Role of sialic acid binding specificity of the 1918 influenza virus hemagglutinin protein in virulence and pathogenesis in mice

The 1918 influenza pandemic caused over 40 million deaths and likely resulted from introduction and adaptation of a novel avian-like virus. Influenza A virus hemagglutinins are important in host-switching and virulence. Avian adapted influenza virus hemagglutinins bind sialic acid receptors linked via {alpha}2-3 glycosidic bonds, while human adapted hemagglutinins bind {alpha}2-6 receptors. Sequence analysis of 1918 isolates showed hemagglutinin genes with {alpha}2-6 or mixed {alpha}2-6/{alpha}2-3 binding. To characterize the role of sialic acid binding specificity of the 1918 hemagglutinin, we evaluated in mice chimeric influenza viruses expressing wild-type and mutant hemagglutinin genes from avian and 1918 strains with differing receptor specificities. Viruses expressing 1918 hemagglutinin possessing either {alpha}2-6, {alpha}2-3 or {alpha}2-3/{alpha}2-6 sialic acid specificity were fatal in mice with similar pathology and cellular tropism. Changing {alpha}2-3 to {alpha}2-6 binding specificity did not increase lethality of an avian adapted hemagglutinin. Thus, the 1918 hemagglutinin contains murine virulence determinants independent of receptor binding specificity.