Search

For patients hospitalized with severe influenza A virus infection, morbidity and mortality remain high. MHAA4549A, a human monoclonal antibody targeting the influenza A virus hemagglutinin stalk, has demonstrated pharmacological activity in animal studies and in a human influenza A challenge study. We evaluated the safety and efficacy of MHAA4549A plus oseltamivir against influenza A virus infection in hospitalized patients. The CRANE trial was a phase 2b randomized, double-blind, placebo-controlled study of single intravenous (i., For patients hospitalized with severe influenza A virus infection, morbidity and mortality remain high. MHAA4549A, a human monoclonal antibody targeting the influenza A virus hemagglutinin stalk, has demonstrated pharmacological activity in animal studies and in a human influenza A challenge study. We evaluated the safety and efficacy of MHAA4549A plus oseltamivir against influenza A virus infection in hospitalized patients. The CRANE trial was a phase 2b randomized, double-blind, placebo-controlled study of single intravenous (i.v.) doses of placebo, 3,600 mg MHAA4549A, or 8,400 mg MHAA4549A each combined with oral oseltamivir (+OTV) in patients hospitalized with severe influenza A virus infection. Patients, enrolled across 68 clinical sites in 18 countries, were randomized 1:1:1. The primary outcome was the median time to normalization of respiratory function, defined as the time to removal of supplemental oxygen support to maintain a stable oxygen saturation (SpO2) of ≥95%. Safety, pharmacokinetics, and effects on influenza viral load were also assessed. One hundred sixty-six patients were randomized and analyzed during a preplanned interim analysis. Compared to placebo+OTV, MHAA4549A+OTV did not significantly reduce the time to normalization of respiratory function (placebo+OTV, 4.28 days; 3,600 mg MHAA4549A+OTV, 2.78 days; 8,400 mg MHAA4549A+OTV, 2.65 days), nor did it improve other secondary clinical outcomes. Adverse event frequency was balanced across cohorts. MHAA4549A+OTV did not further reduce viral load versus placebo+OTV. In hospitalized patients with influenza A virus infection, MHAA4549A did not improve clinical outcomes over OTV alone. Variability in patient removal from oxygen supplementation limited the utility of the primary endpoint. Validated endpoints are needed to assess novel treatments for severe influenza A virus infection. (This study has been registered at ClinicalTrials.gov under registration no. NCT02293863.)

In Escherichia coli , the synthesis of the flagellar organelle is sensitive to catabolite repression. Synthesis requires the presence of the cyclic adenosine monophosphate receptor protein (Crp) and 3′,5′-cyclic adenosine monophosphate (cAMP); i.e., mutants that lack Crp or adenylcyclase (Cya) synthesize no flagella. We isolated and characterized a series of mutants ( cfs ) that restored flagella-forming ability in a Crp strain of E. coli . The mutations in these strains were transferred onto episomes and they were then introduced into a variety of other strains. The presence of the mutation resulted in flagella synthesis in Cya and Crp strains as well as in the wild type grown under conditions of catabolite repression. Deletion analysis and other genetic studies indicated that: (i) the cfs mutations had a dominant effect when they were in the transconfiguration in merodiploids: (ii) they occurred in or very close to the flaI gene: and (iii) their expression required the presence of an intact flaI gene adjacent to the cfs mutation. Biochemical studies showed that the synthesis of at least two flagellar polypeptides, the hook subunit and an amber fragment of flagellin, were absent in strains that carried a cya mutation. Their synthesis was depressed in strains grown under conditions of catabolite repression. The presence of the cfs mutation restored the specific synthesis of these two polypeptides. We suggest that the formation of the flaI gene product is the step in flagellar synthesis that is catabolite sensitive and requires cAMP. We propose a regulatory function for the product of the flaI gene.

Flagellar mutants in Escherichia coli were obtained by selection for resistance to the flagellotropic phage χ. F elements covering various regions of the E. coli genome were then constructed, and, on the basis of the ability of these elements to restore flagellar function, the mutations were assigned to three regions of the E. coli chromosome. Region I is between trp and gal; region II is between uvrC and aroD; and region III is between his and uvrC . F elements carrying flagellar mutations were constructed. Stable merodiploid strains with a flagellar defect on the exogenote and another on the endogenote were then prepared. These merodiploids yielded information on the complementation behavior of mutations in a given region. Region III was shown to include at least six cistrons, A, B, C, D, E , and F . Region II was shown to include at least four cistrons, G, H, I , and J . Examination of the phenotypes of the mutants revealed that those with lesions in cistron E of region III produce “polyhooks” and lesions in cistron F of region III result in loss of ability to produce flagellin. Mutants with lesions in cistron J of region II were entirely paralyzed ( mot ) mutants. Genetic analysis of flagellar mutations in region III suggested that the mutations located in cistrons A, B, C , and E are closely linked and mutations in cistrons D and F are closely linked.

In previous work, at least 10 discrete cistrons involved in the synthesis of flagella in Escherichia coli were described. Six cistrons were located between his and uvrC on the genetic map. These were referred to as hag, flaA, flaB, flaC, flaD , and flaE . Four cistrons referred to as mot, flaG, flaH , and flaI were located between uvrC and aroD . In order to determine whether these genes are organized into transcriptional units, a series of Mu phage-induced flagellar mutants was studied. The mutant strains behaved as if they were carrying strong polar mutations. Of 228 independent Mu-induced mutants, 114 with mutations in the his-aroD region of the genetic map were tested by preparing partial diploid strains with episomes carrying a variety of previously defined mutations. The pattern of complementation that emerged indicated that cistrons flaB, flaC , and flaE form a transcriptional unit. Cistron flaO , defined in the course of this study, is also a member of this transcriptional unit. The order of transcription is B-C-O-E. flaA was found to be complex, and it included four cistrons, flaA, flaP, flaQ , and flaR , with the transcriptional order A-P-Q-R . Cistrons flaG and flaH are cotranscribed with the transcriptional order G-H . The remaining genes, flaD, flaI, hag , and mot do not belong to multicistronic transcriptional units. Complementation analysis suggested that the cheC locus is the same as cistron flaA .

The distribution of flagellin subunits in flagellar filaments synthesized by merodiploid strains carrying two distinguishable hag loci has been examined. The filament was found to be a homogeneous co-polymer of the two subunits. This suggests that the subunits may be able to mix freely before being assembled.