Novel H1N1 influenza A virus infection in a patient with acute rejection after liver transplantation

BACKGROUND:The 2009 H1N1 influenza A virus was first identified in April 2009 and rapidly evolved into a pandemic. Recipients of solid-organ transplants have a higher risk for severe infection because of immunosuppression.There are limited reports of 2009 H1N1 influenza in liver transplant recipients,especially in China. METHODS:We present a case of a 48-year-old male liver transplant recipient with 2009 H1N1 influenza A virus.He received therapy for acute rejection after transplantation and was confirmed with H1N1 virus infection. RESULTS:The patient was started on oseltamivir(75 mg, orally twice daily)and had a benign hospital course,with defervescence and resolution of symptoms within 72 hours. The follow-up chest radiograph after discharge was normal. CONCLUSIONS:The 2009 H1N1 influenza in this hospitalized transplant recipient was relatively mild,and prolonged viral shedding was not noted.Oseltamivir can be a valid measure in immunocompromised individuals.

In silico modification of oseltamivir as neuraminidase inhibitor of influenza A virus subtype H1N1

This research focused on the modification of the functional groups of oseltamivir as neuraminidase inhibitor against influenza A virus subtype H1N1.Interactions of three of the best ligands were evaluated in the hydrated state using molecular dynamics simulation at two different temperatures.The docking result showed that AD3BF2 D ligand（N-[（1S,6R）-5-amino-5-{[（2R,3S,4S）-3,4-dihydroxy-4-（hydroxymethyl） tetrahydrofuran-2-yl]oxy}-4-formylcyclohex-3-en-1-yl]acetamide-3-（1-ethylpropoxy）-1-cyclohexene-1-carboxylate） had better binding energy values than standard oseltamivir.AD3BF2 D had several interactions,including hydrogen bonds,with the residues in the catalytic site of neuraminidase as identified by molecular dynamics simulation.The results showed that AD3BF2 D ligand can be used as a good candidate for neuraminidase inhibitor to cope with influenza A virus subtype H1N1.

Close Relationship between the 2009 H1N1 Virus and South Dakota AIV Strains

Although previous publications suggest the 2009 pandemic influenza A (H1N1) virus was reassorted from swine viruses of North America and Eurasia,the immediate ancestry still remains elusive due to the big evolutionary distance between the 2009 H1N1 virus and the previously isolated strains. Since the unveiling of the 2009 H1N1 influenza,great deal of interest has been drawn to influenza,consequently a large number of influenza virus sequences have been deposited into the public sequence databases. Blast analysis demonstrated that the recently submitted 2007 South Dakota avian influenza virus strains and other North American avian strains contained genetic segments very closely related to the 2009 H1N1 virus,which suggests these avian influenza viruses are very close relatives of the 2009 H1N1 virus. Phylogenetic analyses also indicate that the 2009 H1N1 viruses are associated with both avian and swine influenza viruses circulating in North America. Since the migrating wild birds are preferable to pigs as the carrier to spread the influenza viruses across vast distances,it is very likely that birds played an important role in the inter-continental evolution of the 2009 H1N1 virus. It is essential to understand the evolutionary route of the emerging influenza virus in order to find a way to prevent further emerging cases. This study suggests the close relationship between 2009 pandemic virus and the North America avian viruses and underscores enhanced surveillance of influenza in birds for understanding the evolution of the 2009 pandemic influenza.

Morphofunctional Characteristics of Pulmonary Surfactant System and Its Effect on Immune Cells in Influenza A (H1N1) Pathogenesis

There is an annual increase of influenza-related SARI cases in winter months. Despite the high relevance of this problem, influenza pathogenesis and the role of surfactant system and its SP-A (surfactant protein A) enzyme in antiviral defense remain poorly understood. SP-A activates macrophage M1 polarization and triggers an antiviral response due to the activation of T-cells and dendritic cells. Therefore, surfactant system is an important element of infection protection and a promising therapeutic target.

