Electrostatic interactions at the five-fold axis alter heparin-binding phenotype and drive EV-A71 virulence in mice
Authors: Tee Han Kang , Tan Chee Wah , Yogarajah Thinesshwary , Lee Michelle Hui Pheng , Chai Hann Juang , Hanapi Nur Aziah , Yusof Siti R. , Ong Kien Chai , Lee Vannajan Sanghiran , Sam I-Ching , Chan Yoke Fun 
Published: May 2019

Enterovirus A71 (EV-A71) causes hand, foot and mouth disease epidemics with neurological complications and fatalities. However, the neuropathogenesis of EV-A71 remains poorly understood. In mice, adaptation and virulence determinants have been mapped to mutations at VP1-145, VP1-244 and VP2-149. We hypothesized that heparin-binding phenotype shapes EV-A71 virulence in mice. We constructed six viruses with varying residues at VP1-98, VP1-145 (which are both heparin-binding determinants) and VP2-149 (based on the wild type 98E/145Q/149K, termed EQK) to generate KQK, KEK, EEK, EEI and EQI variants. We demonstrated that the weak heparin-binder EEI was highly lethal in mice. The initially strong heparin-binding EQI variant acquired an additional mutation VP1-K244E, which confers weak heparin-binding phenotype resulting in elevated viremia and increased brain inflammation and virus antigens in mice, with subsequent high virulence. EEI and EQI-K244E variants inoculated into mice disseminated efficiently and displayed high viremia. Increasing polymerase fidelity and impairing recombination of EQI attenuated virulence, suggesting the importance of population diversity in EV-A71 pathogenesisin vivo. Combiningin silicodocking and deep sequencing approaches, we inferred that virus population diversity is shaped by electrostatic interactions at the five-fold axis of the virus surface. Electrostatic surface charges facilitate virus adaptation by generating poor heparin-binding variants for betterin vivodissemination in mice, likely due to reduced adsorption to heparin-rich peripheral tissues, which ultimately results in increased neurovirulence. The dynamic switching from heparin-binding to weak heparin-binding phenotypein vivoexplained the neurovirulence of EV-A71.

Author summary

Enterovirus A71 (EV-A71) is the primary cause of hand, foot and mouth disease, and it can also infect the central nervous system and cause fatal outbreaks in young children. EV-A71 pathogenesis remains elusive. In this study, we demonstrated that EV-A71 variants with strong affinity to heparan sulfate (heparin) have a growth advantage in tissue culture, but are disadvantageousin vivo. When inoculated into mice, strong heparin-binding virus variants are more likely to be adsorbed to peripheral tissues, resulting in impaired ability to disseminate and being cleared from the bloodstream rapidly. The lower viremia level resulted in no neuroinvasion. In contrast, weak heparin-binding variants show greater levels of viremia, dissemination and subsequent neurovirulence in mice. We also provide evidence that the ability of EV-A71 to bind heparin is mediated by electrostatic surface charges due to amino acids on the virus capsid surface. In mice, EV-A71 undergoes adaptive mutation to acquire greater negative surface charges, thus generating new virulent variants with weak heparin-binding which allows greater viral spread. Our study underlines the importance of electrostatic surface charges in shaping EV-A71 virulence.