Re: Positive selection at the receptor-binding site of haemagglutinin H5 in viral sequences derived from human tissues
[SIZE=-1]J Gen Virol
89 (2008), 1805-1810; DOI 10.1099/vir.0.2008/002469-0
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Positive selection at the receptor-binding site of haemagglutinin H5 in viral sequences derived from human tissues
<nobr>Alita Kongchanagul<sup>1</sup><sup>,2</sup></nobr>, <nobr>Ornpreya Suptawiwat<sup>1</sup></nobr>, <nobr>Pumaree Kanrai<sup>1</sup></nobr>, <nobr>Mongkol Uiprasertkul<sup>3</sup></nobr>, <nobr>Pilaipan Puthavathana<sup>1</sup></nobr> and <nobr>Prasert Auewarakul<sup>1</sup></nobr>
[SIZE=-1] <sup>1</sup> Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
<sup>2</sup> Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
<sup>3</sup> Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand [/SIZE]
[SIZE=-1]
Correspondence<sup> </sup>
Prasert Auewarakul<sup> </sup>
sipaw@mahidol.ac.th<script type="text/javascript"><!-- var u = "sipaw", d = "mahidol.ac.th"; document.getElementById("em0").innerHTML = '<a href="mailto:' + u + '@' + d + '">' + u + '@' + d + '<\/a>'//--></script>[/SIZE]
<!-- null -->
<table bgcolor="#e1e1e1" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr><td align="left" bgcolor="#ffffff" valign="middle" width="5%">
</td> <th align="left" valign="middle" width="95%">[SIZE=+2] ABSTRACT [/SIZE]</th></tr></tbody></table> <table align="right" border="1" cellpadding="5"><tbody><tr><th align="left">[SIZE=-1]
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
[/SIZE]</th></tr></tbody></table>
Highly pathogenic H5N1
avian influenza virus has spread through<sup> </sup>at least 45 countries in three continents. Despite the ability<sup> </sup>to infect and cause severe disease in humans, the virus cannot<sup> </sup>transmit efficiently from human to human. The lack of efficient<sup> </sup>transmission indicates the incompletion of the adaptation of<sup> </sup>the
avian virus to the new host species. The required mutations<sup> </sup>for the complete adaptation and the emergence of a potential<sup> </sup>pandemic virus are likely to originate and be selected within<sup> </sup>infected human tissues. Differential receptor preference plays<sup> </sup>an important role in the species-tropism of
avian influenza.<sup> </sup>We have analysed quasispecies of sequences covering the receptor-binding<sup> </sup>domain of the haemagglutinin gene of H5N1 viruses derived from<sup> </sup>fatal human cases. We employed a likelihood ratio test to identify<sup> </sup>positive-selection sites within the quasispecies. Nine of seventeen<sup> </sup>positive-selection sites identified in our analyses were found<sup> </sup>to be located within or flanking the receptor-binding domain.<sup> </sup>Some of these mutations are known to alter receptor-binding<sup> </sup>specificity. This suggests that our approach could be used to<sup> </sup>screen for mutations with significant functional impact. Our<sup> </sup>data provide new candidate mutations for the viral adaptation<sup> </sup>to a human host, and a new approach to search for new genetic<sup> </sup>markers of potential pandemic viruses.<sup> </sup>
<!-- null --> Published online ahead of print on 12 May 2008 as DOI 10.1099/vir.0.2008/002469-0.<sup> </sup>
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</td> <th align="left" valign="middle" width="95%">[SIZE=+2] INTRODUCTION [/SIZE]</th></tr></tbody></table> <table align="right" border="1" cellpadding="5"><tbody><tr><th align="left">[SIZE=-1]
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
[/SIZE]</th></tr></tbody></table>
The high replication error of RNA viruses, such as
influenza<sup> </sup>virus, results in a mixed viral population with many variants,<sup> </sup>referred to as quasispecies (Eigen, 1996

). Although, most sequence<sup> </sup>variations are neutral and offer no competitive advantage, the<sup> </sup>quasispecies provides multiple variants, which can be readily<sup> </sup>selected if there is a change in selective pressure. Transmission<sup> </sup>of the virus to a new host species provides new selective pressures<sup> </sup>and can result in the expansion of the ?best fit?<sup> </sup>minor variants for adaptation to the new environment.<sup> </sup>
In general, human and
avian influenza A viruses differ in their<sup> </sup>recognition of host cell receptors. Human
influenza viruses<sup> </sup>preferentially recognize
-2,6-linked sialic acid, while
avian<sup> </sup>
influenza viruses recognize
-2,3-linked sialic acid (Rogers<sup> </sup>& Paulson, 1983

