Part 1: Amphiregulin (Areg), a growth factor produced by regulatory T (Treg) cells to facilitate tissue repair/regeneration, contains a heparan sulfate (HS) binding domain. How HS, a highly sulfated glycan subtype that alters growth factor signaling, influences Areg repair/regeneration functions is unclear. Here we report that inhibition of HS in various cell lines and primary lung mesenchymal cells (LMC) qualitatively alters downstream signaling and highlights the existence of HS-dependent vs. independent Areg transcriptional signatures. Utilizing a panel of cell lines with targeted deletions in HS synthesis–related genes, we found that the presence of the glypican family of HS proteoglycans is critical for Areg signaling and confirmed this dependency in primary LMC by siRNA-mediated knockdown. Furthermore, in the context of influenza A virus (IAV) infection in vivo, we found that an Areg-responsive subset of reparative LMC upregulate glypican-4 and HS. Conditional deletion of HS primarily within this LMC subset resulted in reduced blood oxygen saturation following infection with IAV, with no changes in viral load. Finally, we found that co-culture of HS-knockout LMC with IAV-induced Treg cells results in reduced LMC responses. Collectively, this study reveals the essentiality of HS on a specific lung mesenchymal population as a mediator of Treg cell–derived Areg reparative signaling during IAV infection. Part 2: Regulatory T (Treg) cells are known to play critical roles in tissue repair via provision of growth factors such as amphiregulin (Areg). Areg-producing Treg cells have previously been difficult to study because of an inability to isolate live Areg-producing cells. In this report, we created a novel reporter mouse to detect Areg expression in live cells (AregThy1.1). We employed influenza A and bleomycin models of lung damage to sort Areg-producing and -non-producing Treg cells for transcriptomic analyses. Single cell RNA-seq revealed distinct subpopulations of Treg cells and allowed transcriptomic comparisons of damage-induced populations. Single cell TCR sequencing showed that Treg cell clonal expansion is biased towards Areg-producing Treg cells, and largely occurs within damage-induced subgroups. Gene module analysis revealed functional divergence of Treg cells into immunosuppression-oriented and tissue repair–oriented groups, leading to identification of candidate receptors for induction of repair activity in Treg cells. We tested these using an ex vivo assay for Treg cell–mediated tissue repair, identifying 4-1BB agonism as a novel mechanism for reparative activity induction. Overall, we demonstrate that the AregThy1.1 mouse is a promising tool for investigating tissue repair activity in leukocytes.

Influenza A virus (IAV) causes annual seasonal epidemics and occasional pandemics resulting in significant levels of mortality and socio-economic costs worldwide. PB1-F2 is a small non-structural protein encoded by an alternate +1 open reading frame in the PB1 gene. PB1-F2 is considered to play important roles in primary influenza virus infection and post-influenza secondary bacterial pneumonia in mice. It is a multifunctional and enigmatic protein with diverse functions attributed to it and the precise contribution of PB1-F2 to the IAV life cycle in avian and mammalian hosts remains largely unknown. In the triple-reassortant H3N2 (TR H3N2) swine influenza virus (SIV) background, we found that PB1-F2 expression did not affect nasal shedding, lung viral load, immunophenotypes, and lung pathology in pigs. On the other hand, in turkeys, deletion of PB1-F2 resulted in early induction of clinical disease and effective transmission among the turkey poults. Interestingly, the virulence associated 66S mutation in PB1-F2 abolished the ability of the IAV to successfully infect turkeys and transmit to in-contacts. These results highlight the strain- and species-specific role of PB1-F2 protein. We also demonstrated that specific amino acid residues in the C-terminal of PB1-F2 determine the pathogenicity of 2009 swine-origin pandemic H1N1 virus in a mouse model. The C-terminal residues 73K, 75R, and 79R together with 66S increased virus replication, decreased type I interferon response, increased infiltration of neutrophils and myeloperoxidase production in lungs resulting in acute respiratory distress syndrome (ARDS) in mice with characteristic clinical and pathological features of acute lung injury (ALI). Further, we found that PB1-F2 induces mitochondrial superoxide production and mitochondrial damage in a sequence dependent manner in IAV-infected lung epithelial cells. PB1-F2-mediated mitochondrial damage promotes Parkin-mediated mitophagy but suppresses the autophagic degradation of damaged mitochondria in the infected lung epithelial cells. Accumulated dysfunctional mitochondria likely to aggravate host cell death and inflammatory responses. Taken together, the present findings enhance our understanding of PB1-F2 protein as a virulence determinant in IAV infection in a species- and strain-specific manner and provide new insights into the impact of genetic changes in PB1-F2 on the host pathogenesis of virulent IAV strains. / Ph. D.

