The M2 channel controversy rides again

Most people never learn about an actual scientific controversy. Almost every "controversy" that bubbles into the public eye is manufactured, often reflecting social or ethical differences rather than genuine disagreements between experts about how different models fit to reality. Actual scientific controversies tend to be highly technical, and often concern points that lay people find to be esoteric. That doesn't mean that the issues involved aren't important, or that they're even difficult to understand. One controversy that has unfolded over the past few years and now may be over relates to a seemingly simple question. Where do adamantane drugs bind to the influenza A M2 channel?

Read the rest...

A step towards incorporating dynamics data into drug design

My field-cycling article (previous post) is part of a dynamics-focused topical issue of JBNMR. In my next few science posts I'll describe some of the other contributions.

Research into the interplay between protein structural dynamics and function is a window into important fundamental knowledge about biochemistry, but the general justification for public funding of these studies by medical agencies is that they will have the ultimate effect of improving our ability to design and optimize drugs. However, even though our ability to characterize macromolecular dynamics has increased dramatically in the past few decades, there are few, if any, cases in which this knowledge has been applied successfully to the design of therapeutic agents. In part this is because incorporating data on fluctuations into the design algorithms poses a significant challenge. It's also true, though, that we understand only part of each system, i.e. the dynamics of the protein target, not the small molecules it binds. If dynamics studies are to make the maximum possible contribution to pharmaceutical sciences, the motions of the ligand must be characterized. In their article in Journal of Biomolecular NMR, Jeffrey Peng and students from Notre Dame attempt to address this shortcoming in the case of a substrate for the phosphorylation-directed prolyl isomerase Pin1.

Pin1 is implicated in a number of regulatory and signaling pathways, which seems strange because it doesn't possess any intrinsic transcriptional regulation ability, nor does it covalently add or remove phosphate groups. Instead, Pin1 has an enzymatic activity that accelerates, generally without altering the relative populations, the conversion of prolines from their cis- to trans- state and vice versa. This activity is specifically targeted to prolines that are adjacent to phosphorylated serines or threonines. In addition to the catalytic domain that does this work, Pin1 possesses a WW domain that has identical specificity. Because Pin1 does not alter the balance between cis- and trans- Pro, only the rate at which one changes to the other, its role in signaling has been difficult to ascertain, although there is intense interest in this area.

You don't need to understand an entire pathway to design an effective inhibitor. What you do need to understand is the relationship between specific chemical groups and binding affinity. Getting that knowledge can be very difficult if the proposed drug is flexible. In that case, refinement methods that focus only on the particular chemical groups rather than their dynamic properties could go badly astray. Unfortunately, the dynamics of protein-bound drug molecules are difficult to measure. Their proton signals are likely to be swamped by the protein, and small molecules are often difficult to label with isotopes convenient for NMR. Peng et al. propose to address this by studying ¹³C relaxation at natural abundance.

A little less than 99% of the world's carbon is in the form of NMR-inactive ¹²C, which is a problem for NMR because carbon is very abundant in proteins and drugs. Of the rest, most (about 1% of all carbon) is dipolar, NMR-detectable ¹³C, which is usually not enough to accomplish anything in terms of protein NMR. As a result, NMR researchers typically adopt the strategy of expressing their proteins using bacteria grown in media containing ¹³C₆ D-glucose. Such enrichment of drug molecules probably could not be carried out for pharmaceutical research due to the cost and the limited availability of properly labeled reagents. Fortunately, advances such as magnets stronger than 17 T and cryoprobes make sensitive detection of natural-abundance ¹³C a plausible approach. Because natural-abundance measurements also simplify the experiments and analysis considerably, Peng et al. adopt this approach in their study.

Peng et al. measure μs-ms fluctuations in a 10-residue peptide in the presence and absence of Pin1. Keeping in mind that such motions can only be detected when they are associated with a change of chemical shift, it is reasonable that no such motions are detected when the peptide is all by itself. In the presence of Pin1, however, methyl groups on phospho-Thr 5 and Val 7 experience some kind of chemical exchange process on the order of several 100 /s (at 278 K), as does a methylene group in Pro 6.