). However, the highly pathogenic
avian influenza<sup> </sup>viruses subtype H5N1 can transmit directly from
avian species<sup> </sup>to humans (Subbarao
et al., 1998

; Tran
et al., 2004

). Even though<sup> </sup>the H5N1 viruses can infect and cause severe disease in humans,<sup> </sup>they do not bind the
-2,6-linked sialic acid receptor with high<sup> </sup>affinity (Ha
et al., 2001

; Stevens
et al., 2006

). This property<sup> </sup>is believed to be one of the major factors that prevent the<sup> </sup>H5N1 virus from transmitting efficiently amongst humans and<sup> </sup>causing a pandemic. Amino acid substitutions in the haemagglutinin<sup> </sup>(HA) gene can lead to the altered receptor-binding preference<sup> </sup>of the virus from
-2,3-linked to
-2,6-linked sialic acid (Auewarakul<sup> </sup>
et al., 2007

; Stevens
et al., 2006

; Yamada
et al., 2006

). This<sup> </sup>would enable
avian H5N1 viruses to recognize human-type host<sup> </sup>cell receptors and could potentially enable the virus to transmit<sup> </sup>efficiently within the human population and cause a catastrophic<sup> </sup>pandemic. Therefore, it is extremely important to monitor the<sup> </sup>viral changes that may lead to the emergence of pandemic viruses.<sup> </sup>
The earliest possible detection of selected mutants is by looking<sup> </sup>at sequences within viral quasispecies before they expand and<sup> </sup>become dominant virus. In order to detect mutants that might<sup> </sup>have altered phenotypes we studied the viral sequences at the<sup> </sup>level of quasispecies. We conducted a study where the viral<sup> </sup>sequence was directly amplified, cloned and sequenced from a<sup> </sup>nasopharyngeal aspirate or tissue specimens. The specimens were<sup> </sup>obtained from fatal human cases in Thailand.<sup> </sup>
Selection at the protein level can be measured by
(
d<sub>N</sub>/
d<sub>S</sub>),<sup> </sup>in which
d<sub>N</sub>=non-synonymous substitution rate (non-synonymous<sup> </sup>changes per non-synonymous site) and
d<sub>S</sub>=synonymous substitution<sup> </sup>rate (synonymous changes per synonymous site). If amino acid<sup> </sup>changes provide better fitness, the mutations will be fixed<sup> </sup>at a higher rate than synonymous mutations. This results in<sup> </sup>
d<sub>N</sub>>
d<sub>S</sub> and
>1. Originally,
was calculated as an average<sup> </sup>for the whole gene, which does not allow sensitive detection<sup> </sup>of individual amino acid residue under positive selection. Subsequently<sup> </sup>codon-based models that allow the
ratio to vary amongst sites<sup> </sup>were developed (Nielsen & Yang, 1998

; Yang & Nielsen,<sup> </sup>2000

). These models describe
ratio distribution amongst sites:<sup> </sup>M0 assumes one constant
for all sites; M3 classifies sites<sup> </sup>into discrete classes with different
; M7 allows
to vary according<sup> </sup>to a distribution that represents negative or neutral selection;<sup> </sup>M8 adds on top of M7 a discrete
class for sites with positive<sup> </sup>selection (
>1). Likelihood ratio test is used as a statistical<sup> </sup>test of goodness-or-fit to compare the two models and test whether<sup> </sup>the more complex model, e.g. M8 or M3, fits the dataset significantly<sup> </sup>better than the simpler model, e.g. M7 or M0. An empirical Bayes<sup> </sup>approach is then used to calculate the posterior probability<sup> </sup>that each site is from a particular site class, and sites with<sup> </sup>high posterior probabilities coming from the class with
>1<sup> </sup>are inferred to be under positive selection (Yang
et al., 2005

).<sup> </sup>
<!-- null -->
<table bgcolor="#e1e1e1" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr><td align="left" bgcolor="#ffffff" valign="middle" width="5%">
</td> <th align="left" valign="middle" width="95%">[SIZE=+2] METHODS [/SIZE]</th></tr></tbody></table> <table align="right" border="1" cellpadding="5"><tbody><tr><th align="left">[SIZE=-1]
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ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
[/SIZE]</th></tr></tbody></table>
[SIZE=-1]
Patient.[/SIZE]
The first patient (patient A) was a non-autopsy case, previously<sup> </sup>reported (Auewarakul
et al., 2007