Influenza A virus (IAV) is generally associated with the seasonal malady that causes brief respiratory illness during the winter months, known simply as "the flu." Most otherwise healthy individuals will suffer from mild fever, congestion, headaches and myalgia that are resolved within 5-7 days of onset. However, there are nearly 500,000 influenza-related deaths that occur world-wide every year. Many of these casualties and patients hospitalized with influenza also test positive for bacterial pneumonia, the most common agent being Streptococcus pneumoniae. Although all individuals are subject to this viral:bacterial synergistic disease, the young, elderly, and immunocompromised are the most susceptible. Previous studies have shown that viral infection creates a prolonged hyper-responsive pro-inflammatory state in the lungs, which increases susceptibility to secondary bacterial infection. Lethality is due to detrimental pulmonary damage from a dysregulated host inflammatory response, known as the "cytokine storm." However, the nature of dual infection has not been well-studied in the elderly demographic. Therefore, we aim to better define this disease synergy in an aged mouse model and explore potential therapeutic alternatives that could be beneficial for the aged and other vulnerable populations. Sphingolipid modulation has emerged as a potential target to ameliorate the excessive inflammation (cytokine storm) elicited by highly pathogenic influenza. There is particular emphasis on sphingosine 1-phosphate (S1P) signaling, as well as control of intracellular S1P levels via sphingosine kinases (SK). Sphingolipids are involved in a multitude of cellular processes, and are tightly regulated by their metabolizing enzymes. We hypothesize that manipulation of sphingolipid signaling and alteration of the internal sphingolipid milieu will diminish the inflammatory response elicited by IAV infection. Using fluorescence-activated cell sorting (FACS), real-time PCR and cytometric bead array (CBA) analysis, we evaluated the immunomodulatory effects of systemic sphingosine analog treatment within the lung microenvironment under homeostatic and influenza-infected conditions. FTY720 treatment caused transient, but significant lymphopenia, influx of neutrophils and efflux of macrophages in the lungs, which was enhanced during a mild influenza infectionGene expression in the lungs was generally unaltered, but protein levels showed increases in specific influenza-induced cytokines, suggesting these treatments may have post-transcriptional effects on cytokine expression. To evaluate sphingolipid modulation in specific pulmonary cell types, we next observed the effects of these compounds and sphingosine kinase (SK) inhibitors in epithelial and alveolar macrophage-like cell lines. SK inhibitors and Enigmol demonstrated anti-viral effects in A549 cells, decreasing viral loads by up to 1.5 logs. Real-time PCR and CBA analysis further demonstrated that these effects were associated with alterations in key cytokine expression, including CCL2, CCL5, CXCL10, IL-6, and IL-8. Collectively, these findings indicate that therapeutic sphingolipid modulation has the potential for creating a protective microenvironment in the lungs that could alleviate or even prevent viral:bacterial synergistic disease. / Master of Science