Peng et al. rationalize their observations with reference to a previously-determined structure of the Pin1 WW domain in complex with this peptide (explore it at the PDB). As you can see from the lowest-energy member of this NMR ensemble (left), the residues where they detect these fluctuations in the methyls and methylenes are those that are most involved in the binding interaction. The WW domain is represented as blue ribbons, while the peptide is shown as sticks down at the bottom. That the Pro and pThr form part of the interface is unsurprising, as they constitute the specific binding sequence, while the Val side chain appears to be in position to make some hydrophobic contacts. Everything makes sense, but that doesn't mean it's telling us what we want to know.

The structure above shows us the interaction of the peptide with the WW domain, while what we're really interested in getting at is the catalytic domain. Using an exchange spectroscopy experiment, Peng et al. determined that the ms dynamics they were observing probably reflected the binding of the peptide to the WW domain. To avoid this interaction, they created an artificial Pin1 that contained only the catalytic domain, and found that this also caused chemical exchange in the methyls and methylenes. Cross-checking against the exchange spectroscopy rates suggested that the ms dynamics in this case reflect the result of Pin1 catalytic activity, namely the interconversion from cis to trans and vice versa.

Unfortunately, this experiment did not report the most desired data, i.e. the dynamics of the ligand on the enzyme. On-enzyme fluctuations certainly contribute to the exchange experienced by the ligand, but because the on-enzyme population is so small (at most 2.5% of ligand) this would only be detectable in the case of an extremely large change in chemical shift. In principle one could deconvolute the dynamics from a partial-occupancy system where 50% or more of the ligand is bound to enzyme, but reliably fitting all the parameters for a two-state chemical exchange system from CPMG data is an already-dicey proposition. Fitting a four-state process from data like these is unlikely to be practical. So, in order to observe on-enzyme dynamics the drug of interest will need be saturated with its target protein, which would require millimolar protein concentrations for most ligands. Under those conditions, the spectra will also contain significant signal from the protein. The 70% deuteration used in this experiment, combined with ¹³C depletion, will probably be enough to suppress this, although these isotopes will increase the cost of the technique (and diminish protein yields).

Nevertheless, this paper establishes that the natural-abundance approach to measuring ligand dynamics on the µs-ms timescale is feasible. Because methylenes and methyls are common moieties in drugs and small molecules this technique may have broad applicability. Investigating the motions of small molecules bound to large proteins poses a unique problem because these systems don't have the advantages of either small molecules (low R₂) or proteins (exotic labeling schemes). The ongoing work of Peng et al. suggests that this problem is tractable, which may have positive consequences for our ability to design and optimize drugs.

Peng, J., Wilson, B., & Namanja, A. (2009). Mapping the dynamics of ligand reorganization via ¹³CH₃ and ¹³CH₂ relaxation dispersion at natural abundance Journal of Biomolecular NMR DOI: 10.1007/s10858-009-9349-4

Read the rest...

How do adamantane drugs block M2?

Vaccination plays such an important role in our seasonal influenza strategy in part because we don't have many medicines that can be brought to bear on the disease. The neuraminidase inhibitors (specifically Tamiflu) are widely stockpiled, and continue to work for now, but the specter of resistance is already lurking. If these drugs are too widely or too improperly used, there is a good chance that resistance mutations will eventually render these drugs ineffective. Universal drug resistance may already be the fate of the drugs amantadine and rimantadine, built on an adamantane backbone (1). The adamantane drugs inhibit the M2 proton channel from influenza A, a tiny tetrameric protein that equalizes pH between the virus and the endosome of the cell that has swallowed it. This process releases the virus contents so that they can do their damage to the cell, so these medicines can significantly retard the infection process. Or rather, they could, if so many influenza strains didn't harbor the S31N mutation that almost completely nullifies their effect. If we are to develop new drugs to attack the M2 channel, it would be helpful to know how this mutation causes drug resistance. Over the past few years a great deal of structural evidence has accumulated showing how adamantane drugs work on the older, non-resistant channels. The problem is that the evidence supports two different models of M2 inhibition, and so far it has proven difficult to determine which of them is probably correct.