). Patient A was a 5-year-old<sup> </sup>boy who had progressive viral pneumonia that led to respiratory<sup> </sup>failure and death by 12 days after the onset of illness.<sup> </sup>In December 2005, he developed a fever, stomach ache, nausea<sup> </sup>and vomiting and was admitted to the hospital 10 days later<sup> </sup>when he developed dyspnea and a chest radiography showed patchy<sup> </sup>infiltration at the right middle lobe. The symptom of dyspnea<sup> </sup>worsened to respiratory failure and the pulmonary infiltration<sup> </sup>spread to both lungs on the following day. The diagnosis of<sup> </sup>
avian influenza was suspected on day 12. The use of the antiviral<sup> </sup>drug oseltamivir was started and the patient expired on the<sup> </sup>same day. The patient was not known to have had direct contact<sup> </sup>with any sick or dying birds, but he played in the yard where<sup> </sup>the birds were often present. Nasopharyngeal aspirate was collected<sup> </sup>on day 12 after the onset of illness.<sup> </sup>
Autopsy was conducted in the second (patient B) and third patients<sup> </sup>(patient C). Patient B, previously reported (Uiprasertkul
et<sup> </sup>al., 2007

), was a 48-year-old man who had progressive viral<sup> </sup>pneumonia in October 2005. He had a fever, cough, runny nose,<sup> </sup>myalgia and chest pain at the onset of illness. Dyspnea developed<sup> </sup>on day 2 of the illness and a chest radiograph showed interstitial<sup> </sup>infiltrations at the right upper and left middle lung fields<sup> </sup>and a mass-like infiltration at the right middle lung field.<sup> </sup>The diagnosis of
avian influenza was suspected on day 4 of the<sup> </sup>illness after a history of direct contact with dying chickens<sup> </sup>was revealed. Respiratory secretions were then sent to national<sup> </sup>laboratories and they were confirmed positive for
influenza<sup> </sup>(H5N1) virus. The patient died on day 6 of the illness.<sup> </sup>
Patient C, previously reported (Uiprasertkul
et al., 2005

),<sup> </sup>was a 6-year-old boy who had progressive viral pneumonia in<sup> </sup>January 2004. He was initially treated with multiple broad-spectrum<sup> </sup>anti-microbial agents. Virological diagnosis of H5N1 infection<sup> </sup>was made on day 7 of the illness. After oseltamivir became available<sup> </sup>in Thailand, he was treated on day 15 of his illness with this<sup> </sup>agent until he died. He was also treated with methylprednisolone<sup> </sup>on day 15 until death and with granulocyte colony-stimulating<sup> </sup>factor for leukopenia from day 5 to 10 of the illness. The patient<sup> </sup>died on day 17 of the illness.<sup> </sup>
The use of the patients' specimens was approved by the Ethics<sup> </sup>Committee of the Faculty of Medicine Siriraj Hospital.<sup> </sup>
[SIZE=-1]
Viral RNA, cloning and quasispecies analysis.[/SIZE]
For patient A, total RNA from the nasopharyngeal specimen was<sup> </sup>extracted according to the manufacturer's protocol (QIAmp RNA<sup> </sup>mini kit; Qiagen). For patients B and C, total RNAs were extracted<sup> </sup>by using Trizol from paraffin-embedded blocks of lung and intestine<sup> </sup>tissue samples and then purified using Qiagen RNAeasy kit according<sup> </sup>to the manufacturer's instructions.<sup> </sup>
A fragment of the HA gene covering the receptor-binding site<sup> </sup>(nt 413?905) was amplified from RNA extracted from the<sup> </sup>specimen by using the high fidelity enzyme
Pfu (Promega) and<sup> </sup>the primers HHAf2 (5'-GGTCCAGTCATGAAGCCTCA-3') and HA-H5r12<sup> </sup>(5'-TTTATCGCCCCCATTGGAGT-3'). The PCR product was cloned into<sup> </sup>pGEM T-Easy. One hundred clones of each sample were picked up<sup> </sup>and sequenced.<sup> </sup>
The selective pressures acting on the receptor region were estimated<sup> </sup>by using the [SIZE=-2]CODEML[/SIZE] program in the [SIZE=-2]PAML[/SIZE] package. We used models<sup> </sup>M7 and M8, where M7 contains 10
categories to describe
amongst<sup> </sup>sites, all constrained to be <1; M8 differs from M7 only<sup> </sup>in that it estimates
for an extra class of sites (p10) at which<sup> </sup>
can be >1 (Yang, 1997