學校停課在世界各國的流感大流行應對方案中常被列為一項社區緩疫措施，而這項措施亦在2009年H1N1流感大流行中被廣泛地使用。然而，這項緩疫措施經常被質疑是否恰當，原因是因為停課會對教育構成重大的影響，而且過往的流行病學硏究亦表示這項緩疫措施不一定有效。本論文硏究學校停課對2009年H1N1流感大流行在香港首5個月疫情中降低大流行流感傳播的效能。 / 在香港，在該大流行流感病毒於2009年4月在美國被發現後，香港政府實施了控疫措施(containment phase measures)，並開始對該流感大流行進行監測。為了判定大流行是否已在香港內蔓延，衛生防護中心設定了一個報告準則來讓本地醫生報告疑似大流行流感感染個案，並為每個懷疑個案作確診測試及為每個確診個案追溯感染源頭。當大流行流感在6月開始在香港內蔓延時，香港政府實施了緩疫措施(mitigation phase measures)。在緩疫措施底下，帶有流感病症的病人求診於指定流感診所和公共醫院急症室會被測試是否感染大流行流感，而停課措施亦在此時開始實行去減低大流行流感的傳播。停課措施一直維持至7月直至暑假開始，並經修改後於9月開學時繼續實行。在9月，鑑於已不再需要對流感大流行進行監測，對懷疑感染個案進行確診測試的政策止於該月下旬。確診個案中記錄了的病人資料，與及由學校停課和暑假所引起的學期變化，為這課題提供了一個理想硏究的機會。 / 在2009年的5月至9月，一共確診了27,687宗大流行流感個案。在確診個案中，所有個案都記錄了確診者的年歲和確診日期，而88%確診者提供了一個可定位的住宅地址。為了觀察學校停課的緩疫效果，本硏究定義了5個社會經濟年齡級別(socio-economic age classes) (當中包括有小學生和中學生)，並繪製了年齡級別與地域特定的疫情曲線(age-class-and-district-specific epidemic curves)。所有的疫情曲線在大流行流感在6月開始在香港蔓延後均穩步上升，而在屬於小學生和中學生的疫情曲線中能看到一個不尋常的上升出現在9月新學年開始時，意味著中小學生在學校的活動提升了大流行流感在他們之間的傳播。 / 先前，學校停課對減低2009年H1N1流感大流行在香港的傳播已被Wu et. al (2010a)進行了調查。透過使用一個具年齡結構的SIR模型(age-structured SIR model)來分析收集至8月27日的監測數據，該硏究表示流感大流行的傳播在暑假開始時減低了25%。在這研究中，我應用了Wu et. al (2010a)的方法來分析整個監測期間所收集的數據。在發現到該數學模型不能準確地擬合附加的監測數據後，我在該模型添加了兩個傳播特徵(當中包含兒童和成人之間的傳染在學校停課期間增加)去更準確地代表現實中的疫情。我的硏究顯示，學校停課雖然降低了兒童的感染率，但卻增加了成年人的感染率，令整體傳播在暑假開始時只減低了7.6%。這硏究結果表示，在將來的流感大流行中，封閉學校不大可能延遲流感大流行疫情至一個可令疫苗產生作用的程度，而且封閉學校可能會增加成人的感染率，從而有可能導致社會運作出現更混亂的情況。 / School closure is often included in national pandemic influenza response plans as a community mitigation measure and it was widely applied in Pandemic (H1N1) 2009. However, the appropriateness of this intervention is often questioned, as school closure causes major disruption to the education system and past epidemiological studies reveal this intervention is not necessarily effective. The present thesis evaluates the effect of school closure in mitigating transmission of Pandemic (H1N1) 2009 in Hong Kong in the initial 5 months of the pandemic. / In Hong Kong, following identification of the pandemic virus in US in April 2009, the government implemented containment phase measures and began surveillance on the pandemic. The Centre for Health Protection established a reporting criteria for doctors to report suspected cases of pandemic infection for laboratory confirmation, and the source of infection of confirmed cases was traced to determine if the pandemic was spreading locally. When local transmission of the pandemic began in June, the government began mitigation phase measures, in which patients with influenza-like- illness seeking treatment at designated flu clinics and public hospital emergency departments were tested for pandemic infection, and school closure was implemented for pandemic mitigation. The school closure policy lasted until summer holiday commenced in July, and was revised and continued in September when the new school season started. At the end of September, in view of pandemic surveillance was no longer useful, laboratory testing for suspected pandemic cases was halted. Patient demographic data collected from confirmed pandemic cases, together with temporal changes in school session induced by school closure and summer holiday, provided an ideal opportunity for investigation. / From May through September 2009, a total of 27,687 pandemic cases were confirmed, in which the age and confirmation date were recorded in all cases, and 88% provided a locatable residential address. To visualise the mitigative effect of school closure, 5 socio-economic age classes (which include primary and secondary school-aged