PA-X is a newly discovered protein that decreases the virulence of the 1918 H1N1 virus in a mouse model. However, the role of PA-X in the pathogenesis of highly pathogenic avian influenza viruses (HPAIV) of the H5N1 subtype in avian species is totally unknown. By generating two PA-X-deficient viruses and evaluating their virulence in different animal models, we show here that PA-X diminishes the virulence of the HPAIV H5N1 strain A/Chicken/Jiangsu/k0402/2010 (CK10) in mice, chickens, and ducks. Expression of PA-X dampens polymerase activity and virus replication both in vitro and in vivo. Using microarray analysis, we found that PA-X blunts the global host response in chicken lungs, markedly downregulating genes associated with the inflammatory and cell death responses. Correspondingly, a decreased cytokine response was recapitulated in multiple organs of chickens and ducks infected with the wild-type virus relative to those infected with the PA-X-deficient virus. In addition, the PA-X protein exhibits antiapoptotic activity in chicken and duck embryo fibroblasts. Thus, our results demonstrated that PA-X acts as a negative virulence regulator and decreases virulence by inhibiting viral replication and the host innate immune response. Therefore, we here define the role of PA-X in the pathogenicity of H5N1 HPAIV, furthering our understanding of the intricate pathogenesis of influenza A virus.
Influenza A virus (IAV) can infect diverse host species, from wild and domestic birds to mammalian species, and the pathogenesis of IAV is complex due to its remarkable genetic variability. The genome of IAV contains eight RNA segments that encode at least 17 viral proteins, including 8 initially identified proteins (PB2, PB1, PA, HA, NP, NA, M1, and NS1), 2 splicing variants of the M and NS genes (M2 and NS2) (1-3), and the recently identified proteins PB1-N40 (4), PB1-F2 (5), PA-X (6), M42 (7), NS3 (8), PA-N155, and PA-N182 (9). PB1-N40 is an N-terminally truncated version of the PB1 protein that lacks the transcriptase function but can still interact with other polymerase complex subunits and regulate virus replication in a specific genetic background (4). PB1-F2, encoded by an alternative open reading frame (ORF) of PB1, has multiple functions, including the induction of apoptosis (10), aggravation of inflammation (11,12), and secondary bacterial infection (13). PA-X is a frameshift product of the ribosome and acts to decrease the virulence of the 1918 H1N1 virus in mice (6). PA-N155 and PA-N182 are N-terminally truncated forms of PA, and the mutant viruses lacking these two proteins exhibit attenuated in vitro replication and pathogenicity in mice relative to the wild-type (wt) virus (9). M42 is the M2 isoform with an alternative ectodomain that can functionally replace M2 and support efficient viral replication (7). Selman et al. have identified NS3 as the isoform of NS1 and speculated that the codon providing NS3 expression could be associated with host adaptation and the overcoming of the species barrier (8)....