). Models were compared using a likelihood<sup> </sup>ratio test and the Bayes Empirical Bayes (BEB) method was used<sup> </sup>for a posteriori estimation of individual codons under positive<sup> </sup>selection (Yang
et al., 2005

).<sup> </sup>
<!-- null -->
<table bgcolor="#e1e1e1" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr><td align="left" bgcolor="#ffffff" valign="middle" width="5%">
</td> <th align="left" valign="middle" width="95%">[SIZE=+2] RESULTS [/SIZE]</th></tr></tbody></table> <table align="right" border="1" cellpadding="5"><tbody><tr><th align="left">[SIZE=-1]
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
[/SIZE]</th></tr></tbody></table>
We have analysed the HA sequences from either each individual<sup> </sup>patient or each organ (lung or intestine) of the patient. During<sup> </sup>a phylogenetic analysis (data not shown), the consensus wild-type<sup> </sup>sequence of each patient was found to be similar to one another<sup> </sup>and closely related to other clade 1 sequences from Thailand.<sup> </sup>All together 17 positive-selection sites were identified (Table 1

)<sup> </sup>within this sequenced region spanning 143 aa residues (128?270).<sup> </sup>At these positions, the sequence majority in all the samples<sup> </sup>contains similar amino acids as in the consensus sequence of<sup> </sup>all human H5N1 viruses available in the GenBank database, except<sup> </sup>for positions 133 and 138 where mutant amino acids were found<sup> </sup>in higher frequencies. Total numbers of synonymous and non-synonymous<sup> </sup>substitutions, as well as lists of non-synonymous substitutions<sup> </sup>in all the RNA samples are shown in Table 2

. Some of these<sup> </sup>mutations with low frequencies were not picked up as positive-selection<sup> </sup>site by the BEB analysis. Amongst the positive-selection sites,<sup> </sup>six sites were repeatedly found when each patient was analysed<sup> </sup>individually. These sites were 133, 138, 161, 186, 222 and 227<sup> </sup>(H3 numbering system). Of these all but the 133 and 161 positions<sup> </sup>are in the known receptor-binding domain. The receptor-binding<sup> </sup>site of HA at the tip of HA1 globular domain is composed of<sup> </sup>three secondary structure elements: the 190 helix (residues<sup> </sup>190?198), the 130 loop (residues 135?138) and the<sup> </sup>220 loop (residues 221?228), forming the sides of each<sup> </sup>site; and the base made up of the conserved residues Tyr<sup>98</sup>,<sup> </sup>Trp<sup>153</sup>, His<sup>183</sup> and Tyr<sup>195</sup> (Skehel & Wiley, 2000

). Although,<sup> </sup>the positions 133 and 230 are not in the receptor-binding domain,<sup> </sup>they flank the 130 and 220 loops and they showed positive selection<sup> </sup>in our analyses, suggesting that mutations at these sites might<sup> </sup>also contribute to the receptor-binding adaptation. A138V, N186K<sup> </sup>and S227N mutations were previously reported to confer
-2,6-linked<sup> </sup>sialic acid binding to H5N1 virus (Auewarakul
et al., 2007