children) were defined, and age-class-and-district-specific epidemic curves were constructed. All epidemic curves rose steadily after local transmission began in June, and an unusual upsurge in the epidemic curve of primary and secondary school-aged children is observed when schools resumed session in September, suggesting school session facilitated transmission amongst them. / Previously, the effect of school closure in mitigating Pandemic (H1N1) 2009 transmission in Hong Kong was investigated in Wu et al. (2010a). By analysing surveillance data collected as of 27 August with an age-structured susceptible- infectious-recovered (SIR) model, the study reported transmission was reduced by 25% when summer holiday commenced. In this study, I adapted the methodology in Wu et al. (2010a) to analyse data collected in the entire surveillance period. Upon observing the model fitted poorly to the additional data, I added 2 transmission features to the model (which include increased transmission between children and adults during school closure) to better represent the epidemic in reality. My analysis revealed that while school closure reduced incidence in children, it increased incidence in adults, leading to a reduction in overall transmission by only 7.6% when summer holiday started. The findings of this study suggest that school closure in a future influenza pandemic is unlikely to be able to delay the pandemic for vaccine to arrive in time, and that implementing this intervention may increase incidence in adults, which may lead to causing more disruption on the functioning of society. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chau, Kwan Long. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 148-154). / Abstracts also in Chinese. / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Influenza --- p.2 / Chapter 1.2 --- Public health response to pandemic influenza & School closure --- p.8 / Chapter 1.3 --- Pandemic (H1N1) 2009 --- p.13 / Chapter 1.4 --- Hong Kongs response to Pandemic (H1N1) 2009 --- p.17 / Chapter 1.5 --- Data and Research Objective --- p.24 / Chapter Chapter 2 --- Descriptive and Exploratory Analysis of Surveillance Data --- p.31 / Chapter 2.1 --- Introduction --- p.31 / Chapter 2.2 --- Methodology --- p.36 / Chapter 2.3 --- Results --- p.40 / Chapter 2.4 --- Discussion --- p.57 / Chapter Chapter 3 --- Evaluating the effect of School Closure by Modelling --- p.62 / Chapter 3.1 --- Introduction --- p.62 / Chapter 3.2 --- Methodology --- p.90 / Chapter 3.3 --- Results --- p.98 / Chapter 3.4 --- Discussion --- p.105 / Chapter Chapter 4 --- Discussion --- p.108 / Chapter 4.1 --- Study Findings --- p.108 / Chapter 4.2 --- Study Limitations --- p.109 / Chapter 4.3 --- Comments on using school closure in future influenza pandemics --- p.111 / Appendices --- p.116 / Bibliography --- p.148

Influenza A Viren besitzen ein segmentiertes, einzelsträngiges RNA-Genom, welches in Form viraler Ribonukleoprotein (vRNP)-Komplexe verpackt ist. Während das virale Genom im Zellkern repliziert wird, finden Assemblierung und Knospung reifer Viruspartikel an der apikalen Plasmamembran statt. Für die Virusbildung müssen die einzelnen viralen Komponenten hierher gebracht werden. Während intrinsische apikale Signale der viralen Transmembranproteine bekannt sind, sind der zielgerichtete Transport und der Einbau des viralen Genoms in neuentstehende Virionen noch wenig