |
PA |
85I, 186S, 336M |
H1N1 |
Enhanced polymerase activity, enhanced morbidity in mice |
[90] |
A343T, K353R, T566A |
H1N1 |
Enhanced replication and virulence in mice |
[91] |
K356R |
H1N1 |
Associated with mammalian adaptation |
[70] |
T97I |
H5N2 |
Associated with mammalian adaptation |
[92] |
V44I, V127A, C241Y, A343T, I573V |
H5N1 |
Increased replication in mammalian cells, enhanced virulence in mice, associated with mammalian adaptation |
[93] |
K142Q |
H5N1 |
Enhanced replication and pathogenesis in mice when combined with PB2 627K, associated with mammalian adaptation |
[94] |
L295P |
H1N1 |
Increased polymerase activity in mice when combined with PB2 E158G/A |
[95] |
HA |
D222G |
H1N1 |
Altered receptor binding specificity |
[99,100,101,102] |
E391K |
H1N1 |
Currently in pdm2009 viruses circulating, potentially alter membrane fusion and antigenicity |
[103] |
142N, 177N |
H1N1 |
Increased virulence and pathogenicity in mice, reduced sensitivity to neutralizing antibodies |
[104,105] |
E190D, G225E |
H1N1 |
Increased receptor binding affinity, associated with mammalian adaptation |
[11] |
D225G |
H1N1 |
Altered receptor binding specificity, increased replication and transmissibility in ferrets |
[106,107] |
NP |
N319K |
H7N7 |
Associated with mammalian adaptation when combined with PB2 D701N |
[62,108] |
D375N |
H1N1 |
Increased virulence in mice, associated with mammalian adaptation |
[4,26,109] |
16D, 283P, 313Y, 357K |
H1N1 |
Circumvent antiviral MxA |
[112,113] |
E53D, R100V, F313V |
H1N1 |
Increased resistance to MxA |
[113] |
A336T, F346S, T378A |
H1N1 |
Adaptation to guinea pigs |
[114,115,116] |
319K |
H5N1 |
Greater virulence in mammals when combined with PA 615R |
[74] |
N319K |
H7N7 |
Associated with mammalian adaptation when combined with PB2 D701N |
[62,108] |
NA |
H275Y, S246N, D198G, D198N, Y155H |
H1N1 |
Oseltamivir resistance |
[44] |
M |
A86S |
LAIV - H2N2 backbone, H3N2 |
Increased viral replication in temperature dependent manner |
[126] |
A41P |
H1N1 |
Reduction of transmission efficiency |
[127] |
A41V |
H1N1 |
Increased virulence in mice |
[128,129] |
F79S |
H1N1 |
Attenuated replication |
[130] |
R101S, R105S |
H1N1 |
Temperature sensitive in vitro, attenuation in vivo
|
[131] |
30D, 215A |
H5N1 |
Increased virulence in mice |
[132] |
F62L; V166M |
H1N1 |
Enhanced replication and transmission in guinea pigs |
[115,121] |
S31N, V27A, L26F, A30T |
H1N1, H3N2 |
Adamantane resistance |
[136] |
L43T |
H1N1 |
Rimantadine resistance |
[137] |