Epidemiology and Genotypic Diversity of Eurasian Avian-Like H1N1 Swine Influenza Viruses in China

Eurasian avian-like H1 N1(EA H1 N1)swine influenza virus(SIV)outside European countries was first detected in Hong Kong Special Administrative Region(Hong Kong,SAR)of China in 2001.Afterwards,EA H1 N1 SIVs have become predominant in pig population in this country.However,the epidemiology and genotypic diversity of EA H1 N1 SIVs in China are still unknown.Here,we collected the EA H1 N1 SIVs sequences from China between 2001 and 2018 and analyzed the epidemic and phylogenic features,and key molecular markers of these EA H1 N1 SIVs.Our results showed that EA H1 N1 SIVs distributed in nineteen provinces/municipalities of China.After a long-time evolution and transmission,EA H1 N1 SIVs were continuously reassorted with other co-circulated influenza viruses,including 2009 pandemic H1 N1(A(H1 N1)pdm09),and triple reassortment H1 N2(TR H1 N2)influenza viruses,generated 11 genotypes.Genotype 3 and 5,both of which were the reassortments among EA H1 N1,A(H1 N1)pdm09 and TR H1 N2 viruses with different origins of M genes,have become predominant in pig population.Furthermore,key molecular signatures were identified in EA H1 N1 SIVs.Our study has drawn a genotypic diversity image of EA H1 N1 viruses,and could help to evaluate the potential risk of EA H1 N1 for pandemic preparedness and response.

Efficacy of seasonal pandemic influenza hemagglutinin DNA vaccines delivered by electroporation against aseasonal H1N1 virus challenge in mice

Prophylactic DNA vaccines against the influenza virus are promising alternatives to conventional vaccines. In this study, we generated two candidate gene-based influenza vaccines encoding either the seasonal or pandemic hemagglutinin antigen （HA） from the strains A/New Caledonia/20/99 （HIN1） （pV1AS） and A/Califorrtia/04/2009 （H1N1） （pVEH1）, respectively. After verifying antigen expression, the immunogenicity of the vaccines delivered intramuscularly with electroporation was tested in a mouse model. Sera of immunized animals were tested in hemagglutination inhibition assays and by ELISA for the presence of HA-specific antibodies. HA-specific T-cells were also measured in IFN-γ ELISpot assays. The protective efficacy of the candidate influenza vaccines was evaluated by measuring mortality rates and body weight after a challenge with 100 LD50 of mouse-adapted A/New Caledonia/20/99 （H1N1）. Mice immunized with either one of the two vaccines showed significantly higher T cell and humoral immune responses （P〈0.05） than the pVAX1 control group. Additionally, the pV1A5 vaccine effec- tively protected the mice against a lethal homologous mouse-adapted virus challenge with a survival rate of 100% compared with a 40% survival rate in the pVEH1 vaccinated group （P〈0.05）. Our study indicates that the seasonal influenza DNA vac- cine completely protects against the homologous A/New Caledonia/20/99 virus （H1N1）, while the pandemic influenza DNA vaccine only partially protects against this virus.

Hospitalized patients with novel influenza A （H1N1） virus infection： Shanghai, June-July 2009

Background From late May 2009, sporadic imported cases of novel influenza A （HIN1） were continuously confirmed in Shanghai, but there were few reports on its clinical presentation in China. The aim of the study was to investigate the demographic and clinical features of the laboratory-confirmed cases and the treatment with oseltamivir. Method We performed a retrospective study in the Shanghai Public Health Clinical Center （SHAPHC）, reviewing the medical records of the laboratory-confirmed patients derived from June 10 to July 20, 2009. Results A total of 156 cases were enrolled, of whom 152 had a history of recent travel. The mean age was 22.6 years and 89 cases （57.1%） were males. The most common symptoms were fever, cough, and sore throat, with children more likely to run a temperature above 38.5℃ than adults. The mean leucocyte count was 5.4×10^9/L, the mean neutrophil count 3.2×10^9/L and the mean lymphocyte count 1.4×10^9/L. Other findings included a normal range or elevated level of C-reactive protein （CRP） and glutamic-pyruvic transaminase and a normal or decreased level of prealbumin; the levels of prealbumin and CRP were significantly lower in the children than in the adults. Fifty-two patients had abnormal chest CT results, with small unilateral or bilateral pulmonary infiltrates, axillary and mediastinal lymphadenopathy and local pleural thickening, while no cases showed symptoms of hypoxia. All the patients received oseltamivir and recovered without complications, but the duration of fever and virus shedding were significantly longer in the children than in the adults. Conclusions Travel-related circulation may be an important reason for the H1N1 epidemic in the non-epidemic areas, and the virus caused mild respiratory symptoms. The infection in children was more severe in terms of prealbumin levels, temperature, the duration of fever and virus shedding. Oseltamivir was effective for H1N1, but more effective in the adults than in the children.