verstanden. In dieser Arbeit wurden potentielle Mechanismen des vRNP-Transportes untersucht, wie die Fähigkeit der vRNPs mit Lipidmembranen zu assoziieren und die intrinsische subzellulären Lokalisation des viralen Nukleoproteins (NP), eines Hauptbestandteils der vRNPs. Es konnte gezeigt werden, dass vRNPs nicht mit Lipidmembranen assoziieren, was mittels Flotation aufgereinigter vRNPs mit Liposomen unterschiedlicher Zusammensetzung untersucht wurde. Die Ergebnisse deuten jedoch darauf hin, dass das virale M1 in der Lage ist, Bindung von vRNPs an negativ-geladene Lipidmembranen zu vermitteln. Subzelluläre Lokalisation von NP wurde des Weiteren durch Expression fluoreszierender NP-Fusionsproteine und Fluoreszenzphotoaktivierung untersucht. Es konnte gezeigt werden, dass NP allein nicht mit zytoplasmatischen Strukturen assoziiert, stattdessen aber umfangreiche Interaktionen im Zellkern eingeht und mit hoher Affinität mit bestimmten Kerndomänen assoziiert, und zwar den Nukleoli sowie kleinen Kerndomänen, welche häufig in der Nähe von Cajal-Körperchen und PML-Körperchen zu finden waren. Schließlich wurde ein experimenteller Ansatz etabliert, welcher erlaubt, den Transport vRNP-ähnlicher Komplexe mittels Fluoreszenzdetektion aufzuzeichnen und Einzelpartikelverfolgungsanalysen durchzuführen. Unterschiedliche Phasen des vRNP-Transportes konnten beobachtet werden und ein 3-Phasen-Transportmodell wird skizziert. / Influenza A viruses have a segmented single-stranded RNA genome, which is packed in form of viral ribonucleoprotein (vRNP) complexes. While the viral genome is replicated and transcribed in the host cell nucleus, assembly and budding of mature virus particles take place at the apical plasma membrane. Efficient virus formation requires delivery of all viral components to this site. While intrinsic apical targeting signals of the viral transmembrane proteins have been identified, it still remains poorly understood how the viral genome is transported and targeted into progeny virus particles. In this study, potential targeting mechanisms were investigated like the ability of vRNPs to associate with lipid membranes and the intrinsic ability of the viral nucleoprotein (NP) – which is the major protein component of vRNPs – for subcellular targeting. It could be shown that vRNPs are not able to associate with model membranes in vitro, which was demonstrated by flotation of purified vRNPs with liposomes of different lipid compositions. Results indicated, however, that the matrix protein M1 can mediate binding of vRNPs to negatively charged lipid bilayers. Intrinsic subcellular targeting of NP was further investigated by expression of fluorescent NP fusion protein and fluorescence photoactivation, revealing that NP by itself does not target cytoplasmic structures. It was found to interact extensively with the nuclear compartment instead and to target specific nuclear domains with high affinity, in particular nucleoli and small interchromatin domains that frequently localized in close proximity to Cajal bodies and PML bodies. An experimental approach was finally established that allowed monitoring the transport of vRNP-like complexes in living infected cells by fluorescence detection. It was possible to perform single particle tracking and to describe different stages of vRNP transport between the nucleus and the plasma membrane. A model of three-stage transport is suggested.