How the question arose

The controversy is the result of two structures published in Nature early in 2008 (2,3). The first of these is a crystal structure of a tetramer of peptides encompassing the transmembrane (TM) region of the M2 channel reported by the DeGrado group at UPenn, which you can see at right (explore this structure at the PDB, noting that the numbering is off by 21). In the detergent used for crystallization, the peptides form a tetramer with a roughly conical pore, which amantadine (purple in these models) physically occludes, giving rise to the pore-blocking model (PBM). This model is consistent with previous results indicating that a single amantadine molecule is sufficient to inhibit the proton channel. In addition, in this model the drug binding site is adjacent to S31 (blue side chain), which is what we'd expect given that an S31N mutation is responsible for most amantadine resistance. The authors propose, given the position of the S31 side chain, that the mutant asparagines form a hydrogen-bonded network that is too constricted for amantadine to bind. Click on the picture for a larger view.

An alternative model was proposed by Schnell and Chou from Harvard University (3). They produced an NMR structure (left) of a 42 amino-acid peptide from M2 encompassing the TM region and an additional C-terminal helix (explore this structure at the PDB). In their structure, taken at pH 7.5 in detergent micelles, the tetramer forms a roughly cylindrical pore that is blocked by the side chains of the known gating residues W41 and H37 (light green in these models). Their structure shows rimantadine bound at four sites near the base of the helix but not in the pore. Using pH-dependent conformational exchange experiments, Schnell and Chou showed that a decrease in pH caused rapid structural changes in the channel, motions that rimantadine slowed. On the basis of this evidence, they proposed a mechanism in which protonation of the gating histidines destabilizes the packing of the TM helices and allows the conductance of protons. Rimantadine blocks the channel by stabilizing the helices, thus this is a dynamic quenching model (DQM). The position of S31 in this model is also somewhat different than the crystal structure, although these models were made at different pH conditions and so this may represent a difference between the closed and open states of the channel.

The distinction here is important. If Stouffer et al. are correct, then drug development should abandon the adamantane backbone altogether and start with a set of significantly different leads to address the resistance problem. The PBM implies that any molecule large enough to occlude the pore will be too large to fit in there following the S31N mutation that induces amantadine resistance. If the DQM is correct, however, then it is conceivable that further refinements to the adamantane base, or similar molecules, could improve affinity enough to overwhelm the mutational effect.

Unfortunately, neither result is unimpeachable. Although it agrees with a great deal of experimental evidence, the low resolution of the crystal structure means that the electron density called amantadine cannot be assigned unambiguously. It is also curious that a hydrophobic molecule like amantadine would bind tightly in the hydrophilic pore. In addition, the crystal form with amantadine bound contains a mutation, G34A (black side chain), which is near the drug binding site and could conceivably have altered the binding specificity of the protein.

The NMR structure has the advantage that it directly includes distance information in the form of NOEs. However, the authors used 40 mM rimantadine to obtain these results, meaning that there were as many rimantadine molecules in the solution as phosphate buffer molecules. Under these conditions, it is possible that the drug bound to a secondary, low-affinity site. Even if this is what happened, it is strange that the rimantadine never bound to the high-affinity site indicated by the crystal structure.

Both experiments use significantly truncated constructs and highly artificial systems to mimic a membrane environment. The structure of any membrane protein depends in often unexpected ways on the composition of the lipid bilayer in which it is embedded and on the structure of that bilayer. The intense curvature of the micelles may have distorted the structure in the NMR experiment, and possibly inappropriate lipids may have had effects on both structures. We know these considerations are relevant for this system, because Schnell and Chou report that the construct used for the crystal structure would not form stable tetramers in the micelle system. Also, as Chris Miller notes in his commentary on these papers (4), there were questions about both constructs with respect to their proton conductivity. Lacking significant stretches of the protein and placed in these environments, it is possible that both structures deviate from in vivo reality in significant ways.

Because the conditions diverge so much, it is difficult to weigh the mechanisms based on these structures alone. The binding site identified by Schnell and Chou is only at the very end of the construct used by Stouffer et al.. In addition, the inhibited crystal structure comes from a low-pH condition while the NMR structure exclusively represents a high-pH condition. Given these differences in conditions, it is not impossible that both models, in whole or in part, are correct. We must turn to additional experiments and alternative evidence to choose between them, specifically data on the stoichiometry of binding and the effects of mutations.

Binding stoichiometry

The crystal structure shows a single binding site for the drug, while the NMR structure implies four, and this is at odds with existing results that indicate that a single molecule of drug is sufficient to inhibit a single channel. Given the homotetrameric nature of the M2 channel, it is in principle not possible for the NMR experiment to distinguish between a single rimantadine binding event and four. That is, the NMR experiment cannot tell us whether the rimantadine-M2 inhibition occurs with a single binding event or requires four drug molecules to bind. Therefore, to argue that DQM is inconsistent with 1:1 stoichiometry overstates the case somewhat.