Reduning plus ribavirin display synergistic activity against severe pneumonia induced by H1N1 influenza A virus in mice

OBJECTIVE:To investigate synergistic effect of Reduning(RDN)injection plus ribavirin against severe pneumonia induced by H1 N1 influenza A virus in mice.METHODS:We established a mouse model of severe pneumonia induced by influenza A virus by infecting Balb/c mice with CA07 virus.We randomly assigned the infected mice into four groups,and treated them with normal saline(NS group),RDN(injection,86.6 mg/kg),ribavirin(injection,66.6 mg/kg)or double Ribavirin plus RDN group,the same dosage as used in the single treatments)for 5 d.Lung index and lung pathology were recorded or calculated in terms of the curative effective.Cytokines,NOD-like receptor family pyrin domain containing 3(NLRP3)inflammasome related protein including caspase-associated recruitment domain(CARD)domain Apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),caspase-1 and NOD-like receptor family,pyrin domain containing 3(NLRP3),and reactive oxygen species were simultaneously investigated.RESULTS:RDN plus ribavirin treatment,not RDN or ribavirin alone,provided a significant survival benefit to the influenza A virus-infected mice.The combination treatment protected the mice against severe influenza infection by attenuating the severe lung injury.The combined treatment also reduced the viral titers in mouse lungs and lung index,downregulated their immunocytokine levels,including IL-1βand IL-18,and down regulated the NLRP3,especially the transcription and translation of caspase-1.Meanwhile NS group had significantly higher reactive oxygen species(ROS)expression which could was dramatically reduced by the treatment of RDN plus ribavirin.CONCLUSION:Our study showed that RDN combined with ribavirin could protect the mice,and reduce the lung immunopathologic damage caused by severe influenza pneumonia.The mechanism could be that it reduced ROS produce and inhibited NLRP3 inflammasome activation so that mainly lower the downstream inflammatory cytokines IL-1βand IL-18.

Influenza A pandemic （H1N1） 2009 virus infection

The clinical spectrum of the 2009 pandemic influenza A （H1N1） infection ranged from self-limited mild illness to progressive pneumonia, or even a fatal outcome. We summarize the clinical manifestations, risk factors for severe and fatal cases, pathologic findings and treatment of this disease in this paper based on current reports from different regions of the world.

Mutations associated with egg adaptation of influenza A(H1N1)pdm09 virus in laboratory based surveillance in China, 2009–2016

Mutations of influenza virus associated with adaptation occurring during passage in embryonated chicken eggs could result in antigenic change or reduced vaccine effectiveness.In this study,we investigated the mutations of influenza A(H1N1)pdm09 egg isolates from the Chinese National Influenza Surveillance Network between 2009 and 2016.Thirteen mutations were identified in the hemagglutinin(HA)protein from viruses passaged in eggs,in comparing to those in cells.After scanning public database,four mutations,D127E,L191I,D222G/N and Q223R in HA1,which may alter the receptor-binding specificity,were observed frequently.Although the A(H1N1)pdm09 virus has evolved in human for nearly ten years,most egg-cultured viruses acquired one or more further mutations.Using the egg isolates for influenza surveillance requires extra caution because of these selected mutations,and their impacts on antigenicity and receptor-binding property need further evaluation.Currently,most of the influenza vaccines are produced using egg isolates,particularly in China.Thus,there is an urge to promote the establishment of an alternative influenza vaccine production platform.

