Resistance mutation R292K is induced in influenza A(H6N2) virus by exposure of infected mallards to low levels of oseltamivir

PLoS One. 2013 Aug 12;8(8):e71230. doi: 10.1371/journal.pone.0071230. eCollection 2013.

Abstract

Resistance to neuraminidase inhibitors (NAIs) is problematic as these drugs constitute the major treatment option for severe influenza. Extensive use of the NAI oseltamivir (Tamiflu®) results in up to 865 ng/L of its active metabolite oseltamivir carboxylate (OC) in river water. There one of the natural reservoirs of influenza A, dabbling ducks, can be exposed. We previously demonstrated that an influenza A(H1N1) virus in mallards (Anas platyrhynchos) exposed to 1 µg/L of OC developed oseltamivir resistance through the mutation H274Y (N2-numbering). In this study, we assessed the resistance development in an A(H6N2) virus, which belongs to the phylogenetic N2 group of neuraminidases with distinct functional and resistance characteristics. Mallards were infected with A(H6N2) while exposed to 120 ng/L, 1.2 µg/L or 12 µg/L of OC in their sole water source. After 4 days with 12 µg/L of OC exposure, the resistance mutation R292K emerged and then persisted. Drug sensitivity was decreased ≈13,000-fold for OC and ≈7.8-fold for zanamivir. Viral shedding was similar when comparing R292K and wild-type virus indicating sustained replication and transmission. Reduced neuraminidase activity and decrease in recovered virus after propagation in embryonated hen eggs was observed in R292K viruses. The initial, but not the later R292K isolates reverted to wild-type during egg-propagation, suggesting a stabilization of the mutation, possibly through additional mutations in the neuraminidase (D113N or D141N) or hemagglutinin (E216K). Our results indicate a risk for OC resistance development also in a N2 group influenza virus and that exposure to one NAI can result in a decreased sensitivity to other NAIs as well. If established in influenza viruses circulating among wild birds, the resistance could spread to humans via re-assortment or direct transmission. This could potentially cause an oseltamivir-resistant pandemic; a serious health concern as preparedness plans rely heavily on oseltamivir before vaccines can be mass-produced.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anseriformes / virology
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / pharmacology*
  • Chick Embryo
  • Computational Biology
  • Drug Resistance, Viral / genetics*
  • Hemagglutinin Glycoproteins, Influenza Virus / genetics
  • Influenza A virus / drug effects*
  • Influenza A virus / genetics*
  • Influenza in Birds / virology*
  • Male
  • Microbial Sensitivity Tests
  • Mutation / drug effects*
  • Neuraminidase / genetics
  • Neuraminidase / metabolism
  • Oseltamivir / administration & dosage
  • Oseltamivir / analogs & derivatives
  • Oseltamivir / chemistry
  • Oseltamivir / pharmacology*
  • Water / chemistry
  • Zanamivir / pharmacology

Substances

  • Antiviral Agents
  • Hemagglutinin Glycoproteins, Influenza Virus
  • Water
  • Oseltamivir
  • Neuraminidase
  • oseltamivir carboxylate
  • Zanamivir

Grants and funding

The Family Olinder-Nielsen’s Foundation, the Swedish Research Council and the Swedish Research Council (FORMAS) provided financial support. F. Hoffman-La Roche Ltd. donated OC and deuterium labeled OC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.