;<sup> </sup>Gambaryan
et al., 2006

; Shinya
et al., 2005

; Yamada
et al.,<sup> </sup>2006

). The mutant sequences in our analyses are similar to these<sup> </sup>mutations at positions 138 and 227, whereas our mutation at<sup> </sup>position 186 is N186D. Amongst the 17 positive-selection sites<sup> </sup>that were identified in our study, eight sites are not known<sup> </sup>to be related to the receptor-binding domain. But, these sites<sup> </sup>all showed only low mutation frequencies. In other words, all<sup> </sup>strong positive-selection sites with high mutation frequencies<sup> </sup>are related to the receptor-binding domain.<sup> </sup>
<!-- null -->
<center><table cellpadding="0" cellspacing="0" width="95%"><tbody><tr bgcolor="#e1e1e1"><td> <table cellpadding="2" cellspacing="2"><tbody><tr bgcolor="#e1e1e1"><td align="center" bgcolor="#ffffff" valign="top">
View this table:
<nobr>
[in this window]
[in a new window]
</nobr> </td><td align="left" valign="top"> Table 1. Positive-selection sites on the HA gene from residue 128 to 270 Sources of sequences, wild-type and mutant amino acids, positions (H3 numbering), frequencies of mutant amino acids and site-specific
(
d<sub>N</sub>/
d<sub>S</sub>)?[SIZE=-2]SEM[/SIZE] are shown (
>1 indicates positive selection). The wild-type amino acids are from the consensus sequence of all human H5N1 viruses available in the GenBank database. Bold-typed residues are related to the receptor-binding domain. The residues that have been shown to carry receptor preference determinant for H5N1 are underlined.
</td></tr></tbody></table> </td></tr></tbody></table></center>
<!-- null -->
<center><table cellpadding="0" cellspacing="0" width="95%"><tbody><tr bgcolor="#e1e1e1"><td> <table cellpadding="2" cellspacing="2"><tbody><tr bgcolor="#e1e1e1"><td align="center" bgcolor="#ffffff" valign="top">
View this table:
<nobr>
[in this window]
[in a new window]
</nobr> </td><td align="left" valign="top"> Table 2. Numbers of all synonymous and non-synonymous substitutions and a list of non-synonymous substitutions in each dataset
</td></tr></tbody></table> </td></tr></tbody></table></center>
In patients A, B and C, we found seven, five and ten positive-selection<sup> </sup>sites, respectively. Of these five, three and five sites, respectively,<sup> </sup>are in or they flank the receptor-binding domain (Table 1

).<sup> </sup>The higher frequency of positive-selection sites in patient<sup> </sup>C may be related to the fact that this patient died on day 17<sup> </sup>of the illness, while the samples from the other two patients<sup> </sup>were collected earlier in the course of the illness. The longer<sup> </sup>duration of infection provided a longer period under the selective<sup> </sup>pressure and might cause the virus to gain more adaptation.<sup> </sup>In patient C, there were markedly more positive-selection sites<sup> </sup>that are not related to the receptor-binding domain, including<sup> </sup>the
N-linked glycosylation site at position 158. This suggests<sup> </sup>that other selective pressures, such as the immune response,<sup> </sup>might be involved in late phases of the disease.<sup> </sup> When each type of tissue from patients B and C was analysed,<sup> </sup>four and seven positive-selection sites were identified in the<sup> </sup>lung and intestine, of which two and four sites are related<sup> </sup>to the receptor-binding domain, respectively. (Table 1

).<sup> </sup>There are some differences in the positive-selection sites from<sup> </sup>different tissues. In particular, the S227N mutation was found<sup> </sup>in high frequency (36.7 %) in the intestine of patient C and<sup> </sup>in low frequency (3 %) in the intestine of patient B, while<sup> </sup>it was absent in the lung tissue from both cases. This suggested<sup> </sup>a strong selection for this mutation and a compartmentalization<sup> </sup>of the viral population within the patients.<sup> </sup>
Most of the identified positive-selection sites concentrated<sup> </sup>in the N-terminal 2/3 part of the sequences. Sixteen sites were<sup> </sup>identified in the region covering the receptor-binding domain<sup> </sup>from residue 128 to 230, whereas only two sites were identified<sup> </sup>in the rest of the sequences (residue 231?270).<sup> </sup>
Mutations that have been reported to alter receptor-binding<sup> </sup>specificity of H5 are A138V, N186K, Q196R, S227N, Q226L and<sup> </sup>G228S (Auewarakul
et al., 2007