Insights from investigating the interactions of natural product inhibitors with neuraminidase of the 2009 H1N1 influenza virus

Neuraminidase(NA) plays a biologically vital role in the replication of influenza virus, and NA inhibitors(NAIs) are most widely used in the clinical anti-flu therapy. NA of 2009 H1 N1 influenza virus(09 N1) possesses a different substrate-binding cavity compared with other NA subtypes, making 09 N1 a more appropriate starting point for the discovery of potent 09 N1 inhibitors. As natural products are of great structural diversity, research on the interaction between natural NAIs and 09 N1 can throw light on the design of new structural NAIs. In this study, we, for the first time, conducted molecular docking procedure with GOLD on 10 natural inhibitors to 09 N1, and acquired their binding modes with 09 N1. The docking results showed that the active site S1 was important in the binding of NAIs to 09 N1. Then five scaffolds were extracted from these NAIs with interactions to site S1, and these could be used in the structural modification of NAIs. Besides, we found that the addition of H-bonding interaction with the active site could improve the NA inhibitory activity of NAIs, and it might be the reason why the approved NAIs showed high efficiency. Two terminal hydrophobic sites(Terminal 1 and Terminal 2) with no interactions to the approved NAI zanamivir were found in the 09 N1 active cavity, and four NAIs were first found to bind with the terminals. Till now, there are few studies on the meaning of Terminal 2 in the binding of NAI to NA, which could be a new direction for the rational design of NAIs.

Detection and pathogenesis of a novel swine H3N2 influenza virus containing three genes from the 2009 pandemic H1N1 influenza viruses in Korea in 2015

Dear Editor,Influenza A viruses cause pandemics at an interval of approximately 10-40 years,and pigs are regarded as a＂mixing vessel＂because they are easily infected with avian and human influenza viruses（Ito et al.,1998）.According to previous studies,H3N2,H1N2,and H1N1 subtypes o（swine influenza viruses have been detected in Korean pigs （Pascua et al., 2013; Kim et al., 2014; Song et al., 2007）. Moreover, a novel H3N2 influenza virus containing the matrix （34） gene from a 2009 pandemic influenza virus was detected in Korean pigs in 2013 （Pascua et al., 2013）, an H1N2 influenza virus con- taining the internal genes from a 2009 pandemic influ- enza virus was found in Korean pigs in 2014 （Kim et al., 2014）, and an H1N1 influenza virus containing all genes from the classical swine influenza viruses was isolated from Korean pigs in 2007 （Song et al., 2007）.

Rapid detection of influenza A(H1N1)virus by conductive polymer-based nanoparticle via optical response to virus-specific binding

A recurrent pandemic with unpredictable viral nature has implied the need for a rapid diagnostic technology to facilitate timely and appropriate countermeasures against viral infections.In this study,conductive polymer-based nanoparticles have been developed as a tool for rapid diagnosis of influenza A(H1N1)virus.The distinctive property of a conductive polymer that transduces stimulus to respond,enabled immediate optical signal processing for the specific recognition of H1N1 virus.Conductive poly(aniline-co-pyrrole)-encapsulated polymeric vesicles,functionalized with peptides,were fabricated for the specific recognition of H1N1 virus.The low solubility of conductive polymers was successfully improved by employing vesicles consisting of amphiphilic copolymers,facilitating the viral titer-dependent production of the optical response.The optical response of the detection system to the binding event with H1N1,a mechanical stimulation,was extensively analyzed and provided concordant information on viral titers of H1N1 virus in 15 min.The specificity toward the H1N1 virus was experimentally demonstrated via a negative optical response against the control group,H3N2.Therefore,the designed system that transduces the optical response to the target-specific binding can be a rapid tool for the diagnosis of H1N1.

Houttuynia cordata polysaccharide alleviated intestinal injury and modulated intestinal microbiota in H1N1 virus infected mice

Houttuynia cordata polysaccharide(HCP) is extracted from Houttuynia cordata, a key traditional Chinese medicine. The study was to investigate the effects of HCP on intestinal barrier and microbiota in H1N1 virus infected mice. Mice were infected with H1N1 virus and orally administrated HCP at a dosage of 40 mg×kg^(–1)×d^(–1). H1N1 infection caused pulmonary and intestinal injury and gut microbiota imbalance. HCP significantly suppressed the expression of hypoxia inducible factor-1α and decreased mucosubstances in goblet cells, but restored the level of zonula occludens-1 in intestine. HCP also reversed the composition change of intestinal microbiota caused by H1N1 infection, with significantly reduced relative abundances of Vibrio and Bacillus, the pathogenic bacterial genera. Furthermore, HCP rebalanced the gut microbiota and restored the intestinal homeostasis to some degree. The inhibition of inflammation was associated with the reduced level of Toll-like receptors and interleukin-1β in intestine, as well as the increased production of interleukin-10. Oral administration of HCP alleviated lung injury and intestinal dysfunction caused by H1N1 infection. HCP may gain systemic treatment by local acting on intestine and microbiota. This study proved the high-value application of HCP.