It may also be somewhat overstating the case to say that there is only one amantadine binding site on M2. Washing amantadine out of your buffer does not reverse inhibition, in part because of slow kinetics of leaving the binding site and in part because these drugs, being very greasy, preferentially partition into the lipid membranes and are therefore not readily removed from a system when its aqueous phase is replaced. It is difficult to measure a binding constant for the drugs because the equilibria under consideration will be quite complex. The studies often cited on the 1:1 stoichiometry (5,6) use structural and kinetic evidence to get at this question.

Czabotar et al. (5) measured tryptophan fluorescence in M2 as a function of pH and rimantadine concentration. They found that fluorescence from W41 was quenched by decreased pH, but recovered when 1 equivalent rimantadine per tetramer was added. This result implies that structural or dynamic changes caused by histidine protonation are reversed by rimantadine inhibition, but this is so general that it cannot be taken to support either the PBM or DQM.

Wang et al. (6) measured the reduction of surface currents in X. laevis oocytes after addition of various concentrations of amantadine. From these results they are able to construct a Hill plot with a coefficient of 1, showing that binding of amantadine is not cooperative. In further results, Wang et al. find that amantadine inhibits M2 channels slightly better at high pH (when the pore is closed) than at low pH, and that amantadine inhibits proton conductance in either direction (rather than favoring one). Both these outcomes are unexpected for PBM, but can be easily explained by DQM. However, the differences in the binding constants are relatively minor and the linearity of the current-voltage relationship may result from some other idiosyncratic feature of the M2 channel, so these results are not unequivocal.

Neither experiment refutes DQM because they do not measure the number of binding sites, but rather the number of efficacious binding sites. If there are four binding sites, but 95% or more of the inhibitory or structural effect is caused by the first drug molecule bound, then these experiments would be unable to distinguish DQM from PBM. Overall, the evidence on the question of binding stoichiometry does not eliminate the possibility of four binding sites existing, but it does place a requirement on DQM that the inhibitory effect of amantadine on the tetramer result from a single binding event. Because the proposed DQM binding site for rimantidine lies between monomers and is linked to the gating tryptophan, this is not unbelievable. Other evidence from these experiments is equivocal, but can be seen as somewhat more problematic for PBM than DQM.

Functional effects of mutations

A serious problem for DQM is that the mutations known to give M2 resistance to adamantane drugs are all located near the PBM binding site. In particular, S31 is adjacent to the drug in the crystal structure and quite distant in the NMR structure. As Miller notes in his commentary, mutational studies are substantially more difficult to interpret than is typically suggested, so this isn't absolutely probative. In general, however, one predicts mutations to have short-range rather than long-range effects, so at least some resistance mutations ought to evolve at the binding site. However, many of the residues surrounding the DQM site are almost absolutely conserved, presumably because they are essential to the function of the channel. As a result, it would be very difficult to interpret any studies on point mutants in this area. What would be ideal, however, would be to find a set of mutations that produced a functional protein and abrogated amantadine inhibition.

This is the basis for an interesting experiment conducted by the lab of Robert Lamb and reported last year in PNAS (7). In this case, the authors took advantage of the fact that the M2 protein from influenza B virus is not sensitive to adamantane drugs. They constructed a chimeric protein containing about a dozen residues from influenza A M2 — specifically, the dozen or so residues surrounding the PBM site. If PBM is correct, then we would expect that these residues, which define that site, would impart amantadine susceptibility to the influenza B channel. This is what happens, sort of. For your benefit, I have shamelessly stolen their figure (right), but you can check out this paper yourself because it is open access. In this assay, again involving X. laevis oocytes, the hybrid channel is sensitive to amantadine (bottom trace), but only half as sensitive as the wild-type influenza A channel (second from top). This result suggests that there is important context conferring susceptibility outside the PBM site. However, this could be something as simple as helix orientation, so the result does not necessarily imply that there is an external binding site.