Influenza A Viren (IAV) infizieren die Epithelzellen unserer Atemwege und stellen ein weltweites Gesundheitsproblem dar. Die Infektion beginnt mit der Bindung an Sialinsäure (SA) auf der Wirtszelloberfläche. Zwischen einem SA-Molekül und dem viralen Oberflächenprotein Hämagglutinin (HA) kommt es dabei zur Interaktion durch nicht kovalente Bindung. Die Inhibierung dieses entscheidenden Schrittes des Infektionszyklus durch Präsentation eines kompetitiven Binders ist ein möglicher Ansatz für ein antiviral wirkendes Mittel. Das Prinzip, mit dem IAV an Zellen binden, ist die Multivalenz. Detailliertes Wissen zur Multivalenz, speziell zur HA-SA-Interaktion, ist für eine effektive IAV-Inhibition von Nöten. Diese Arbeit untersucht und charakterisiert die HA-SA-Interaktion auf zwei unterschiedlichen Wegen. Wird SA auf einer ausgewählten Gerüststruktur funktionalisiert, kann es zu einer multivalenten Anordnung des IAV-Rezeptors kommen. Derartige multivalente Nanopartikel (NP) wurden in Bindungsstudien hinsichtlich ihres Potenzials charakterisiert IAV effektiv zu binden und zu inhibieren. Die Effektivität und die damit einhergehende Stabilität der HA-SA-Interaktionen der getesteten NP, die auf drei verschiedenen Gerüststrukturen basieren (Coiled-Coil-Peptid, PNA-DNA-Strang, Polyglycerolkomplex), hängt von der Verteilung elektrostatischer Oberflächenladungen und der Flexibilität der Gerüststruktur ab. Im zweiten Teil der Arbeit wurden Veränderungen auf Seiten des HAs analysiert. Zwei IAV mit Mutationen in der HA-Bindetasche, sowie das Wildtypvirus wurden in Messungen mittels Einzel-Virus-Kraft-Spektroskopie hinsichtlich ihres Bindungsverhaltens an SA charakterisiert. Die Daten belegen, dass die Verteilung elektrostatischer Oberflächenladungen im HA Einfluss auf die HA-SA-Interkation hat. Alle Ergebnisse zusammengenommen liefern neue Erkenntnisse über die Einflussnahme der HA-SA-Interaktion und wie daraus abgeleitet multivalente Nanopartikel weiter optimiert werden können. / The Influenza A virus (IAV) infects epithelial cells of the human respiratory tract and represents a global health problem. Every infection starts with virus binding on sialic acid (SA) displayed on the host cell surface. This step is characterized by interaction between the viral surface protein hemagglutinin (HA) and sialic acid (SA) that leads to a non-covalent binding. Inhibition of this crucial step of viral infection cycle by presenting a competitive binder to IAV is one approach utilized during the design of antiviral compounds. IAV binds specifically to cells by using the principle of multivalency. Targeting an effective virus inhibition requires detailed knowledge about the binding mechanism, especially about the HA-SA-interaction. This work focuses on the evaluation and characterization of the HA-SA-interaction following two different approaches. In case SA is functionalized on an appropriate scaffold structure, the IAV receptor can arrange in a multivalent fashion. These multivalent nanoparticles (NP) have been studied regarding their potential to effectively bind and inhibit IAV. This potential is directly linked to the stability of the HA-SA-interactions of the tested NPs, which are based on three different scaffold structures (coiled-coil peptide, PNA-DNA-strand, a complex of polyglycerols) and depends on the distribution of electrostatic surface charges and the flexibility of the scaffold structure. The second part of this thesis analyzed changes at HA. The wildtype virus and two IAVs comprising each a mutation in the binding pocket of HA were characterized regarding their binding behavior by single-virus-force-spectroscopy. Results revealed that the arrangement of electrostatic surface charges on HA affecting the HA-SA-interaction. Taken together, all results provide new and important insights into the dependence of the HA-SA-interaction and how this knowledge can be used to further optimize multivalent NPs.

