Enteroviruses are well known for their ability to cause neurological damage and paralysis. The 2 0 model enterovirus is poliovirus (PV), the causative agent of poliomyelitis, a condition characterized by acute flaccid paralysis. A related virus, enterovirus 71 (EV-A71), causes similar clinical outcomes in recurrent outbreaks throughout Asia. Retrospective phylogenetic analysis has shown that recombination between circulating strains of EV-A71 produces the outbreak-associated strains which exhibit increased virulence and/or transmissibility. While studies on the mechanism(s) of 2 5 recombination in PV are ongoing in several laboratories, little is known about factors that influence recombination in EV-A71. We have developed a cell-based assay to study recombination of EV-A71 based upon previously reported assays for poliovirus recombination. Our results show that: (1) EV-A71 strain-type and RNA sequence diversity impacts recombination frequency in a predictable manner that mimics the observations found in nature; (2) recombination is primarily a replicative 3 0 process mediated by the RNA-dependent RNA polymerase (RdRp); (3) a mutation shown to reduce recombination in PV (L420A) similarly reduces EV-A71 recombination suggesting conservation in mechanism(s); and (4) sequencing of intertypic recombinant genomes indicates that templateswitching is by a mechanism that requires some sequence homology at the recombination junction and that the triggers for template-switching may be sequence independent. The development of this 3 5 recombination assay will permit further investigation on the interplay between replication, recombination and disease. encephalitis (11, 12). EV-A71 variants have been classified into three groups (GgA, GgB, and GgC) and recombination has been linked to the founding of each subgroup lineage (13). More importantly, co-circulation of the species A EV-A71 and Coxsackievirus A16 (CV-A16) viruses has been associated with large-scale outbreaks of HFMD (14, 15). Sequence analysis of clinical isolates obtained since 2008 from patients with fatal neurological symptoms has demonstrated that these 6 5 cases are mainly due to subgenogroup C4 of EV-A71, which was previously identified as an EV-A71 / CV-A16 recombinant virus (1, 16). In related enteroviruses, recombinant forms (RF), defined by serotype according to their capsid proteins, have been shown to emerge, prevail, and then disappear in temporal epidemiological surveys of globally distributed serotypes (13, 17, 18). In many of these examples, the recombinants are pathogenic.
0It is evident that recombination is a critical driver of virus evolution with medically important consequences. While the triggers and mechanisms of recombination in PV are starting to be understood (10,(19)(20)(21), the ability to predict the likelihood of a recombination event between circulating viruses of public health relevance has not been available. We wanted to use the cellbased approaches that have been developed to study recombination in PV as a tool to test whether 7...