Additionally, the authors made point mutations at residues (L38, D44, and R45) that were presumed to be important in the DQM mechanism or have long-range effects on amantadine binding. None of these mutations appeared to affect amantadine resistance. In contrast, experiments in liposomes reported by the Chou group this May showed that a D44A mutation prevented rimantidine from having an effect (8). This conflict in results is difficult to reconcile, but may result from the different constructs used (the Chou group used a truncated form of M2 while the Lamb group used the full-length protein) or from changes in ion specificity caused by the D44A mutation. It might be of value to repeat these experiments with the alternative construct: truncated in oocytes, full-length in liposomes. Because the D44A mutant does not appear to conduct protons as efficiently as WT, the proposition that the function of this mutant is too deranged to provide trustworthy information should also be considered.

Additional experiments in the Chou paper are meant to address the relationship between the DQM site and the mutations at the PBM site. They show that the S31N mutation prevents rimantidine binding to the remote site, and also that this mutation makes the protein generally more dynamic. From this evidence they propose that this mutation, at least, disrupts amantadine binding by destabilizing the helical packing of the channel and thus interfering with the organization of the lipid-facing pocket.

They also examine an S31A mutation and find that it is not rimantadine-resistant or destabilizing to the packing. This supports their dynamic model in a limited way, because it demonstrates that only certain mutations at the S31 site will generate resistance. It does not cast any doubt on PBM, however, because in that model resistance in the S31N mutant is explained by the idea that its side chain will partially obstruct the pore so that rimantadine will not fit. I do not think it was ever proposed that specific contacts between S31 and the drug stabilize the binding; in fact, the general absence of such contacts strikes me as a concern about PBM.

Chou et al. also examine the effect of rimantadine on the shorter construct used for the crystal studies. They find that the inhibition of this construct is substantially weaker. However, it also conducts protons at a much slower rate in this assay, suggesting that there may be additional serious problems with the function of this construct. It may be that it simply is not appropriate to use this construct for studies in solution or living membranes. That doesn't necessarily imply that this peptide will give incorrect information in the stabilizing environment of a crystal.

What do we know, and what do we need?

Very little of this evidence unequivocally prefers one model to the other. We know that a single adamantane molecule is sufficient to inhibit M2, and while this is most obviously compatible with PBM it need not be inconsistent with DQM. It is also apparent that various constructs of the M2 channel retain adamantane susceptibility after ablation of the DQM site, either by truncation, mutation, or the construction of a chimeric protein. In all assays, however, the adamantane drugs lose a considerable amount of inhibitory power, so these results are not entirely consistent with PBM either. And, at least in the Chou lab's assays, interference with the DQM site also reduces adamantane susceptibility and deranges function. Moreover, the NMR data from the Chou lab shows that mutations at PBM site have a long range effect on the DQM site, which mitigates the probative power of the S31N mutation.

How do we address this question? One important step would be to start comparing like to like. We are considering evidence from a plethora of constructs and conditions, and the evidence in conflict is often collected in very divergent experiments. Ideally we would like to have structures of the wild-type channel at low and high pH in a lipid environment that closely mimics the composition and curvature of a mature influenza virion. As this is unlikely in the near term, we must hope for NMR and crystal structures that at least use the same construct, minimally mutated, under similar conditions. NMR studies at low pH would be of value in assessing whether these studies in fact contradict one another. Additionally, it would be useful to make adamantane derivatives labeled with a free radical or other paramagnetic label; this would presumably allow the identification of a binding site at lower drug concentrations in an NMR experiment. Labeling the drug with a metal might also allow its identification in a crystal structure without any need to push the resolution significantly higher. Finally, actual structures of the S31N mutant, positively identifying the disposition of this side chain, would be of great value in judging the question.

Structural experiments can take a great deal of time and careful tuning, a requirement exacerbated by the often-fickle behavior of membrane proteins. As such, additional mutational studies could prove useful. Inverting the chimera experiment of Jing et al. to create a chimeric protein with the upper channel from influenza B and the lower channel from influenza A may be a helpful supplement to the existing experiments. If the C-terminal portion of the channel makes a contribution to adamantane inhibition this chimera will also be rimantidine-sensitive. In addition, new mutations at S31 could help distinguish the possibilities. The PBM supposes that the N31 side chains stick into the pore and form hydrogen bonds, while the DQM supposes that they stick into the interface of the TM helices and destabilize them. An S31L mutant should disrupt the helical packing but not form hydrogen bonds or extend the L31 side chains into the pore. If functional, such a mutant ought to be rimantidine resistant if the DQM is correct, but not if PBM is correct. Assuming the geometry of the longer side chain is wrong for formation of a hydrogen bonding network, an S31Q mutation might be useful as well. Similarly, mutations that increase the size of the L40, I42, or L43 side chains could prevent adamantane binding to the DQM site without degrading the channel's transport capabilities; the drug sensitivity of such a mutant would be a powerful argument either way. Any experiments of this kind would likely be easier to perform than to interpret, but could provide valuable insight. Obviously, it would also be important to establish that each mutant was competent at transporting protons.