Clinical features of initial cases of 2009 pandemic influenza A （H1N1） in Macao, China

Background The first case of pandemic influenza A （H1N1） virus infection in Macao Special Administrative Region （SAR） of the People＇s Republic of China was documented on June 18, 2009. Subsequently, persons with suspected infection or of contact with suspected cases received screening. All the confirmed cases were hospitalized and treated with oseltamivir. Their clinical features were observed. This may help for better management for later patients and be of benefit to the government of Macao SAR to adjust its strategy to combat the pandemic influenza A （H1N1） virus infection more efficiently. Methods From June to July 2009, the initial 72 cases of influenza A （H1N1） in Macao were hospitalized in Common Hospital Centre S. Januario （CHCSJ）. The infection was confirmed by real-time reverse-transcriptase polymerase chain reaction （RT-PCR）. The clinical features of the disease were closely observed and documented. Oseltamivir was given to all patients within 48 hours after the onset of disease and maintained for 5 days. Results The mean age of the 72 patients was 21 years old. Forty of them were men and 32 were women. The median incubation of the virus was 2 days （1 to 7 days）. The most common symptoms were fever （97.2%） and cough （77.8%）. The rate of gastrointestinal symptoms including nausea, vomiting, and diarrhea was 2.8%. Fever typically lasted for 3 days （1 to 9 days）. The median time from the onset to positive results of real-time RT-PCR was 6 days （3 to 13 days）. After treatment with oseltamivir, most patients became afebrile within 48 hours. Only one aged patient with a history of glaucoma and hypothyroidism was found to have lung infiltration on chest X-ray. Conclusions The initial cases of pandemic influenza A （H1N1） virus infection in Macao SAR showed that most of the infected persons had a mild course. The virus could be detected by real-time RT-PCR within a median of 6 days from the onset. Oseltamivir was effective.

Sixty-two severe and critical patients with 2009 influenza A （H1N1） in Shanghai, China

Background Pandemic influenza A （H1N1） emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A （HIN1） disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with HIN1 in Shanghai, China.Methods A retrospective study on 62 severe and critically ill patients with 2009 influenza A （H1N1） was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments, and clinical outcomes were collected for analysis.

Antigenic Drift of the Hemagglutinin from an Influenza A(H1N1) pdm09 Clinical Isolate Increases its Pathogenicity In Vitro

The influenza A(H1 N1)pdm09 virus emerged in 2009 and has been continuously circulating in humans for over ten years.Here,we analyzed a clinical influenza A(H1 N1)pdm09-infected patient case hospitalized for two months in Guangdong(from December 14,2019 to February 15,2020).This isolate,named A/Guangdong/LCF/2019(LCF/19),was genetically sequenced,rescued by reverse genetics,and phylogenetically analyzed in the context of other relevant pdm09 isolates.Compared with earlier isolates,this pdm09 virus’s genetic sequence contains four substitutions,S186 P,T188 I,D190 A,and Q192 E,of the hemagglutinin(HA)segment at position 186–192(H3 numbering)in the epitope Sb,and two of which are located at the 190-helix.Phylogenetic analysis indicated that the epitope Sb started undergoing a rapid antigenic change in2018.To characterize the pathogenicity of this novel substitution motif,a panel of reassortant viruses containing the LCF/2019 HA segment or the chimeric HA segment with the four substitutions were rescued.Kinetic growth data revealed that the reassortant viruses,including the LCF/2019 with the PTIAAQE substitution,propagated faster than those rescued ones having the STTADQQ motif in the epitope Sb in Madin-Darby Canine Kidney(MDCK)cells.The HI test showed that the binding activity of escape mutant to 2018 pdm09 sera was weaker than GLW/2018,suggesting that old vaccines might not effectively protect people from infection.Due to the difference in the selection of vaccine strains,people vaccinated in the southern hemisphere could still suffer a severe infection if infected with this antigenic drift pdm09 virus.

