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Comprehensive assessment of amino acid substitutions in the trimeric RNA polymerase complex of influenza virus detected in clinical trials of baloxavir marboxil
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  • Takashi Hashimoto,
  • Keiko Baba,
  • Kae Inoue,
  • Miyako Okane,
  • Takahiro Noda,
  • Satoshi Hata,
  • Takao Shishido,
  • Akira Naito,
  • Steffen Wildum,
  • SHINYA OMOTO
Takashi Hashimoto
Shionogi and Co Ltd
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Keiko Baba
Shionogi and Co Ltd
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Kae Inoue
Shionogi TechnoAdvance Research, Co., Ltd.
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Miyako Okane
Shionogi TechnoAdvance Research, Co., Ltd.
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Takahiro Noda
Shionogi TechnoAdvance Research, Co., Ltd.
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Satoshi Hata
Shionogi TechnoAdvance Research, Co., Ltd.
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Takao Shishido
Shionogi and Co Ltd
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Akira Naito
Shionogi and Co Ltd
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Steffen Wildum
F. Hoffmann-La Roche Ltd.
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SHINYA OMOTO
Shionogi and Co Ltd
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Peer review status:POSTED

19 Jun 2020Submitted to Influenza and other respiratory viruses
22 Jun 2020Assigned to Editor
22 Jun 2020Submission Checks Completed

Abstract

Background: Baloxavir marboxil (BXM) is an approved drug that selectively targets cap-dependent endonuclease on PA subunit in the RNA polymerase complex of influenza A and B viruses. Amino acid substitutions at position 38 in the PA subunit were identified as a major pathway for reduced susceptibility to baloxavir acid (BXA), the active form of BXM. Additionally, substitutions found at positions E23, A37, and E199 in the PA subunit impact BXA susceptibility by less than 10-fold. Methods: We comprehensively evaluated the impact of novel amino acid substitutions identified in PA, PB1 and PB2 subunits in BXM clinical trials and influenza sequence databases by means of drug susceptibility and replicative capacity. Results: PA/I38N in A(H1N1) and PA/I38R in A(H3N2) were newly identified as treatment-emergent substitutions in the CAPSTONE-2 study. The I38N substitution conferred reduced susceptibility by 24-fold, whereas replicative capacity of the I38N-substituted virus was impaired compared to the wild-type. The I38R-substituted virus was not viable in cell culture. All other mutations assessed in this extensive study did not significantly affect BXA susceptibility (< 2.4-fold change). Conclusion: These results provide additional information on the impact of amino acid substitutions in the trimeric viral polymerase complex to BXA susceptibility and will further support influenza surveillance.