The unspoken assumption of the debate so far is that these mechanisms are mutually exclusive, but there is no particular reason to believe this must be so. The structural experiments definitively show that binding to both sites is at least possible — even if one clings tenaciously to the idea that the density observed in the crystal is not in fact amantadine, that structure at least shows that the PBM site is capable of accommodating the drug. It might therefore be plausible that adamantane drugs inhibit M2 using both mechanisms simultaneously, or that DQM predominates at high pH and PBM at low pH. Redundancy in inhibitory mechanisms may explain the curious features of amantadine inhibition noted by Wang et al., and the inability of experiments specific to a single site to completely account for adamantane inhibition. In addition, the fact that S31N interferes with both mechanisms may explain why it is the primary resistance mutation.

An experiment with the alternate chimera mentioned above could test this possibility. In addition, if the mechanisms switch off in a pH-dependent fashion, then this should be testable with the hybrids: specifically, the A/B M2 used by Jing et al. should have lower susceptibility to adamantane drugs at high pH than at low pH. Similarly, the B/A M2 chimeric protein, if inhibited by amantadine, would be more resistant at low pH.

Doubtless these suggestions are nothing new to the members of the labs working on this perhaps unexpectedly hairy question. Membrane protein structure and function is one of the most difficult experimental subjects in biochemistry, and constitutes a critically important frontier in scientific efforts to improve human health. It is infinitely easier to propose most of these experiments than it is to perform them, and I would be remiss if I did not temper the persistently critical tone of this post with some praise for the efforts of all the scientists involved in this research, and for their commitment to getting the right answer. These papers represent years of work by incredibly talented people using some of mankind's most advanced scientific techniques. The lack of clarity on the question of adamantane drugs binding to M2, even in the face of this amazing effort, is a testament to the enormous difficulty of researching these critical systems.

---

1. Deyde, V., Xu, X., Bright, R., Shaw, M., Smith, C., Zhang, Y., Shu, Y., Gubareva, L., Cox, N., & Klimov, A. (2007). Surveillance of Resistance to Adamantanes among Influenza A(H3N2) and A(H1N1) Viruses Isolated Worldwide The Journal of Infectious Diseases, 196 (2), 249-257 DOI: 10.1086/518936 OPEN ACCESS

2. Stouffer, A., Acharya, R., Salom, D., Levine, A., Di Costanzo, L., Soto, C., Tereshko, V., Nanda, V., Stayrook, S., & DeGrado, W. (2008). Structural basis for the function and inhibition of an influenza virus proton channel Nature, 451 (7178), 596-599 DOI: 10.1038/nature06528

3. Schnell, J., & Chou, J. (2008). Structure and mechanism of the M2 proton channel of influenza A virus Nature, 451 (7178), 591-595 DOI: 10.1038/nature06531

4. Miller, C. (2008). Ion channels: Coughing up flu's proton channels Nature, 451 (7178), 532-533 DOI: 10.1038/451532a

5. Czabotar, P., Martin, S.R., & Hay, A.J. (2004). Studies of structural changes in the M2 proton channel of influenza A virus by tryptophan fluorescence Virus Research, 99 (1), 57-61 DOI: 10.1016/j.virusres.2003.10.004

6. Wang, C., Takeuchi, K., Pinto, L.H., & Lamb, R. (1993) Ion Channel Activity of the Influenza A Virus M2 Protein: Characterization of the Amantadine Block J. Virol. 67 (9) 5585-5594 Available free from PubMed Central

7. Jing, X., Ma, C., Ohigashi, Y., Oliveira, F., Jardetzky, T., Pinto, L., & Lamb, R. (2008). Functional studies indicate amantadine binds to the pore of the influenza A virus M2 proton-selective ion channel Proceedings of the National Academy of Sciences of the United States of America, 105 (31), 10967-10972 DOI: 10.1073/pnas.0804958105 OPEN ACCESS

8. Pielak, R., Schnell, J., & Chou, J. (2009). Mechanism of drug inhibition and drug resistance of influenza A M2 channel Proceedings of the National Academy of Sciences of the United States of America, 106 (18), 7379-7384 DOI: 10.1073/pnas.0902548106

The Scientific Activist and Discovering Biology in a Digital World also have interesting posts on this subject.