2009-2011年广东省甲型H1N1流感病毒血凝素基因的进化特征

目的了解2009--2011年广东甲型H1N1流感病毒血凝素基因的HA1进化特征。方法选取广东甲型H1N1流感病毒83株，提取病毒RNA，经RT—PCR反应扩增HA1并测序，测定的序列用生物信息软件分析，与GenBank中相关序列比较，并对推导的编码氨基酸序列进行进化分析。结果2009--2011年广东甲型H1N1流感病毒HAl基因的进化速率是5．2×10^-3，高于人季节性H1N1病毒；变异氨基酸多数位于HA蛋白表面，其中部分位于抗原决定簇；在两例死亡病例分离株HA1的第222位氨基酸发生D222G／D222N变异。结论遗传进化分析表明，甲型H1N1流感病毒发生了一定程度的变异，造成2011年初在广东的再次流行。HA1的第222位氨基酸变异可能与疾病的严重程度有关。

Viral shedding in Chinese young adults with mild 2009 H1N： influenza

Background The duration of viral shedding and the transmission of 2009 H1N1 influenza among individuals, especially among the younger population with mild illness, are not well understood now. The aim of this study was to determine the viral shedding of the young adult patients with mild 2009 H1N1 influenza in China.Methods From September 2009 to January 2010, the clinical data and serial nasopharyngeal swabs of 67 patients with 2009 H1N1 influenza and 37 patients with seasonal influenza aged from 18 years to 35 years were collected. The nasopharyngeal swab samples were detected by real time RT-PCR to determine the viral shedding. All the patients did not receive the antiviral therapy but Chinese medicine for detoxicating.Results Among the patients with H1N1 virus infection, 82.1% （55/67） patients presented with fever symptom, while more patients with high fever （≥39℃） were found in seasonal influenza patients （P〈0.05）. For the H1N1 patients, the median interval between the symptom onset and the undetectable RNA was six days （4-10 days）. But viral shedding was still found in 31.3% patients after 7 days following illness onset. The median interval between disappearance of fever and an undetectable viral RNA level was three days （2-8 days）, and 17.9% patients were found to be viral shedding 6 days later after normalization of body temperature. For the seasonal influenza patients, 94.6% patients were detected out viral RNA within 7 days. The median interval of seasonal influenza between the symptom onset and the undetectable RNA was four days （3-8 days）. The median interval between disappearance of fever and an undetectable viral RNA level was three days （2-6 days）.Conclusion It suggests that 7 days isolation period from the illness onset or 24 hours after the resolution of fever and respiratory symptoms are not long enough to cut off the transmission among Chinese young adults with mild illness

Interferon as a Mucosal Adjuvant for an Influenza Vaccine in Pigs

Interferon, a natural protein that is produced by a variety of cells during viral infection, activates the transcription of multiple functional genes in cells, regulates synergy among various signaling pathways, and mediates many biological functions such as antiviral activity, immune regulation, and cell growth. However, clinical research on interferon in livestock is lacking. In this study, recombinant porcine interferon(PoIFNa) was used as an adjuvant, in combination with inactivated influenza virus, to vaccinate 6-week-old pigs via nasal infusion. The transcription of target genes was then monitored and the functions of PoIFNa were determined with respect to the activation of mucosal immunity. We found that a combination of low-dose PoIFNa and inactivated influenza virus could significantly up-regulate the expression of immunoregulatory cytokines such as IL-2, IL-18, IFN-c, IL-6, and IL-10 by real-time PCR, suggesting the induction of a strong mucosal innate immune response after administration. In addition, low-dose PoIFNa can significant enhancing the transcription of genes encoding homing factors including CCR9 and CCR10(P \ 0.001), thereby resulting in the induction of higher levels of HA-specific antibodies(P \ 0.05), which can be determined by ELISA and IFA. Post-immunization challenges with H1 N1 virus demonstrated that PoIFNa, combined with inactivated influenza virus, could alleviate clinical signs in pigs during the early stages of viral infection. These studies reveal low-dose PoIFNa as a potential mucosal adjuvant for influenza virus in pigs.