This thesis explores the evolution of avian influenza A viruses (IAV), as well as host-pathogen interactions between these viruses and their main reservoir host, the Mallard (Anas platyrhynchos). IAV is a genetically diverse, multi-host virus and wild birds, particularly dabbling ducks, are the natural reservoir. At our study site, up to 30% of migratory Mallards are infected with IAV during an autumn season, and host a large number of virus subtypes. IAV diversity is driven by two main mechanisms: mutation, driving genetic drift; and reassortment following co-infection, resulting in genetic shift.   Reassortment is pervasive within an autumn season, both across multiple subtypes and within a single subtype. It is a key genetic feature in long-term maintenance of common subtypes, as it allows for independent lineage turn-over, generating novel genetic constellations. I hypothesize that the decoupling of successful constellations and generation of novel annual constellations enables viruses to escape herd immunity; these genetic changes must confer antigenic change for the process to be favourable. Indeed, in an experiment utilizing vaccines, circulating viruses escaped homosubtypic immunity, resulting in the proliferation of infections with the same subtype as the vaccine. While the host plays an important role in shaping IAV evolutionary genetics, one must consider that Mallards are infected with a multitude of other microorganisms. Here, Mallards were infected with IAV, gamma coronaviruses, and avian paramyxovirus type 1 simultaneously, and we found a putative synergistic interaction between IAV and gamma coronaviruses.   Mallards occupy the interface between humans, poultry, and wild birds, and are the reservoir of IAV diversity. New incursions of highly pathogenic H5 viruses to both Europe and North America reaffirms the role of wild birds, particularly waterfowl, in diffusion of viruses spatially. Using European low pathogenic viruses and Mallard model, this thesis contributes to aspects of epidemiology, ecology, and evolutionary dynamics of waterfowl viruses, particularly IAV

published_or_final_version / abstract / Microbiology / Master / Master of Philosophy

The influenza A virus non-structural (NS1) protein is multifunctional, and during virus-infection NS1 interacts with several factors in order to manipulate host-cell processes. This study reports that NS1 binds directly to p85β, a regulatory subunit of phosphoinositide 3-kinase (PI3K), but not to the related p85α. Expression of NS1 was sufficient to activate PI3K and cause the phosphorylation of a downstream mediator of PI3K signalling, Akt. However, in virus-infected MDCK cells, the kinetics of Akt phosphorylation did not correlate with NS1 expression, and suggested that negative regulation of this signalling pathway occurs subsequent to ~8h post-infection. Mapping studies showed that the NS1:p85β interaction is primarily mediated by the NS1 C-terminal domain and the p85β inter-SH2 (Src homology 2) domain. Additionally, the highly conserved tyrosine at residue 89 (Y89) of NS1 was found to be important for binding and activating PI3K in a phosphorylation-independent manner. The inter-SH2 domain of p85β is a coiled-coil structure that acts as a scaffold for the p110 catalytic subunit of PI3K. As NS1 does not displace p110 from the inter-SH2 domain, a model is proposed whereby NS1 forms an active heterotrimeric complex with PI3K, and disrupts the ability of p85β to control p110 function. Biological studies revealed that a mutant influenza A virus (Udorn/72) expressing NS1 with phenylalanine substituted for tyrosine-89 (Y89F) exhibited a small-plaque phenotype, and grew more slowly in MDCK cells than wild-type virus. Unexpectedly, another mutant influenza A virus strain (WSN/33) expressing NS1-Y89F was not attenuated in MDCK cells, yet appeared to be less pathogenic than wild-type in vivo. Overall, these data indicate a role for NS1-mediated PI3K activation in efficient influenza A virus replication. The potential application of this work to the design of novel anti-influenza drugs and vaccine production is discussed.