Read the rest...

Long-range effects in the ribosome

Antibiotics such as chloramphenicol suppress infections by inhibiting bacteria from making proteins. They achieve this by binding to and blocking the peptidyl transferase center (PTC) of the ribosome, a large complex of RNA and protein that performs nearly polypeptide synthesis in living cells. Although PTC-binding antibiotics comprise several different families of compounds, mutations in the ribosome that confer resistance to one family often produce cross-resistance to other families. This is difficult to understand because the PTC itself is highly conserved and not very tolerant of mutations. In an upcoming paper (open access, read along) in the Proceedings of the National Academy of Sciences, a team of researchers from the Weizman Institute of Science analyze several crystal structures of the ribosome to understand how this cross-resistance arises.

Davidovich et al. mapped nucleotide mutations known to confer resistance to PTC antibiotics onto x-ray crystal structures of the large ribosomal subunit from D. radiodurans in complex with antibiotics. One interesting facet of the resistance mutations became immediately apparent: they were almost all clustered on one side of the antibiotic binding site.

You can see this pretty clearly in Figure 2 panels B&D. Although the antibiotics (large pink surface) are surrounded by nucleotides, most of those that are on the left side (thin tan sticks) do not confer resistance if mutated. Resistance-conferring mutations instead cluster around the "rear wall" of the PTC (to the right). The authors explain that in this region ribosomal functions primarily rely on the sugar-phosphate backbone of the rRNA. Because the backbone elements are the same for all ribonucleotide bases, mutations in this region are more likely to be tolerated without significant loss of function.

Another striking feature of resistance mutations is visible in Figure 2 and quantified in Figure 3A, namely that many of these mutated bases do not contact the antibiotics directly. In particular, mutation of G2032 appears to play a role in conferring resistance to several different antibiotics. Overall, however, it appears that numerous long-range interactions can interfere with antibiotic binding.

The lynchpin of these interactions seems to be U2504, a base that directly contacts the bound antibiotic in most cases. Mutations to U2504 itself do not appear to be well-tolerated, but many of the long-range mutations occur in the layer of bases surrounding it. The authors describe in detail several mechanisms by which the observed mutations might increase the flexibility of U2504, allowing it to adopt positions that could allow continued protein synthesis while reducing the binding of antibiotics. The commonality of interactions with U2504, and the importance of the structural context of the surrounding nucleotides, explains why many mutations can give rise to cross-resistance.

The practical upshot of these findings is that they may serve as a guide for the design of future antibiotics. Since the majority of the drug-resistance mutations lie on the rear wall of the PTC, the effectiveness of these antibiotics may be enhanced by improving their binding to other parts of the site. With further modeling it may also be possible to design antibiotics that can compensate for flexibility at U2504. These findings also remind us that dynamics and long-range interactions can be important to the function of any biomolecule with a folded three-dimensional structure, not just proteins.

C. Davidovich, A. Bashan, A. Yonath (2008). Structural basis for cross-resistance to ribosomal PTC antibiotics Proceedings of the National Academy of Sciences, 105 (52), 20665-20670 DOI: 10.1073/pnas.0810826105 OPEN ACCESS

Read the rest...

Fit H5N1 with oseltamivir resistance

I noted in a previous post on the persistence of oseltamivir in the environment that most known mutations conferring oseltamivir resistance also diminished the infectivity of H5N1 influenza. Unfortunately, new research seems to have proven me wrong on that point. The good folks at Effect Measure have a post up about a recent paper from researchers at St. Jude's indicating that at least some of the mutations that confer resistance to tamiflu preserve neuraminidase activity. Check it out.

For those of you at academic or industrial institutions that have online journal access, read the article:
Yen HL, Ilyushina NA, Salomon R, et al. "Neuraminidase inhibitor-resistant recombinant a/vietnam/1203/04 (H5N1) influenza viruses retain their replication efficiency and pathogenicity in vitro and in vivo." J Vir 2007:81(22); 12418-12426.

