Investigation of a recent rise of dual amantadine-resistance mutations in the influenza A M2 sequence.

Background: The S31N amantadine-resistance mutation in the influenza A M2 sequence currently occurs more frequently in nature than the S31 wild type. Overcoming the resistance of the S31N mutation is the primary focus of M2 researchers who aim to develop novel antiviral therapies. Recent studies have noted a possible rise in frequency of the V27A/S31N double amantadine-resistance mutation in recent years. The purpose of this study is to investigate this recent rise in frequency of the double mutation and any possible bias of the other mutations toward co-occurrence with S31N or S31 strains.

Results: The primary dataset used for this study was comprised of 24,152 influenza A M2 channel sequences which were downloaded from UniProt. There is an increased frequency for the S31N/V27A dual AR mutation in recent years, especially in swine. A test for difference in two proportions indicates that the V27A mutation is co-occurring with S31N more often than expected (p-value<0.001) when considering individual amino acid frequencies. At the same time, the different propensities for the V27A as compared to the V27T dual mutant may reflect differences in viral fitness or protein energetics, and this information could be exploited to focus drug development so as to reduce further drug insensitivity.

Conclusions: The development of the S31N/V27A variant in the Midwestern US swine may be a harbinger of novel human strain development. V27A/S31N is a possible path forward for the evolution of M2 which may convey a new level of drug resistance and should receive attention in drug design.