Introdução: Em 13 de Setembro de 2009, a OMS reportou que existiam mais de 296.471 casos confirmados laboratorialmente de infecção pelo p-H1N1 2009. Ainda assim muitas questões permanecem, incluindo o papel de regras de probabilidade clínica e escores de gravidade de pneumonia adquirida na comunidade nestes pacientes. Nós descrevemos as características clínicas e epidemiológicas de pacientes internados por pneumonia adquirida na comunidade com ou sem infecção pelo p-H1N1. Objetivos: Verificar a incidência e características clínicas da pneumonia adquirida na comunidade associada com infecção pelo p-H1N1 2009, comparado as pneumonias adquiridas na comunidade sem infecção pelo p-H1N1 2009 e a aplicação de regras de probabilidade clínica e escores de gravidade de pneumonia. Métodos: Estudo observacional prospectivo avaliando pacientes consecutivos hospitalizados por pneumonia adquirida na comunidade por mais de 24 horas no HC-FMUSP. A infecção pelo p-H1N1 foi confirmada utilizando ensaios realtime PCR (RT-PCR). Os dados coletados incluíam variáveis clínicas e laboratoriais e 3 escores de gravidade de pneumonia: PSI (Pneumonia Severity Index), CURB-65 e o SMART-COP. Resultados: De 12 de julho a 17 de agosto de 2009, um total de 118 pacientes com pneumonia foram hospitalizados e RT-PCR realizado em 105 pacientes, infecção pelo p-H1N1 foi identificada em 53 pacientes. Comparado com os 52 pacientes sem infecção pelo p-H1N1, o grupo p-H1N1 apresentou significativamente mais coriza [razão de chances (RC): 6,09;intervalo de confiança 95% (IC95%): 1,72-21,52) e infiltrado bilateral (RC: 11,08; IC95%: 3,48-35,2).Um modelo clínico baseado em nossos resultados, incluindo infiltrado bilateral, febre, coriza e idade menor que 65 anos, foi capaz de predizer infecção pelo p-H1N1 2009 com sensibilidade de 90,6% e acurácia de 82% e com uma área sobre a curva (AUC) de 0,82. Nós também verificamos que, em pacientes com infecção pelo p-H1N1 2009, apenas 9,52% com escore SMART-COP entre 0-2 foram admitidos em UTI ou evoluíram para óbito intra-hospitalar comparado a 36,84% dos pacientes com escore PSI 1-2 e 51% dos pacientes com escore CURB-65 de 0-1. O prognóstico da pneumonia foi similar nos grupos com ou sem infecção pelo p-H1N1 2009. Conclusões: A pneumonia associada com infecção pelo p-H1N1 2009 possui apresentação clínica diferente de pacientes sem infecção pelo p-H1N1, entretanto, possuem prognóstico similar. Escores tradicionais de gravidade de pneumonia como PSI e CURB-65 tiveram desempenho ruim em pacientes com infecção pelo p-H1N1 e o escore SMART-COP foi o melhor preditor de internação em UTI em pacientes com pneumonia e infecção pelo p-H1N1. / Introduction: As of September 13, 2009, the WHO had reported over 296.471 laboratory-confirmed cases of p-H1N1 2009. However many questions remain unanswered, including the role of clinical prediction rules and community-acquired pneumonia severity scores. We describe clinical and epidemiologic characteristics of patients hospitalized for pneumonia at our tertiary hospital with laboratory-confirmed and laboratory-excluded H1N1 infection. Objectives: Verify the incidence and clinical characteristics of community-acquired-pneumonia associated with p-H1N1 2009 infection compared with community-acquired pneumonia without p-H1N1 infection and the applicability of clinical prediction rules and pneumonia severity scores. Methods: We prospectively reviewed medical chart in daily basis to collect data on that patients. H1N1 infection was confirmed in specimens using a real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) assay. The data collected included clinical and laboratorial variables and three pneumonia severity scores: Pneumonia Severity Index, CURB-65 and the SMART-COP rule. Results: From 12 of July through August 17, 2009, a total of 118 cases of pneumonia were hospitalized, and RT-PCR was performed in 105, indentifying p-H1N1 infection in 53 patients. Compared with the 52 patients without p-H1N1 infection , the p-H1N1 group presented significantly more often with rhinorrhoea (OR 6,09 IC 95 1,72-21,52) and bilateral infiltrates ( OR 11,08 IC 95 3,48-35,2), a clinical model based on our results and using bilateral infiltrates, fever, rhinorrhoea and age less than 65 years was capable of predict p-H1N1 infection with 90,6% sensitivity, 82% accuracy and area under the ROC curve (AUC) being 0.82. We also find that in the patients with pneumonia and p-H1N1 infection, only 9.52% of those with SMART-COP score of 0-2 presented ICU admission/in-hospital mortality, compared with 36.84% of those with PSI score of 1-2 and 51% of those with CURB-65 score of 0-1. The prognosis of pneumonia was similar in the patients with and without p-H1N1 2009 infection. Conclusions: Pneumonia associated with p-H1N1 2009 has different clinical presentation than in pneumonia patients without p-H1N1 infection, but the prognosis is similar. Traditional pneumonia severity scores like PSI and CURB-65 performed poorly in patients with p-H1N1 infection and the SMART-COP rule was the best predictor of ICU admission in pneumonia patients with p-H1N1 infection.