Read the rest...

Resistance: Fall of Tamiflu

The past decade, and in particular the past five years, has seen a steadily increasing drumbeat of concern over the possibility of another influenza pandemic. Avian flu has been a topic of special concern, but the American health system's inability to deal effectively with even normal flu variants has led to significant efforts to upgrade capacity to manufacture the flu vaccine, as well as improve the supply and distribution of the neuraminidase inhibitor oseltamivir phosphate, better known as tamiflu. Because there are so few effective antiviral drugs, tamiflu is an essential line of defense in case vaccination fails. Unfortunately, it appears that the influenza virus can develop resistance to tamiflu treatment, which would be a serious blow to efforts to control the disease in an emergency. The wise course is to use tamiflu sparingly and at a high enough dosage that the infection does not have time to adapt. But will this be enough?

Tamiflu has the interesting property that the drug in the tablet is ineffective against the influenza virus. Tamiflu gains function inside the body due to chemical processing in the liver that reveals a reactive moiety. If you have an influenza infection, some proportion of the oseltamivir molecules will end up binding to neuraminidase, but the remainder will be excreted without further modification. This means that every time you are dosing a person with tamiflu you are also dosing the environment with it. That could be trouble, because some strains of influenza incubate in the wild, among ducks, for instance, who are likely to be swimming on the rivers or ponds where excreted tamiflu might be expected to end up. If these animals are constantly exposed to very low doses of tamiflu, it is quite conceivable that the viruses within them could evolve resistance to it without losing neuraminidase activity.

The question then becomes whether anything in the environment might degrade tamiflu before it reaches the ducks. We have one advantage in this regard: we generally treat our sewage before we let it go. In an experiment I do not envy one little bit, a Swedish team led by Jerker Fick tested actual sewage to see if oseltamivir carboxylate (the active form of the molecule) would break down in it (the article is open source on PLoS ONE). They took raw sewage, as well as samples of sewage at various stages of treatment, added oseltamivir, and incubated them with a similar temperature and duration to what they might experience in the treatment plant. The results were not encouraging: the amount of tamiflu they were able to recover from these samples was as much as or more than what they could recover from plain tap water incubated under the same conditions. Moreover, they found that the UV/visible light absorbance spectrum of tamiflu would not be conducive to photolysis in the environment. The conclusion from this is that we cannot expect any help from our water-treatment facilities in eliminating oseltamivir from water supplies that might eventually reach host organisms for influenza.

This puts us in a bit of a bind. It is impossible to use tamiflu without releasing it to the environment, even if it is used in accordance with rigorous guidelines designed to prevent resistance from arising in people. Yet, the more tamiflu that reaches the environment, the more likely it is that continued exposure among waterfowl will lead to the development of resistance. Although this is bad news for the future of tamiflu, it doesn't necessarily herald the inevitable onset of some kind of superflu. For one thing, some of the mutations that confer tamiflu resistance also diminish the ability of the influenza virus to infect hosts. Moreover, there's no guarantee that tamiflu in the environment will end up dosing avians — it might break down in their stomachs, even if it doesn't in the sewage plant.

Also, some mutations that confer this kind of resistance leave neuraminidase vulnerable to other inhibitors such as zanamivir (Relenza). Granted, Relenza does not appear to be as effective as Tamiflu, but the fact that resistance is not necessarily shared is an encouraging sign that it will be possible to continue developing improved inhibitors even if the worst happens.

However, the results of this paper and the fact that tamiflu-resistant strains can be transmitted to people who have never used tamiflu indicate that we should be making a greater effort to prepare ourselves for the appearance of resistance. Much has been made about efforts to stockpile tamiflu in case of a pandemic, and while there is nothing wrong with that idea per se, it is foolish to assume that tamiflu is some kind of panacea. If a pandemic does occur, with the attendant explosion of evolutionary possibilities for the influenza virus, the chances of a rapid development of resistance in humans may be quite high. At that point it will be too late to start developing alternatives. In the near term, we should do as has been suggested — use tamiflu sparingly and aggressively to minimize the chances of developing resistance in humans. But we should also provide incentives or a mandate to develop a back-up plan in case tamiflu fails.

Read the rest...