; Gambaryan
et al., 2006

; Shinya<sup> </sup>
et al., 2005

; Stevens
et al., 2006

; Yamada
et al., 2006

). Our<sup> </sup>analyses provide new candidate mutations that may affect the<sup> </sup>receptor-binding specificity. Whether these mutations have functional<sup> </sup>consequences is under investigation.<sup> </sup>
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ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
[/SIZE]</th></tr></tbody></table>
Minimal positive selection in the C-terminal region outside<sup> </sup>the receptor-binding domain suggests that the observed positive-selection<sup> </sup>sites were not fortuitous. Although, most of the positive-selection<sup> </sup>sites were within or very close to the receptor-binding domain,<sup> </sup>there were also other sites not related to the receptor-binding<sup> </sup>pocket. It is not clear what drove positive selection at these<sup> </sup>sites. It is possible that a mutation outside the receptor-binding<sup> </sup>pocket may induce conformational changes that indirectly affect<sup> </sup>the pocket. On the other hand, among the eight positive-selection<sup> </sup>sites outside the receptor-binding pocket, five sites are on<sup> </sup>the surface of HA (129, 158, 161, 163 and 168) and only three<sup> </sup>sites are hidden inside the molecule (180, 150 and 152). Although,<sup> </sup>these five exposed sites are not within known antigenic epitopes<sup> </sup>(Kaverin
et al., 2002

, 2007

), it is possible that they constitute<sup> </sup>an unknown epitope.<sup> </sup>
The observed differences in the viral quasispecies in lung and<sup> </sup>intestine suggest that there might be a compartmentalization<sup> </sup>of viral infection and that the selective pressure might be<sup> </sup>different among different tissues. Human lung has been shown<sup> </sup>to contain
-2,3-linked sialic acid in alveolar epithelial cells,<sup> </sup>whereas human intestinal epithelium lacks this receptor. In<sup> </sup>human intestine the
-2,3-linked sialic acid receptor was identified<sup> </sup>only on neurons (Yao
et al., 2008

). It is not clear whether<sup> </sup>the difference in the sialic acid receptor distribution between<sup> </sup>the two tissues contributed to the different selection of viral<sup> </sup>sequences.<sup> </sup>
Our data demonstrate adaptation of the receptor-binding domain<sup> </sup>of H5N1 virus in infected human tissues. If allowed to be transmitted<sup> </sup>further to other human hosts, the mutants would be likely to<sup> </sup>be selected further and expand, and eventually cause emergence<sup> </sup>of a potential pandemic virus. Understanding the adaptation<sup> </sup>is therefore of upmost importance. Adaptation of
avian influenza<sup> </sup>virus to human host involves multiple mechanisms. However, the<sup> </sup>receptor usage preference is likely to be a major step in the<sup> </sup>adaptation process. Although, there have been reports on mutations<sup> </sup>that altered receptor-binding specificity of H5, those reported<sup> </sup>mutations only conferred partial switching from
-2,3-linkage<sup> </sup>tropism to dual tropism (Auewarakul
et al., 2007

; Gambaryan<sup> </sup>
et al., 2006

; Stevens
et al., 2006

; Yamada
et al., 2006

). It<sup> </sup>is likely that these mutations are not sufficient and full switching<sup> </sup>to
-2,6-linkage tropism is probably needed for an efficient<sup> </sup>transmission in the human population. Such mutation that can<sup> </sup>cause a complete switching of H5 is not known. The fact that<sup> </sup>our analyses could pick up mutations that are known to change<sup> </sup>the receptor-binding property of H5N1 viruses indicates that<sup> </sup>they can be used to screen and search for mutations with significant<sup> </sup>functional effects. Our analyses offer an approach to find candidate<sup> </sup>mutations, which should be studied further for determining functionality.<sup> </sup>Finding mutations with pandemic potential before the actual<sup> </sup>emergence of such viruses will provide genetic markers for vigilant<sup> </sup>monitoring, which will hopefully help us to avoid the pandemic.<sup> </sup>
<sup> </sup>
<sup> </sup>
<!-- null -->
<table bgcolor="#e1e1e1" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr><td align="left" bgcolor="#ffffff" valign="middle" width="5%">
</td> <th align="left" valign="middle" width="95%">[SIZE=+2] ACKNOWLEDGEMENTS [/SIZE]</th></tr></tbody></table>
This work was supported by a research grant from the National<sup> </sup>Center for Genetic Engineering and Biotechnology of Thailand.<sup> </sup>A. K. is a PhD candidate of the Department of Immunology.<sup> </sup>
<!-- null -->
<table bgcolor="#e1e1e1" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr><td align="left" bgcolor="#ffffff" valign="middle" width="5%">
</td> <th align="left" valign="middle" width="95%">[SIZE=+2] REFERENCES [/SIZE]</th></tr></tbody></table> <table align="right" border="1" cellpadding="5"><tbody><tr><th align="left">[SIZE=-1]
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
[/SIZE]</th></tr></tbody></table>
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[SIZE=-1]Received 28 March 2008; accepted 2 May 2008.[/SIZE]
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